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Research

Lessons learned after 4 years of marijuana legalisation

Smart Approaches to Marijuana – October 2016

FULL REPORT https://learnaboutsam.org/wp-content/uploads/sites/3/2016/11/SAM-report-on-CO-and-WA-issued-31-Oct-2016.pdf

In the wake of multimillion-dollar political campaigns funded with out-of-state money, Colorado and Washington voted to legalize marijuana in November 2012. Though it would take more than a year to set up retail stores, personal use (in Colorado and Washington) and home cultivation (in Colorado, which includes giving away of up to six plants) were almost immediately legalized after the vote.

Using marijuana in public, which remains illegal under these new laws, has increased conspicuously in both states. Also, a brand-new marijuana industry selling candies, cookies, waxes, sodas, and other marijuana items has exploded—and with it a powerful lobby to fight any sensible regulation.

Though it is still early—the full effects on mental health and educational outcomes, for example, will take many more years to fully develop—these “experiments” in legalization and commercialization are not succeeding by any measure.

Colorado now leads the country in past-month marijuana use by youth, with Washington not much further behind. Other states that have since legalized marijuana occupy 4th place (District of Columbia) and 5th place (Oregon). States with lax “medical marijuana” laws occupy 2nd and 3rd place (Vermont and Rhode Island, respectively).

Additionally, as explained in greater detail below, the laws have had significant negative impacts on public health and safety, such as:

  • Rising rates of pot use by minors
  • Increasing arrest rates of minors, especially black and Hispanic children
  • Higher rates of traffic deaths from driving while high
  • More marijuana-related poisonings and hospitalizations
  • A persistent black market that may now involve increased Mexican cartel activity in Colorado

The federal government, through the Department of Justice (DOJ), announced it would initially take a hands-on approach to state implementation of legalization, instead promising to track eight specific consequences—from youth marijuana use to use on public lands—and determine action later. So far, however, neither the federal nor state authorities have implemented a robust public tracking system for these criteria. This failure led the U.S. Government Accountability Office (GAO) to criticize DOJ in 2016 for not appropriately monitoring and documenting legalization outcomes. As of the date of this publication, there has been no word from the Department of Justice about state marijuana program compliance with any of the eight criteria it identified. Quietly, however, state agencies such as the Colorado Department of Public Safety, have released very negative updates on marijuana data and other indicators.

In the meantime, the promises of tax revenue windfalls and decreased crime have not materialized. Pot tax revenue comprises a tiny fraction of the Colorado state budget— less than one percent—and after costs of enforcement are subtracted, the remaining revenue is very limited. Colorado schools have not received money for new teachers or smaller class sizes despite pot taxes. And in Washington, half of the marijuana tax money legalization advocates promised for prevention and schools has been siphoned into the state’s general fund.

Topics covered in the report:

  • Youth Marijuana Use Since Legalization
  • Black Market Activity Since Legalization
  • A Possible Link To Homelessness
  • Impact on Businesses and the Workforce
  • Driving While High
  • Emergency Marijuana-Related Poison Control Calls in Colorado
  • Edibles: A Growing Public health problem
  • Crime and Marijuana
  • Tax Revenues

 

Pot Populism and Vested Interests

John WhitehallDr John Whitehall Quadrant Online
https://quadrant.org.au/magazine/2016/07-08/capitulating-populism-vested-interests/

Medical practice has been turned on its head in the US, with the practitioner giving permission for a third party to advise on type and dose of cannabis. A gross perversion of sound and ethical medicine, moves to legalise ‘medical marijuana’ will see the same consequences here

The Queensland government has released a draft Public Health (Medicinal Cannabis) Bill and has invited discussion of its “framework for regulating the lawful supply and use of medicinal cannabis products” in that state. The Bill is an exercise in sophistry: an attempt to justify the medical prescription of a complex herb without scientific examination by the Therapeutic Goods Administration (TGA) of its components, safety and efficacy…. It does not explain that cannabis is composed of over 400 chemicals whose quantities vary from bud to bud, even from the same plant, and that prediction of composition for prescription is impossible.

… Data from nine Californian clinics has revealed 73 per cent of users to be males aged between eighteen and forty-four. Data from Colorado has confirmed 68 per cent of recipients to be males with a mean age of forty-two. As to the reasons for consumption, Californian data lists pain from back and neck injuries (82.6 per cent), sleep disorders (70.7 per cent), need for relaxation (55.1 per cent), muscle spasms (41.1 per cent), headaches (40.7 per cent), anxiety (37.8 per cent), nausea and vomiting (27.7 per cent), depression (26.1 per cent), poor concentration (22.5 per cent), anger control (22.4 per cent), more energy (15.9 per cent), diarrhoea (5 per cent), seizures (3.2 per cent) and itching (2.8 per cent). These results contradict the image of medical marijuana providing relief for the dying.

The Bill is a capitulation to vested interest. It rejects lessons that have been achieved through much suffering: there was no TGA to protect children when thalidomide was promoted by Big Pharma.

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The Comforting Myths of Medical Marijuana

John WhitehallDr John Whitehall
Quadrant Online
https://quadrant.org.au/magazine/2014/10/comforting-myths-medical-marijuana/

Refractory epilepsy used to be considered a curse: it still is a curse and, though blame has moved from magic to molecule, it remains one of life’s great afflictions. It is not surprising, therefore, that parents of an afflicted child will consider all possibilities for cure. But what should be made of recent publicity that “medical marijuana” has stopped convulsions and reduced associated brain dysfunction in two children in such miraculous manner that its advantages deserve to be available not only for epilepsy but for all kinds of other diseases?….

…Can marijuana prevent fits? Despite the rare but exciting anecdotes, no one knows, because no reliable trials have been published anywhere in the world, according to the reputable Cochrane system of review. The drug has been available for medical purposes, including epilepsy, in California for almost twenty years and is now available in twenty-two US states, but there is nothing to report! Despite repeated claims of “potential” for the drug, there is silence, though all humanity is crying out for better anti-epileptic drugs. This silence could mean there is no convincing effect, or that the doctors who prescribe it have no idea of what is happening to their so-called patients. If it were a miracle drug, it could be expected that the purveyors of marijuana would trumpet statistical success….

…. On perhaps a churlish note, another problem for rushed research on cannabis might be the opinion of “ethics committees” which must approve research in hospitals and universities. It would be interesting to see response to an application for a trial on children of a substance you could not chemically define, for effect that might not be obvious, with known ability to shrink a brain or precipitate madness, and create dependence in 9 per cent, complicated by the expectation of sudden death, underpinned by contradictory effects on animals, and all because it seemed a wonderful idea to the media, and had the support of a few politicians! I had to wait for over twelve months for approval of a study that merely questioned volunteering mothers when they initiated solid foods to their offspring!

….I would like to close by saying that in almost fifty years of medicine I have seen almost more than I can bear of brain-damaged and dying human beings. I believe relief of pain is one of the greatest benefits a doctor can share, and scientific evaluation one of the greatest gifts we all enjoy. I think, therefore, we should wait a little longer for scientific revelation of the effects of the components of the natural herb and then, if positive, use them lavishly. In the meantime, we should not unleash a destructive force despite the persuasion of anecdote.

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Medical Marijuana – a Dopey Idea?

Medical Marijuana – a Dopey Idea?

Dr Gregory K Pike
Director, Adelaide Centre for Bioethics and Culture
May, 2013

Introduction

As long as humans have suffered from ailments, medicine has sought treatments. To attempt to alleviate suffering is a mark of the better face of humanity, or at least recognition that we all, at one time or another, are subject to illnesses that need relief. Hence, maladies are markers of our shared condition and an opportunity for our better qualities to find expression.

The search for healing has taken many turns down the centuries, and along the way there have been good and bad treatments, effective ones, futile ones, burdensome ones, ‘miraculous’ ones, deceptive ones and downright dangerous ones. Just as humans can act wisely or foolishly, so treatments have been wisely or foolishly developed and employed. And noble motives are no guarantee that genuinely good treatments will be used.

As the scientific enterprise has grown and understanding of human biology advanced, so has our understanding of the biological basis of medicine. While our knowledge is far from complete, modern medicine now has an impressive array of treatments, and in many cases cures. There will always be mistakes, more inquiry, refinement, and new discoveries, but the general trend is moving forwards with hope for improvements and new ways of alleviating human suffering. Modern medicine is not only built upon understanding human biology, but also upon an understanding of human nature itself. This is where a proper appreciation of human nature aligns with an ethical framework directed towards the good of the person receiving treatment.

Hence, medicine has always developed codes of ethics that serve as a foundation or point of constant referral against which the discipline measures any new development. A sound ethical framework also recognizes the place of the patient within a community and also the unique nature of the relationship between patient and physician.

It is within this broad context that the question of medical marijuana needs to be considered.

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The FAQs: What You Should Know About Medical Marijuana

The Gospel Coalition 28 September 2016
This November four states—Arkansas, Florida, Montana, and North Dakota—will vote on legalizing medical marijuana. Here are some things you should know to navigate the public debate about the legalization of cannabis for medicinal purposes.

What is medical marijuana?

The terms marijuana and cannabis refer to all parts of the plant Cannabis sativa L., whether growing or not; the seeds thereof; the resin extracted from any part of such plant; and every compound, manufacture, salt, derivative, mixture, or preparation of such plant, its seeds or resin.

The term “medical marijuana” (or medical cannabis) refers to the use of the unprocessed plant or its basic extracts to treat a disease or symptom. However, the use of the term “medical marijuana” is controversial since the U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine, and its efficacy for medicinal use is disputed.

Is medical marijuana a form of “medication”?

No. A medication is a substance used in treating disease or relieving pain. The term medical marijuana refers to treating a disease or symptom with the whole unprocessed marijuana plant or its basic extracts. Neither the unprocessed plant nor its extracts is medication, though each may contain substances (specifically cannabinoids) that do have medicinal value.

As Dr. Greg Bledsoe, the surgeon general of Arkansas, explains,

Unequivocally, the plant is not medicine. The plant cannot go through the FDA-approval process because you don’t know the dose, you don’t the other compounds that are in there, you can’t control the amount you are giving to patients. So a plant can never be FDA-approved. . . The compounds are so potent in the marijuana plant that if you do it with anything less than an FDA -pproval process with strict confines on it, it could be dangerous to people.

If the plant (cannabis) contains medicine, why shouldn’t it be considered a form of medication?

To understand why there is a distinction, it helps to compare cannabis to other plants that contain compounds of medicinal value. As Dr. Bledsoe says,

One of the best drugs we have for malaria still today is a drug that was developed from a tree in Peru. We get the tree bark from this tree and isolate a compound from it and make the drug quinine. Quinine is used all over the world to fight malaria. That’s the correct way of doing this. We don’t go around prescribing tree bark to patients who have malaria. We proscribe the compound within the tree bark. It’s the same thing with marijuana. We take the plant, isolate the compounds that have therapeutic value, study those and put them through the FDA approval process, and offer those to patients.

What compounds in marijuana have medicinal use?

The compounds that may have medicinal uses are cannabinoids, a class of chemical compounds that acts on cannabinoid receptors in cells that represses neurotransmitter release in the brain. The marijuana plant contains more than 100 cannabinoids. Currently, the two main cannabinoids from the marijuana plant that are of medical interest are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).

According to the National Institute on Drug Abuse, THC increases appetite and reduces nausea and may also decrease pain, inflammation (swelling and redness), and muscle control problems. CBD is a cannabinoid that does not affect the mind or behavior. It may be useful in reducing pain and inflammation, controlling epileptic seizures, and possibly even treating mental illness and addictions.

The National Institutes of Health and other researchers are exploring the possible uses of THC, CBD, and other cannabinoids for medical treatment.

What FDA-approved medications contain cannabinoids?

The FDA has approved two drugs, dronabinol and nabilone, which contain THC. These drugs treat nausea caused by chemotherapy and increase appetite in patients with extreme weight loss caused by AIDS.

The United Kingdom, Canada, and several European countries, notes the National Institute on Drug Abuse, have approved nabiximols (Sativex®), a mouth spray containing THC and CBD. It treats muscle control problems caused by multiple sclerosis (MS). (Clinical trials are being conducted for use in treating cancer pain.) And although it has not yet undergone clinical trials, scientists have recently created Epidiolex, a CBD-based liquid drug to treat certain forms of childhood epilepsy.

Does medical marijuana help treat glaucoma?

Marijuana is not recommended as a treatment for glaucoma, according to the American Academy of Ophthalmology (AAO).

Glaucoma is an eye condition in which the optic nerve becomes progressively damaged. Over a period of time the condition can lead to reduced peripheral vision and even to blindness. A primary cause of optic nerve damage in glaucoma is higher-than-normal pressure within the eye, known as intraocular pressure or IOP.

Currently, the only way to control glaucoma and prevent vision loss, says the AAO, is to lower IOP levels. Some research has shown that ingesting marijuana does lower IOP for a short period of time—about three or four hours. Because glaucoma needs to be treated 24 hours a day, notes the AAO, a patient with glaucoma would “need to smoke marijuana six to eight times a day around the clock to receive the benefit of a consistently lowered IOP.” However, marijuana not only lowers IOP, but also lowers blood pressure throughout the body—including to the optic nerve, effectively canceling out the benefit of a lowered IOP.

Can a doctor write a prescription for medical marijuana?

No. According to the Journal of the American Medical Association,

Under federal law, marijuana has no currently accepted medical use and has a high potential for abuse. For these reasons, doctors cannot prescribe marijuana. In a state that allows the use of marijuana to treat medical conditions, however, a doctor may be able to certify its use. Your state may require you to apply for a state-issued identification card to use medical marijuana.

Do medical association support the use of medical marijuana?

The general consensus is that medical associations do not support the use of the cannabis plant as medicine. The American Medical Association (AMA) states that they do not endorse “state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product.” The American Psychiatric Association (APA) states that, “There is no current scientific evidence that marijuana is in any way beneficial for the treatment of any psychiatric disorder. In contrast, current evidence supports, at minimum, a strong association of cannabis use with the onset of psychiatric disorders.” The American Society of Addiction Medicine (ASAM) says, “Given the uncertain evidence to support the safety and efficacy of cannabis and cannabinoid-products in the treatment of medical conditions, ASAM and a number of other professional medical societies have advised that all cannabis-based medicinal products, like all other medicinal products, should be approved by FDA.”

Where is the use of medical marijuana currently legal?

The following 25 states (and the District of Columbia) have legalized medical marijuana: Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington.
https://www.thegospelcoalition.org/article/the-faqs-what-you-should-know-about-medical-marijuana

Growing Like a Weed

Citizen Magazine
As more states look at loosening laws on the sale and use of marijuana, Colorado is offering a disturbing preview of what may be in store for them.

Colorado OK’d the use of medical marijuana in 2000, as 23 others have over the last several years.

But in 2013, it, along with Washington state, took the unprecedented step of legalizing the recreational use of marijuana—and catastrophic calls have been on the rise ever since.

There has been a sharp increase in pot-related calls to poison control; seizures have quadrupled; two deaths so far are attributed to marijuana overdoses; neighboring states are experiencing a surge in pot use; and advertising through every available medium blankets the Centennial State, desensitizing people to the risks.

Perhaps most troubling, the drug is infiltrating Colorado schools, which now have lists of young people waiting to get help. Teens who use pot face nearly twice the risk of addiction as adult users,  and juvenile usage increases the brain damage associated with the drug.
http://saynopetodope.org.nz/wp-content/uploads/sites/3/2015/08/Citizen-Magazine.Growing-Like-a-Weed1.pdf 

READ CITIZEN MAGAZINE – GROWING LIKE A WEED

Where There’s Smoke

Citizen Magazine
Resistance to a Colorado law passed in 2012 legalizing the recreational use of marijuana is growing steadily as unnerving results continue to mount.

Some voters who supported the law are now voting to block pot shops in their communities. Education organizations are springing up around the state, and a fledgling repeal movement is underway.

“There is a growing angst among people who are now pushing back,” says Bob Doyle, executive director of the advocacy group Colorado Tobacco Education and Prevention Alliance. “People have become aware of what this is all about—the mass commercialization of marijuana, not social justice or (reducing) incarceration rates.”

A top concern for many people who are now part of the resistance is the fact that kids under the age of 21—the minimum age for purchasing marijuana that was written into the law—are nonetheless consuming it at stunning levels, according to the Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA), an offshoot of the Office of National Drug Control Policy, which coordinates efforts between federal, state and local drug-enforcement agencies.

Moreover, today’s marijuana includes concentrated products, like cannabis butter or oil, which are made by extracting the psychoactive ingredient of the plant for a very powerful effect.
http://saynopetodope.org.nz/wp-content/uploads/sites/3/2015/08/Citizen-Magazine.Where-Theres-Smoke1.pdf

READ CITIZEN MAGAZINE – WHERE THERE’S SMOKE

 

 

The hard lessons of legal marijuana

Dr Greg Pike – MercatorNet 20 April 2015
In recent years, several US states have legalised marijuana for recreational purposes.  This has happened after many years of legal access to marijuana as medicine in those same states.

It has been an unsurprising transition when viewed from at least one perspective, even though from another it is entirely odd.

The reason the transition was anticipated is because changing the image of cannabis by promoting it as medicine is powerful.  There doesn’t need to be much nuance in the idea that medicines are good and abstracted from that nasty business of “illicit drugs”.  The latter wreck lives whereas the former heal people.

The image change gets into the collective consciousness and people start to think differently, gradually allowing a medical paradigm to overtake even strong contrary evidence of harm.  Not everyone has the time to delve deeply, so a cursory overarching framework within which to place the question must suffice for many.  Moreover, it is not only those who might actually use marijuana who influence that perception.  Moderates, who are unlikely to ever use themselves, are nevertheless an essential part of public opinion and its voice.

This transitional strategy was something recognised years ago by one of the wealthiest supporters of drug legalisation movements worldwide, billionaire financier George Soros.  When approached for funding he made it clear he would first support “winnable issues” like medical marijuana.  Once they were won the ground would be laid for the main game.  Along with others, he heavily bankrolled medical marijuana initiatives in the 90s, and now the fruit of that strategy is ripening.

It always seemed curious that organisations like NORML (National Organisation for the Reform of Marijuana Laws – the acronym says it all), would suddenly become interested in the treatment of MS, glaucoma, spasticity and neuropathic pain.  They are not a patient-advocacy group.  From the very beginning NORML were only ever interested in legalising marijuana for recreational purposes.  Medical marijuana was their beachhead, and at the time all they had to do was stay on message.  By focusing on potential medical uses for marijuana, a distorted and simplistic story was hammered home by media savvy operators.  Now 23 US states have medical cannabis and a further three are pending.

How strange to promote smoked cannabis as medicine when much of the research on potential therapeutic uses of its active ingredients was still being done, or at best showed only a modest effect.  That’s not how modern medical research proceeds for any other potential medicine, so why should it be different for cannabis?  In fact several pharmaceutical preparations are readily available, so smoking is unnecessary.  Smoking marijuana as medicine is a bit like revisiting opium eating despite pharmaceutical morphine and codeine.  That’s 18th century medicine, not 21st.

Moreover, there is a certain irony in the fact that any therapeutic value in cannabis could well be found in elements unrelated to the ingredient that evokes the mind-altering effects.  So the medical marijuana movement may have inadvertently been founded upon a non-mind-altering ingredient, whilst paving the way for users to get high on another ingredient altogether.

One reason the transition from medical cannabis to legalisation for recreational use is odd is because it has happened at much the same time as a significant body of research has emerged on how damaging recreational marijuana can be, especially on a young developing brain.  The evidence of harm is stronger than it has ever been, and growing.  How did that message get lost?

Just last month, work by Hungarian researchers publishing in Nature Neuroscience added to an already disturbing picture about how cannabis has damaging effects on neuronal communication, even at relatively modest doses.  Right at the time that communities are becoming more cognizant of a broad mental health problem – some say crisis – an agent that is known to directly contribute to it is endorsed as a lifestyle choice.

Now that four US States have legalised marijuana for recreational purposes, and more could follow, the stage is set for the entry of big commercial operators who will be keen to move swiftly to establish themselves as key product suppliers.

There must be considerable excitement at the prospect of a large new market, especially one that involves addiction.  Markets in addictive substances and practices are almost a license to print money.  Take poker-machines in Australia for example.  It is estimated that approximately half of all revenue is derived from “problem gamblers”.  That is, people addicted to pokies who, along with their families and friends, are bearing the brunt of the damage.  Or take tobacco.  Since over 80% of smokers smoke daily they are likely to be dependent users and therefore represent a guaranteed ongoing market.

Getting hooked is great for business.  Someone else’s that is.

Meanwhile, the nascent marijuana industry in the US is taking off.  Willie Nelson has started his own brand: Willie’s Reserve; and Bob Marley’s widow and children want us to help “build Marley Natural into a worldwide force for positive change”.   I bet they do.  The brand-name product will “celebrate life, awaken well-being and nurture a positive connection with the world.”  Don’t laugh, it’s serious, as is the money behind Marley business-partner Privateer Holdings.

In reality these are celebrity endorsements that will front hard-nosed businesses that may end up operating much like big tobacco – if it ever gets that far.  And as recreational use takes off, we should expect dispensaries for medical cannabis to gradually disappear.  Why pay to go see a doctor when you can “self-medicate”?

In Australia, about 1.3% of people smoke marijuana daily, whereas 16% smoke tobacco daily.  That 16% figure has come down dramatically over the past few decades and is evidence of an accepted cultural practice being reconfigured because of research about harm.  The subsequent shifting social norm has put considerable pressure on smokers.  However, having done just about everything possible through education, taxation, social pressure, and various restrictions, the problem, though lessened, has not gone away – by a long shot.  16% smoking tobacco still represents a serious cost, both financial and human.

After all that effort to reduce smoking, what a dumb idea it is to undermine the message by endorsing the smoking of marijuana.

Arguably, as big cannabis and its promotional juggernaut gets rolling, the 1.3% could rise significantly.  Not only is it logically consistent that it should increase when restraint is lifted, but in fact that is what happens when more permissive policies are implemented.  Holland is a good example.  In a paper published in Science in 1997, MacCoun and Reuter chart the trebling in rates as cannabis became available through the “coffee shops”.  Notably, the increase was more aligned with ramping-up commercial production than with decriminalisation per se.

If Australia’s 1.3% figure “only” trebled for example, and got to just one quarter of daily tobacco use, the costs, financial and human, would be a far bigger problem than those of tobacco.  After all, no one gets stoned on tobacco.  Neither does nicotine seem to have anywhere near the disruptive effect on neurodevelopment as cannabis. And trebling could be a conservative estimate.

Addiction to cannabis is real, and most people can recount sad stories of waste and loss amongst family, friends or acquaintances.   But just as real is the addiction of governments to the revenue stream.  Once that source of income for any addictive substance or practice is embedded they have always found it hard if not impossible to wean themselves off it.  For their role in health promotion, it is a conflict of interest writ large.

Despite all the complexity and unknowns about what may or may not happen as cannabis becomes the next “dot-bong”, there is one key question no one seems really keen to raise.  That is, what really is the distinction between use and abuse, between a legitimate role or purpose for a substance and its illegitimate use?  When does licit turn illicit?  Isn’t this the unpalatable moral question, especially when entering an alcoholic stupor (alcohol’s equivalent of getting stoned) is a normalized part of many Western democracies?

Interestingly, that doesn’t seem to be too much of a problem when it comes to some common pharmaceuticals, for example: benzodiazepines like Xanax, opiates like Morphine and Oxycodone, antipsychotics like Seroquel, and amphetamines like Ritalin and Adderall.  With these, medicine represents the only legitimate context.  Recreational use is not on.

So acceptance by the state that marijuana can be legitimately used for recreational purposes is a major moral statement.

Other countries will be watching the US very carefully.  Especially those who have done the experiment and since backed away.  It is not wise to ignore them, and to do so will be to learn the hard way.
Dr Gregory K Pike is the Director of the Adelaide Centre for Bioethics and Culture.
http://www.mercatornet.com/articles/view/the-hard-lessons-of-legal-marijuana/15998

 

The Debate on Drug Law Reform

THE DEBATE ON DRUG LAW REFORM

Gregory K Pike, Director, Adelaide Centre for Bioethics and Culture

INTRODUCTION

Most people have been affected at some level by drug abuse. Many have close family members, relatives, friends or acquaintances who struggle with an addiction. Those with the addiction can cause a lot of grief to others but are nevertheless loved. They are often charming, sensitive, intelligent, complex individuals who can also behave appallingly. Those who love them are often placed in a terrible predicament. How to work for the best for someone who seems to be self-destructing? It cannot be good to abandon someone to their addiction, but neither is it good to harshly punish them or magnify their struggle. Paths to recovery are often slow, complicated by a range of deep psychological and perhaps physical issues, and require a commitment to what is genuinely in the person’s best interests. There are no easy answers, just the reality of messy human behavior, messy relationships, all interwoven with joy and sorrow.

Sensible policies about mind-altering substances must start with a realistic account of the reasons why and how people use them and how that fits with human dignity and flourishing. Naturally following from this will be an honest account of any putative contribution to human fulfillment and an equally honest account of all of the potential harms that might result from their use in any given manner. And this must include harm to individuals who use as well as to the whole community.

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Medical Marijuana – a Dopey Idea?

DrugFree. Org
Introduction 
As long as humans have suffered from ailments, medicine has sought treatments. To attempt to alleviate suffering is a mark of the better face of humanity, or at least recognition that we all, at one time or another, are subject to illnesses that need relief. Hence, maladies are markers of our shared condition and an opportunity for our better qualities to find expression.

The search for healing has taken many turns down the centuries, and along the way there have been good and bad treatments, effective ones, futile ones, burdensome ones, ‘miraculous’ ones, deceptive ones and downright dangerous ones. Just as humans can act wisely or foolishly, so treatments have been wisely or foolishly developed and employed. And noble motives are no guarantee that genuinely good treatments will be used.

As the scientific enterprise has grown and understanding of human biology advanced, so has our understanding of the biological basis of medicine. While our knowledge is far from complete, modern medicine now has an impressive array of treatments, and in many cases cures. There will always be mistakes, more inquiry, refinement, and new discoveries, but the general trend is moving forwards with hope for improvements and new ways of alleviating human suffering.

….. It is also important to note that the intrinsic harm of addiction makes all the difference. Substances with addictive potential are categorically unique and add a problematic dimension that must be taken into proper account when considering any possible therapeutic effect.

…. Is Marijuana Medicine?
If marijuana has medicinal value, the first question to be asked is, “In what form might it have medicinal value?”

The modern scientific approach to medicines typically follows a path of inquiry directed towards obtaining the most beneficial form of a medicine to treat a specified condition. For example, while opium has been recognised for its medicinal value for many centuries, the active ingredients codeine and morphine have now been extracted and subjected to extensive research and analysis over many years. We now have both in various formulations with known dosage and purity, a body of information on side-effects, known indications and contraindications, knowledge of therapeutic targets, patient populations for whom treatment is appropriate, and knowledge of abuse potential. No medical authority would ever prescribe or even recommend smoking opium, not only because of the availability of formulations of active ingredients which are superior, but also because of the harm of smoking as a delivery system.

… Dronabinol was approved by the US Food and Drug Administration (FDA) in 1985 for treating chemotherapy-induced nausea and vomiting and AIDS-related wasting, and although proven effective, both dronabinol and nabilone have not become the mainstays of treatment mainly because of their side effects, which include sedation, anxiety, dizziness, euphoria/dysphoria and hypotension, as well as the presence of superior alternatives. Dronabinol and nabilone have also been shown to produce symptomatic relief of neuropathic pain and the spasticity associated with multiple sclerosis. However, whilst patients report alleviation of spasticity, measures of objective changes are mixed. In a recent study by Kraft and co-workers, an orally administered extract of cannabis containing mainly THC was found to have no beneficial impact on acute pain and may possibly have enhanced pain sensation. This study highlights not only the complex nature of pain itself, but also the importance of identifying specific therapeutic contexts in which THC may or may not be useful.

… Similarly, the FDA has stated, No sound scientific studies supported the medical use of marijuana for treatment in the United States and no animal or human data supported the safety or efficacy of marijuana for general medical use. There are alternative FDA-approved medications in existence for treatment of many of the proposed uses of smoked marijuana.

… It is not surprising that other peak organisations like the American Medical Association, the American College of Physicians, the American Nurses Association, the American Cancer Society, the American Glaucoma Foundation, the National Multiple Sclerosis Society, the American Academy of Pediatrics and the American Society of Addiction Medicine all support the FDA approval process and have expressed either opposition to or concern over the use of smoked marijuana as a therapeutic product.

… Groups like the National Organisation for the Reform of Marijuana Laws (NORML) have been agitating for medical marijuana for a long time, as has the Drug Policy Alliance. However, particular individuals have also put in considerable funds. These include billionaire financier George Soros and insurance magnate Peter Lewis. It is estimated that Lewis alone has spent between $40 and $60 million on medical marijuana initiatives since the early 80s. Soros-watcher Rachel Ehrenfeld has described the Soros strategy as set forth to pro-legalisation group Drug Policy Foundation in the early nineties: .. in 1993 Soros gave DPF a “set of suggestions to follow if they wanted his assistance: Come up with an approach that emphasizes `treatment and humanitarian endeavors,’ he said … target a few winnable issues, like medical marijuana and the repeal of mandatory minimums.” Apparently, they took his advice.
http://www.drugfree.org.au/fileadmin/library/Cannabis/MedicalMarijuana-DopeyIdea.pdf