As the head of the Department of Surgical Disciplines at the All India Institute of Medical Sciences, New Delhi, Anurag Srivastava sees pain every day. One of the patients, he recounts, who was a cancer patient, was perennially depressed from the chemotherapy and associated medication. Dr. Srivastava then made an unusual suggestion to the woman’s family. Because it was also the festival of Shivratri, he suggested: “Give her some bhaang. ” (This is an edible form of marijuana commonly available in north India.) The next day, when he met her, the woman seemed far more “joyful” and more responsive and optimistic about her treatment, he recalls.
Sounding it out
Dr. Srivastava’s suggestion was not a prescription or endorsement of marijuana — the possession of which is still illegal in India in most forms — but a response to an amplifying chorus among doctors, patient groups and scientists for a more liberal regime in India regarding research into marijuana for medical purposes.
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“There is no permanent damage seen on the body… as in the case of alcohol or tobacco… you just laugh or cry a lot at worst,” he said at a recent conference in the capital to explore the challenges around medical marijuana in India. “Tobacco is not a native plant… but cannabis (the formal botanical name of the plant) is native to India and known for thousands of years. Let’s support it.”
Says Prasanna Namboodiri, a senior High Court advocate, “The bar under the Narcotic Drugs and Psychotropic Substances Act, 1985, requiring cannabis to be delivered by cultivators to the State government is a major impediment to the cultivation of cannabis for medical and scientific purposes.”
With several States in the United States, and Canada this year, permitting the use of the marijuana for medical as well as recreational use, there is a loosening of the taboo associated with the plant. Indian doctors and researchers are hoping to take advantage of this. This is because science, in the last decade, has paid serious attention to other chemical compounds in the plant. Traditionally, marijuana has been associated with tetrahydrocannabinol — one of about 100 compounds present in the plant and responsible for the mind-altering (psycho-activity) as well addictive properties of the plant.
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Now, cannabidiol (CBD), which is non-addictive and non-psychotic and may alleviate pain, is among the emerging stars.
Exploration in the West
The U.S. Food and Drug Administration (FDA) has approved three cannabinoids as drugs. In 2018, ‘the agency approved Epidiolex (CBD) oral solution for the treatment of seizures associated with two rare, severe forms of epilepsy. This drug is derived from marijuana. The FDA has also approved the laboratory-produced cannabinoids, dronabinol and nabilone, to treat nausea and vomiting associated with cancer chemotherapy in people who have already taken other medicines to treat these symptoms without good results’.
While these new compounds reportedly reduce seizures in epilepsy and alleviate nausea, there is very limited clinical trial data to suggest that cannabinoids can fundamentally cure disease.
The Alberta College of Family Physicians, Canada, in a report on the evidence available on the therapeutic potential of cannabinoids, says: “For most conditions (for example, anxiety), cannabinoid evidence is sparse (at best), low quality and non-convincing. Dronabinol/nabilone improve control of nausea/vomiting post chemotherapy for 1 in 3 users over placebo. Nabiximols likely improve multiple sclerosis spasticity ≥30% for ~1 in 10 users over placebo. Patients’ preference for cannabinoids exceeds cannabinoids effectiveness”
A collection of articles about cannabis, in Nature, in 2015 revealed a plethora of potential scientific investigations that Indian researchers say they did not want to be left behind on.
A start in India
India is likely to kick off its own studies on medical marijuana. Led by the Council of Scientific & Industrial Research-Indian Institute of Integrative Medicine (CSIR-IIIM) and the Tata Memorial Centre (TMC), Mumbai, researchers will test whether strains of marijuana grown at the CSIR-IIIM campus in Jammu could be effective in the treatment of breast cancer and sickle-cell anaemia as well as be “bio-equivalent” (similar in make-up and effect) to marijuana-derived drugs already approved by the U.S. FDA.
“There are two aspects. One, it is unforgivable that when pain-relieving medications based on cannabinoids exist elsewhere, it cannot be given to Indian patients affordably. And two, we have all the raw material and the scientific know-how to conduct our own medical investigations,” says Ram Vishwakarma, Director, CSIR-IIIM.
jacob.koshy@thehindu.co.in