Date: Mon, 18 Aug 2008
Subject: #382 Medical Marijuana Pro-Con
MEDICAL MARIJUANA PRO-CON
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DrugSense FOCUS Alert #382 – Monday, 18 August 2008
Today the Los Angeles Times printed in its Monday Health Section four
articles about medicinal marijuana, below.
Yesterday the Los Angeles Times printed an OPED by Kenji Yoshino,
Professor of Constitutional Law at New York University School of Law
titled ‘Pot Power Play – Should State or Federal Law Prevail on
Medical Marijuana?’ as featured in the alert at http://www.mapinc.org/alert/0381.html
The weekday readership of the newspaper is slightly over two million
people.
The Los Angeles Times advises that published letters typically run 150
words or less and may be edited.
You may use the newspaper’s webform at http://drugsense.org/url/bc7El3Yo
to send letters or email them to [email protected]
There are many sources of information about medicinal marijuana. One
that makes the pro-con arguments far better than any newspaper could
is at http://medicalmarijuana.procon.org/
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Pubdate: Mon, 18 Aug 2008
Source: Los Angeles Times (CA)
Copyright: 2008 Los Angeles Times
Author: Jill U. Adams
MEDICAL MARIJUANA: WHAT DOES SCIENCE SAY?
A Look at the Pros and Cons of Medical Marijuana Use, a Topic That
Inspires Strong Opinions on Both Sides.
DEPENDING ON whom you ask, marijuana is a dangerous drug that should
be kept illegal alongside heroin and PCP, or it’s a miracle herb with
a trove of medical benefits that the government is seeking to deny the
public — or something in between: a plant with medical uses and
drawbacks, worth exploring.
As the political debates over medical marijuana drag on, a small cadre
of researchers continues to test inhaled marijuana for the treatment
of pain, nausea and muscle spasms.
All drugs have risks, they point out — including ones in most
Americans’ medicine cabinets, such as aspirin and other pain-relievers
or antihistamines such as Benadryl. Doctors try to balance those risks
against the potential for medical good — why not for marijuana as
well, they ask.
The truth, these researchers say, is that marijuana has medical
benefits — for chronic-pain syndromes, cancer pain, multiple
sclerosis, AIDS wasting syndrome and the nausea that accompanies
chemotherapy — and attempts to understand and harness these are being
hampered. Also, they add, science reveals that the risks of marijuana
use, which have been thoroughly researched, are real but generally
small.
Dr. Donald Abrams, chief of hematology and oncology at San Francisco
General Hospital and professor of clinical medicine at UC San
Francisco, says he sees cancer patients in pain, not eating or
sleeping well, experiencing nausea and vomiting from treatment, and
being depressed about their situation. He says he is glad that he
lives in California, where use of medical marijuana is allowed by
state law, although federal officials continue to raid cannabis
dispensaries in the state and scrutinize practices of physicians who
specialize in writing cannabis recommendations for patients.
“I can talk to patients about medicinal cannabis [and] I’m often
recommending it to them for these indications,” Abrams says.
Read on to learn what science has to say about the medical pros and
cons, and some mitigating factors, of Cannabis sativa.
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Pubdate: Mon, 18 Aug 2008
Source: Los Angeles Times (CA)
Copyright: 2008 Los Angeles Times
Author: Jill U. Adams
PRO: MARIJUANA USE FOR CHRONIC PAIN AND NAUSEA
Smoked Marijuana Can Bring Relief To Sufferers Of Neuropathic Pain
Comparable To That Of Other Painkiller Drugs, Some Studies Show.
Medical marijuana use has a history stretching back thousands of
years. In prebiblical times, the plant was used as medicinal tea in
China, a stress antidote in India and a pain-reliever for earaches,
childbirth and more throughout Asia, the Middle East and Africa.
In recent decades, medical researchers have investigated marijuana’s
effects on various kinds of pain — from damaged nerves in people with
HIV, diabetes and spinal cord injury; from cancer; and from multiple
sclerosis. Marijuana has also been hypothesized to help with nausea
induced by chemotherapy and antiretroviral therapy, and with severe
loss of appetite as seen in people with the AIDS wasting syndrome.
The weed’s actions are due to the active ingredients
tetrahydrocannabinol (THC) and some 60 other cannabinoids, which mimic
the action of chemicals — known as endogenous cannabinoids — that
exist naturally in the brain. Those cannabinoids activate receptors in
our nerves, triggering physiological responses.
A legal prescription form of THC (Marinol) exists, yet researchers say
it’s far from a perfect drug. Taken orally, its absorption is highly
variable and unpredictable and often delayed, says Dr. Igor Grant, a
UC San Diego psychiatrist who directs the university’s Center for
Medicinal Cannabis Research. “Smoking is a very efficient way to
deliver THC,” he says.
As a result of its federally illegal status, medicinal use of
marijuana is restricted to carefully vetted clinical research studies
or to patients in states such as California that have passed laws to
allow for personal medical use. Research on the medicinal use of
marijuana relies on government-issued marijuana cigarettes, which come
in different strengths and are supplied by the National Institute on
Drug Abuse.
The UC Center for Medicinal Cannabis Research in San Diego helps
coordinate clinical studies to investigate the safety and
effectiveness of marijuana. Here’s what they’ve found.
Neuropathic Pain
Recent research suggests that marijuana can assuage this chronic-pain
syndrome in which burning sensations occur and simple touch can feel
like hurt. It is unaffected by aspirin-like drugs and fairly resistant
to stronger analgesics such as opiates.
In a 2007 study on neuropathic pain related to HIV infection, 50
patients smoked marijuana cigarettes three times a day or marijuana
cigarettes from which active ingredients had been extracted. Subjects
then rated their pain on a scale ranging from “no pain” to “worst pain
imaginable.” The results, published in the journal Neurology, showed a
34% reduction in ratings of pain in the marijuana group compared with
17% in the placebo group over five days of treatment.
Another study in 44 patients reported in June in the Journal of Pain
found that marijuana alleviated neuropathic pain arising from a
variety of conditions, including spinal-cord injury and diabetes.
Participants smoked marijuana on a set schedule — first two puffs,
then three puffs an hour later, then four puffs an hour after that —
from a single cigarette containing either 0%, 3.5%, or 7% THC. Average
pain ratings before smoking were 55 on a 100-point scale and decreased
by 46% in both treatment groups and by 27% in the placebo group one
hour after the last puff.
Analgesic drugs are often tested against experimentally induced pain.
Such studies have been conducted for marijuana too. In one 2007 report
in the journal Anesthesiology, 15 healthy volunteers received skin
injections with capsaicin — the chemical behind that fiery spice in
chile peppers — and then smoked different-strength marijuana
cigarettes. The medium dose, with a 4% THC concentration, lessened the
burning pain.
These three pain studies all concluded that smoked marijuana can bring
relief to sufferers of neuropathic pain comparable to other analgesic
drugs. It is not a cure, Grant says: “It’s like other pain medicines,
you have to keep taking it.”
Study subjects did feel high, an effect that varied among individuals.
Marijuana also affected thinking, shown as problems with tasks of
memory and complicated reasoning after the strongest marijuana
cigarettes were used. Potentially problematic, these effects were
tolerated by subjects — no one opted out of the study because they
couldn’t think straight.
Grant says it’s important to have a choice of treatments because not
everyone responds to or can tolerate the available drugs.
Antidepressants are used for neuropathic pain but cause dry mouth,
constipation and urinary problems, and must be avoided by people with
conditions such as glaucoma. Others can’t take aspirin-like drugs.
“Having an alternative compound is always good,” Grant says.
Multiple Sclerosis
Patients with multiple sclerosis suffer muscle spasms, pain and
tremor. Anecdotal reports suggest that marijuana may be helpful, but
controlled studies are few. One, presented at an April meeting, had 51
multiple sclerosis patients smoke 0% or 4% THC marijuana cigarettes
daily for three days. Intensity of spasms was reduced by 32% and pain
ratings by 50% after smoking marijuana, compared with 2% and 22%
reductions after placebo cigarettes. Five subjects withdrew, citing
side effects: feeling too high, dizzy or fatigued.
Other studies in patients with multiple sclerosis used a cannabis
extract that can be taken orally. In a 2007 European Journal of
Neurology study, nearly half of 184 patients experienced at least 30%
improvement in muscle spasms.
But a 2004 Neurology paper showed no reduction in objective measures
of arm tremor with cannabis extract, although five subjects out of 13
reported feeling improvement. This might have resulted from
mood-altering effects of the drug or from some aspect of tremor not
measured.
Nausea
A 2008 review published in the European Journal of Cancer Care
analyzed 30 clinical studies using cannabinoid drugs synthesized in
the lab and concluded that they were better than standard antinausea
drugs in alleviating the nausea and vomiting that accompanies
chemotherapy. One such drug is Marinol, a THC preparation approved by
the Food and Drug Administration for precisely this purpose.
Survey studies suggest that some people with HIV smoke marijuana to
counteract nausea caused by antiretroviral therapy. Researchers at the
UC Center for Medicinal Cannabis Research have tried to study the
effect of smoked marijuana on nausea and vomiting in patients
undergoing chemotherapy but have struggled to enroll enough subjects,
Grant says.
Bruce Mirken, director of communications for the Marijuana Policy
Project — a group that lobbies for the decriminalization of marijuana
— says he is all for research on the chemical components in marijuana
with the goal of making more-purified and perhaps more-targeted drugs
that do not deliver a “high,” but does not see “criminalizing use of
that plant by people who are ill when you are making its main
psychoactive ingredient legal in the form of a very expensive pill.”
Tom Riley, a spokesman for the White House Office of National Drug
Control Policy, says marijuana advocates are seeking a free pass.
“They want to be exempted from the regular [drug] approval process,”
he says.
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Pubdate: Mon, 18 Aug 2008
Source: Los Angeles Times (CA)
Copyright: 2008 Los Angeles Times
Author: Jill U. Adams
CON: MARIJUANA’S DAMAGING EFFECTS
Scientists Say Pot’s Health-Related Risks Are Real but Small in Some
Instances.
Marijuana is the most widely used illicit drug in the country — an
estimated 25 million Americans smoked it within the last year and
close to 100 million have smoked it at least once in their life,
according to the most recent National Survey on Drug Use and Health by
the federal Substance Abuse and Mental Health Services
Administration.
Rates and severity of marijuana addiction pale in comparison to that
of legal addictive drugs, alcohol and nicotine, according to the
Advisory Council on the Misuse of Drugs, a panel of independent
experts advising the British government, in a rare head-to-head,
scientific comparison.
Yet, the fact is, recreational use can lead to addiction, and inhaling
marijuana smoke is unhealthful for the lungs. Some researchers argue
that marijuana may predispose heavy users to mental illnesses such as
psychosis and depression.
How big are these risks and how should they be measured against health
benefits? “The FDA has ruled that marijuana has no medical benefits,
but its harms are well known and proven,” says Tom Riley, a spokesman
for the White House Office of National Drug Control Policy, referring
to an April 2006 statement released by the FDA and several other
federal agencies concluding that smoking marijuana was not of
medicinal use.
For comparison’s sake, Riley cites the prescription drug Vioxx. The
FDA, he notes, pulled Vioxx off the market in spite of its proven
efficacy, because it created problems in a small number of people.
Then, too, the number of people adversely affected by marijuana use is
large, Riley says. “There are more teens in drug treatment for
marijuana dependence than for alcohol or any other drug,” he says.
Marijuana is a Schedule 1 drug by the Drug Enforcement
Administration’s Controlled Substances Act, a classification reserved
for drugs carrying the highest risk for addiction and no medical benefit.
Scientists have reviewed the weed’s risks and find them to be real,
but small. Ten years ago, the Institute of Medicine reviewed the
scientific evidence about marijuana at the request of the Office of
National Drug Control Policy. The 1999 report states that, “except for
the harms associated with smoking, the adverse effects of marijuana
use are within the range of effects tolerated for other
medications.”
In February, the American College of Physicians, the nation’s
second-largest physicians group, released a position paper in support
of medical-marijuana research, protecting doctors from criminal
prosecution and rescheduling marijuana as a less harmful drug.
A British advisory group this year found no evidence to reclassify
cannabis as a more harmful drug in that country. In contrast to the
U.S., the U.K. puts cannabis in the lowest category (Class C) in terms
of criminal penalties for possession or sale, although government
officials are campaigning to move it to Class B.
To investigate the risks of marijuana, researchers typically use heavy
marijuana smokers as subjects. Though such a study design may be
convenient, it makes interpretation tricky because heavy users may
have traits in common besides smoking pot. Thus, says psychologist and
marijuana researcher Stanley Zammit of Cardiff University in Wales, it
is not easy in these kinds of studies to separate out the contribution
of marijuana to any measurable effect in the group.
Psychosis
Claims of a link between marijuana use and psychotic episodes came
under scrutiny after the U.K. downgraded cannabis from Class B to
Class C in 2004. In 2007, Zammit was asked by England’s Department of
Health to survey the existing evidence to determine the long-term
risks for mental illness from using cannabis. After researching the
literature and including only those studies that satisfied certain
criteria, he combined the results in a 2007 Lancet paper.
He concluded that marijuana use was associated with an increased risk
of psychosis — ranging from self-reported symptoms such as delusions
or hallucinations to clinically diagnosed schizophrenia.
The risk is small, he adds. Cannabis use was associated with a 40%
increase in risk overall and up to a twofold increase in heavy users.
Because the risk of any person developing psychosis in their lifetime
is about 2% to 3%, cannabis use at worst increases that to 5%. “So 95%
of the people are not going to get psychotic, even if they smoke on a
daily basis,” Zammit says.
Zammit adds that “the main limitations of these studies is that you
can never be sure that it’s the cannabis itself that’s causing this
risk.” Heavy users of marijuana may differ from nonusers in other
traits — including those that lead independently to increased drug
use and risk of psychosis. The studies he reviewed tried to take into
account this possibility but could not rule it out entirely.
The bottom line? “The evidence is probably strong enough that people
should be aware of this risk,” he says.
Even if it’s real, the risk of developing psychosis because of
marijuana use is smaller than with use of some other drugs —
including legal ones such as cigarettes, says Mitch Earleywine, a
psychologist at the State University of New York University at Albany.
Grant says that numbers of schizophrenia cases have not increased
since before the 1960s, when widespread marijuana use began. “The data
are variable to be sure, but most studies have found that over the
years the rate of schizophrenia has been stable or even declining,” he
says.
Depression
In an American Journal of Psychiatry study, 1,920 adults were assessed
for marijuana use and depression and followed for 15 years. In those
subjects who had no depressive symptoms at the study’s start,
marijuana abusers were four times more likely to develop depressive
symptoms down the road. But Zammit, who reviewed this paper and 23
others in his 2007 Lancet paper, says the data overall are even
murkier than for psychosis. Most of the studies he reviewed did not
assess symptoms of depression before marijuana use, and so didn’t rule
out the idea that depression makes someone more likely to smoke
marijuana — and not the other way around.
Thinking
A review of the scientific literature published in the Journal of the
International Neuropsychological Society in 2003 looked at whether
marijuana smoking had lasting effects on cognition after THC has left
the body. Marijuana use was found to have small effects on memory in
long-term users — measured by asking subjects to recall words, for
instance — but no differences were seen on attention, verbal skills
and reaction time. “We were actually surprised,” says Grant, an author
on the study. Even if the marijuana itself wasn’t causing such things,
he expected marijuana users might have other less-than-healthful
behaviors — they may drink a bit more, or use some other drugs, and
“you might expect them to do a little worse.”
A 2002 study published in the Journal of the American Medical Assn.
found that a group of 51 heavy marijuana users (two joints per day)
recalled two to three fewer words on average than nonusers in a memory
test with a list of 15 words.
A second study, published in the Archives of General Psychiatry in
2001, found a similar deficit in 63 daily marijuana smokers who hadn’t
smoked for up to a week. After 28 days of not smoking marijuana the
effect disappeared.
Children
Studies on brain function and mental illness cited above were
conducted in adult marijuana users. How the drug affects adolescents
is not completely resolved, but the data are more troubling.
A 2000 paper in the Journal of Addictive Diseases recruited 58
marijuana users and found structural changes in the brains of those
who had starting smoking marijuana before age 17 but not in those who
didn’t start smoking until they were older.
“There’s also a modest decrease in IQ if teens use heavily, though
weekly users and folks who quit don’t seem to show it,” Earleywine
says. Adolescence, he says, is a time when brain neurons are making
oodles of new connections, and it’s possible that a psychoactive drug
such as marijuana may adversely influence that process.
Lungs
Before it has any effect on the brain, marijuana smoke enters the body
through the lungs. Dr. Donald Tashkin, professor of medicine at the
UCLA David Geffen School of Medicine, has studied the pulmonary
consequences of marijuana use for 25 years, recruiting a group of 280
heavy habitual pot smokers in the early 1980s, including some who also
smoked cigarettes. (Subjects averaged three joints per day for an
average of 15 years.) For comparison, he also recruited cigarette
smokers who didn’t use marijuana and people who didn’t smoke anything.
Tashkin has done a number of studies over the decades comparing these
groups. “I began with the hypothesis that regular smoking of marijuana
would have an impact on the lungs qualitatively similar to the impact
of regular tobacco smoking,” he says. That’s because the smoke of both
plants are more similar than different.
Tashkin and his colleagues did find symptoms of chronic bronchitis in
his marijuana-smoking group. In a 1987 study in the American Review of
Respiratory Diseases, they reported that incidence of chronic cough,
sputum production and wheezing was similar to that in cigarette smokers.
In a second study in the same subjects published in the American
Journal of Respiratory and Critical Care Medicine in 1998, examination
of the airways and the cells lining the airways found swelling,
redness and increased secretions in marijuana users. Biopsies showed
“extensive, widespread damage to the mucosa,” Tashkin says, similar to
what was seen in tobacco users. “This is amazing, because the
marijuana smokers average three joints a day, but the tobacco controls
smoked 22 cigarettes, suggesting that on a cigarette-to-cigarette
basis, marijuana may be more damaging.”
But marijuana smokers differ from tobacco smokers in other,
potentially more important ways, Tashkin adds. They do not seem to
develop more serious consequences of cigarette smoking, namely chronic
obstructive pulmonary disease (COPD) — the fourth leading cause of
death in the U.S., killing 130,000 people each year — or lung cancer,
the most common cancer in Americans and responsible for an additional
160,000 annual deaths, according to 2005 statistics from the Centers
for Disease Control and Prevention.
To study lung cancer, Tashkin looked at more than 600 lung cancer
patients and more than 1,000 control patients matched for age,
socioeconomic class, family history and other alcohol and drug use
(along with many other potential influences).
The results, published in a 2006 paper in Cancer Epidemiology
Biomarkers and Prevention, found a large number of regular marijuana
smokers were present in both groups, but statistically there were no
more in the cancer group than control group, suggesting no association
between marijuana use and lung cancer. Tobacco smokers, on the other
hand, showed a dose-dependent increase in risk: with a 30%, 800% and
2,100% increased risk of lung cancer in those who smoked less than a
pack, one to two packs or more than two packs per day,
respectively.
Other studies have found increased cancer risk. A study of 79 lung
cancer patients and 300 controls published in the European Respiratory
Journal this year found a fivefold increased risk in the heaviest
marijuana users (daily use for 10 years) and no effect in less heavy
users.
But Tashkin says this conflicting report was much smaller in scale,
having fewer than 20 subjects in the group of heaviest marijuana
users. “My critique would be: It’s a small study. I think that their
small sample size is responsible for vastly inflated estimates,” he
says.
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Pubdate: Mon, 18 Aug 2008
Source: Los Angeles Times (CA)
Copyright: 2008 Los Angeles Times
Author: Jill U. Adams
VAPORIZERS CAN CUT MARIJUANA SMOKE, RETAIN SIMILAR MEDICAL EFFECTS
Smoking anything is perceived as bad these days, says Dr. Donald
Abrams, chief of hematology and oncology at San Francisco General
Hospital and professor of clinical medicine at UC San Francisco. So he
devised a pilot study to evaluate a novel inhalation method conducted
in 18 otherwise-healthy subjects. “We used a device that heated
cannabis below the point of combustion — basically, a heating element
and a fan. The fan filled up a balloon from which the patients could
inhale,” he says.
The findings, published in Clinical Pharmacology and Therapeutics in
2007, showed that levels of THC were “virtually identical,” as were
patients’ reports of subjective “high.” No increase in exhaled carbon
monoxide was observed with vaporized marijuana, as was the case with
smoked marijuana, and patients preferred vaporization to smoking.
“The fact is that whole marijuana, particularly when vaporized and not
smoked, is a safe and effective delivery system,” says psychiatrist
Dr. Igor Grant, director of the UC Center for Medicinal Cannabis
Research in San Diego.
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