Medical Marijuana – a Dopey Idea?

DrugFree. Org
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.



What do the Public Health experts say?

American Society of Addiction Medicine: “ASAM asserts that cannabis, cannabis-based products and cannabis delivery devices should be subject to the same standards that are applicable to other prescription medications and medical devices, and that these products should not be distributed or otherwise provided to patients unless and until such products or devices have received marketing approval from the Food and Drug Administration. ASAM rejects smoking as a means of drug delivery since it is not safe. ASAM rejects a process whereby State and local ballot initiatives approve medicines because these initiatives are being decided by individuals not qualified to make such decisions.”

American Cancer Society: “The ACS is supportive of more research into the benefits of cannabinoids. Better and more effective treatments are needed to overcome the side effects of cancer and its treatment. The ACS does not advocate the use of inhaled marijuana or the legalization of marijuana.”

American Glaucoma Foundation: “Marijuana, or its components administered systemically, cannot be recommended without a long term trial which evaluates the health of the optic nerve. Although marijuana can lower IOP, its side effects and short duration of action, coupled with a lack of evidence that its use alters the course of glaucoma, preclude recommending this drug in any form for the treatment of glaucoma at the present time.”

National Multiple Sclerosis Society: “Although it is clear that cannabinoids have potential both for the management of MS symptoms, such as pain and spasticity, as well as for neuroprotection, the Society cannot at this time recommend that medical marijuana be made widely available to people with MS for symptom management. This decision was not only based on existing legal barriers to its use but, even more importantly, because studies to date do not demonstrate a clear benefit compared to existing symptomatic therapies and because issues of side effects, systemic effects, and long-term effects are not yet clear.” — Recommendations Regarding the Use of Cannabis in Multiple Sclerosis: Executive Summary. National Clinical Advisory Board of the National Multiple Sclerosis Society, Expert Opinion Paper, Treatment Recommendations for Physicians, April 2, 2008.

The American Academy of Pediatrics (AAP) believes that “[a]ny change in the legal status of marijuana, even if limited to adults, could affect the prevalence of use among adolescents.” While it supports scientific research on the possible medical use of cannabinoids as opposed to smoked marijuana, it opposes the legalization of marijuana. — Committee on Substance Abuse and Committee on Adolescence. “Legalization of Marijuana: Potential Impact on Youth.” Pediatrics Vol. 113, No. 6 ( June 6, 2004): 1825-1826. See also, Joffe, Alain, MD, MPH, and Yancy, Samuel, MD. “Legalization of Marijuana: Potential Impact on Youth.” Pediatrics Vol. 113, No. 6 ( June 6, 2004): e632-e638h.

The American Medical Association (AMA) has called for more research on the subject, with the caveat that this “should not be viewed as an endorsement of 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.”

John Knight, director of the Center for Adolescent Substance Abuse Research at Children’s Hospital Boston, recently wrote: “Marijuana has gotten a free ride of sorts among the general public, who view it as non-addictive and less impairing than other drugs. However, medical science tells a different story.”

Similarly, Dr. Christian Thurstone, a psychiatrist board-certified in general, child and adolescent and addictions psychiatry, who serves as an associate professor of psychiatry at the University of Colorado and as medical director of one of Colorado’s largest adolescent substance-abuse-treatment programs, said: “In the absence of credible data, this debate is being dominated by bad science and misinformation from people interested in using medical marijuana as a step to legalization for recreational use. Bypassing the FDA’s well-established approval process has created a mess that especially affects children and adolescents. Young people, who are clearly being targeted with medical marijuana advertising and diversion, are most vulnerable to developing marijuana addiction and suffering from its lasting effects.”

Dr. Ed Gogek, an addictions psychiatrist in Arizona wrote in the New York Times: “Indeed, marijuana activists use phony science, just as global warming deniers do. For years they claimed pot was good for glaucoma and never apologized when research found it could actually make glaucoma worse. They still insist weed isn’t addictive, despite every addiction medicine society saying it is. They’ve even produced their own flawed scientific studies supposedly proving that medical marijuana laws don’t increase use among teenagers, when almost all the evidence says just the opposite.”


Criminal justice outcomes for cannabis use offences in New Zealand, 1991–2008

Criminal justice outcomes for cannabis use offences in New Zealand, 1991–2008
International Journal of Drug Policy 2012
Background: There have been no changes to the statutory penalties for cannabis use in New Zealand for over 35 years and this has attracted some criticism. However, statutory penalties often provide a poor picture of the actual criminal justice outcomes for minor drug offending.
Aim: To examine criminal justice outcomes for cannabis use offences in New Zealand over the past two decades.
Method: Rates of apprehension, prosecution, conviction and related criminal justice outcomes for the use of cannabis in New Zealand (per 100,000 population) were calculated for 1991–2008. The same measures were calculated (per 1000 last year cannabis users) for 1998, 2001, 2003 and 2006. Trends were tested for using logistic regression with year predicting each measure outcome and with chi-square tests.
Results: The number of police apprehensions for cannabis use per year (per 100,000 population) declined from 468 in 1994 to 247 in 2008. The number of apprehensions for cannabis use per year (per 1000 cannabis users) also declined from 36 in 1998 to 21 in 2006. There were similar declines in prosecutions and convictions for cannabis use from 1991 to 2008. Those prosecuted for cannabis use in 2000–2008 were less likely than those prosecuted in 1991–1999 to be convicted and were more likely to be diverted away from the courts, ‘discharged without conviction’ and ‘convicted and discharged’.
Conclusion: There has been a substantial decline in arrests for cannabis use in New Zealand over the past decade and this lead to similar declines in prosecutions and convictions for cannabis use. The decline in convictions for cannabis use was further assisted by the expansion of police diversion to include cannabis use offences. Our findings underline the importance of examining the implementation of law, as well as statutory penalties, when characterising a country’s criminal justice approach to minor drug offending.