Journal of Cannabis Therapeutics: A Requiem

Dr. Ethan Russo writes A Requiem for the Journal of Cannabis Therapeutics. (also available in Word format)

It is with great regret, but sense of pride, that we now “close the book” on this journal and allow it to stand on its previous offerings. This represents a decision that has been very difficult, but considered after extensive consultation with numerous Editorial Board members. I would like to outline issues we have faced, the background of this decision, and review the accomplishments of the journal in its brief history.

A History of Our Goals

The Journal of Cannabis Therapeutics began as an idea advanced by Lester Grinspoon upon our first meeting in Washington, DC in November 1998. I immediately saw the logic of his concept: a place to publish the emerging abundance of information about clinical cannabis, the newly discovered endocannabinoid system that turns out to modulate so many vital physiological functions, as well as explore the offerings of synthetic cannabinoids. We envisioned a publication that would highlight the developing science, and hopefully serve as an educational resource for physicians and scientists, as well as interested members of the lay public.

I seized upon Lester’s idea, and advanced it to my friend, mentor and editor of the Haworth Herbal Press, the late Dr. Varro (Tip) Tyler, who paid it and me the ultimate compliment, by saying that it was an idea whose time had come, but he would only support the concept if I were to be its Editor-in-Chief. Next to consult was Bill Cohen, the president and publisher of Haworth Press. He was wisely skeptical, but agreed to educate himself on the issue. To his surprise, the available information convinced him of the advisability to proceed. Within three weeks, the idea became a concept. Bill’s subsequent support has been unwavering.

Very quickly, a distinguished group of physicians and scientists agreed to take part as a core editorial advisory. A perusal of our contingent, 24 strong, reads as a “Who’s Who” of influential authorities and authors in the area. Again, many voiced doubts, but agreed to lend their support. To their credit, there have been no defections from their ranks in the life of the journal.

From the beginning, I set a number of goals. I felt that the journal should establish itself or cease publication after three years. We have just crossed that threshold, but barely. I naively thought at the time that JCANT might be rendered superfluous within this time-frame by a widespread acceptance of the concept of clinical cannabis. That, obviously, will take a little longer.

One benchmark I set was for a building subscriber base of 1000 or more. Another was acceptance in major university libraries. Finally, was the gold standard: we sought acceptance by Index Medicus for that critical accolade of acceptance of listing in that publication and the National Library of Medicine database.

We also wanted to be a home for expansive concepts and discussions on the topic; the kind of article that would never gain acceptance in “mainstream” medical journals. Annual theme double-issues would be co-published in book form.

Obstacles and Realities

After a year of planning, and gathering material, JCANT’s charter issue was released in early 2001, to critical surprise and reward. Subsequently, numerous copies were circulated at major meetings, to numerous compliments, including two letters of thanks from members of the US Supreme Court as they were considering the landmark Oakland Cannabis Buyers’ Club case. I will treasure those.

Advanced subscriptions were respectable in number, but despite the endorsements, rose but slowly over time. Our 2001 theme issue became Cannabis Therapeutics in HIV/AIDS, which remains today the only book of its kind beyond the late Bob Randall’s 1991 Marijuana & AIDS. More acclaim followed, but the numbers did not follow suit. North American physicians have been particularly slow to familiarize themselves with the new literature, and to attempt to understand what is motivated their patients to employ clinical cannabis, frequently without their knowledge or endorsement.

In 2002, we employed a generous grant from the Marijuana Policy Project to attempt to enter the realm of medical libraries. Free sample issues were offered to every such facility in the USA and Canada. Few actual subscriptions resulted. A reality of modern publishing is that such institutions have little shelf-space, and much sparser budgets for the new. Even the University of Montana asked me what current journal should be discontinued to make room for this offering. Mass mailings were met with similar ennui. The year was capped off with our second theme issue, Women and Cannabis: Medicine, Science and Sociology, ably co-edited by Melanie Dreher and Mary Lynn Mathre. Once more, it was a unique offering on a previously taboo topic.

A similar scenario played out in 2003: critical acclaim and encouragement, but little advancement in subscriber base. Our initial application for Index Medicus recognition was turned aside negatively. The quest for double-blind controlled studies, the gold-standard of current medical proof, continued, but quite expectedly, the small numbers of available studies went to recognized large circulation publications. The year was completed with our last theme issue: Cannabis-From Pariah to Prescription that documents the current state of the art with respect to phytocannabinoids, endogenous and synthetic cannabinoids, and advances our knowledge thereof as the first products approach marketing and acceptance in Europe.

By this time, a critical juncture was reached. Although the threshold of prescription clinical cannabinoids as a reality was nearing, the available pool of articles that would advance the knowledge and might lead to greater recognition has diminished. Prospects for additional database listing seem less than promising, and subscriber numbers have not risen despite additional grants-in-aid.

I am experiencing some major life transitions of my own at this time: moving our household and leaving neurology practice after 20 years to accept a position as Senior Medical Advisor to GW Pharmaceuticals. I had voiced my personal concerns about possible conflicts of interest with the publisher, and numerous editorial board members, and am pleased with their reassurance and vote of confidence. That, ultimately, has had no bearing on the decision to cease publication at a time when JCANT has maintained its quality on a consistent basis, rather than witness its possible diminution over time.

Our Accomplishments

I believe that the Journal of Cannabis Therapeutics has in its short sojourn, advanced knowledge and acceptance of this emerging field. We have gained notice beyond the apparent numbers. Although JCANT may not have influenced the Supreme Court to accept clinical cannabis, our articles have been cited in major national commissions, including A Report of the National Commission on Ganja in Jamaica in 2001, and even more prominently in Cannabis: Our Position for a Canadian Public Policy, the report of the Canadian Senate in 2002. Both commissions strongly endorsed public access to clinical cannabis.

I was very pleased that our lead article of volume 1, number 1, was a review of the current state of cannabis therapeutics as conceived by Leo Hollister, the American dean of scientific study of the herb, but was saddened that it came to be his final publication. Another landmark of the inaugural edition was the study of Musty and Rossi describing the success of smoked cannabis in allaying nausea in several hundred subjects in state-sponsored studies of previous decades that had never before been published.

Innovative articles on therapeutic possibilities of cannabis and cannabinoids followed, including music appreciation, an examination of ancient and ethnobotanical evidence, and many more. Surveys of clinical cannabis use in various countries were offered, as well as closer examinations of non-cannabinoid components, endogenous cannabinoids, and novel delivery systems. Volume 2 saw the publication of the “Chronic Use Study” in which for the first time, information was made available concerning the benefits and side effects of cannabis for a small cohort of legal patients in the US Compassionate Use Investigational New Drug Program. This study has had an influence far beyond the subscribers, and has lead to many associated news stories and publicity about the issues. Further evolutionary ideas concerning cannabis were provided by many authors. Volume 3 continued in a similar vein, with more information on use surveys, vaporization technology, pharmacokinetics, and the advent of cannabis-based medicine extracts and oro-mucosal delivery.

The Future

I envision that the fields of cannabis and cannabinoid therapeutics will flourish in the coming decade as our understanding of the key role of endogenous mechanisms unfolds, and governments slowly accept the wisdom that these medicines can play in alleviating human suffering from legion complaints. The advancement of that concept should properly occur in venues with greatest accessibility and visibility, and I will be working toward that goal. I hope and expect to continue to publish review material in book form with the continued largesse and support of Haworth Press.

Franjo Grotenhermen, the founder and president of the International Association of Cannabis as Medicine, has graciously agreed to expand the newsletter so that topical reviews and new ideas that might not see publication in mainstream sources will have an outlet.

We will make further efforts to ensure that the useful legacies of the Journal of Cannabis Therapeutics will endure and be accessible. Currently, portions of the content are available online, and we will secure additional availability at intervals after publication as time progresses. Eventually, we would essay to make the entire body of the work available electronically to all.

In closing, I would like to thank Lester for his idea, Tip for his support that has sustained me beyond his passing, Bill for his enduring encouragement, Dale Gieringer, Franjo Grotenhermen, John McPartland for their multitudinous submissions, GW Pharmaceuticals for their commitment to the future of cannabinoid therapeutics, and all the remaining board members and subscribers for their attention and largesse. For this, I am extremely grateful.

Ethan Russo, MD
Editor-in-Chief, Journal of Cannabis Therapeutics
October 2003