Pubdate: Sun, 22 Nov 2009
Source: New York Times (NY)
Copyright: 2009 The New York Times Company
Page: A39A
Author: Katherine Ellison
Cited: Wo/Men's Alliance for Medical Marijuana
Cited: The National Organization for the Reform of Marijuana Laws
Bookmark: (Cannabis - California)
Bookmark: (Cannabis - Medicinal - United States)


At the Peace in Medicine Healing Center in Sebastopol, the wares on 
display include dried marijuana -- featuring brands like Kryptonite, 
Voodoo Daddy and Train Wreck -- and medicinal cookies arrayed below a 
sign saying, "Keep Out of Reach of Your Mother."

The warning tells a story of its own: some of the center's clients 
are too young to buy themselves a beer.

Several Bay Area doctors who recommend medical marijuana for their 
patients said in recent interviews that their client base had 
expanded to include teenagers with psychiatric conditions including 
attention-deficit hyperactivity disorder.

"It's not everybody's medicine, but for some, it can make a profound 
difference," said Valerie Corral, a founder of the Wo/Men's Alliance 
for Medical Marijuana, a patients' collective in Santa Cruz that has 
two dozen minors as registered clients.

Because California does not require doctors to report cases involving 
medical marijuana, no reliable data exist for how many minors have 
been authorized to receive it. But Dr. Jean Talleyrand, who founded 
MediCann, a network in Oakland of 20 clinics who authorize patients 
to use the drug, said his staff members had treated as many as 50 
patients ages 14 to 18 who had A.D.H.D. Bay Area doctors have been at 
the forefront of the fierce debate about medical marijuana, winning 
tolerance for people with grave illnesses like terminal cancer and 
AIDS. Yet as these doctors use their discretion more liberally, such 
support -- even here -- may be harder to muster, especially when it 
comes to using marijuana to treat adolescents with A.D.H.D.

"How many ways can one say 'one of the worst ideas of all time?' " 
asked Stephen Hinshaw, the chairman of the psychology department at 
the University of California, Berkeley. He cited studies showing that 
tetrahydrocannabinol, or THC, the active ingredient in cannabis, 
disrupts attention, memory and concentration -- functions already 
compromised in people with the attention-deficit disorder.

Advocates are just as adamant, though they are in a distinct 
minority. "It's safer than aspirin," Dr. Talleyrand said. He and 
other marijuana advocates maintain that it is also safer than 
methylphenidate (Ritalin), the stimulant prescription drug most often 
used to treat A.D.H.D. That drug has documented potential side 
effects including insomnia, depression, facial tics and stunted growth.

In 1996, voters approved a ballot proposition making California the 
first state to legalize medical marijuana. Twelve other states have 
followed suit -- allowing cannabis for several specified, serious 
conditions including cancer and AIDS -- but only California adds the 
grab-bag phrase "for any other illness for which marijuana provides relief."

This has left those doctors willing to "recommend" cannabis -- in the 
Alice-in-Wonderland world of medical marijuana, they cannot legally 
prescribe it -- with leeway that some use to a daring degree. "You 
can get it for a backache," said Keith Stroup, the founder of the 
National Organization for the Reform of Marijuana Laws.

Nonetheless, expanding its use among young people is controversial 
even among doctors who authorize medical marijuana.

Gene Schoenfeld, a doctor in Sausalito, said, "I wouldn't do it for 
anyone under 21, unless they have a life-threatening problem such as 
cancer or AIDS."

Dr. Schoenfeld added, "It's detrimental to adolescents who 
chronically use it, and if it's being used medically, that implies 
chronic use."

Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, 
said she was particularly worried about the risk of dependency -- a 
risk she said was already high among adolescents and people with 
attention-deficit disorder.

Counterintuitive as it may seem, however, patients and doctors have 
been reporting that marijuana helps alleviate some of the symptoms, 
particularly the anxiety and anger that so often accompany A.D.H.D. 
The disorder has been diagnosed in more than 4.5 million children in 
the United States, according to the Centers for Disease Control and Prevention.

Researchers have linked the use of marijuana by adolescents to 
increased risk of psychosis and schizophrenia for people genetically 
predisposed to those illnesses. However, one 2008 report in the 
journal Schizophrenia Research suggested that the incidence of mental 
health problems among adolescents with the disorder who used 
marijuana was lower than that of nonusers.

Marijuana is "a godsend" for some people with A.D.H.D., said Dr. 
Edward M. Hallowell, a psychiatrist who has written several books on 
the disorder. However, Dr. Hallowell said he discourages his patients 
from using it, both because it is -- mostly -- illegal, and because 
his observations show that "it can lead to a syndrome in which all 
the person wants to do all day is get stoned, and they do nothing else."

Until the age of 18, patients requesting medical marijuana must be 
accompanied to the doctor's appointment and to the dispensaries by a 
parent or authorized caregiver. Some doctors interviewed said they 
suspected that in at least some cases, parents were accompanying 
their children primarily with the hope that medical authorization 
would allow the adolescents to avoid buying drugs on the street.

A recent University of Michigan study found that more than 40 percent 
of high school students had tried marijuana.

"I don't have a problem with that, as long as we can have our medical 
conversation," Dr. Talleyrand said, adding that patients must have 
medical records to be seen by his doctors.

The Medical Board of California began investigating Dr. Talleyrand in 
the spring, said a board spokeswoman, Candis Cohen, after a KGO-TV 
report detailed questionable practices at MediCann clinics, which, 
the report said, had grossed at least $10 million in five years.

Dr. Talleyrand and his staff members are not alone in being willing 
to recommend marijuana for minors. In Berkeley, Dr. Frank Lucido said 
he was questioned by the medical board but ultimately not disciplined 
after he authorized marijuana for a 16-year-old boy with A.D.H.D. who 
had tried Ritalin unsuccessfully and was racking up a record of minor arrests.

Within a year of the new treatment, he said, the boy was getting 
better grades and was even elected president of his special-education 
class. "He was telling his mother: 'My brain works. I can think,' " 
Dr. Lucido said.

"With any medication, you weigh the benefits against the risks," he added.

Even so, MediCann patients who receive the authorization must sign a 
form listing possible downsides of marijuana use, including "mental 
slowness," memory problems, nervousness, confusion, "increased 
talkativeness," rapid heartbeat, difficulty in completing complex 
tasks and hunger. "Some patients can become dependent on marijuana," 
the form also warns.

The White House's recent signals of more federal tolerance for state 
medical marijuana laws -- which pointedly excluded sales to minors -- 
reignited the debate over medical marijuana.

Some advocates, like Dr. Lester Grinspoon, an associate professor 
emeritus of psychiatry at Harvard University, suggest that medical 
marijuana's stigma has less to do with questions of clinical efficacy 
and more to do with its association, in popular culture, with illicit 
pleasure and addiction.

Others, like Alberto Torrico of Fremont, the majority leader of the 
California Assembly, argue for more oversight in general. "The 
marijuana is a lot more powerful these days than when we were growing 
up, and too much is being dispensed for nonmedical reasons," he said 
in an interview last week, bluntly adding, "Any children being given 
medical marijuana is unacceptable."

As advocates of increased acceptance try to win support, they may 
find their serious arguments compromised by the dispensaries' playful 

OrganiCann, a dispensary in Santa Rosa, has a Web site advertisement 
listing the "medible of the week" -- butterscotch rock candy -- 
invitingly photographed in a gift box with a ribbon. OrganiCann also 
offers a 10 percent discount, every Friday, for customers with a 
valid student ID. 
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MAP posted-by: Richard Lake