Pubdate: Sun, 14 Sep 2014
Source: Denver Post (CO)
Copyright: 2014 The Denver Post Corp
Contact:  http://www.denverpost.com/
Details: http://www.mapinc.org/media/122
Author: Alicia Caldwell
Page: 1D

PLAYING CATCH-UP ON SCIENCE OF POT

The case was as sad and as tragic as we've seen in metro Denver in 
recent memory.

A man, supposedly stoned on marijuana-infused candy, flipped out and 
killed his wife with a gunshot to the head while their three children 
were in their Observatory Park house. Or so the story goes.

Yet, recent court testimony from cops was that Richard Kirk had "low" 
THC levels, a psychoactive ingredient in marijuana, when tested five 
hours after the shooting. How in the world does that square with a 
guy who was said to be hallucinating and subsequently asked his 
7year-old son to kill him?

If it was alcohol at work, there would be loads of research to call 
upon that could explain human behavior associated with its use. 
Unfortunately, that is not the case with marijuana.

The paucity of research-good, scientifically valid research-is a 
problem that will only get worse unless the federal government eases 
regulations constricting research, much the same way it loosened 
restrictions on the banking industry and how it handled money 
generated from marijuana businesses.

"We can figure out pretty precisely the extent to which alcohol can 
have an impact," said Stan Garnett, Boulder County district attorney, 
who has followed the Kirk case closely, though he is not working on 
it. "The situation with marijuana is completely different because 
there has not been much research."

Obviously, said Garnett, when you have a murder involving marijuana 
and you don't know the nuances of how it affects people, that's a real problem.

Those nuances are something Kari Franson, associate dean for 
professional education at the University of Colorado's Skaggs School 
of Pharmacy, has spent some time studying. And not just here in the 
U.S., but in the Netherlands where she said she was able to conduct 
clinical marijuana trials.

For instance, she said a woman's estrogen status has an impact on her 
sensitivity to THC, an important psychoactive substance in marijuana, 
but not the only one. Women are more sensitive to marijuana until 
they go through menopause, Franson said.

It is fascinating information that has potentially important public 
policy implications when considering how much a person can safely 
consume prior to driving, for instance.

Franson agrees heartily that more research is needed to examine 
howmarijuana affects people. As for the Kirk case, and the report 
that he had lowTHC levels, she said tolerance could be a salient issue.

"If he was truly naive and was not a frequent user of the drug, he 
would not be tolerant to it and would require lower doses of the 
drug," she said.

In fact, when sheworked in theNetherlands, Franson said, researchers 
did not want first-time users in their studies because of the 
sometimes erratic nature of their reactions.

There are many variables to consider, including different strains of 
marijuana (which are not created equal), marijuana potency, personal 
body chemistry, weight, and the drug's interaction with other 
substances that a person might have ingested.

While marijuana is often compared to alcohol, Franson said she found 
the comparison ill suited. She said it's more like morphine. For both 
drugs, first time users don't need much to feel it. But over time, 
far more is needed to get the desired effect.

That would explain why some of Colorado's medical marijuana users 
report having to consume massive amounts to knock down pain. But how 
does that affect a person's ability to, for instance, safely drive a car?

While heavy users will tell you they believe they are competent 
behind the wheel, we need to see the studies-the highly-controlled 
clinical studies - that show that to be the case. It's an issue that 
is too important to public safety to rely upon anecdotes or studies 
of questionable integrity.

"We don't know very much about chronic users and tolerance versus the 
naive user," said Paula Riggs, a psychiatry professor at the 
University of Colorado's School ofMedicine. She is a big proponent of 
better research to inform marijuana public policy

efore using a study to make decisions on public health and safety 
policy, it's imperative to assess and understand the difference 
between the different types of research in order to understand their 
value, she said.

Two types of studies

A clinical trial is one in which those participating are highly 
monitored. Their doses are controlled, as are other variables. An 
observational study, while still valuable, would rely on recording 
the conditions of those who came into an emergency room stoned, for 
example. The issue that sometimes arises with observational studies 
is that a patient's other conditions could affect the results.

"The barriers to good studies are myriad," Riggs said.

Too often, existing studies are not well replicated by other 
researchers or there are other factors involved that make it 
difficult to draw solid cause-and-effect conclusions from the work.

Riggs, however, maintains that some research into marijuana has 
yielded reliable results. For instance, the work on how marijuana 
interferes with the brain development of young people is clear, she says.

She said chronic, heavy use by teens can result in a six-to 
eight-point reduction in adult IQ , an effect that seems permanent. 
Riggs compares it to environmental lead exposure.

"There are some data that are very clear," she said. "We ought to at 
least take the data we do have and use it."

Research restrictions

Federal restrictions on doing research on what is classified as a 
Schedule I drug by the Drug Enforcement Administration- as is 
marijuana-make it very difficult for institutions. In particular, 
universities that get federal grants and fear losing them have every 
incentive to shy away from the kind of marijuana research that would 
inform good public policy.

A Schedule I drug is one that is defined as dangerous, has no 
accepted medical use and comes with a high potential for abuse. The 
restrictions on research on these drugs are onerous.

It seems clear that the assessment of marijuana conferred by its 
Schedule I status isn't shared by decision makers in 23 states and 
the District of Columbia, which have legalized medical marijuana.

Yet, how the feds view marijuana is important to the advancement of 
the research needed to undergird appropriate public policy.

For instance, the National Institute of Drug Abuse controls. the 
marijuana that can be legally used in federally approved research. 
Researchers will tell you that the marijuana that NIDA grows isn't 
comparable to what people buy on the street or from dispensaries, 
which often is far more potent and sometimes a different variety from 
what NIDA cultivates at a contract farm in Mississippi.

CU's Franson said the federal government needs to relax rules around 
marijuana research so universities can conduct necessary studies. 
Surely, reclassifying marijuana so that it's not a Schedule I drug 
would do the trick, but the action doesn't even have to be that 
dramatic, according to Franson.

If the federal government were to issue guidance giving universities 
the leeway to more easily conduct marijuana research-much as it did 
earlier this year when it relaxed banking rules so legitimate 
marijuana businesses could have bank accounts-that would be enormously helpful.

The message, Franson said, should be: We're not going to punish 
universities trying to learn more about marijuana by taking away 
their federal funding.The American College of Physicians and the 
American Medical Association both support clearing the way for more 
high quality research on marijuana.

Interestingly, the folks at NIDA said in an e-mail to me that the 
agency is very interested in research on the effects of marijuana 
administered orally since very little exists.

NIDA says there is a clinical trial under way that is designed to 
figure out how people respond to THC administered in different ways, 
including orally. However, the study is in its early stages and 
results are not expected until September 2016.

And surely, that study will be of benefit. But research has to be 
more widespread and cover foreseeable issues in various states.

Grants in Colorado

In Colorado, the state's health department is on the cusp of 
considering applicants for roughly $9 million in grants.

Larry Wolk, executive director and chief medical officer for the 
Colorado Department of Public Health, said the research funded by the 
grants must stay true to the source of the money, which is the 
registration fees paid by medical marijuana users. So, the research 
will focus on medical uses of marijuana.

In the process of studying medicinal uses such as the efficacy of 
using marijuana to treat a seizure disorder in children, or whether 
it eases post traumatic stress disorder or chronic pain, it is Wolk's 
hope that other information can be gleaned.

That could include some observations on how marijuana affects people 
who also consumed alcohol.

"It's definitely an interest, but it is information we'll have to 
glean secondarily," he said.

These studies, Wolk said, are a step in the right direction as policy 
makers try to make good decisions with limited information.

"We're sort of in a living laboratory right now," Wolk said.

Indeed. Unfortunately, moves to legalize marijuana, particularly 
medical marijuana, have gotten in front of the scientific research 
that could have better informed those decisions. It's time to catch 
up so our laws, rules and understanding of how marijuana affects 
people keep pace with its use.
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MAP posted-by: Jay Bergstrom