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 F,edm| Regtst_ / VoL ,_0 Noo 249 / Friday, December 29, 1989 / Nonces
 by a statmticM meaetu_ of in_aocu._ applieation_ Topi_I applio_tlo_ r_d_ces _o There _re few pub|ished s_entific
 pressure (a notre), meaning that ff an the possib_ty of systemic adverse reports or studies which evaluate
 indixdduars pressure we= higher than effects from a drug since the total marijuana's effect on lowering
 the average, he was thought to have amount of the drug being delivered to l_traocular pressing In 81sucomatose .
 glaucoma; ff the pressure was below the the body is considerably lease _dividuals. Ail of the studies Involve
 norm, he was thought not to hera _. In 1971, Robert S. Hep_er, I_AD. and acute administration of the drug and
 glaucoma. It is now known Chat this is Ira R. Frank, M.Do p_b_ished preli_r_nary each involve relatively areal! nvmtbers o_
 not the proper method for diagnosing results of one of the first e_cperiments research subjects, In 197S, Drs. Hepler
 glaucoma. Ninety-five pe_en_ of which measured the effec_ of smoked and Petrus reported the results of their
 Individusl_ with sta_isfical_y_l_ve_ed ma_juans _n In_aoctflar pressures of _tudy which involved IZ research
 intraocui_ p_ssure are never afflicted normal, healthy meleeo The study _ubjects who suffered from galucemao
 with glaucoma, while one-third of involved acute administration of Each subject was seen on four
 glaucomatose mdividu_d_ _ave smoked mafiiuana through an _ce.,cooled occa_Ot_o On one occaeioz_ _e sub_e_:_
 intrsomdar pressures in the statlsticsl_y water pipe to eleven youthfu,l men who were given e placebo in a smokable
 nommd r_rq_e, did not suffer from glaucoma° After the furm_ on the other occasions, the
 i S3. _e_ve _xeatment f_ glauc_ o_e-_me adm_r_s_at_on of the subiec_a were eithe_ given oral
 involves the use of pharmaceutio_l marijuana, r_ne subjects e:_cperiencsd (synthetic) THC or smoked maHjuanao
 agents ot surgical procedures that decreases in intraocalat pressure w_ch Some of the resareh subjects continued
 i prevent progressive optic nerve da_ge, ra_ed from I_ percent to _S percent+ their usual courses of medication duri_
 If hntr_ocul_ pressure can be Iowe_d one subject experienced a _ percent the testing. The published study onJy
 sufflclently, it can usually altar the increase m Intraoctdar pressure, and one reported the resets of four of the
 con.we of the _aucoma. Butt merely subject experienced no chanse following research subjects. Two subjects failed to
 reducing intrsocul_r pressvx_ ie net smolch_o These results were later achieve a reduction in intraoctdar
 neces_srily beneficial to the eye, and published in 1_7_ es part of a lapser pressue. Also, the study did not h_dic_t_
 pressm_ reduction does not necessarily study in which Thomas J. Ungerle_der0 which of the four subjects, if any, had
 prevent glaucomatose optic nerve M,D. part_cipate_ aimed at meesv_ng continued their conventional medicatio_
 damage. For a treatment to be effective, pup_llary constrictior_ intraocular during the study. The study did not
 it must lower intraocular presstu_ pressure, tear production, and differentiate between the effectiveness
 sufficiently to prevent additional coniunctival hTperemia [redness _d o_ mariju_a or oral THC. The
 damage to tee optic nerve and retina, hn'_tation of the eye]. The overall study researchers concluded that "patients
 and also not cause unacceptable involved 2.1 healthy subjects who with proven glaucoma frequently,
 damage to the eye or to other paris of smoked marijuana in an ice-coo|e_i a_ough not LnvaHably, demonstrate
 the body. Ln additlo_ R must be able to wa_er pipe. Only the 11 subjects _ substantial decrease Ln intraoctdar
 sustahn the lowered pressure and described in the earlier publication were pressu._s foB. owing smoking of m_xiiuene
 preserve visuM function for the p_tien_'_ tested for changes in intraoctdax or LngeatJon of THC." In 1976. Drs.
 lifelim_, pressures. _ addition to the results of Hepler, Frank and Petrsa reported os
 S4. When new 81aucoma _reaCments changes in Lntraocular pressures, the the results of another small study
 •re tested for e_cac% they a_ authors also noted that smo_da_ Invol_ng _I galucumatose individuals
 evaluated for the_ ability to suff_ently marijuana was associated with min_z who were observed" after acute
 lower intraocular pressure and to decreases in pup_sry size, decrease in administration of marijuaaa, O_ the II
 maintain visual field_. To prop_srly te_ productlon, and r_njunctiv_ patients stadia& seven demonstrated
 measure the treatment's effect on both_ hTpe_mia. Central visual acuity, drops in h_traocuJat pressure avara#_
 it must be used hn long-term testing, re_ractioa_ peripheral visu_t fl_id_ 30 percent The remai_ia_ four did not
 TimoloL a drug ctzrr_ntly used to treat b_oculax fusion and color _sion were experience any chop _ _traocular
 glauconmo has been tested in this not altered by the sin_le._iosa preseureo
 manner. Before it was approved for use acb_rttrdstratlon of the matiju_taa. _ In IOTa, Drag Metritt and Crawford
 in tr_atin8 glaucoma, fimolol was addition the authors noted that fa tiara published resulm of _m acute study of
 rigorously tested in 3_ to 400 per_m_ _ad e}eep_e_ occ_u,_ed several hours the effe_s of marijuana and placebo or_
 through controlled, doubie-_skcd following the marijuana-lndu_d "high". I_ glaucomatose z_semmh subjects. Th_,
 clinical _als. These studies involved _F, There are no published sdenEfic concluded that "inhM_d
 treatin8 patients with the chug fen a t_:_rts or studies which demonstrate tetrahydroc_nnabinol (delta-_
 minimum of three months, with a mar!juana's ability to lower L_aocul_ tetrahydzocanaabinol} lowers blood
 ma|or_ty of the studies lasth_ for s_ pressures in lorq_-term echx_nic testirt_ of pressure and intraocular pressure,
 months or more, d_'ing wMch LLme_ flta glaucomatose research subject. Th_ commensurately with tachycardia {rapid
 patient' visuM flail were meamur _d to only IoRgoterm study reported was one heart rate], in systemic normotensive
 deteraflae whether there had been any conducted by Dr° Hepler at U.C_L.A_ The and hypertensive glaucoma patientso '_ t_
 pro_uion of the disease, ba add3ti_r_ s_dy evaluated _sponses of 19 normaL I_80, D_o MerritL Crawford, Alexander:
 other conven_onal glaucoma non-$1auccomato_e patienm for a period Andv.ta, and Gelbart reported the
 medications have proven theh. efffl_cc3_ of 94 days, The resu.l_ of the _day teeutta of a study w_ch observed the
 throv,gh yen of dinie_d experiet_˘e_ The study were not available at the time Dr. effec! of a_ate administration of
 mio_c_, epinephrine compo_mds and HapleSs paper was pubJi_had_ The only marijuana and placebo to 18 glaucoma
 carbonic anhydi_se LnJdbitore have conclusions made were that in the patients, They concluded that acute
 been proven effective m lowe_ normal re_eea,rc,h _ubjec,_ lntraocutL_ administration of marijuana lowered
 intraooulse pressure _nd _serving pre_ur_ showed e prompt d.zop as soon both m_raocular pressure and blood
 visual _tmction. as the subjects began to smoke, _nd Lhat pressure in a heterogenous glaucom_
 US. The meet _/icaciou_ way of there w_ no _dic_tions of _umula_ve pop_ation. They atso noted that eight _
 deliv__n_ _ dzu_ to the _ i_ _ effects upon the _ntraocu1_ p_ure the pet_rat_ suffered fi'om _r_dety with
 e topical drop, _th_ _ by _atemlc reep_ tachycardia _nd _lFlta_ens; five

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