Pubdate: Mon, 29 May 2017
Source: Daily Courier, The (CN BC)
Copyright: 2017 The Okanagan Valley Group of Newspapers
Author: Keith Roach
Page: A7


DEAR DR. ROACH: What advice do you have for both doctors and patients
for approaching medical marijuana use? What is your ideal vision of
its future?

ANSWER: I look at marijuana as a potentially useful medicinal plant
that has several potential downsides. One of the downsides is an
unrealistic expectation of its usefulness by believers. I increasingly
see claims that marijuana (or one of its extracts) can treat or cure
almost every known disease. It also is hampered by its status as a
Schedule I drug by the Drug Enforcement Agency, so high-quality
research is difficult to do. Finally, it has been used for many years
as a recreational drug (which is partially responsible for the first
two downsides). This has led to resistance to the idea among
nonbelievers that it might have legitimate use. The psychological
effects for which it is used recreationally can cause it to be
intolerable for some. Further, a small percentage of people (estimates
range between 2 percent and 6 percent) have difficulty quitting the
drug, even when they want to.

Marijuana contains many potentially active chemicals, of which only
two (THC and cannabidiol) have been studied well. The best evidence of
effectiveness for any type of marijuana product is in epilepsy and
chronic pain, but the quality of the data is limited. There are very
few situations where I would consider prescribing medical marijuana,
but they do exist.

Most of the risks of medical marijuana are also unknown. Anecdotal
reports suggest that fewer users of medical marijuana are smoking it,
in favour of ingesting extracts. I suspect that this will lead to
lower risk of heart and lung problems, but I withhold judgment until
there are good data. It also is clear that marijuana can cause or
worsen anxiety in some people. Adolescents who use marijuana may be at
higher risk of schizophrenia.

My ideal future regarding medical marijuana is one where it is studied
openly and subjected to the same scrutiny as other medicines, where
both the purified extracts are studied as well as the whole plant.
Marijuana needs to be compared against the best treatments we have,
not just against placebo. Only this way can we confirm or refute the
benefits and risks of this drug.

DEAR DR. ROACH: My physician has recommended a colonoscopy. I've never
had one and am overdue. My question involves the prep protocol. My
wife had one with the doctor who will do mine at the local hospital,
and he prescribed a liquid prep mixture that my wife found quite
unpleasant. A friend from out of state who had a colonoscopy was given
a single pill as a prep. Please discuss the difference and efficacy of
these two types of prep. I'm inclined to ask the doctor doing my
colonoscopy for the pill prep rather than the liquid.

ANSWER: There are several different preparations available. Most of
them involve a fairly large amount of liquid: 2 to 4 liters. I'm
afraid my experience is like your wife's: The preparations are not
particularly pleasant, but drinking them quickly, having them cold and
using flavorings in them (such as Mio or Crystal Light, but not
red-colored ones, though) can make them much more tolerable.

Pill-based colonoscopy preparations, like your friend had, are based
on sodium phosphate, and they are used less frequently now because of
safety concerns. This is especially true in people whose kidneys are
less than perfect (which includes a lot of older people). I recommend
the lower-volume liquid (polyethylene) preparation as a good balance
between safety and tolerability.
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MAP posted-by: Matt