Pubdate: Sun, 13 Dec 2009
Source: Pueblo Chieftain (CO)
Copyright: 2009 The Star-Journal Publishing Corp.
Contact:  http://www.chieftain.com/
Details: http://www.mapinc.org/media/1613
Author: Carl Bartecchi
Note: Dr. Carl E. Bartecchi, a Pueblo physician, is clinical  professor of 
medicine at the University of Colorado  School of Medicine.

MEDICAL MARIJUANA

Still Another Drug Of Abuse, So Weigh The Consequences

Marijuana certainly has been in the news lately. My  goal here is not
to question whether marijuana should  be legalized, or to claim that
it has no medical  benefits or to suggest that I have the answers to
the  many problems that it poses. There are some reasonable  arguments
for legalization of marijuana. It is still,  however, another drug of
abuse. Many supporters of  marijuana legalization claim it is safer
than  cigarettes and causes fewer problems than alcohol  abuse.
Marijuana may be safer and cheaper than opiates  and other medications
used for cancer patients.

Many of the medical benefits of marijuana have been  overstated, as is
the case with many herbs and  supplements. Many of the claims for
marijuana's value  in illnesses such as MS, glaucoma, Crohn's disease,
  Parkinson's disease or the agitation of Alzheimer's  disease have not
borne out. It does, however, appear to  have some value in patients
with weight loss due to  chronic disease and disease-related nausea
problems.

We don't have a lot of good data on the use of  marijuana as a
medicine. We have little knowledge of  its safety profile when used
alone or along with other  medicines.

Can it make other medicines weaker and less effective  or possibly
more potent? What will happen when patients  use it as a medicine,
using it more often, for longer  periods? Its availability will surely
encourage  individuals to use it for its many unproven disorders.  It
is being used already to treat autism, though no  studies support such
a usage.

In California, we hear of doctors recommending medical  marijuana for
teenagers with psychiatric conditions  including attention-deficit
hyperactivity disorders.  For such patients, it ought to be a concern,
using a  drug like marijuana that is known to disrupt attention,
memory and concentration. We have no clue as to what  will be the
long-term complications of marijuana use  for these young people.

Marijuana smoke contains some of the same cancer  causing toxins found
in tobacco.

Recent studies have shown that long-term marijuana use  increases the
risk of lung cancer in young adults.  Cigarette smoking, common among
marijuana users,  further increases the risk. It is just recently that
we  discovered the increased heart attack rate among people  exposed
to secondhand tobacco smoke. We have no idea if  the same might be
true with marijuana smoke exposure.

According to the National Institute of Health,  marijuana (like
heroin) has a similar structure to  chemical messengers, called
neurotransmitters, which  are naturally produced by the brain. Because
of this  similarity, these drugs are able to "fool" the brain's
receptors and activate nerve cells to send abnormal  messages.

Most people today smoke marijuana only occasionally. A  small percent
smoke it on a daily basis. Another small  percentage of marijuana
smokers develop dependence on  it. This is even more likely if they
use tobacco  products.

We need to consider whether better availability of  marijuana, loss of
its stigmatization, designation as a  legal substance and lower cost
will result in more  marijuana users, more frequent usage, and greater
usage  in younger individuals with the eventual detection of  more
individuals whose genetic, social or environmental  constitution makes
them more prone to dependency and  withdrawal reactions. Marijuana
often has been called a  "gateway drug," though supporters of its use
often  reject this and claim tobacco and alcohol might easily  fit
into that same category. According to the NIH,  long-term studies of
high school students and their  patterns of drug use show that very
few young people  use other illegal drugs without first trying
marijuana.  It may be that using marijuana puts children and teens  in
contact with people who are users and/or sellers of  other drugs. So,
there is more of a risk that a  marijuana user will be exposed to and
urged to try more  drugs.!

For me, the greatest concern about the ready  availability of
marijuana is the effect it will have on  our youth.

In California and several other states, adults can  acquire "medical
marijuana" for the most insignificant  problems. A segment of the
physician population has  become "marijuana providers" (writing
prescriptions for  patients they don't know and have not examined) at
great personal profit.

Parents who smoke and/or drink heavily and now abuse  marijuana
definitely will have a negative impact on  their children and their
early experiments with drugs  of abuse.

One recent study tells us that 40 percent of high  school students
have tried marijuana. Marijuana use -  at 11 percent of eighth
graders, 23.9 percent of 10th  graders and 32.4 percent of 12th
graders - had been  slowly declining until recently when it appears to
have  leveled off.

Another recent study of first-year college students at  a large
Eastern university found marijuana use  disorders in over 9 percent of
first-year students and  26.6 percent among past-year marijuana users.
Such use  disorders for those using marijuana over five times  over
the past year, included concentration problems (40  percent), driving
while high (18.6 percent) and missing  class (13.9 percent).

Marijuana has played a role in car accidents. A study  conducted in
Memphis, Tenn., showed that of 150  reckless drivers who were tested
for drugs at the  arrest scene, 33 percent tested positive for
marijuana  and 12 percent tested positive for both marijuana and  cocaine.

Studies also have shown that while smoking marijuana,  people show the
same lack of concentration on standard  "drunk driver" tests as people
who have had too much to  drink.

Again one wonders what will happen when marijuana  becomes more
accessible and cheaper for adult as well  as teen drivers.

Certainly for adults, but especially for young people,  is the problem
of marijuana withdrawal.

A recent study out of Columbia University, describing  frequent users
of marijuana as those using it three or  more times per week, found
withdrawal symptoms in over  one-third of users. These withdrawal
symptoms included  such problems as weakness, sleepiness, psychomotor
retardation, anxiety, restlessness, depression and  difficulty sleeping.

Marijuana withdrawal symptoms are very similar to the  picture seen
with nicotine discontinuation. Those  withdrawal symptoms caused some
users significant  distress and led them to use other substances to
relieve or avoid the withdrawal symptoms.

Another recent study from the University of Minnesota  found
significantly elevated marijuana use disorders at  each of the teenage
years (ages 12 to 18) when compared  to older recent onset users (ages
22 to 26) suggesting  that adolescence is a particularly vulnerable
period  for developing a substance abuse disorder.

In summary, as we are pondering the programs to make  marijuana more
available for medical use, we need to  consider:

For what medical disorders has marijuana been  scientifically proven
effective?

What is the safety profile for medical marijuana? Will  it interfere
with other medications? What is its long  term safety profile?

Are there proven drugs of equal or better efficacy and  proven safety
that can accomplish the same therapeutic  goals?

Are there oral forms of marijuana that are just as  effective, and
which avoid the toxic compounds in the  smoke and the secondhand smoke
component?

Who will determine whether physicians are  indiscriminate in
prescribing, or prescribing marijuana  for questionable medical purposes?

Who will control the number of "pot" dispensaries? It  has been
suggested that there are as many pot  dispensaries as there are
Starbucks in parts of  California. Won't this make it difficult to
oversee and  regulate these dispensaries and their activities?

Who will look out for the illegal pot ventures that pot  dispensaries
are known to spawn?

And, most important, what safeguards can be achieved  that will
prevent the increased flow of marijuana from  pot dispensaries from
reaching our children?

We need to ask if our parents, educators and community  leaders are
ready to meet the challenge presented by  the greater availability of
still another drug of  abuse.

Dr. Carl E. Bartecchi, a Pueblo physician, is clinical  professor of
medicine at the University of Colorado  School of Medicine.
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MAP posted-by: Jo-D