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Medical Marijuana: Smoke & Mirrors?

Jason M. Broderick
Published Online: February 2, 2010 - 11:27:24 AM (CST)
In January, New Jersey became the 14th state in the nation to legalize marijuana use for certain chronic illnesses. Other states where the use of medical marijuana is permitted include Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington; around a dozen more states are weighing pending bills. The New Jersey law is the most restrictive in the nation and authorizes prescribed marijuana for only a handful of chronic illnesses, such as multiple sclerosis, cancer, glaucoma, epilepsy, Crohn’s disease, AIDS, muscular dystrophy and Lou Gehrig’s disease. Unlike other states, physicians in New Jersey will not be able to prescribe medical marijuana for anxiety, headaches, or chronic pain.

The state plans to authorize 6 dispensaries, and patients will receive identification cards authorizing them to purchase the drug. They will not be able to grow their own marijuana or use it in public, however. And individuals without a prescription will still be subject to criminal prosecution if caught in possession of marijuana.

Richard J. Rosenbluth, MD, is medical director of the Hospice Program and division chief of Geriatric Oncology at John Theurer Cancer Center at Hackensack University Medical Center in New Jersey. He is also the editor of the Journal of Pain Management, and he supports New Jersey’s decision to legalize marijuana for medical use, predicated on a physician’s determination that good clinical evidence exists to prescribe it. “I believe any drug that might be beneficial should be decriminalized, if currently not available,” he said. “Marijuana should be available and doctors should treat it as any other drug, as per the Medical Board of California’s 2004 recommendations,” said Rosenbluth.

Shifting attitudes toward medical marijuana

According to Patrick Stack and Claire Suddath, authors of “A Brief History of Medical Marijuana,” published in Time, medicinal marijuana can be traced back to Emperor Shen Neng of China, who prescribed marijuana tea in 2737 BCE as a treatment for gout, rheumatism, malaria, and poor memory. Its use became widespread throughout Asia and the Middle East. As of the late 18th century, medical journals in Britain and the United States were recommending hemp seeds for everything from inflamed skin to incontinence and venereal disease. Marijuana for medical use eventually fell out of favor in the United States, however, as state and federal regulators imposed increasingly harsh criminal penalties for growing, possessing, using, and selling marijuana. 

Paul M. Zeltzer, MD, clinical professor in neurosurgery, David Geffen School of Medicine, University of California Los Angeles, explained that medical marijuana has been tainted with an association between marijuana and criminal enterprise. “Smoking medical, ordinary marijuana helps to alleviate many symptoms of pain and depression in persons who have cancer,” he said, but he noted that marijuana use has been commingled with “an underground that involves crime syndicates and domestic/foreign nationals who may kill and maim in the process of cultivation, acquisition, and distribution.” Some people have had trouble divorcing these two issues. “One alternative,” Zeltzer suggests, “would be for [marijuana] to be [completely] legalized, thus sidestepping or eliminating the crime connection and adding to our country’s tax base.”

Although a minority of Americans support legalizing marijuana outright, 81% do support legalizing marijuana for medical purposes, according to an ABC News/Washington Post poll. Presidential administrations have differed on what approach to take toward medical marijuana, which remains a federal crime. Under the Obama administration, the Justice Department formally announced that it will not prosecute people who are using marijuana in compliance with state laws that permit its use for medicinal purposes. This is a reversal of the position taken by the previous administration, which dispatched federal agents to raid marijuana dispensaries and farms in states with legalized medical marijuana. Operators were charged under federal drug laws. 

The FDA maintains that “marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision.” Though the FDA bans the use of raw marijuana, delta-9-tetrahydrocannabinol (THC) is the herb’s most active ingredient and has been available by prescription as dronabinol (Marinol) since 1985. It is sometimes used to treat chemotherapy-induced nausea and vomiting. Rosenbluth said in terms of patient benefit, research fails to show either dronabinol or raw marijuana as superior to one another. He added that “anecdotally, patients who have prior history of smoking marijuana seem to get more benefit from smoking than from oral preparations.” The NCI advocates THC use only when first-line therapies prove ineffective. 

How does medical marijuana affect patients?

Despite marijuana being available for centuries, years of study have failed to elucidate its curative and palliative properties. Some studies have provided pretty strong evidence that marijuana reduces nausea and improves appetite in patients on chemotherapy. It also relieves aching and numbness in patients with AIDS and may alleviate some neurological problems associated with multiple sclerosis.

In patients with cancer, Rosenbluth said, “Several benefits have been attributed to marijuana, including improvement in anorexia/cachexia (cancer wasting syndrome), anti-nausea [properties], and help with depression and anxiety.” Rosenbluth said there have not yet been any good clinical trials that confirm these benefits, however. “What trials do exist have generally not used smoked marijuana—only dronabinol.” Rosenbluth said he is not convinced that marijuana is superior to other approved agents and suggested it may be significantly less effective than many of them. 

Adverse effects associated with marijuana use are few and manageable, Rosenbluth said. “They include dysphoria, depersonalization syndromes, drowsiness, dizziness, and mild cardiac and circulatory side effects. These effects may be less apparent in younger patients and more so in the elderly.”

Can marijuana slow tumor growth? 

“There is a good deal of interest in some basic laboratory research indicating anti-tumor effects of cannabinoids,” Rosenbluth said. Some researchers are experimenting with THC to reduce tumor growth. These studies are all in their early phases, but Rosenbluth said preliminary findings are interesting, and he hopes relaxation of medical marijuana laws will allow “cannabis and its components to be studied freely throughout the country, as any other potentially beneficial drug.”

Despite the Obama administration’s relaxation on prosecutions, many researchers are still having difficulty getting approval to conduct studies that involve smoking marijuana. Requests to conduct the studies must go through the National Institute on Drug Abuse (NIDA), which controls supply from a plantation at the University of Mississippi, the only federally approved source of marijuana. NIDA routinely turns down study requests unless they are designed to evaluate the potential harm from smoking marijuana. The Drug Enforcement Agency has also declined petitions from researchers requesting permission to grow their own marijuana for use in studies.

The thorny side of medical marijuana

Legalizing medical marijuana has not been without problems. Law enforcement officials in states where it is legalized complain that many healthy people take advantage of the law to procure marijuana and that growers are spreading from rural areas into the city. The city of San Jose, California, which has as many as 30 dispensaries operating within the city limits, recently announced it would be forcing all dispensaries to close. Related crime has also been a concern, and several states and municipalities are tightening regulations on marijuana dispensaries. 

Most states with medical marijuana laws allow employers to refuse employment to individuals who use medical marijuana. In some states, like Colorado, the laws are ambiguous and employers are unclear as to whether they can forbid employees to use medical marijuana outside of work. Schools are also grappling with the issue, as well, with more high school students—particularly in areas with less restrictive medical marijuana laws—receiving prescriptions for marijuana, increasingly to treat ADHD. In addition, some facilities that perform organ transplants acknowledge denying transplants to patients who use medical marijuana. 

In the absence of any proven benefits from smoking marijuana, physicians in the 14 states where it is legal may want to discuss some of the pros and cons with their patients prior to issuing a prescription. Patients need to be aware of the potential impact of medical marijuana on all facets of life and should be wary of letting the anecdotal hype surrounding medical marijuana use dissuade them from first trying a proven treatment option. 



See our companion article, "Medical Marijuana: An Oncologist's Perspective."


COMMENTS
F MEZZADRI MD MS,RPH
- February 3, 2010 - 12:00:00 (CST)
Society needs one more substance that will dumb us down. medical use may be questionable risks are comparable to tobacco and we have other meds to deal with chemotherapy sied effects. Who is going to be responsible for the increase of automobile accidents, work related injuries, school failure and inattentive failure to perform at work. Who is going to pay the price of testing for those who are responsible for other lives.

All for more tax revenue. It didnt help California. It wont help any state. Next time anyone questions the benefit verses risk speak to a Rastafarian about the complex issues of world politics or the economics and policy regarding their third world country . For the Californians who voted for Boxer or Pelosi who are delusional enough to believe that they are good for the country-- go for it. Instead of using this as tax income how about spending less(novel idea).

The legislators need to be accountable for all of their weak psychotic decisions.
Leon Wateska
- February 3, 2010 - 12:00:00 (CST)
I DO NOT support the use of medical marijuana.

I live in a state (Ohio) where medical marijuana is not legalized, and I hope it stays that way.
Anonymous
- February 3, 2010 - 12:00:00 (CST)
Legalize it now!!!!!!!!!!!!!
mike owens
- February 3, 2010 - 12:00:00 (CST)
you want to stand up against something that kills people every day? try alcohol.
Jennifer Houston RN
- February 3, 2010 - 12:00:00 (CST)
Legalize it! It's so much safer than alcohol. You never hear of people fighting, killing each other, beating their wives or killing people driving under marijuana use.It doesn't change consciousness drastically enough that people would be "out of their minds" (as stated by another writer above) There are plenty of more dangerous (and legal) things than marijuana. Legalize it and TAX it....NY state would get completely out of debt if we legaized and taxed it.
Keli Rising - HCPLive
- February 3, 2010 - 12:00:00 (CST)
This article references using marijuana for patients with multiple sclerosis, cancer, glaucoma, epilepsy, Crohn's disease, AIDS, muscular dystrophy, Lou Gehrig's disease, anxiety, headaches, and chronic pain. What I want to know is how prescribing marijuana helps people with epilepsy? I have the disorder and have never heard of anyone who has used it.

Docs, what disorders would you prescribe marijuana for?
Jay Sochoka, R.Ph.
- February 3, 2010 - 12:00:00 (CST)
In pain management, cannabis is far less addictive than the brutal opiates. It is also less addictive than benzodiazepines when treating anxiety. I believe cannabis, under the correct supervision, is a better first line treatment than prescription medications.
William K. Harrison
- February 3, 2010 - 12:00:00 (CST)
There goes my thoughts of every one getting free services from the Government being able to pass a drug test. I had pass a drug test in order to earn money so that my taxes can be used to pay them.
Farrel Klein, MD
- February 3, 2010 - 12:00:00 (CST)
I live in a Medical Marijuana state. I do not prescribe it because I do not want to be known as Dr. Pot. There is clear evidence it increases the risks of psychosis and impairment when driving. That said, all drug enforcement is a futile waste of money. People who really want drugs will find a way to get them. Prisons will be filled, police will chase users and dealers, taxes will be raised to support all this, and narcotics will still be available. The illegal drug trade will fuel terrorism, violent cartels, corruption, and pork barrel projects here and abroad. If people want to abuse drugs, laws will not stop them. I would prefer at least decriminalizing ALL drugs and spending the money wasted on law enforcement on education and treatment. Tobacco is still legal, but the rates of use have dropped dramatically with an education and treatment approach. Take the disease model to substance abuse. The "War on Drugs" approach is the ultimate quagmire. That said, employers should be free to drug test employees and intoxicated drivers should still lose their licenses. Wasting yourself is your business. Endangering others becomes the business of law enforcement.
Stu R.
- February 3, 2010 - 12:00:00 (CST)
Legalize and tax it to street level prices
sonata
- February 3, 2010 - 12:00:00 (CST)
Statistics say about 6-8% of the population consists of so called "addictive personalities". This percentage will not increase with the addition of legal mj.

As a pharmacist I have seen the potential for use and abuse of many "legal" drugs.

I have long said, go ahead and legalize it, control it, and let the government/FDA approve and regulate the production, use and sale as with alcohol and tobacco and not have to hide behind the "medical" aspect of its use "which is very real and valuable for many people". It's time we let the legalization of mj out of the closet and get all the monetary benefits of the tax revenues which would return to the population as a whole. We still need law enforcement to take care of traffic accidents, etc. Mj wouldn't increase the overall problem and would move many "users" into the legal system as overnite drunks instead of trial/prison at much greater taxpayer expense. By the way, I have never used it nor considered trying.

Thanks for letting me sound off.
Ron Seigla
- February 3, 2010 - 12:00:00 (CST)
The way we are getting patients addicted to narcotics, we might as well be legalizing marijuana. If it helps a patient, they should be able to legally obtain it.
Jon Dennis, MD, MPH
- February 3, 2010 - 12:00:00 (CST)
My perspective is that of a physician who takes care of adolescents. Legalization of marijuana in California seems to be playing out to be a disaster, with thousands of "clinics" popping up all over, and marijuana being used for a huge population of people who don't need it medically. There was inadequate thought, planning, and funding put into enforcement; it's a joke. So who will suffer when MOST of the teens are smoking daily, when MORE people are killed or injured in an accident due to marijuana intoxication, when MORE parents neglect children, when MORE workers neglect there jobs? The teens we treat for marijuana abuse use it to treat the "emotional pain" of growning up, or of their life situation. If they start smoking at age 13, and they finally have cleaned up their act at age 17 in chemical dependency treatment (for the 3rd or 4th time), their emotional development has retarded. They are frequently like the 13 year old who started smoking. Teens need to process through some of the pain of growing up; if they get stoned to avoid it, they never progress.

New Jersey seems to have the right idea; hopefully the state restrictions come with adequate enforcement. The huge national mistake is that there isn't adequate national funding for research to refute or support legalization for medical purposes.
David Simsek, R.Ph.
- February 3, 2010 - 12:00:00 (CST)
We all know that Marinol has been around for years, but so had Nicotine Patches. Most people agree that cigarettes contain lots of other ingredients besides Nicotine and that the patches aren't a complete substitute for smoking. Sure the patches help you quit but it just doesn't cut it without lots of work and self disipline. So why then do people think Marinol is a complete substitute for smoking Marijuana? As a pharmacist, we as a country need to let go of this war against Marijuana. This war is costing billions for what? The states, our country, our prisions and our patients would be so much better off, legalizing it, controlling it and taxing it. But fighting crime (Marijuana) is such big business that I dont think I'll see any changes in my lifetime. Really now, who cares if some terminal dying person gets some psychotropic benifit in addition to there medicinal benifits from smoking Marijuana?
Patrick Bone, D.Min
- February 3, 2010 - 12:00:00 (CST)
Andrew Weil wrote a book, The Natural Mind, in early 70's supporting the decriminalization of MJ.

His thesis is simple: mood altering substances such as alcohol, though legal, have much greater physical and social consequences than THC. Furthermore THC does not seem to have the aggressive and violent side effects of alcohol. Weil made another general observation that social users of THC seem to reflect its "mellowing" effect during periods when the user is not using. In my experience, minister, police officer, corrections officer, parole officer, the criminal justice system is stressed beyond its capabilities to prevent use of THC. Prisons spend vast amounts of government money and resources on non-violent users of THC. The legal prohibition of THC has created an enormous underground economy which is not taxed and which regulates itself through violence and exploitatioin of underaged "mules" for distribution, thus making these children legally recognized criminals and subject to prosecution and entry into the college for criminals we call prisons. If legalized, would there be abuse of THC? Without a doubt. But, nowhere near the violent and anti-social abuses of legal alcohol. Yes, we arrest public intoxicants. But we do not put ordinary citizens into prisons for having a Bud in private or in public. Much of the mythology about drug-addiction came out of fear and moral dogma of the 50's. B-movies added to the mix. Prisons became good business in the 80's, and filling them became the priority of politicians pretending to act tough on crime. Canon City, Colorado, as the story goes, chose the state prison over the state university, and have never regretted the choice. It's industy is prison. I ought to know I worked there and have a healthy pension to prove it. The benefits of compensation aside, I also met hundred of non-violent criminals who need not have served time for drugs. Yes, there were some who did deserve to be in prison for drug-related crime. But even that could have been avoided had someone stopped to evaluate the breeding ground created by criminalizing a substance never proven to promote the downfall of society. Good luck in the dialogue supported by this survey. By the way, I am not a user of THC, and I don't drink or smoke. But I would like to think that those who do can be trusted, for the most part, to regulate their habits, or, if necessary, find effective treatment to correct problems. That does not happen in prison.
Allie Kurschner
- February 3, 2010 - 12:00:00 (CST)
Absolutely legalize. If ANYTHING has medicinal purpose why wouldn't you?? I think it's crazy that alcohol is legal and marijuana isn't.
David Dansdill M.D.
- February 3, 2010 - 1:20:52 (CST)
THC/Marinol has been available in pill form since 1985. What is the deal? Why doesnt anyone ever remind people this drug is already legal and available. No one is hiding it from the sick people. It may be expensive and underpresribed, but "medical maijuana" has been available for 25 years.
Fay Mead
- February 3, 2010 - 1:45:56 (CST)
I live in the Houston, TX area and also have Crohn's Disease. I think medical marijuana should be legalized in Texas. I have been told to smoke it and because it is illegal I am afraid to. So what does one do. I hope the State of Texas moves forward with this. Many people with chronic illnesses would benefit from the relief. Why is it ok for us to take all the legal drugs such as pain pills and Fentanyl patches with so many side effects that are harming our bodies, but medical marijuana has the lesser of all.
Yvonne Barash RN BSN
- February 3, 2010 - 1:50:37 (CST)
I was thinking the same thing as Dr. Dansdill, although the last thing most folks want to do when they're nauseated is swallow a pill. I also wonder why we can't develop an alternative form of administering Marinol to patients who may benefit from it, such as nebulized. That might make the "legalization" issue a moot point.
Ted Walters, MD
- February 3, 2010 - 1:54:03 (CST)
"Medical" mj is a joke. Several studies have shown that the inhalation of the burning weed causes significant bronchial irritation, and probably results in COPD and possibly even cancer, if done for a long enough time.

I'm convinced that this movement is just a way to get mj legalized -- which I happen to agree with! Our jails are so full of these folks that we have no room for real criminals, and restriction of the drug results in extremely high costs (hemp is very cheap). Minor crimes are then committed to support what would otherwise be an affordable habit. Besides, if regulated, mj could be taxed and help the gov't get out of its deficit.
richard newton
- February 3, 2010 - 2:30:29 (CST)
THE USE OF MEDICAL MARIJUANA IS NOT JUSTIFIED. ABUSE BY ADDICTS IS OVERWHELMING. I TREATED SUCH AN ADDICT, WHOSE BRAIN HAD BEEN "FRIED" AND COULD HARDLY REMEMBER ANYTHING.
Dr. Tom Natale
- February 3, 2010 - 2:31:29 (CST)
IMHO: New Jersey has it right. Other states are inviting significant abuse of a well-intentioned law. Lots of abuse potential for "chronic pain", "anxiety", etc. And public use should definitely be discouraged. I am not so concerned about loser adults who want to waste their minds and bodies (that is their right). My concern is for the subtle societal approval of use in younger age groups.
Ron Voigt RPh
- February 3, 2010 - 2:37:39 (CST)
People, especially with terminal conditions, should be able to use about anything that helps with their well-being. And as long as its use is confined to the home, any substance that helps people feel better should be allowed under the supervision of a health care provider.
Susan, RPH
- February 3, 2010 - 2:46:17 (CST)
I have first hand seen the benefits of medical marijuana with my nephew. he was unable to tolerate any other medications during his chemo. The marinol helped but it was not the same.
Linda Casali
- February 3, 2010 - 2:47:16 (CST)
Having worked with individuals requiring THC, it is about time it has been legalized. I think more states should follow in line for patient care.
Felix Smith
- February 3, 2010 - 2:55:11 (CST)
I live in a state where it is not legal, but do nott see a problem with it being legalized for certain chronic conditions. As health care providers, our number one concern is providing the best health available, and if that is marijuana I do not see a problem with that.
Bruce Reitz
- February 3, 2010 - 2:56:09 (CST)
The fact that possession of marijuana is illegal has not stopped it's use any more than prohabition stopped the drinking of alcohol. I see no reason that marijuana sould be illegal and would support its legalization. If marijuana was legal and could be purchased through established outlets this would stop the adulteration of marijuana with other more dangerous substances, LSD and PCP. It could be a source of tax revenue and not a source of income for the criminal element. Whether marijuana has legitimate medical uses is not the issue, many prescription drugs are no more effective for the conditions they are used to treat consider the recent reports about antidepressants. The placebo effect is real and if people think that marijuana helps glacoma, nausea or pain in that patinet it may be the best medicine. As with everything from alcohol to food overuse is more an issue and health problem. Lets not keep our heads in the sand and think that if it's illegal it will go away, it won't! Just grow up and accept that it is hear to stay, it's been here a long time already.
Dave Parsons
- February 3, 2010 - 3:00:47 (CST)
Medical marijuana is legal in the state where I live. The legislation, the dispensaries, and the patients have all bee poorly dealt with. I am of the opinion that half measures such as this are another layer of authority, rules and regs. I would like to see Colorado cancel all the marijuana law and go back to the imperfect way things were.
Ron Lyscas R.Ph.
- February 3, 2010 - 3:15:50 (CST)
Marijuana or cannabis needs to be legalized and taxed and brought into the mainstream market, far away from criminal hands.

Cannabis has no addictive potential other than psychological addiction, which is not a true physical addiction.

The truth is so far removed from this issue that it is hard to relate to anything with regards to Cannabis with an informed opinion.
Anonymous
- February 3, 2010 - 3:33:12 (CST)
why don't we just have marijuana used for all ailments and eliminate the government-backed, FDA- approved OTC's and other nonsense meds, such as cold remedies, NSAIDS, tylenol, seroquels, prozacs, celexa (these items cause more harm than good in side effects alone).
drbill
- February 3, 2010 - 3:44:45 (CST)
just as well legalize marijuana for general use.

the idea of using it for anxiety or other neuropsychiatric disorders is ludicrous and irresponsible considering marijuana causes or exacerbates many psychiatric disorders including axiety, addiction and withdrawal manifestd by tought and mood dysregulation and thc ranks with pcp and lsd for neuropsychiatric morbidity.

this is tantamount to drinking whiskey for medicinal purposes; of course they can be mood altering and anxiety relieving in a very limited aspect. prior to the advent of modern anethesia it was common practice to intoxicate a surgical patient before surgery, but having a choice I don't think that is well accepted.
jimbo
- February 3, 2010 - 3:56:37 (CST)
Make it all legal and tax it like cigarettes so we can stop paying for the stupid things these potheads do. The price will go down, it will be semi-regulated, Columbia and Mexico will go broke and life will go on for all of us
Dr Bruce
- February 3, 2010 - 4:04:32 (CST)
Of course medical marijuana should be legalized! The FDA approved Marinol, a pretty crummy drug, presumably because it proved beneficial for a subgroup of patients (nausea, cancer cachexia). I suspect that smoked marijuana has additional alkaloids with therapeutic properties but politics seems to trump all. There is abundant anecdotal evidence of benefit. Why deprive the suffering?
Karen Hays
- February 3, 2010 - 4:05:31 (CST)
Marijuana is so less frightening than many of the drugs that are available either by Rx (narcotics, barbiturates, hypnotics) or OTC (acetaminophen, alcohol, weight loss products). The history of why it is illegal and the century of craziness and waste around its illegality makes no sense for anyone. Legalize it, standardize it, regulate it, tax it, prescribe it. And then let's quit wasting our time talking about it and solve some real problems.
Charmel F
- February 3, 2010 - 4:07:04 (CST)
I agree that mj may have a medical benefit, but I also agree with those who spoke about the psychological consequences. So we want to have people who aren't in pain or discomfort but crazy, out of their minds people walking around that will do anything. The human mind can be a very dark and cruel place. I think the long-term use of mj should be studied more rather than a now solution.
bob
- February 3, 2010 - 4:07:29 (CST)
I do not live in a state with legal mariuna. However, IF handled correctly, I can see no real issue with doing so.

I also follow some stories in Colorado newspapers, from my viewpoint the state did not consider all the details before jumping in to legalize it � resulting in a worse mess than if it was still totally illegal.

What is it legal for? Who "prescribes"? Can anyone with a medical license "prescribe"? Or can only certain people "prescribe"? Are "patients" maintained on a list? Is it a RX item? If so should it be only in "pharmacies" {NO in my opinion}. Is it an item, at special store? Who regulates the stores? Is it open to all to buy and regulated similarly to alcohol?
Joseph M. Hughes
- February 3, 2010 - 4:11:05 (CST)
As an old undercover narcotics agent for the State of Georgia in the 1960's and 1970's, I can say from long experience that marijuana is bad, bad, bad.
Dr. John Coleman
- February 3, 2010 - 4:13:59 (CST)
The medical profession needs to apologize for letting the public down on this one � once again. In the early 1900s, although medical organizations like the AMA were against patent medicines and refused to post ads in JAMA that did not list the ingredients of the product being promoted, there were quite a few doctors who nonetheless sold and promoted the use of patent medicines, most of which were worthless elixirs of cocaine or morphine or heroin or cannabis or combinations thereof laced with copious amounts of alcohol, coloring agents and flavorings. They were promoted as curing everything from the common cold to cancer. The docs knew better, of course, but, they argued, they were giving their patients what they wanted and if they didn�t buy it from the doc, they would get these potions from sidewalk vendors and/or door-to-door salesmen. Ethical? As best we can determine the positive effects of these nostrums came in the form of intoxication, a normal reaction to psychotropic substances, including alcohol. Therapeutic they were not. Even during alcohol prohibition (1919-1933), the federal government issued special prescriptions that permitted physicians only to prescribe "medicinal alcohol" in the form of wine, whiskey, and beer. And doctors did, indeed, prescribe alcohol and plenty of it during Prohibition. Ethical?

Fast-forward to the 1980s and 1990s and along comes the return of "medical marihuana" only this time it's not in the form of a tincture but, instead, promoted in the crude form of smoking dried plant material. Not surprisingly, smoked pot is touted as the cure-all for anything that ails one, from stress, to headache, to multiple sclerosis, to cancer pain and even cancer itself. How could a drug so great be overlooked so long? And, again, as in the case of alcohol prohibition, only doctors are permitted to prescribe (or recommend) it for their patients and for medicinal purposes only. Ethical?

What all these brief histories have in common is the use of intoxicants as therapeutic substances. In all three cases, doctors promoted their use knowing full well that they do not improve the patient's condition but only mask symptoms temporarily through intoxication. We could add tobacco to this list, too. A favorite ad of mine is a magazine ad from the 1950s that touts a survey of doctors who, in a national survey of physicians, preferred Camels over any other brand of cigarette.

Wake up, America, and realize that whatever therapeutic benefits we might be able to squeeze out of the pot plant needs to be synthesized, purified and manufactured to specific standards and dosing units in order to be a beneficial medicine. Consider morphine and codeine. We don't recommend that people grow opium poppies, harvest and chew the gum to get pain relief. Instead, we have synthesized and standardized pharmaceutically pure medicines. Current pot research is underway that will isolate and remove the genetic pathways that provide the molecular basis for the psychic effect.

This will be done without interfering or reducing in any way the therapeutic properties of the beneficial cannabinoids in the plant. The analogy I use to describe this research is the final product will be safe and effective � far more effective than smoking pot because the dosage will be concentrated and stronger � and not controlled because there will be no psychotropic response. In effect, if pot has medicinal benefits independent of its intoxicating effects, they should be more readily available in a finished pharmaceutical form. The users will be spared the toxic effects of inhaling smoke. Smoking anything, whether it is paper, tobacco, dry weeds, or pot, cannot be good for the lung tissue of any living organism. Finally, the new pot with its psychic effect genetically removed can be likened to decaffeinated coffee. It will have many of the same properties of the real thing except the kick. And, let�s face it, a good strong cup of Starbuck�s decaf can�t be distinguished from the regular stuff.

When all this happens in a few years, the pot heads now desperately trying to promote pot for everything and anything will be left with nothing but the fact that their story will join the other historical artifacts I described above. Their kids and grand-kids will look back and say the same thing we say when we look at those old cigarette ads from the 1950s: What were you thinking?
selwyn oskowitz MD
- February 3, 2010 - 4:18:07 (CST)
Marijuana should be legal and regulated like alcohol and taxed.
Brenda L., Rph
- February 4, 2010 - 12:00:00 (CST)
I am all for legalization and regulation. I would prefer Marijuana dispensaries, where patients are required to have a Doctor's order to obtain it. Personally, I believe it to be LESS addictive than alcohol, and definitely having medicinal value, unlike alcohol. I live in a state where Medical Marijuana is approved, but I could still be arrested for it, since the Federal Law still bans it--It is still a Schedule I drug.
rkl
- February 4, 2010 - 12:00:00 (CST)
Ethics and principles are going so low to reach the stage of legalizing marijuana as were the insuling syringes legalized in california to allow street drug abusers and users not to share needles , therefore wont get aids infections.I had a sister who had multiple sclerosis and lived and died from it without taking for once any pain killer such as acetaminophen with codeine her and our faith were so strong and she will be rewarded in heaven . making something legal does NOT cancel the fact that it is prohibited by God's books whether its The Holy Koran or the Bible . Its a pity to see all morals and ethics evaporate to be replaced with lose attitudes and judgements and regulations
Nauman Rahim Khan
- February 4, 2010 - 12:00:00 (CST)
It is available in the market since 30 years and have been used since long for curing various disorders.
Randall Weissbuch, MD
- February 4, 2010 - 12:00:00 (CST)
Marijuana has significant medical benefits. It is the least dangerous of all the recreational drugs, especially when compared to tobacco and alcohol.

Marijuana legalization is supported by 53% of the U.S. population and 56% of the California population. An initiative in California to legalize marijuana will almost certainly pass in November.

As a Libertarian running for Congress in November, I have this to say about the war on drugs:

Individuals have the moral right to engage in what others might consider to be self-destructive behavior. This is the essence of human freedom. The war on drugs is not only a denigration of this right, it is also a failure from the standpoint of its own goals. Moreover, it has destroyed families, caused violent crime, encouraged government corruption, and trampled upon our Constitution. In sum, the war on drugs is destroying the very fabric of our society. It should be ended through the total legalization of all drugs (no DEA and no FDA; drugs should be evaluated by private organizations (like Underwriters Laboratories evaluates electrical devices) and then people can make their own decisions (stupid or smart).

Resources should be utilized to offer help to people who want to quit using the really dangerous drugs---especially tobacco and alcohol.
Darwin, RPh
- February 4, 2010 - 12:00:00 (CST)
Not only should it be approved for medical purposes, it should be legalized without restriction other than age. Sell it at convenience stores and TAX the hell out of it. If we can buy cancer sticks and booze, why not marijuana? Many would argue it is safer than both. The drug problem in this country is NOT due to pot, and efforts to control it are misguided at best.
Bernadette Humphrey
- February 4, 2010 - 12:00:00 (CST)
LEGALIZE IT!!!
Sophia De Monte
- February 4, 2010 - 12:00:00 (CST)
Our aim is to provide the best medical care to our patients, and to allow each individual relief from the discomforts of acute and chronic ailments.
Lori Clark
- February 4, 2010 - 12:00:00 (CST)
I say legalize it and all other recreational drugs and let anyone over 18 buy it and let them pay a large tax on it for recreational use. Then we can get out of this ever growing debt in our country. The users are going to but it anyway, may as well make tax dollars on them.
Dr. Ati Ahmed
- February 4, 2010 - 12:00:00 (CST)
Legalization would provide tax revenue, stop illegal traffic of marijuana, stop border issues, and the list goes on and on. Also, I would like to comment on the United States lack of use of heroin for terminal patients in an earlier post by R. Cailer,NP. I am perplexed as to why we add insult to injury by witholding help to these patients. They are "terminial"! Can't they have some peace as they prepare to leave this life?
Fred Maffei
- February 4, 2010 - 12:00:00 (CST)
Do it already !!!
richard thacker
- February 4, 2010 - 12:00:00 (CST)
all drugs should be legalized-all drugs
lf
- February 4, 2010 - 12:00:00 (CST)
I agree that it has medicinal purposes and dont see that in most individuals that it really will be abused - no more so and probably less so than alcohol. Anything that is forbidden is always more sought out , so relaxing laws will allow more useful research as to beneficial medical properties of the drug.
Nancy
- February 4, 2010 - 12:00:00 (CST)
Sounds like New Jersey has learned from the other states that have legalized marijuana before them. We have a BIG mess out here in Colorado. Cudo's to NJ.
Keli Rising, HCPLive
- February 4, 2010 - 12:00:00 (CST)
Jon Dennis, MD, MPH wrote, "Legalization of marijuana in California seems to be playing out to be a disaster, with thousands of 'clinics' popping up all over, and marijuana being used for a huge population of people who don't need it medically."

Do you think people are taking advantage of legalizing marijuana for medical purposes? What about people who sell marijuana illegally? Can they claim the reason for selling it is medical-related?
harmony
- February 4, 2010 - 12:00:00 (CST)
BHP, Pharm.D.Legalization of medical marijuana is little concerning to me, we have to weigh risk vs benefits closely. I understand that termianlly ill patinet need the releif and they should get what make them feel better, but i am concerned with narcotics pain killers, benzo etc and even suboxone are now being used by people not only those who are in real need but in street and youth of america is wasteing. If medical marijuana legal in our state NJ, we have to come up with some strict regulation.

Harmony
barb
- February 4, 2010 - 12:00:00 (CST)
Yes, I think people are definately taking advantage of "medical marijuana." Smoking is an awful dosage form, with far more toxins than normal cigarettes. I think that most conditions could be treated with conventional meds. More research needs to be done to isolate certain compounds in marijuana to use specific compounds in traditional dosage forms for specific purposes.
up in smoke
- February 4, 2010 - 12:00:00 (CST)
ck out the bbc review
HCPLive
- February 4, 2010 - 12:00:00 (CST)
In line with OBTN's current feature, the news cycle continues to exhale medical marijuana stories. An airline passenger claims taking too much medical marijuana caused him to drop his pants and attack crew members. His story blows smoke in the face of the archetypal image of the marijuana user as a relaxed, unexcitable pacifist. Authorities confirmed the unruly gentleman possesses a legally issued California medical marijuana registration card. The incident will no doubt provide ammunition to anti-marijuana groups, while advocates will seek an alternative explanation for the man's high jinks.
JANICE
- February 4, 2010 - 12:00:00 (CST)
Pot should be legalized for medicinal purposes. Legalization would help reduce violence and profiting by illegal drug cartels. Let's remember the pharmaceutical industry or "legal drug cartels" have made a habit of promoting many unsafe drugs whose side effects pale in comparison to pot. In addition alcohol has probably caused more harm to our society in the number of preventable deaths than pot. Our American culture needs to learn the value of using everything in moderation. Many patients with chronic illness would benefit from put use.
Mary R, MD
- February 4, 2010 - 12:00:00 (CST)
I am from Europe and even if cannabis is illegal in many european countries,the american approach to this relatively benign drug when compared to other " legal" drugs such as pain meds and ETOH is way exagerated. The social implications of cannabis use when compared to driving drunk or dying from end-stage liver disease, or getting addicted to pain meds and break into pharmacies in order to get your fix are minor. The medical use should not even be in question, but I think that legal use of MJ in this country would not only diminish the desire to obtain it since it will be easily available but will also save the taxpayer's money, not mentioning the money made by the state in sale taxes!.
r.ashby
- February 4, 2010 - 12:00:00 (CST)
I don't think that marijuana should be legal for psychiatric disorders, only for pain control AND if it is TAXED and regulated.
Tom
- February 4, 2010 - 12:00:00 (CST)
DR. David Dansdilll (first post) is correct, it is available legally. How can we have a "war" to stop smoking and then advocate smoking a very poor drug.

I am amazed that so many people can justify it by say it will increase tax income. As if that were a good thing. I guess that is how we justify alcohol and gambling.
Mary Lynn Mathre, RN, MSN, CARN
- February 4, 2010 - 12:00:00 (CST)
As I read the oncologist's perspective on therapeutic cannabis and the comments that follow, I find those who dismiss its efficacy are basing their judgment on "reefer madness" and old myths. Cannabis is a remarkably safe and effective medicine. A tidal wave of research has been conducted over the past 2 decades. This research has not only validated the anecdotal reports of cannabis as medicine, but led to the discovery of the endogenouse (from within or self-made)cannabinoid system (ECS) that is essential to life and helps maintain homeostasis or balance. Humans have receptor sites throughout the body specifically made for cannabinoid molecules and humans make their own cannabinoids (endo-cannabinoids). It just so happens that cannabis is the ONLY plant with cannabinoids (phyto-cannabinoids) and the emerging science behind the ECS helps us understand why cannabis has such a wide variety of indications. For those who expressed concern about patients smoking cannabis - it would not be an issue if health care professionals could teach patients about vaporization or the use of tinctures and extracts that can be absorbed through the mouth. For those who think Marinol is the same as cannabis, you clearly don't know anything about the other cannabinoids,flavinoids or terpinoids found in cannabis. Marinol is synthetic THC (the primary psychoactive cannabinoid in cannabis) in sesame oil. It is highly psychoactive, may take up to 40 minutes for the onset of action, and does not provide all of the therapeutic activity found in other components of cannabis. For those concerned about the addiction potential - you need to get a realistic perspective. Cannabis has a very low potential for addiction compared to most drugs of abuse.

I strongly encourage all of you who have concerns or reservations about the efficacy of cannabis to attend The Sixth National Clinical Conference on Cannabis Therapeutics (c-osponsored by Patients Out of Time and UCSF School of Medicine)that will be held in Warwick-Providence, RI on April 16-17,2010. Its time to come out of the dark ages and learn about the evidence based clinical applications of cannabis and the ECS. Information about the conference and cannabis in general can be found at www.medicalcannabis.com. Its time you enter the 21st century cannabis research world.
Ian D. Essen, RPh
- February 5, 2010 - 12:00:00 (CST)
Marijuana has been used for thousands of years, in many forms, by many diverse societies. There are varieties grown all over the world. The bottom line, or lines, is that it is a useful plant (medicinally, recreationally and in every day life), has been demonized (mostly by uninformed politicians), is far less dangerous than alcohol, and should be available, controlled and taxed (how much of our debt could be "eaten" away by decriminalizing or legalizing it) and available to the same people that are able to drink alcohol. It was the tax question, after all, that made it "illegal" in the first place. Make it less profitable for the criminals that abuse the system as it is today!
Craig Hazen RPh.
- February 5, 2010 - 12:00:00 (CST)
If it is legalized for medical purposes then in should be dispensed in a PHARMACY on order from a medical practioner. This would ensure potency, amount, etc while proper record keeping would be maintained. It is the only thing that makes sense.
PR Kelley MD
- February 5, 2010 - 12:00:00 (CST)
It should be legalized and treated like alcohol. Let's not kid ourselves though, "medical" marijuana is all about marijuana and very little about medical. It's easier to see ETOH being used medically than pot. I believe the medical profession loses credibility by going along with the medical part of the "medical" marijuana.

More so than most drugs, it is a short term pseudo-fix with significant risks and downsides.
nnn
- February 6, 2010 - 12:00:00 (CST)
IMPORATNT???????!!!!!!!


no doubt what the united states has reached of high crime rates and high rape rates and girls at age of 13 and 14 becoming moms without husbands,is all due to the legalization of many bad medicines and habbits all through the past years,and i want to ask a question if they legalize the marijuana would they be able to control it properlly inside every house at every hour??!!

where is the united states going further on,not a single holly book or a single wise man will accept such talk and if they continue like this i think the destruction of the society and thus the whole country is just begining!!!!!!GET BACK TO WHERE WE STARTED INNOCENT PEACEFULL CREATURES JUST LIKE ALLAH SOBHANAH WANTS US TO BE,DOES ALLAH ACCEPTS THIS YOU SHOULD ASK WHO BROUGHT YOU TO THIS WORLD AND NOT HELPLESS HOPELESS CREATURES,and please read the side effects :

Marijuana Side Effects

Marijuana side effects come from smoking or consuming the drug and marijuana side effects influence the mind and body of the user. Marijuana side effects can be as seemingly innocent as an increased appetite to as life threatening as lung cancer. Increased likelihood for accidents is also one of the marijuana side effects. Studies show that 6 to 11 percent of fatal accidents are contributed to by marijuana side effects. Other external marijuana side effects include legal problems, work and financial problems and troubles at home.

Marijuana is most often smoked but can be eaten or steeped in tea to drink. Most over-doses occur actually when the drug is eaten because it is easier to consume a large dose all at once. Marijuana side effects from an overdose include toxic psychosis including hallucinations, delusions and a loss of self-identification. When smoked, marijuana is rolled up into a cigarette called a joint or smoked in a pipe or water pipe called a bong. Marijuana has many street names like pot, hash, chronic and there are many paraphernalia available to smoke it.

Marijuana side effects include physical problems like breathing difficulties and deteriorating physical abilities. Despite a popular belief, marijuana side effects speed up the heart, blood and breathing rate. The body is taxed more and this speeds up the aging process just like methamphetamines do. The marijuana side effects from this extra exertion on the body include a higher risk for lung cancer, heart attacks and strokes.

Marijuana side effects also wreak havoc on the brain when the drug is used habitually. The natural chemical balance of the brain is disrupted affecting the pleasure centers and regulatory systems. The ability to learn, remember and adapt quickly to changes is impaired by marijuana use. Depression often occurs with marijuana usage, which feeds into the cycle of more drug use to treat the pain created by drug use. This cycle of addiction is very powerful and users soon find that they cannot stop using the drug even if they want to.

Marijuana addiction is a progressive disease and marijuana side effects include withdrawal and obsessive thought with the drug when it is not made available. Addiction is identified as a compulsive, uncontrollable craving for the drug even with pending negative consequences. Often users will attempt to stop smoking marijuana for an important event such as a job interview or court hearing and find themselves using very close or just before the event. This act goes beyond a flexing of willpower. This describes being enveloped by a disease that has taken control and needs to be treated.
Kerrie K
- February 6, 2010 - 12:00:00 (CST)
As a patient with chronic pain, daily nausea and lifelong migraines, I would benefit from medical marijuana. It is not allowed in my state. I am currently undergoing multiple tests to find the source of my nausea. I can easily tell them it is because of the 15 different pills I have to take numerous times a day. Honestly, I don't see why the doctor doesn't see this, it is so obvious. I pray daily that soon, my state will approve the use of MM, so I may have good days, not just long, black days of pain. My pain pills are limited and of little relief. The doctor is so afraid of prescibing narcotics, I wonder why he practices at all. I truly NEED MM, but doubt I will live long enough to see it come to fruition in my state.
Jerrome
- February 6, 2010 - 12:00:00 (CST)
Legalize MM; put it under strict control; only available by CII prescriptions; pts can gain access by the equivalent of pain management centers ... LEGALIZATION is coming; should main stream medicine and our politicians continue to 'legally' deny our fellow Americans real relief? It would be terrific economically compared to the SUPER HIGH COSTS of many alternatives now being used ... with DAMN fewer side effects.

When will we get it ... what is holding us back?
Teresa Stickler, Rph
- February 7, 2010 - 12:00:00 (CST)
Legalize it!
Yvonne Barash RN BSN
- February 8, 2010 - 12:00:00 (CST)
Reading Mary Lynn Mathre's post gets me to thinking: If you want to legalize it, then we should have a standard pharmaceutical product that we can deal with. Maybe bump it down a notch or two on the DEA controlled substance schedule. Otherwise, in my opinion, it may send the wrong message (especially to young people prone to experimentation).
LiLa
- February 11, 2010 - 12:00:00 (CST)
marijuana helps migraine headache sufferers, with no side effects.
DUNCAN OVERDORFF PHARMACIST
- February 14, 2010 - 12:00:00 (CST)
Orally administered maryjane is probably the a safe naturally occuring substance that should be available without prescription. Probably the only bill that was ever passed unamously by both the national senate and congress should exempt the fda FROM control of this substance. Virtually every year the Drug companies and the FDA try to align our system with the one in Europe by making natural substances prescription only. This would be a big mistake leading to orphan nutritional substances that would be by prescription only. Unfortunately very few would ever be avaialbe due to the expenses involved with FDA APPROVAL. Currently we need to write our senators once again to prevent moves in this direction. Senator McCain is currently trying to change the Dietary Supplement Health and Education Act which I mention was passed unamously. See the alliance for natural health for more details. It might not hurt to ask you representitives to defeat this bill as well as to legalize some natural form of maryjane.
Phyllis
- March 13, 2010 - 12:00:00 (CST)
"If the Lord put marijuana on this earth for a purpose, and we have found many purposes for its use, then whom are you to dispute it." Phylisofical
systah
- June 24, 2010 - 5:36:24 (CDT)
The THC is not the issue, the legalization is not the real issue, it's that people like me who DO NOT want pot in their systems are now fighting "legal" marijuana smokers in their own homes. There is no recourse for those of us living in an apartment with someone smoking pot beneath us. YES I could move but is that right? If I was there first? What about the family next door who is poor, can't afford to move who has an asthmatic child? They have gone to the emergency room twice now because of pot smoke in their apartment has caused a reaction. There is nothing we can do about it. We can't call the cops or management cannot evict them. Now ONE pot smoker is displacing multiple families so they can be high. We hear the young guys below who have their friends over partying and smoking pot all the time. NO DO NOT LEGALIZE MARIJUANA, it will get worse. The government needs to retract the legalization, reset it, and make it only legal to take THC pills or only use marijuana vaporizers for terminally ill and those with approved disorders. I live in California, it is very out of hand. My ex boyfriend who had a knee injury from last year, he rock-climbs now and mountain bikes. He went to a pot doc who gave him a prescription. He wasn't even taking ibuprofen before. No one checked up on him. He now has a prescription for 1 year WTF????!!!
Jill Pitcher, DO
- July 21, 2010 - 10:51:35 (CDT)
Even a short time spent on research articles finds signficant support for many uses of medical marijuana including 2 referenced US dept of Health sponsored studies that show positive results against brain tumors, unlike the article states. It is the physicians who are allowing abuse of the system, not the system that fails here.
 
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