Pubdate: Fri, 01 Nov 2013
Source: Portland Press Herald (ME)
Copyright: 2013 MaineToday Media, Inc.
Source: Portland Press Herald (ME)
Author: Ellen Jean Hirst, Chicago Tribune
Page: A2

In Focus: Medical Marijuana


Research Has Yet to Nail Down Exactly If, and How, Marijuana
Alleviates Symptoms of Diseases.

CHICAGO - Even though 20 states have passed laws legalizing medical
marijuana, swayed in part by thousands of personal testimonies,
current research hasn't nailed down exactly if, and how, marijuana
alleviates all the specific diseases the drug is being legalized to
treat, experts say.

A number of proponents believe marijuana could benefit people with
everything from glaucoma to cancer, and it's been legalized in
Illinois to aid patients with some 40 medical conditions. But
opponents of its medicinal use believe the risks of smoking medical
marijuana outweigh the benefits, while others question whether
patients really improve or only feel like they improve.

Marijuana's best-known compound is THC, but the plant actually has 105
unique cannabis compounds with potential for medicinal use, proponents
say. THC has already been approved by the Food and Drug Administration
in synthetic form to help patients with nausea and decreased appetite.


Some scientists believe the plant's other compounds  called
cannabinoids  could have equal promise. Although research has
increased in recent years as more states legalize medical marijuana,
solid evidence of how individual cannabinoids could help people with
specific diseases has been significantly lacking, a review of medical
literature and interviews with experts shows.

Researching the potential effects of marijuana's various components on
conditions such as multiple sclerosis, fibromyalgia or lupus could
have serious implications for doctors who want to prescribe medical
marijuana to patients.

If the specific benefits could be proved, experts say, doctors
ultimately would be able to assign particular strains to people,
depending on their condition. Further research also may help determine
optimal doses and whether marijuana works better than other medicines,
experts say.

While most medicines derived from nature are tested before they reach
the masses, the process to evaluate marijuana has been confounded by
its longtime status as an illegal drug, which it retains in the eyes
of the federal government.

The only study specifically cited in Illinois' law, signed by Gov. Pat
Quinn in August and due to go into effect next year, is a 1999
Institute of Medicine report. But Dr. John Benson, a lead editor of
the report, said legislators stretched the conclusion of the
book-length study when it said modern medical research "has confirmed
the beneficial uses of cannabis."

While the report did say there was promise that marijuana could have
medical benefits, it also suggests researchers need to continue to dig
deeper into the issue. It also says marijuana should not be smoked, he

"Smoking marijuana is not recommended," the report says. "The
long-term harm caused by smoking marijuana makes it a poor delivery

The 14-year-old article has become a primary source for both critics
and supporters of medical marijuana  the Drug Enforcement
Administration and advocacy groups have cited it to prove opposite

The legislators relied mostly on personal testimonies and compared
notes with states that have also passed medical marijuana laws.

Mike Graham, of Manteno, was one person who shared his story with
legislators. A little more than a decade ago, he was using 14
different pharmaceuticals. Living with an extremely painful
degenerative spine disease, he has been through multiple surgeries in
efforts to remedy it. But doctors feared one more could paralyze him,
so he took medications for pain instead.

"I didn't even know my name," Graham said. "It was

When he was in his late 30s, doctors sent him home with a hospice care
nurse. After reviewing his medications, she told him he would die
early if he continued taking all of them. To his surprise, she
recommended pot, he said.

"I almost fell out of bed laughing," said Graham, 51. "I come from a
law enforcement family."

Increasingly desperate, in 2002, he decided to give it a try. He was
able to cut back on all his previous medications except a morphine
pump under his skin. Now, he takes three or four puffs of marijuana in
the morning and at night. Once down to 135 pounds, the more than
6-foot-tall Graham now says he's back up to 250 after regaining his

"What it comes down to here (is) I wouldn't be here if I hadn't made
that decision," Graham said.

While stories like Graham's are plentiful, doctors and researchers say
the nonmedical elements of the plant could have sometimes serious
adverse effects.

Dr. Eric Voth, a Topeka, Kan., internist and pain specialist and
chairman of the Institute on Global Drug Policy, said relying on
anecdotal evidence is dangerous because other factors could influence
why patients start to feel better.

"It's very hard to differentiate whether somebody feels better because
they're stoned or because they're getting a true therapeutic benefit
from the drug," Voth said.


Smoking marijuana could increase the risk of cancer because of
inhalation of tar and other carcinogens in the plant, Voth said. While
proponents of its use point to the 105 unique compounds that may be
useful for medicine, there are hundreds more compounds in marijuana
that some scientists believe not only have no use but may be harmful.

"You've still got (hundreds of other) substances in there," Voth said.
"It just (shouldn't) be smoked. That is a crazy precedent."

Illinois' law allows dispensaries to sell marijuana-infused baked
goods in addition to joints, but advocates say it takes longer to feel
the effects of marijuana when it's ingested instead of smoked.

Several papers in scientific journals have found that marijuana use
over a long period of time can have negative cognitive effects, too.
Users can't concentrate or remember as well as before, in some cases
years after they have quit.

Voth said he doubts that even identifiable benefits would be enough to
outweigh the negative effects, because of other potentially harmful
components that are mixed in.

"Essentially what they are, are toxic chemicals," Voth said. "None of
those things would you ever mix with medicine."

In 1937, the U.S. criminalized marijuana, and today it's considered a
Schedule I drug, along with heroin and LSD.

The FDA approved a synthetic THC pill called Marinol in 1985,
acknowledging the drug's benefits for people with nausea and decreased
appetite. In Canada and some parts of Europe, a similar drug called
Sativex - containing synthetic THC and cannabidiol - has been approved
in recent years, offered as an oral spray. In the late 1980s,
scientists discovered a previously unknown biological system called
the endocannabinoid system, which proponents for marijuana theorize
could show how it works.

The National Institutes of Health reported in 2006 that the system
holds "therapeutic promise in a wide range of disparate diseases."

But experts say more research is needed before determining exactly
what the system may be able to do.Mary Lynn Mathre, a founding partner
of Patients Out of Time, a marijuana advocacy group that focuses on
health issues, said the leading theory regarding the system is that
the human body has cannabinoid receptors - essentially keyholes that
cannabis compounds fit into, helping the body regulate.

"You take cannabis, which has similar chemicals that we need, and you
put it in the body and they work if we're not making the cannabinoids
that we need," said Mathre, a longtime registered nurse. "You can
liken this to a diabetic. Their pancreas isn't making insulin, so we
give them insulin. If our body can't make this chemical, there happens
to be this plant on earth that is there to supply us."
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