Pubdate: Tue, 22 Sep 2015
Source: Orlando Sentinel (FL)
Copyright: 2015 Orlando Sentinel
Contact:  http://www.orlandosentinel.com/
Details: http://www.mapinc.org/media/325
Note: Rarely prints out-of-state LTEs.
Author: Leslie Mann, Tribune Newspapers Leslie Mann is a freelancer.

DOCTOR URGES FOCUS ON HOW BEST TO USE MEDICAL MARIJUANA

Before he wrote "Stoned: A Doctor's Case for Medical Marijuana," Dr. 
David Casarett said, he echoed skeptical medical school peers who 
viewed medical marijuana with "detached amusement."

"We were told it caused schizophrenia and depression and it leads to 
abuse of dangerous drugs," said Casarett, 47, palliative care 
physician and professor at the University of Pennsylvania's Perelman 
School of Medicine.

Then Casarett read the research, which he learned is "not 
pseudoscience after all." He interviewed dozens of patients and 
doctors, visited dispensaries and tried marijuana to relieve his back 
pain. "Taking control" is the phrase he heard repeatedly from 
patients who turned to marijuana after mainstream drugs failed to 
alleviate their symptoms. "Yes, it has side effects," they told 
Casarett. "But so do FDA-approved drugs."

Bottom line, Casarett said, is that medical marijuana "deserves 
further research, so we know when it works and doesn't work."

Following is an edited transcript.

Q: Why did you write the book?

A: It's time to move the discussion from "Should it be legal?" to 
"How effective and safe is it?" And physicians have to be able to 
answer questions.

Q: Where does medical marijuana offer the greatest promise?

A: Relieving nausea, neuropathic pain, muscle spasticity, pain due to 
multiple sclerosis, and appetite loss. And probably insomnia. We 
don't have the data yet, but maybe PTSD and seizures too.

Q: What's the legal status of medical marijuana?

A: It's legal in 23 states and in the District of Columbia and 
pending in others. The number of people using it legally, though, is 
just the tip of the iceberg. Many live in states where it's legal, 
but they're not registered, or live in states where it isn't legal.

Q: Will legalizing medical marijuana lead to a nation of addicts?

A: If it were always addictive, whole generations would be addicted. 
Only 1 in 10 people who use it regularly become addicted.

Q: Why do we need more research about medical marijuana?

A: Most of the studies of the benefits are small. And most of the 
studies of the risk are with recreational users. Side effects are not 
the same for the 20-yearold who smokes it regularly as for the 
40-year-old administrative assistant from Des Moines who uses it when 
she can't sleep. The war on drugs prevents the government-funded 
studies we need. Big Pharma is not behind research of whole plants, 
because there's no patent to be had; the plant already exists. So 
research money will come from other sources.

Q: What are THC (tetrahydrocannaboid) and CBD (cannabidiol)?

A: In marijuana, there are dozens of cannabinoids, but these are the 
ones we know more about. Probably, both have medical benefits. But 
THC gives you the "high," while CBD does not.

Q: What are the pros and cons of different ways of using it?

A: Smoking is the tried-and-true method but not discreet. In food, 
the dosage varies, and the effect is delayed. Effectiveness varies 
with a vape pen, though it's convenient. A tincture (concentrated 
marijuana dissolved in alcohol) is effective and works quickly. A 
vaporizer is fast-acting but not portable.

Q: Why don't more doctors prescribe dronabinol (the synthetic form of 
THC), which is FDAapproved?

A: My patients say it isn't very effective, and it makes them 
disoriented and confused.

Q: How can patients learn more about medical marijuana?

A: Read my book and the studies by Drs. Raphael Mechoulam, Barth 
Wilsey and Don Abrams. Find a doctor who is willing to discuss it 
with you. Visit www.americansforsafeaccess.org and www .marijuanaresults.org.
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