Pubdate: Sun, 13 Dec 2009 Source: Pueblo Chieftain (CO) Copyright: 2009 The Star-Journal Publishing Corp. Contact: http://www.chieftain.com/ Details: http://www.mapinc.org/media/1613 Author: Carl Bartecchi Note: Dr. Carl E. Bartecchi, a Pueblo physician, is clinical professor of medicine at the University of Colorado School of Medicine. MEDICAL MARIJUANA Still Another Drug Of Abuse, So Weigh The Consequences Marijuana certainly has been in the news lately. My goal here is not to question whether marijuana should be legalized, or to claim that it has no medical benefits or to suggest that I have the answers to the many problems that it poses. There are some reasonable arguments for legalization of marijuana. It is still, however, another drug of abuse. Many supporters of marijuana legalization claim it is safer than cigarettes and causes fewer problems than alcohol abuse. Marijuana may be safer and cheaper than opiates and other medications used for cancer patients. Many of the medical benefits of marijuana have been overstated, as is the case with many herbs and supplements. Many of the claims for marijuana's value in illnesses such as MS, glaucoma, Crohn's disease, Parkinson's disease or the agitation of Alzheimer's disease have not borne out. It does, however, appear to have some value in patients with weight loss due to chronic disease and disease-related nausea problems. We don't have a lot of good data on the use of marijuana as a medicine. We have little knowledge of its safety profile when used alone or along with other medicines. Can it make other medicines weaker and less effective or possibly more potent? What will happen when patients use it as a medicine, using it more often, for longer periods? Its availability will surely encourage individuals to use it for its many unproven disorders. It is being used already to treat autism, though no studies support such a usage. In California, we hear of doctors recommending medical marijuana for teenagers with psychiatric conditions including attention-deficit hyperactivity disorders. For such patients, it ought to be a concern, using a drug like marijuana that is known to disrupt attention, memory and concentration. We have no clue as to what will be the long-term complications of marijuana use for these young people. Marijuana smoke contains some of the same cancer causing toxins found in tobacco. Recent studies have shown that long-term marijuana use increases the risk of lung cancer in young adults. Cigarette smoking, common among marijuana users, further increases the risk. It is just recently that we discovered the increased heart attack rate among people exposed to secondhand tobacco smoke. We have no idea if the same might be true with marijuana smoke exposure. According to the National Institute of Health, marijuana (like heroin) has a similar structure to chemical messengers, called neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to "fool" the brain's receptors and activate nerve cells to send abnormal messages. Most people today smoke marijuana only occasionally. A small percent smoke it on a daily basis. Another small percentage of marijuana smokers develop dependence on it. This is even more likely if they use tobacco products. We need to consider whether better availability of marijuana, loss of its stigmatization, designation as a legal substance and lower cost will result in more marijuana users, more frequent usage, and greater usage in younger individuals with the eventual detection of more individuals whose genetic, social or environmental constitution makes them more prone to dependency and withdrawal reactions. Marijuana often has been called a "gateway drug," though supporters of its use often reject this and claim tobacco and alcohol might easily fit into that same category. According to the NIH, long-term studies of high school students and their patterns of drug use show that very few young people use other illegal drugs without first trying marijuana. It may be that using marijuana puts children and teens in contact with people who are users and/or sellers of other drugs. So, there is more of a risk that a marijuana user will be exposed to and urged to try more drugs.! For me, the greatest concern about the ready availability of marijuana is the effect it will have on our youth. In California and several other states, adults can acquire "medical marijuana" for the most insignificant problems. A segment of the physician population has become "marijuana providers" (writing prescriptions for patients they don't know and have not examined) at great personal profit. Parents who smoke and/or drink heavily and now abuse marijuana definitely will have a negative impact on their children and their early experiments with drugs of abuse. One recent study tells us that 40 percent of high school students have tried marijuana. Marijuana use - at 11 percent of eighth graders, 23.9 percent of 10th graders and 32.4 percent of 12th graders - had been slowly declining until recently when it appears to have leveled off. Another recent study of first-year college students at a large Eastern university found marijuana use disorders in over 9 percent of first-year students and 26.6 percent among past-year marijuana users. Such use disorders for those using marijuana over five times over the past year, included concentration problems (40 percent), driving while high (18.6 percent) and missing class (13.9 percent). Marijuana has played a role in car accidents. A study conducted in Memphis, Tenn., showed that of 150 reckless drivers who were tested for drugs at the arrest scene, 33 percent tested positive for marijuana and 12 percent tested positive for both marijuana and cocaine. Studies also have shown that while smoking marijuana, people show the same lack of concentration on standard "drunk driver" tests as people who have had too much to drink. Again one wonders what will happen when marijuana becomes more accessible and cheaper for adult as well as teen drivers. Certainly for adults, but especially for young people, is the problem of marijuana withdrawal. A recent study out of Columbia University, describing frequent users of marijuana as those using it three or more times per week, found withdrawal symptoms in over one-third of users. These withdrawal symptoms included such problems as weakness, sleepiness, psychomotor retardation, anxiety, restlessness, depression and difficulty sleeping. Marijuana withdrawal symptoms are very similar to the picture seen with nicotine discontinuation. Those withdrawal symptoms caused some users significant distress and led them to use other substances to relieve or avoid the withdrawal symptoms. Another recent study from the University of Minnesota found significantly elevated marijuana use disorders at each of the teenage years (ages 12 to 18) when compared to older recent onset users (ages 22 to 26) suggesting that adolescence is a particularly vulnerable period for developing a substance abuse disorder. In summary, as we are pondering the programs to make marijuana more available for medical use, we need to consider: For what medical disorders has marijuana been scientifically proven effective? What is the safety profile for medical marijuana? Will it interfere with other medications? What is its long term safety profile? Are there proven drugs of equal or better efficacy and proven safety that can accomplish the same therapeutic goals? Are there oral forms of marijuana that are just as effective, and which avoid the toxic compounds in the smoke and the secondhand smoke component? Who will determine whether physicians are indiscriminate in prescribing, or prescribing marijuana for questionable medical purposes? Who will control the number of "pot" dispensaries? It has been suggested that there are as many pot dispensaries as there are Starbucks in parts of California. Won't this make it difficult to oversee and regulate these dispensaries and their activities? Who will look out for the illegal pot ventures that pot dispensaries are known to spawn? And, most important, what safeguards can be achieved that will prevent the increased flow of marijuana from pot dispensaries from reaching our children? We need to ask if our parents, educators and community leaders are ready to meet the challenge presented by the greater availability of still another drug of abuse. Dr. Carl E. Bartecchi, a Pueblo physician, is clinical professor of medicine at the University of Colorado School of Medicine. - --- MAP posted-by: Jo-D