Pubdate: Sat, 15 Mar 2014
Source: Free Press, The (MN)
Copyright: 2014 The Free Press
Contact:  http://www.mankatofreepress.com/
Details: http://www.mapinc.org/media/2566
Author: Dan Linehan
Bookmark: http://www.mapinc.org/mmj.htm (Marijuana - Medicinal)

SHOULD MARIJUANA BE MEDICINE, LOCALS ASK

Medicinal Marijuana Debate Continues in Legislature

Rachael Nelson is 11 years old, and her Mankato family has tried 
everything to stop the seizures.

Diets, medication, even a nerve stimulator implanted in her chest. 
Not only did the drugs not stop her seizures, they had nasty side 
effects, like vomiting and drowsiness so bad she couldn't go to 
school. One drug made her seizures worse and another stopped her breathing.

Rachael has Rett syndrome, a rare brain disorder that overwhelmingly 
affects girls. She started having seizures at about 18 months and has 
had "hundreds and thousands" since then, said her mother, MaryAnn.

"It's a life-or-death type situation," she said. "I don't know if the 
next one is going to be the time that she can't get out."

She is looking longingly at relaxed marijuana laws in Colorado to 
help treat Rachael.

"I don't want to uproot my family to do that," she said. "On the 
other hand I need to keep my daughter healthy and alive."

Marijuana is known for the compound THC, which is responsible for its 
psychoactive effects and its use as a recreational drug. It also 
contains a compound called CBD, which may help relieve seizures in 
children. Rachael wouldn't need to smoke marijuana -- and it wouldn't 
be unhealthy, considering her frequent cases of pneumonia -- because 
it's available in oil form.

In Colorado, it's sold over the counter -- not that it helps Minnesotans.

"I cannot transport it across state lines and I certainly want to be 
under the advisement of a neurologist if I'm giving it to my daughter 
for seizures," Nelson said.

Children in pain for the lack of an illegal plant-based oil have made 
for persuasive testimony at the Legislature in recent days. There's a 
push toward a compromise that would allow children like Rachael to get relief.

The debate over legalizing smoked marijuana for medicinal purposes, 
though, is far less settled in Minnesota. Twenty states allow some 
form of medicinal marijuana.

Medical marijuana has been stuck in a political stalemate. Gov. Mark 
Dayton has said he wouldn't support the measure unless law 
enforcement supports it, and they haven't been willing to budge much. 
And Mankato-area law enforcement leaders are no exception.

The proposal seemed to stall last week, when the bill's House sponsor 
pulled her bill from its next committee stop. On Thursday morning, 
its prospects dimmed further as Dayton elaborated on his criticism it 
in a conference call.

But after meeting with advocates later in the afternoon, Dayton told 
his commissioners to work on a compromise.

Nelson said she's frustrated by the political maneuvering.

"I would like both the governor and the leaders of law enforcement to 
explain to my daughter why she can't have something that could stop 
her seizures ..." she wrote. "And there is too much at stake to throw 
in the towel so soon."

The proposal faced similar hurdles in 2009, when it was vetoed by 
Gov. Tim Pawlenty.

Mankato state Rep. Kathy Brynaert has asked for input from doctors. 
Any sort of consensus, though, will be hard to find.

Muddling in the Middle

Dr. Michael Bostwick, a professor of psychiatry in Rochester's Mayo 
Medical School, wrote a paper in 2012 about marijuana as medicine for 
the journal Mayo Clinic Proceedings.

Advocates and opponents can seem pretty sure that marijuana is a 
wonder drug or a menace to society, but Bostwick found something else 
in his research.

"I found that it's confusing," he said.

In 1942, when marijuana was taken off a list of drugs in medical use, 
it wasn't for a medical reason. The drug had come to be associated 
with "scary Mexicans or black people," Bostwick said. By 1970, 
marijuana was declared by Congress to be of no medical benefit, 
despite the lack of evidence on that point.

That means, from the federal government's perspective, marijuana has 
the same medical benefit as heroin.

The separation of science from regulation is one confusing aspect of 
the drug's recent history. One consequence of that split has been ignorance.

"One of the overarching points of this piece is we have not been able 
to do the research to realize the promise of this, as well as the 
danger," Bostwick said.

Despite all the fuss around marijuana, the questions it poses really 
aren't unique.

"It is well understood that drugs with medical benefits have risks 
related to addiction and abuse," he said.

According to Bostwick, about 9 percent of marijuana users become addicted.

But the rates of abuse for marijuana are lower than for nicotine (32 
percent), heroin (23 percent), cocaine (17 percent) or alcohol (15 
percent), Bostwick said. The alternatives to marijuana, including 
prescription painkillers, have abuse risks of their own.

The risk for becoming addicted to marijuana if you start after age 25 
is "essentially zero."

This may be in part because it's simply not socially acceptable for 
30-somethings to regularly smoke marijuana like it is for them to 
drink or smoke tobacco, he said.

"We're very familiar with these kinds of conundrums," he said. 
Adderall, a drug for attention-deficit hyperactivity disorder, is a 
cousin of methamphetamine. Morphine is similar in that way to heroin.

"The issue is why have we singled out marijuana for particular 
problems," Bostwick said. "It's, in many ways, not as bad as other drugs."

That's not to say negative side effects don't exist. In his paper, 
Bostwick wrote at length about particular dangers for young people 
and those with pre-existing mental disorders. A 1994 study compared 
24 abusing and 69 nonabusing schizophrenic patients. It found that 
abusers were more than twice as likely to have a relapse during the 
yearlong study period.

Bostwick believes that much of the concern is about smoking, though 
the lack of research has partly blunted the advances that could turn 
the chemicals in marijuana into pills, oils and other forms.

A drug called Sativex, which is sprayed into the lining of the mouth, 
has been legal in Canada and England for years. But it has remained 
stuck in trials for more than a decade in the United States.

Bostwick isn't advocating that people should just start using 
marijuana. Mayo Clinic doesn't prescribe the drug, even in states 
where it's legal, such as Arizona. That conservative wait-and-see 
approach makes sense to Bostwick.

But the federal government's contention that the drug has "no medical 
benefit" is "simply wrong," he said.

Second Opinion

Dr. Julie Gerndt, psychiatrist and chief medical officer for the 
Mankato Clinic, shares the common view that the lack of controlled 
studies -- comparing similar groups of users and non-users, in other 
words -- has left the science unsettled.

But that is perhaps her most flattering assessment.

There are at least four studies, she said, that show marijuana users 
are up to six times as likely to develop severe mental illness, such 
as schizophrenia.

That's simply a correlation, and it means that some third factor 
could predict both marijuana use and mental illness. Furthermore, the 
rate of mental illness did not rise in the '60s and '70s as marijuana 
use became more widespread.

But Gerndt said these studies show something more: That people who 
are pre-disposed to illness can be triggered by marijuana's 
psychoactive effects.

"We all carry genes that don't express until certain circumstances," she said.

Furthermore, she has noticed that when her patients are using 
marijuana, they have a more difficult time keeping out of trouble, 
but when they stop using, their condition improves.

In addition, studies show that people's intellectual abilities and 
memory are impaired over long-term use.

For these reasons, medicinal marijuana stacks up poorly against drugs 
that are already available to treat these illnesses, she said. As a 
physician, why would she prescribe a pain relief drug if it might 
trigger schizophrenia?

"Legalizing marijuana will not do my patients good," she said.

Both Gerndt and Bostwick are psychiatrists who've read the studies. 
They don't explicitly disagree, but neither do they stress the same 
potential benefits and harms of marijuana. That's not unusual.

"I have not found about any aspect of medical marijuana there is 
consensus about anything," Bostwick said.

How It Works

Marijuana's reputation today as a recreational drug comes after 
thousands of years of it being used as medicine, Bostwick said. 
During the past few decades, scientists are beginning to understand why.

The brain and other parts of the body are primed to be affected by 
marijuana's active ingredients.

"We have this knowledge over the past 40 years that there is, in 
fact, a widespread system in the body that involves cannabinoids made 
in the body," he said.

Two cannabinoid receptors, CB1 and CB2, have been discovered, and 
they're part of a system that spreads throughout the whole body, not 
just the brain. That makes sense, considering the drug's myriad 
effects, from stimulating appetite to relieving pain to, of course, 
causing intoxication.

It turns out, in other words, that marijuana taps into a pre-existing 
network of receptors, a veritable maze of actions and reactions.

This complexity is not necessarily a good thing.

The presence of these receptors on the brain can help multiple 
sclerosis victims feel less stiff, but it also makes recreational 
users clumsy and uncoordinated, Bostwick writes.

When the body makes its own cannabinoids, which we call anandamide, 
it is using a "delicate chisel," he writes. When someone smokes 
marijuana, the flood of cannabinoids is like a "sledgehammer."

Still, this hammer has its limits. Because there are very few CB1 or 
CB2 receptors on the brainstem, the drug can't stop your lungs or 
your heart. There have been no lethal overdoses recorded in humans.

Officers Weigh In

Like the vast majority of their colleagues around the state, 
Mankato's top law enforcement officers are deeply skeptical that 
medical marijuana will remain a medicine.

Todd Miller, Mankato's public safety director, said he's concerned 
about spreading the idea that marijuana isn't as dangerous as alcohol.

"My concern is the message we're sending to our youth is that, 'Oh, 
it must be OK'" if it's used for medicinal purposes.

Though legal prescription medications have long been used by adults 
without being normalized as recreational drugs by youth, Miller said 
the difference is that marijuana is easier to get. In schools, he 
said, it's easier to get marijuana than tobacco.

After 41 years in law enforcement, Miller said he's seen too many 
people who've committed crimes to get the drug or who're just strung out.

"Maybe they're not fighting, but they're not productive," he said.

Dan Davidson, the officer on the front lines of this region's War on 
Drugs, has said the drug can't keep going on as it is, both illegal 
and with relatively minor penalties. Since January of 2007, Davidson 
has been the commander of the River Valley Drug Task Force, a 
four-county agency based in Mankato.

In a Sept. 29, 2010, legislative panel, Davidson admitted that 
sentiment might raise eyebrows.

"I've been asked lots of times by legislators how I feel about the 
legalization of marijuana. And, at the expense of being run out of 
town, I don't care. Legalize it or penalize it. We need to do one 
thing or the other. And where you land on that is up to you."

By that, he meant people can be caught with a substantial amount of 
the drug -- a half pound or more -- without a big penalty. Compared 
with the amount of money dealers earn, the risks of getting caught 
aren't large enough to deter them.

When it comes to medicinal marijuana, Davidson said he's got no 
problem with a medical use of the drug. He, too, has heard the pleas 
of suffering people and thinks they should be able to use marijuana 
if that's what gives them relief.

"Because I think I'm a fairly reasonable, rational person, just like 
anybody else, and I don't know very many people who would say, 'No, 
that woman doesn't need marijuana because it's illegal,'" Davidson said.

But some states with medical marijuana don't have strict standards 
about when a person can be given the drug, he said. "My problem is it 
turns into a joke ... it's just kind of a way to skirt the law."

Though Davidson isn't apocalyptic about marijuana, he described two 
major public safety risks with it becoming more widely available.

Keep in mind first, he said, that the drug has become much more 
powerful than it was in the '70s.

According to a study cited in Bostwick's paper, average THC content 
has risen from 2 percent in 1980 to 8.55 percent by 2006.

The first risk is that police have no test to determine if a driver 
is under the influence of marijuana. Unlike alcohol, the active 
ingredient in marijuana stays in the bloodstream for days or weeks 
after the high ends.

The second is what happens to frequent users.

"They have a flat effect and it kills their motivation," he said. 
Worse, he's seen it act as a gateway drug for more serious drugs.

He's not arguing that everyone who smokes marijuana will move on to 
heroin or crack. And, based on surveys, only a small percentage do. A 
2013 survey showed that 38 percent of Americans have admitted to 
trying marijuana. According to estimates from the National Institute 
on Drug Abuse, about 1.4 percent have tried heroin and less than 1 
percent have tried cocaine.

But Davidson said all of the drug addicts he's interviewed started 
with marijuana. And if they haven't tried marijuana, he believes that 
many of them would never have gotten involved with harder drugs.

"In my opinion, it is a huge gateway drug," he said.

Blue Earth County Sheriff Brad Peterson said a father-son team came 
to Mankato about three years ago to sell medicinal marijuana they 
grew in California, where the market was too saturated. If the drug 
were legalized as medicine here, he said, we could expect more of the same.

"I feel it'd be an open door for more illegal activities to take 
place in Minnesota."

Marijuana is still the "No. 1 choice drug, used and abused most, from 
what I see and hear," he said.

So if the horses are out, why bother shutting the barn door?

"I guess I look at it this way," he said. "There are a lot of 
speeders out there, too. Are we going to disregard the speed laws 
because everybody's doing it?"
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MAP posted-by: Jay Bergstrom