Pubdate: Thu, 28 Feb 2013
Source: Gainesville Sun, The (FL)
Copyright: 2013 The Gainesville Sun
Contact: http://drugsense.org/url/yMmn4Ifw
Website: http://www.gainesville.com/
Details: http://www.mapinc.org/media/163
Author: Kristine Crane

UF PHYSICIAN ARGUES THAT MEDICAL MARIJUANA REALLY ISN'T MEDICINE

With medical marijuana now legal in 18 states and the District of 
Columbia, a national conversation is taking place that pits state 
laws against marijuana's federal prohibition and advocates of the 
drug for pain relief against those who say it's non-medical and 
dangerously addictive.

Dr. Gary Reisfield, the chief of pain medicine in the University of 
Florida's department of psychiatry, has weighed in on the debate with 
an article in the latest issue of the New England Journal of 
Medicine, in which he argues that marijuana should not be used in 
medical practice.

"It's not really the way physicians think; it's not medical, and it's 
not medicine," Reisfield said.

Reisfield's article was based on a case study of a female patient 
with advanced breast cancer experiencing severe pain in her spine - 
where the cancer had spread - along with nausea and loss of appetite. 
The woman lived in a state where medicinal marijuana is legal, so the 
question posed in the study was whether she should be able to take 
marijuana for pain and nausea.

"Many people would say, 'Have compassion, let her smoke,'?" Reisfield 
said. "The bigger question is as a society what do we think about the 
use of smoked marijuana?"

Reisfield contends that precisely because the drug is smoked, it goes 
to the brain very quickly - which is partly what makes the drug both 
pleasurable and potentially addictive.

"We don't really have any examples of smoked medicine. If we have 
patients with pain, we don't recommend that they go out and smoke 
opium," Reisfield said. "So by the same token, it doesn't really make 
sense to say, smoke this plant, which has thousands of chemicals, and 
once you light it up, thousands more are released."

Furthermore, the effects those chemicals might have are relatively 
unknown, Reisfield said, especially since marijuana's status as a 
"Schedule I" drug, according to the federal government, has 
roadblocked clinical trials that might be able to clarify the drug's 
side effects.

Reisfield said the case study patient, with her already severely 
compromised immune system, could be at risk for developing a 
pulmonary infection from exposure to pesticides that might have been 
used to grow the marijuana plant.

Despite the absence of clinical certainties about marijuana's 
effects, anecdotal evidence shows promise for using it "for patients 
with certain kinds of pain and certain kinds of desperate 
situations," said Dr. J. Michael Bostwick, a psychiatrist at the Mayo 
Clinic in Minnesota, who wrote the counterpoint article to 
Reisfield's in the journal.

Bostwick said cancer, AIDS and multiple sclerosis patients might 
especially benefit as "people who are really needing something more 
than traditional medicine."

Bostwick added that patients typically use smaller doses that can 
relieve pain and induce an appetite without necessarily getting high. 
Pill forms of certain cannabinoids, the active ingredients in 
marijuana, are available, but are less effective than smoking would 
be, Bostwick said.

However, "I do not want to give the impression that this is a 
panacea," Bostwick said, adding that patients with the potential of 
psychosis and adolescents should not take marijuana for medicinal 
purposes because of the risk of addiction.

One in 10 adults risks addiction to marijuana, which rises to one in 
six for adolescents, Reisfield said, adding that legalizing it 
increases the risk of addiction - as well as the odds that the drug 
will fall into the wrong hands.

"My colleagues in California and Colorado tell me that the people who 
frequent medical marijuana clinics are males in their 20s and 30s, 
which really doesn't equate" with people who would most need pain 
control, Reisfield said, adding, "We know that legalization also 
leads to more abuse and dependence."

He said that with a quarter of Americans abusing tobacco and more 
than half abusing alcohol, "the question is why do we need to have to 
add another?"

But for Bostwick, the federal government's position "smacks of Prohibitionism."

"Maybe this will be the equivalent of gay marriage. The reality is 
that 18 states are already defying the American government," he said.

Maybe so, but that defiance shouldn't take place in a doctor's 
office, Reisfield argued.

"Patients' lives don't begin and end in doctors' offices. But I think 
it would be a mistake to medicalize this."
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