Pubdate: Sat, 08 Mar 2014
Source: Post-Bulletin (Rochester, MN)
Copyright: 2014 Post-Bulletin Company, LLC
Author: Lorna Benson, Minnesota Public Radio News
Bookmark: (Marijuana - Medicinal)
Bookmark: (Cannabis - Medicinal - U.S.)


Is marijuana an effective treatment for pain, illness and disease?

It's a question many Minnesota physicians are pondering as the 
Legislature prepares to debate a measure that would allow doctors to 
prescribe some form of the drug.

Mayo Clinic psychiatrist Michael Bostwick reviewed more than 100 
medical studies and reports on the possible benefits and risks of 
marijuana. He published his findings in February 2012 in the journal 
Mayo Clinic Proceedings. Bostwick said most marijuana studies are not 
high-quality because they're not randomized, controlled studies -- 
the kind the U.S. Food and Drug Administration requires to approve 
any new medication.

Randomized patient trials have been nearly impossible to conduct in 
the United States because marijuana has been classified as a Schedule 
I drug under the federal Controlled Substances Act since 1970. 
Schedule I substances are regarded as having high abuse potential and 
no currently accepted medical use, which puts a damper on almost any 
treatment research.

There have been a handful of international, randomized studies on 
medical marijuana. But in the United States, the bulk of marijuana 
research has been observational, frequently involving individual or 
group case reports.

Bostwick said there is scant evidence that anyone has died from a 
marijuana overdose. But he said there is a growing body of research 
linking marijuana to addiction in about 10 percent of users.

By comparison, the addiction rate for alcohol is 15 percent and for 
tobacco, 32 percent. Marijuana also is associated with worsening 
psychosis in a small number of patients who are predisposed to schizophrenia.

"And if you keep on using the drug while you have the illness, you'll 
have a worse course," Bostwick said. "It will be harder to treat. 
You'll be more likely more psychotic."

Still, Bostwick said he found plenty of believable evidence that 
supports marijuana's potential medical benefits for relieving cancer 
pain, nausea, wasting syndrome from AIDS and muscle problems 
associated with Multiple Sclerosis. In that context, he said concerns 
about addiction seem hardly worth worrying about for patients who 
cannot get relief in other ways.

"If you're a person dying of a terminal illness and you have 
intractable pain, and smoking marijuana actually helps you, then it 
can be a great thing," he said.

Yet, Bostwick concludes that from a research perspective, the verdict 
on medical marijuana is still out, largely because rigorous studies 
that would answer lingering questions have been stymied. He argues 
that the federal government should reclassify marijuana as a Schedule 
II drug. That would allow research to move forward more easily.

Dr. Jacob Mirman, medical director at Life Medical, a private, 
primary care clinic in St. Louis Park that offers conventional 
medicine and homeopathy, agrees that more research is needed, but he 
doesn't think the Minnesota Legislature should wait for that to 
happen. Two of his patients have admitted to him that they have used 
marijuana to treat their pain. One patient has Multiple Sclerosis and 
the other had end-stage cancer. Mirman sees no convincing reason why 
Minnesota should continue to deny access to marijuana for medical purposes.

"I feel it's safe, much safer than some of the other drugs we use and 
some of the substances that are sold in stores without a 
prescription," he said.

Many psychiatrists and addiction medicine physicians disagree with 
that reasoning. The American Society of Addiction Medicine opposes 
state ballot measures to legalize marijuana. ASAM member Dr. Sheila 
Specker, an addiction psychiatrist at the University of Minnesota, 
said lawmakers shouldn't circumvent the federal drug-approval process.

"I don't think that the public or legislators understand the medical 
aspect of this or should be voting," Specker said. "That's not their domain."

Specker said she's worried if Minnesota lawmakers legalize medical 
marijuana, it will be much easier for kids to get pot. She said 
states that have allowed access to the drug for medical reasons have 
seen increases in adolescent marijuana use.

On Tuesday, the Minnesota Medical Association will hold a policy 
forum in Eagan to gauge physician interest in medical marijuana legislation.
- ---
MAP posted-by: Jay Bergstrom