Pubdate: Sun, 12 Jul 2015
Source: Pueblo Chieftain (CO)
Copyright: 2015 The Pueblo Chieftain
Contact:  http://www.chieftain.com/
Details: http://www.mapinc.org/media/1613
Author: Libby Stuyt
Note: Libby Stuyt, MD, is the medical director for the Circle Program 
at the Colorado Mental Health Institute in Pueblo, a 90-day inpatient 
treatment program.

Marijuana Research

PLACING THE HORSE IN FRONT OF THE CART

I would like to respond to Dr. Hasan's allegation ("Hasan decries 
anti-med premise," Chieftain, June 24) that points I made in my 
previous opinion piece ("Time to put on the brakes," June 21) were 
"sheer nonsense."

Just because Dr. Hasan "couldn't find" a study doesn't mean it didn't 
happen. I think I was very clear that it was an "observational study" 
and, yes, the Veterans Administration is not into prescribing 
marijuana. But they can observe their patients' behavior.

The report by lead author Samuel T. Wilkinson, MD, from Yale School 
of Medicine, which states "marijuana use is associated with worse 
outcomes in symptom severity and violent behavior in patients with 
PTSD" is currently in press in the Journal of Clinical Psychiatry.

Observed were a total of 2,276 veterans who were admitted to 
intensive PTSD treatment programs between 1991 and 2011. The study 
determined that those who never used marijuana or quit using 
marijuana in treatment had the best improvement in symptoms of PTSD 
and a lower risk of violence.

Those who started using marijuana after treatment demonstrated 
significantly less improvement in PTSD symptoms and risk of violence. 
They also found that this group was more likely to turn to other 
drugs to cope with their residual PTSD symptoms.

This supports the idea that cannabis use can be a "gateway" to other 
illicit drug use. I totally agree that alcohol and tobacco can also 
be gateways to illicit drug use as they all cause "cross 
sensitization" in the brain. In fact the majority of patients who I 
have treated over the years started using tobacco, alcohol and/or 
marijuana during their teen years, but I saw them in treatment for 
problems with more powerful drugs as adults.

While there very well may be people who start using cannabis as 
adults and never have a problem, the association with cannabis use in 
adolescents and increased risk of illicit drug use is undeniable. 
Once someone is addicted to an addictive substance, the best hope for 
full recovery is avoidance of all drugs of abuse.

I have spent my entire career trying to convince people that ongoing 
tobacco use can increase the risk for relapse to their drug of choice 
and have published several studies supporting this. Now, sadly, I 
will have to start including cannabis use in this venture, especially 
since the governor of Colorado recently signed a bill allowing people 
on parole or probation to use medical marijuana and 75 percent of the 
people I treat are on probation.

Luckily, the majority of them have the insight that using marijuana 
will be a "gateway" back to their drug of choice.

Additionally, it is not just patients who have the diagnosis of 
schizophrenia or adolescents who are at risk for psychosis with 
cannabis use. Numerous people are at risk for psychosis, worsened 
with increased doses of THC. A recent study in London demonstrated 
that the use of high potency "skunk" cannabis (THC concentrations of 
15 percent) resulted in three times the risk of psychosis - five 
times if used daily. The cannabis available in the 1970s was 1-2 
percent THC. Colorado now has the reputation of having the most 
potent cannabis in the world (25 percent THC and up).

This quest for growers and dispensaries to increase the concentration 
of THC has nothing to do with any known medical benefit, it is simply 
to provide a better "high." There are no recommendations given for 
the dose, duration and what the recipient should do with their other 
medications they are already taking for the medical problem for which 
they are seeking marijuana.

I believe there is a possibility that cannabinoids may be helpful 
medically, but we want good medicine that has been through the proper 
drug approval process. As eloquently put by a recent editorial in 
JAMA (Journal of the American Medical Association), "perhaps it is 
time to place the horse back in front of the cart."

These views are solely mine and do not represent the views of the 
Colorado Mental Health Institute at Pueblo or the Colorado Office of 
Behavioral Health.
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MAP posted-by: Jay Bergstrom