Pubdate: Sun, 5 Sep 2010
Source: San Francisco Chronicle (CA)
Page: E - 11
Copyright: 2010 Hearst Communications Inc.
Contact: http://www.sfgate.com/chronicle/submissions/#1
Website: http://www.sfgate.com/chronicle/
Details: http://www.mapinc.org/media/388
Author: Leonard Krivitsky
Referenced: http://www.mapinc.org/drugnews/v10/n677/a08.html

'PHYSICAL DEPENDENCE' ON CANNABIS NOT DOCUMENTED

In response to Dr. Timmen Cermak ("What doctors say about marijuana," 
Insight, Aug. 22), I am not questioning the fact that a small 
minority of cannabis users can develop a "problem use" or even some 
symptoms of withdrawal upon the cessation of cannabis use.

The same, I am sure, would happen with cessation of caffeine use. I 
question the validity of "physical dependence" on cannabis, because 
such dependence can be diagnosed only if there is a documented 
physical withdrawal syndrome, such as consistent changes in vital 
signs, pupil sizes, increased bowel sounds, fever and the like.

I worked as a program physician in methadone clinics for years, and 
as you know very well, all these symptoms of "discomfort" are 
absolutely not enough to put a patient on methadone. There must be 
physical signs of dependence, not just some "non-specific discomfort."

Or, let's take an alcohol withdrawal. Surely, no one will question 
the physical nature of alcohol dependence after having seen a patient 
going into "DTs."

I continue to strongly believe that this constellation of dependable 
and reproducible physical signs of cannabis dependence are not 
documented, so we are not entitled to postulate the existence a true 
physical dependence on cannabis/marijuana.

Leonard Krivitsky, M.D., Philadelphia
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