Pubdate: Sun, 16 Aug 2015
Source: Washington Post (DC)
Copyright: 2015 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Susan Okie

SMOKE A JOINT FOR WHATEVER AILS YOU? IT'S NOT THAT SIMPLE

STONED A Doctor's Case for Medical Marijuana By David Casarett 
Current. 289 pp. $27.95

'Does medical marijuana 'work'?" That question, posed in an 
illuminating new book by David Casarett, a hospice physician and 
researcher at the University of Pennsylvania, sounds simple and turns 
out to be anything but.

The short answer is that it depends on the symptom or problem being 
treated, on the physiology of the patient using it, on the mode of 
drug delivery (a joint? a brownie? a vapor pen? a beer?) and on 
various other factors.

A small but growing trove of research suggests that for some symptoms 
- - insomnia, nausea, certain kinds of pain, muscle spasms, perhaps 
even the disabling anxiety of post-traumatic stress disorder or the 
agitation often experienced by people with Alzheimer's-medical 
marijuana does work. And for some other conditions, marijuana or 
drugs based on some of its active ingredients appear promising.

"It's starting to look to me like marijuana might offer real medical 
benefits," Casarett acknowledges halfway through "Stoned," noting 
that he embarked on the book project believing he'd find little 
evidence of weed's effectiveness.

That's potentially good news for people living in states where 
medical marijuana is legal-currently 23, plus the District-but it's 
only half the picture.

Research has also identified risks clearly associated with marijuana 
use. Casarett reports worrisome evidence of a link between marijuana 
use and psychosis, and somewhat weaker findings suggest that it may 
increase users' chance of developing schizophrenia. It can also cause 
addiction in some people, since it lights up the brain's pleasure 
circuitry in essentially the same way as alcohol, cigarettes or 
cocaine - although a user's risk of becoming addicted probably 
depends on her genetic makeup, frequency of use and the strength of 
the marijuana product being inhaled or ingested.

Much of the marijuana sold in the United States today contains five 
to 10 times more THC (short for tetrahydrocannabinol, the ingredient 
that makes people high) than the weed smoked in the 1970s. Smoking or 
"vaping" potent marijuana or hashish delivers a rapid bolus of THC 
into the bloodstream, and the resultant swift rise, crest and fall of 
the drug's level in the brain probably enhances its addictive 
potential. Withdrawal symptoms can occur in heavy or frequent users, 
and may include anxiety, insomnia, decreased appetite, aggression, 
depression, and physical symptoms such as stomach pain or headache.

Some studies have also found subtle structural changes in the brains 
of heavy marijuana users, fueling worries about possible permanent 
effects on learning and memory.

On the other hand, some of the theoretical concerns long cited by 
researchers about marijuana's potential for damaging organs have not 
been borne out by studies.

In particular, marijuana - despite containing many of the same 
components as tobacco - has not been found to damage the lungs or 
cause lung cancer in longtime smokers.

In one study, smoking it even improved lung function in people with asthma.

And, although smoking it can lower a user's blood pressure, increase 
heart rate and make blood more likely to clot, so far it hasn't been 
shown to lead to heart attacks or strokes.

Still, Casarett warns that people with diabetes, high blood pressure 
or other risk factors should be warned of the possibility of such an 
event, and he cautions that marijuana should not be used during pregnancy.

Statistically, the most life-threatening danger of marijuana - both 
to users and to the general public - is probably the herb's 
welldocumented impairment of driving skills.

Recent use slows a driver's reaction time, reduces the brain's 
ability to focus and worsens performance when faced with multiple tasks.

Studies indicate that driving while stoned approximately doubles the 
risk of an accident. Moreover, the effects persist for hours, and 
there's currently no reliable sobriety test for users.

Casarett advises: "If you're thinking of getting high and then 
driving a car . . . Don't. Just don't."

Although his methodical parsing of the scientific evidence makes the 
book slow going at times, Casarett spices things up with a hands-on 
approach to investigative reporting.

Not only did he seek out and interview numerous patients who said 
their symptoms had been relieved by marijuana when nothing else had 
worked, he experimented on himself. By my count, he describes trying 
marijuana in four different forms, testing their ability to relieve 
what ails him as well as their effect on his consciousness. His first 
trial - a marijuana poultice applied to his sore knee by a local 
healer during a hiking trip in Nepal - was a failure: little or no 
pain relief, since the herb's active ingredients can't get through 
skin unless the dose is dissolved in chemicals to make it pass 
through more easily.

The second, a sip of marijuana-infused beer, "is a little like 
drinking Kool-Aid out of a Wellington boot that's been used 
extensively for barnyard labor," Casarett reports.

Hoping to quaff the herb in a tastier beverage, he downed half a 
bottle of marijuana-infused red wine. The result: He was tipsy but 
felt no buzz, even though two pounds of weed went into each barrel of 
the vintage.

Casarett explains why: The herb's active ingredients are poorly 
absorbed from the digestive tract, then are chemically modified in 
the liver, reducing their ultimate effect on the brain. Smoking or 
inhaling vapor is a much more efficient way to deliver marijuana's 
components to the body than eating pot.

For his final trial, Casarett tested the ability of smoking marijuana 
to relieve the muscle spasms he had been suffering as a result of a 
recurrent lower-back condition.

Sitting on his patio, he smoked part of a joint.

The good news: His back muscles began to loosen up. The bad news: He 
sawhis patio chairs dancing and seemed to hear the voices of air 
traffic controllers coming from inside his house.

His first-hand account of weed-induced hallucinations underscores the 
book's message that marijuana's effects are produced by dozens of 
chemicals whose levels vary in different strains of plants, and that 
choosing a particular strain or dose and predicting how it will work 
in a particular patient is difficult, requiring both expert advice 
and trial and error.

But with the medical use of marijuana expanding and additional states 
likely to legalize the practice, Casarett argues that it's time to 
test and standardize the quality of the products being dispensed to 
patients, and to require clinics and dispensaries to educate would-be 
consumers more thoroughly about the herb's potential benefits and 
risks. Posing as a patient at two different marijuana clinics, he 
encountered one that fulfilled those responsibilities and one that 
fell far short.

In the future, he predicts, researchers will explore how the plant's 
several dozen cannabinoids-the active ingredients - affect the brain, 
immune system and other organs, and may create new, targeted drugs as 
a result of those discoveries.

In the meantime, he believes that well-informed patients who want to 
try marijuana should be allowed to weigh the risks against the 
hoped-for benefits. "Why don't we give the public a role in 
research?" he asks. "Let them see what happens.

And then let their experiences guide the design of rigorous trials 
that reflect the wisdom of the crowd."

Anyone considering whether to use marijuana for a medical condition 
will find this book a valuable introduction to becoming an educated consumer.
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MAP posted-by: Jay Bergstrom