Every month the United States government ships a giant metal tin containing 300 pre-rolled, low-THC cannabis joints to a dwindling number of glaucoma patients across the nation. The University of Mississippi has been responsible for growing and studying the federally funded marijuana crops for 50 years.
The deliveries come courtesy of the Compassionate Investigational New Drug (IND) Program, which was established after one man proved, in a federal court, that using cannabis was essential in protecting his eyesight. Following a citation in 1976 for growing his own marijuana at home, Robert Randall successfully sued the U.S. government for the right to treat his glaucoma with cannabis.
Displaying symptoms that were considered severe, Randall had participated in a UCLA study which determined that smoking cannabis was the only way to effectively lower the glaucoma-worsening pressure in his eyes. Doctors told Randall that he would be blind by the time he turned 30 if he was not able to maintain healthy levels of intraocular pressure.
Knowing that the Federal Drug Administration (FDA) and the National Institute for Drug Addiction (NIDA) were in charge of the marijuana cultivation and research at Ole Miss, Randall petitioned both agencies for access to their plants. He was granted permission, and began receiving shipments of medical marijuana in 1978.
“That petition was a real surprise to the federal agencies,” explained Alice O’Leary, Randall’s wife. “Medical marijuana was nowhere on the radar at this point, and here’s this lone individual coming into a federal office and asking for access to their supplies. Their first reaction was one of great compassion—they granted him the petition.”
The Compassionate IND Program stopped accepting new patients in 1992, and will soon be obsolete because only a few members are still alive today.
Cannabis and Glaucoma
There is plenty of anecdotal evidence supporting that cannabis is effective in the treatment of glaucoma, including high-profile personal testimonies from the 15 members of the Compassionate IND Program and celebrities like Whoopi Goldberg.
Glaucoma is included on the list of conditions qualifying for medical marijuana in most of the states where it’s legal. There are also some scientific studies confirming that tetrahydrocannabinol (THC) reduces intraocular pressure, which is the main goal for those afflicted by glaucoma.
The United States federal government even allows a few people to smoke marijuana for their glaucoma symptoms, but scientific research on the subject remains limited. This is because cannabis is classified as a Schedule I drug under the Controlled Substances Act of 1970. Described as the most dangerous of all, it is nearly impossible for scientists to be awarded access to study Schedule I substances.
As a result, we are left asking the question: Should cannabis really be used in the treatment of glaucoma?
What is glaucoma?
Glaucoma is a disease that affects the eyes, and is characterized by irreversible damage to the optic nerve which slowly causes tunnel vision, and ultimately leads to blindness. Up to 70 million people suffer from glaucoma worldwide.
The human eye is filled with a colorless liquid called aqueous humor that is made up mostly of water and vital nutrients like sugars and proteins. In a healthy eye, aqueous humor is in a constant state of simultaneous inflow and outflow. It is produced in the ciliary body, and then follows the path of outflow across the front of the eye, delivering nutrients to the lens and cornea where it must remain clear to allow the transmission of light.
The constant inflow and outflow establishes a state of equilibrium, providing a balance in eye pressure (intraocular pressure), and it also maintains the shape of the eye. The optic nerve is damaged when the outflow of aqueous humor is disrupted or hindered, causing a buildup in intraocular pressure. Pressure in the eye increases because there is too much liquid being stuffed into not enough space. Over time, the damage to the optic nerve slowly reduces the patient’s peripheral vision until sight is lost completely.
There is no known cure for glaucoma at this time. The goals of treatment are to keep intraocular pressure low, slow the progression of the disease, and ease discomfort for the patient. Glaucoma is commonly treated with several different methods including medicated eye drops, pharmaceuticals, laser surgery, and traditional surgery. Most patients are prescribed more than one of these therapies, and some also supplement with medical cannabis.
THC Reduces Intraocular Pressure
Several studies from as early as the 1970s, indicate that tetrahydrocannabinol (THC), the most abundant cannabinoid occurring in marijuana, effectively reduces intraocular pressure for a period up to four hours following consumption. Some of the studies declare that although it is effective in lowering eye pressure, its “toxifying” psychoactive effects render it unsuitable for some patients.
Depending on the quantity consumed and the method of administration, marijuana consumption may initially spike a user’s heart rate and blood pressure for a short time before the intraocular pressure reducing effects take over. As a result, it is sometimes a poor treatment option for older patients who also suffer from heart problems, and the majority of glaucoma patients are over the age of 60.
How Does CBD Affect Glaucoma?
Cannabidiol (CBD), the most medicinally popular cannabinoid found in cannabis, is praised for its ability to reduce the severity and frequency of seizures caused by some rare forms of childhood epilepsy that are otherwise unresponsive to treatment. CBD is non-psychoactive and easily found in non-smokable forms like oils and tinctures, so it is considered safe to administer to children and seniors.
Also known to reduce inflammation, spasticity, and anxiety, one may assume CBD could be effective in the treatment of glaucoma. A recent study from Indiana University, published in the journal Investigative Ophthalmology & Visual Science, found just the opposite to be true. According to the study, CBD increases intraocular pressure, counteracting the beneficial effects of THC.
We know that THC lowers the intraocular pressure that causes irreversible damage to the optic nerve, but CBD makes it worse. Should glaucoma patients only consume strains that contain high quantities of THC and very low amounts of CBD? Do they require single cannabinoid medications containing only THC? Or is a little bit of CBD necessary for the entourage effect to work? If so, what is the best ratio of THC to CBD for glaucoma patients? How do cannabinoids like cannabigerol (CBG) and cannabinol (CBN) affect eye pressure? Is it better for glaucoma patients to inhale marijuana or ingest it?
Mounting anecdotal and scientific evidence suggests that cannabinoid medications have a place somewhere in the treatment of glaucoma, but we will not have answers to these specific questions until the United States government reschedules cannabis or completely removes if from the Controlled Substances Act.