Pubdate: Sun, 21 Mar 2010
Source: Herald-Republican (Angola, IN)
Copyright: 2010 KPC Media Group, Inc.
Contact:  http://www.heraldrepublicanonline.com/
Details: http://www.mapinc.org/media/4507
Author: Dr. Terry Gaff

MARIJUANA NOT A GOOD CHOICE AS MEDICINE

In my work as an emergency physician and as a county  coroner, I
frequently order tests to determine whether  a person has illicit
drugs in their blood or urine.  While I am not naive enough to think
that all people  will turn out to be clean and sober, I am amazed at
how  many people have a positive test for cannabinoids,  which are the
active ingredients in marijuana (Cannabis  sativa).

I recognize that there are some legitimate medical uses  for
cannabinoids. However, the people with the positive  tests are
generally not suffering from nausea,  vomiting, pain, loss of
appetite, asthma, glaucoma, nor  spasticity. They have been consuming
marijuana for  other reasons.

Although 14 states in the U.S. (Alaska, California,  Colorado, Hawaii,
Maine, Michigan, Montana, Nevada, New  Jersey, New Mexico, Oregon,
Rhode Island, Vermont and  Washington) now permit, or soon will
permit, some  medical use of marijuana, Indiana still does not
recognize it for legal medical use.

In some states, by prescription, licensed facilities  dispense
marijuana grown in controlled settings. In  others, limited
self-cultivation (grow your own) is  permitted for medical use.

Nationally, the marijuana plant itself is a Drug  Enforcement Agency
(DEA) schedule I controlled  substance (high abuse potential with no
legitimate  medical use).However, it may be both eaten and smoked  to
relieve nausea, vomiting and pain and to treat many  other ailments as
noted above.

It appears to be fairly effective, depending on the  dose, for some of
these disorders. But there are no  really good studies large enough
and standardized  enough to be convincing.

On the other hand, two cannabinoid-like drugs,  dronabinol (Marinol)
and nabilone (Cesamet), have been  FDA-approved since 1985.

Both of these drugs are effective for prevention and  treatment of
nausea and vomiting due to mild or  moderate side effects of
anticancer drugs. However,  they are less effective with the more
severe side  effects of drugs such as cisplatin, where other
available drugs such as ondansetron (Zofran, and  others) and
aprepitant (Emend) appear to be more  effective and better tolerated.

There is even a drug to spray in the mouth called  Nabiximols
(Sativex), which is a liquid extract  containing constituents of
marijuana. This is approved  in Canada for treatment of central
nervous system pain  in multiple sclerosis (MS). It is also in phase
III  trials in the U.S. for treatment of uncontrollable  cancer pain.

A small study in healthy young adults of the effects of  active
chemicals from marijuana on sleep found no  significant effect on the
ability to fall asleep,  length of time sleeping, or the quality of
sleep.  Subjects who took only one of the components called
tetrahydrocannabinol (THC) reported difficulty with  memory the next
morning.

Although death from acute overdose of marijuana alone  has not been
reported, there are many possible side  effects. Dry mouth,
drowsiness, low blood pressure when  sitting or standing, difficulty
standing or walking,  and dizziness do occur frequently with medical
use of  both natural marijuana and synthetic products. Anxiety,  rapid
heartbeat, agitation and confusion are also  common, especially in
older patients, and driving may  be impaired.

In 2008, an article was published in a prestigious  British medical
journal, The Lancet, which indicated  that individuals who used
marijuana on a weekly or  daily basis had up to three times more risk
for  developing psychosis later in life compared to  non-users.

The authors carefully looked at dozens of previous  studies and found
the evidence to be strong enough to  advise everyone, particularly
young people, that the  use of marijuana does potentially have some
health  risks, especially if they are using it on a regular  basis.

Although an individual's lifetime risk of developing a  serious
psychotic illness is only about two or three  percent, the use of
medical marijuana may increase that  risk.

Since there are other drugs available to treat the  problems for which
medical marijuana is suggested, I  see no need to add it to my
prescribing choices if it  becomes legal in Indiana.

However, I note that Michigan is among the 14 states  listed above. If
someone shows up in the ER with a  prescription bag of marijuana, I am
not sure what I  will do about it.

[sidebar]

Editor's note: Past columns by Dr. Gaff as well as  reader comments
and Dr. Gaff's responses can be found  at kpcnews.com/special/health.
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MAP posted-by: Richard Lake