Pubdate: Fri, 27 Jun 2014
Source: Buffalo News (NY)
Copyright: 2014 The Buffalo News
Author: Catherine Saint Louis, New York Times
Page: A1


NEW YORK - New York moved last week to join 22 states in legalizing 
medical marijuana for patients with a diverse array of debilitating 
ailments, encompassing epilepsy and cancer, Crohn's disease and 
Parkinson's. Yet there is no rigorous scientific evidence that 
marijuana effectively treats the symptoms of many of the illnesses 
for which states have authorized its use.

Instead, experts say, lawmakers and the authors of public referendums 
have acted largely on the basis of animal studies and heart-wrenching 

The lists of conditions qualifying patients for marijuana treatment 
vary considerably from state to state. Like most others, New York's 
includes cancer, HIV/AIDS and multiple sclerosis. Studies have shown 
that marijuana can relieve nausea, improve appetite and ease spasms 
in those patients.

But New York's list also includes Parkinson's disease, Lou Gehrig's 
disease and epilepsy, conditions for which there are no high-quality 
trials indicating marijuana is useful. In Illinois, more than three 
dozen conditions qualify for treatment with marijuana, including 
Alzheimer's disease, lupus, Sjogren's syndrome, Tourette's syndrome, 
Arnold-Chiari malformation and nail-patella syndrome.

"I just don't think the evidence is there for these long lists," said 
Dr. Molly Cooke, a professor of medicine at the University of 
California, San Francisco, who helped research a position paper on 
cannabis for the American College of Physicians.

Even some advocates of medical marijuana acknowledge that the state 
laws legalizing it did not result from careful reviews of the medical 

"I wish it were that rational," said Mitch Earleywine, chairman of 
the executive board of directors for NORML, a national marijuana 
advocacy group. Earleywine said state lawmakers more often ask 
themselves, "What disease does the person in a wheelchair in my office have?"

Research into marijuana's effects is thin not because of a lack of 
scientific interest, but chiefly because the federal government has 
long classified it as a Schedule 1 drug with "no currently accepted 
medical use." Scientists who want to conduct studies must register 
with the Drug Enforcement Administration and win the approval of 
National Institute on Drug Abuse, which is the only supplier of 
legal, research-grade marijuana and can decline to supply it.

The legal and administrative hoops make it hard for investigators to 
start the randomized, placebo-controlled trials that are the gold 
standard of medical research and the basis for determining which 
drugs are effective, at what doses, and in which patients.

"It's one thing to say we need to have more research, and it's 
another thing to obstruct the research," said Dr. Steven A. Jenison, 
former medical director of New Mexico's medical cannabis program.

The dearth of data has not prevented legislators and voters across 
the nation from endorsing marijuana for more than 40 conditions. 
Patients with rheumatoid arthritis, for instance, qualify for 
marijuana treatment in at least three states.

Yet there are no published trials of smoked marijuana in rheumatoid 
arthritis patients, said Dr. Mary-Ann Fitzcharles, a rheumatologist 
at McGill University who reviewed the evidence of the drug's efficacy 
in treating rheumatic diseases.

"When we look at herbal cannabis, we have zero evidence for 
efficacy," she said. "Unfortunately this is being driven by 
regulatory authorities, not by sound clinical judgment."

New York considered including the chronic inflammatory disease on its 
list, a development that astonished Dr. Mary K. Crow, an arthritis 
expert at the Hospital for Special Surgery, in Manhattan. People with 
rheumatoid arthritis have higher rates of certain respiratory 
problems, she noted.

"Inhaling into your lungs is not a great idea with rheumatoid 
arthritis, given the substantial number of patients who have lung 
disease," Crow said. (The final version of New York's law prohibits 
smoking marijuana and did not end up including rheumatoid arthritis.)

In Arizona and Rhode Island, among other states, people with 
Alzheimer's disease may receive medical marijuana to help quell 
nighttime agitation. But Dr. Gary Small, director of the division of 
geriatric psychiatry at the University of California, Los Angeles, 
said he does not recommend cannabis to Alzheimer's patients: 
Agitation and increased confusion are possible side effects.

Still, he said he would not discourage a caregiver from providing it 
if it calmed someone with dementia.

Parents of children with intractable epilepsy have lobbied hard in 
several states, including New York, for inclusion in medical 
marijuana legislation. They want access to an oil called Charlotte's 
Web that is rich in CBD, a nonpsychoactive ingredient of marijuana 
that they say reduces the number of seizures.

This month, Gov. Rick Scott of Florida, a conservative Republican, 
signed a law allowing epilepsy patients access to the oil, calling it 
"the best treatment available."

Scientists have begun randomized, placebo-controlled research to 
determine whether CBD effectively treats severe forms of childhood 
epilepsy. But at the moment, high-quality research showing that 
marijuana is a safe or effective treatment for epilepsy does not 
exist, experts say.

"As far as data out there, there are great animal models and very 
provoking anecdotes," said Dr. Orrin Devinsky, director of the 
Comprehensive Epilepsy Center at NYU Langone Medical Center. "The 
human data is not there right now."

Even if strong medical research regarding marijuana did exist, it is 
not clear that state lawmakers would be swayed.

"It would be possible to take case studies or anecdotal information 
from patients or research done from a university, put it in front of 
a legislator and say, 'We need to include this disease,'" said state 
Rep. Lou Lang, sponsor of the medical marijuana law in Illinois.

"But the legislative mind, be it in D.C. or in Springfield, Ill., 
doesn't always go to public policy," Lang said. "The default position 
is politics."
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MAP posted-by: Jay Bergstrom