Pubdate: Tue, 19 Jan 2010
Source: Wall Street Journal (US)
Copyright: 2010 Dow Jones & Company, Inc.
Contact:  http://www.wsj.com/
Author: Anna Wilde Mathews
Bookmark: http://www.mapinc.org/find?253 (Cannabis - Medicinal - U.S.)

IS MARIJUANA A MEDICINE?

Charlene DeGidio never smoked marijuana in the 1960s, or afterward. 
But a year ago, after medications failed to relieve the pain in her 
legs and feet, a doctor suggested that the Adna, Wash., retiree try the drug.

Ms. DeGidio, 69 years old, bought candy with marijuana mixed in. It 
worked in easing her neuropathic pain, for which doctors haven't been 
able to pinpoint a cause, she says. Now, Ms. DeGidio, who had 
previously tried without success other drugs including Neurontin and 
lidocaine patches, nibbles marijuana-laced peppermint bars before 
sleep, and keeps a bag in her refrigerator that she's warned her 
grandchildren to avoid.

"It's not like you're out smoking pot for enjoyment or to get high," 
says the former social worker, who won't take the drug during the day 
because she doesn't want to feel disoriented. "It's a medicine."

For many patients like Ms. DeGidio, it's getting easier to access 
marijuana for medical use. The U.S. Department of Justice has said it 
will not generally prosecute ill people under doctors' care whose use 
of the drug complies with state rules. New Jersey will become the 
14th state to allow therapeutic use of marijuana, and the number is 
likely to grow. Illinois and New York, among others, are considering new laws.

As the legal landscape for patients clears somewhat, the medical one 
remains confusing, largely because of limited scientific studies. A 
recent American Medical Association review found fewer than 20 
randomized, controlled clinical trials of smoked marijuana for all 
possible uses. These involved around 300 people in all--well short of 
the evidence typically required for a pharmaceutical to be marketed in the U.S.

Doctors say the studies that have been done suggest marijuana can 
benefit patients in the areas of managing neuropathic pain, which is 
caused by certain types of nerve injury, and in bolstering appetite 
and treating nausea, for instance in cancer patients undergoing 
chemotherapy. "The evidence is mounting" for those uses, says Igor 
Grant, director of the Center for Medicinal Cannabis Research at the 
University of California, San Diego.

But in a range of other conditions for which marijuana has been 
considered, such as epilepsy and immune diseases like lupus, there's 
scant and inconclusive research to show the drug's effectiveness. 
Marijuana also has been tied to side effects including a racing heart 
and short-term memory loss and, in at least a few cases, anxiety and 
psychotic experiences such as hallucinations. The Food and Drug 
Administration doesn't regulate marijuana, so the quality and potency 
of the product available in medical-marijuana dispensaries can vary.

Though states have been legalizing medical use of marijuana since 
1996, when California passed a ballot initiative, the idea remains 
controversial. Opponents say such laws can open a door to wider 
cultivation and use of the drug by people without serious medical 
conditions. That concern is heightened, they say, when broadly 
written statutes, such as California's, allow wide leeway for doctors 
to decide when to write marijuana recommendations.

But advocates of medical-marijuana laws say certain seriously ill 
patients can benefit from the drug and should be able to access it 
with a doctor's permission. They argue that some patients may get 
better results from marijuana than from available prescription drugs.

Glenn Osaki, 51, a technology consultant from Pleasanton, Calif., 
says he smokes marijuana to counter nausea and pain. Diagnosed in 
2005 with advanced colon cancer, he has had his entire colon removed, 
creating digestive problems, and suffers neuropathic pain in his 
hands and feet from a chemotherapy drug. He says smoking marijuana 
was more effective and faster than prescription drugs he tried, 
including one that is a synthetic version of marijuana's most active 
ingredient, known as THC.

The relatively limited research supporting medical marijuana poses 
practical challenges for doctors and patients who want to consider it 
as a therapeutic option. It's often unclear when, or whether, it 
might work better than traditional drugs for particular people. 
Unlike prescription drugs it comes with no established dosing regimen.

"I don't know what to recommend to patients about what to use, how 
much to use, where to get it," says Scott Fishman, chief of pain 
medicine at the University of California, Davis medical school, who 
says he rarely writes marijuana recommendations, typically only at a 
patient's request.

Researchers say it's difficult to get funding and federal approval 
for marijuana research. In November, the AMA urged the federal 
government to review marijuana's position in the most-restricted 
category of drugs, so it could be studied more easily.

Gregory T. Carter, a University of Washington professor of 
rehabilitation medicine, says he's developed his own procedures for 
recommending marijuana, which he does for some patients with serious 
neuromuscular conditions such as amyotrophic lateral sclerosis, or 
Lou Gehrig's disease, to treat pain and other symptoms. He typically 
urges those who haven't tried it before to start with a few puffs 
using a vaporizer, which heats the marijuana to release its active 
chemicals, then wait 10 minutes. He warns them to have family nearby 
and to avoid driving, and he checks back with them after a few days. 
Many are "surprised at how mild" the drug's psychotropic effects are, he says.

States' rules on growing and dispensing medical marijuana vary. Some 
states license specialized dispensaries. These can range from small 
storefronts to bigger operations that feel more like pharmacies. 
Typically, they have security procedures to limit walk-in visitors.

At least a few dispensaries say they inspect their suppliers and use 
labs to check the potency of their product, though states don't 
generally require such measures. "It's difficult to understand how we 
can call it medicine if we don't know what's in it," says Stephen 
DeAngelo, executive director of the Harborside Health Center, a 
medical-marijuana dispensary in Oakland, Calif.

Some of the strongest research results support the idea of using 
marijuana to relieve neuropathic pain. For example, a trial of 50 
AIDS patients published in the journal Neurology in 2007 found that 
52% of those who smoked marijuana reported a 30% or greater reduction 
in pain. Just 24% of those who got placebo cigarettes reported the 
same lessening of pain.

Marijuana has also been shown to affect nausea and appetite. The AMA 
review said three controlled studies with 43 total participants 
showed a "modest" anti-nausea effect of smoked marijuana in cancer 
patients undergoing chemotherapy. Studies of HIV-positive patients 
have suggested that smoked marijuana can improve appetite and trigger 
weight gain.

Donald Abrams, a doctor and professor at the University of 
California, San Francisco who has studied marijuana, says he 
recommends it to some cancer patients, including those who haven't 
found standard anti-nausea drugs effective and some with loss of appetite.

Side effects can be a problem for some people. Thea Sagen, 62, an 
advanced neuroendocrine cancer patient in Seaside, Calif., says she 
expected something like a pharmacy when she went to a marijuana 
dispensary mentioned by her oncologist. She says she was disappointed 
to find that the staffers couldn't say which of the products, with 
names like Pot 'o Gold and Blockbuster, might boost her flagging 
appetite or soothe her anxiety. "They said, 'it's trial and error,' 
"she says. "I was in there flying blind, looking at all this stuff."

Ms. Sagen says she bought several items and tried one-eighth teaspoon 
of marijuana-infused honey. After a few hours, she was hallucinating 
, too dizzy and confused to dress herself for a doctor's appointment. 
Then came vomiting far worse than her stomach upset before she took 
the drug. When she reported the side effects to her oncologist's 
nurse and her primary-care physician, she got no guidance. She 
doesn't take the drug now. But with advice from a nutritionist, her 
appetite and food intake have improved, she says.

Other marijuana users may experience the well-known reduction in 
ability to concentrate. At least a few users suffer troubling 
short-term psychiatric side effects, which can include anxiety and 
panic. More controversially, an analysis published in the journal 
Lancet in 2007 tied marijuana use to a higher rate of psychotic 
conditions such as schizophrenia. But the analysis noted that such a 
link doesn't necessarily show marijuana is a cause of the conditions.

Long-term marijuana use can lead to physical dependence, though it is 
not as addictive as nicotine or alcohol, says Margaret Haney, a 
professor at Columbia University's medical school. Smoked marijuana 
may also risk lung irritation, but a large 2006 study, published in 
Cancer Epidemiology, Biomarkers & Prevention, found no tie to lung cancer.
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MAP posted-by: Richard Lake