There are marked differences in the knowledge on the medical uses of cannabis and cannabinoids in different diseases. For nausea and vomiting associated with cancer chemotherapy, anorexia and cachexia in HIV/AIDS, spasticity in multiple sclerosis and spinal cord injury there is strong evidence for medical benefits. For many other indications, such as epilepsy, movement disorders and depression there is much less available data.
Clinical studies with single cannabinoids or, less often with whole plant preparations (smoked marijuana, encapsulated cannabis extract) have often been inspired by positive anecdotal experiences of patients employing crude cannabis products. The anti-emetic, the appetite enhancing, relaxing effects, analgesia, and therapeutic use in Tourette's syndrome were all discovered in this manner.
Incidental observations have also revealed therapeutically useful effects in a study with patients with Alzheimer's disease wherein the primary issue was an examination of the appetite- stimulating effects of THC. Not only appetite and body weight increased, but disturbed behaviour among the patients also decreased. The discovery of decreased intraocular pressure with THC administration in the beginning of the 1970s was also serendipitous. For this reason, more surveys have been conducted in the past decade questioning individuals that use cannabis therapeutically.
(Ellis and colleagues):
The urinary excretion patterns of 86 chronic cannabis users were examined after their last cannabis use by two common screening methods (...). We demonstrated that under very strictly supervised abstinence, chronic users can have positive results for cannabinoids in urine (...) for as many as 46 consecutive days from admission, and can take as many as 77 days to drop below the cut-off calibrator for 10 consecutive days. For all subjects, the mean excretion time was 27 days (...). Demographic, body type, and drug history variables proved to be only moderate predictors of excretion patterns."
Ellis GM Jr Mann MA Judson BA Schramm NT Tashchian A. Excretion patterns of cannabinoid metabolites after last use in a group of chronic users. Clin Pharmacol Ther 1985;38(5):572-578.
Excretion of THC and its metabolites in chronic users can be found in the range of 4-6 weeks. In the literature a 10 year long intensive cannabis use was reported to result in detection of use after 77 days with common tests. With single or occasional use excretion in urine is rarely short (some hours), usually it lasts for 3-5 days.
Aderjahn R. Toxikologischer Cannabisnachweis [Toxicological cannabis detection]. In: In: Berghaus G, Krüger HP, eds. Cannabis im Straßenverkehr [Cannabis in road traffic]. Stuttgart: Gustav Fischer, 1998.
(Coleman en Baselt):
OBJECTIVE: We have become aware of several commercial products that, when orally ingested, will purportedly not only eliminate "toxins" from a person's system, but will also correct any urinary imbalances caused by excessive water consumption. METHOD: Unblinded study of one volunteer subject, tested weekly x 4 for 24-hour urine elimination of test drug under conditions of control, control plus 1200 ml water, Quick Flush, and Eliminator. RESULTS: Each of the treatment protocols studied caused reductions of drug or metabolite concentrations as measured by gas chromatography-mass spectrometry in urine specimens (...), yet the radioimmunoassay screening results demonstrated very little effect. Water alone was approximately as effective as the two commercial products in reducing the metabolite level. None of the treatment protocols employed in this study altered urinary pH, specific gravity, or creatinine concentration outside the normally accepted physiological range. CONCLUSIONS: Attempts to conceal drug abuse by water dilution are most likely to play a substantial role when concentrations are at or near the detection threshold for a particular assay such as the terminal stages of drug eliminations. Coleman DE Baselt RC. Efficacy of two commercial products for altering urine drug test results. J Toxicol Clin Toxicol (1997) 35(6):637-642.
The commercial urine cleaner are relatively reliable, if one follows the instructions for use. But these products should only be tried if it is urgent. If there are several weeks of time it is sufficient to drink much (about three litres a day), do much exercise, take vitamins as well as sweat much. However, with this amount of fluids the concentration of creatinine (degradation product of creatine that is also tested) is lowered. This can be prevented by starting to take a creatine preparation from the pharmacy some days before the test.
Old formulas on medicines of cannabis suggest the following procedure (if you have no special pharmaceutical equipment):
Cannabis tincture: Take about 3-5 parts of alcohol (e.g. brandy or ethyl alcohol from the pharmacy, 40-70%) and 1 part cannabis leaves/flowers (e.g. 25 g marijuana and 100 ml alcohol). Keep it in a dark and cool place for about 10 days. Shake it from time to time. Filter it using a sieve. Store the finished tincture dark and cold (e.g. in your refrigerator), so that efficacy will remain for several weeks and months.
Cannabis oil: Take some dried cannabis, reduce it to very small pieces, and add edible oil (e.g. olive oil) so that the plant material is completely covered with the oil. Keep it in a dark and cool place for about 3 weeks. Shake it a little every day. Filter it using a sieve. You may use this oil for internal and external application.
Dr. Fankhauser is a Swiss pharmacist.
(José T. Gállego):
It is easy to prepare a tincture or an oil from cannabis, that concentrates the active compounds of the plant. You need marijuana (any quality, good or bad, leaves or flowers), ethyl alcohol of 96-99% (e.g. from the pharmacy), a glass that can be closed (e.g. used for marmalade), a coffee filter or a piece of fabric (e.g. a part of a t-shirt), a deep plate or a frying pan, a bottle with a dropper.
Reduce the cannabis to small pieces and put it into the glass. Cover it with enough alcohol. Keep it in a dark and cool place for about a week. Shake it every day. Filter it using a coffee filter or the fabric. Press the last drops of alcohol out of the plant material. You may repeat this process several times, at least once, better two times: you may again put the cannabis into the glass and cover it with alcohol…. Finally, put all the alcohol (it will have a green colour) into to a deep plate. Keep it in a tempered and ventilated place so that some of the alcohol will be evaporated increasing the cannabinoids concentration of the tincture. This may take ten days. When enough alcohol is evaporated fill the extract into the bottle with the dropper.
The cannabis tincture can be used directly, or dissolved in a drink or food, or vaporized. To vaporize the tincture a commercial vaporizer or the old silver paper system can be used. Form a teaspoon out of silver paper, put some drops of the tincture on it, carefully heat it with a candle until the alcohol evaporates. Than inhale it using a small tube (e.g. the body of a ball point pen).
To produce hashish oil you have to evaporate all the alcohol from the tincture until the extract becomes a dark paste (similar to tar). It is possible to place the glass at a warm place to accelerate the process of evaporation. It should not be placed into the sun because the THC will be destroyed faster than. It should not be heated to avoid an explosion of the alcohol.
According to: Gállego JT: Tintura de cannabis. Canamo, No 46, July 2001:76-77.