MEDICAL MARIJUANA AT ODDS WITH DOCTORS' PROMISE

Several of my patients have asked about the medicinal use of
marijuana. Some are cancer patients, others have chronic pain syndromes.

There's a conundrum here. Physicians must do their utmost to alleviate
pain and suffering, adhere to an accepted standard of care based on
scientific evidence and data and, most importantly, not harm the patient.

There is new evidence that marijuana does help alleviate pain and
combats the nausea and vomiting associated with chemotherapy. Other
uses include slowing the progression of weight loss in AIDS and cancer
sufferers; treating non-stop hiccups; glaucoma therapy; reduction of
tremors; and improvement of multiple-sclerosis symptoms.

What has research uncovered about marijuana?

Tetrahydrocannabinol (THC). marijuana's active ingredient, is a
cannabinoid. There are two known specific cannabinoid receptors or
binding areas within the brain and central nervous system. The
physical and psychological effects derive from THC binding to these
receptors.

Intoxication occurs after the first few minutes of smoking marijuana
and lasts three or four hours. The physical effects include rapid
heart and breathing rate, increased blood pressure, reddened eyes, dry
mouth, increased appetite, impaired reaction time and immune system
suppression.

Psychological effects include euphoria, a distorted sense of time,
depression and/or anxiety, impaired short-term memory, paranoia and
mystical thinking.

Users assume that after their high they axe no longer under the
influence of THC, but this isn't true. Body fat accumulates marijuana
and will continue to release THC over an extended time. Recent
evidence indicates thought processes, decision-making ability,
judgment and coordination remain compromised 13 to 24 hours after the
last joint. This impairment worsens with alcohol or other drug use.
Evidence indicates that individuals who test positive for THC are more
often involved In fatal traffic accidents.

Consistent and reproducible evidence indicates marijuana use does
cause cognitive deficits lasting hours, if not days, after use.
Research continues to look at whether this deficit persists with
long-term use.

Marijuana is physically addictive. Stopping marijuana after 21 days
of heavy use produces a withdrawal syndrome within 10 hours of the
last dose. The symptoms include irritability, agitation, depression,
insomnia, nausea, loss of appetite, and shakes. They peak in 48 hours
and last five to seven days.

The health risk is akin to tobacco smoking. Marijuana smoke's tar
content is four times greater than tobacco's and contains 50 per cent
more cancer causing chemicals (carcinogens). Marijuana and cigarette
smoking technique differs: inhaling from a joint delivers almost twice
as much smoke, inhalation time lasts one-third longer and
breah-holding is four times longer than with cigarette smoking.

Joints do not have filters. More particulate matter deposits
throughout the upper airway and lung tissue. Continued use will
reduce the smoker's exercise capacity and cause chronic obstructive
lung disease. Three to four joints per day produce the equivalent
lung damage of 20 cigarettes a day as proven by microscopic
(histological) evaluation of lung tissue.

Marijuana reduces testosterone levels in men leading to impotence,
impaired sex drive and breast development (gynecomastia). Infertility
is a risk because of a reduction in sperm counts and sperm motility.

Chronic use in women can shorten menstrual cycles and stimulate the
breast to produce and leak milk as a result of increases in the
hormone prolactin. THC will accumulate in breast milk and will enter
the fetus's bloodstream increasing the risk of low birth weight babies
and abnormal newborn reflexes and responses.

Recent studies in the British Medical Journal and the American Journal
of Psychiatry evaluated the relationship between marijuana use and the
development of clinical depression/anxiety in teens. Daily smoking by
young women had a five-fold increase in the odds of reporting
depression and anxiety, even when accounting for the use of other drugs.

There may indeed be subgroups of people who can tolerate frequent use
of marijuana better than others. This argument is like the
95-year-old, chain-smoking grandmother outliving her family.
Unfortunately, most of us do not have Grandma's luck or genes.

The studies raise more questions than they answer. There are too many
unknown variables and known serious consequences that increase the
risk of patient harm contravening the "do not harm" tenet of medical
care.

Marijuana's legislated use as a prescription drug circumvents standard
drug safety protocols and is not the standard of care. There is a
safer drug alternative for some patients that mimics THC's effects.

Cesamet (nabilone), a cannabinoid available in pill form, received
approval to treat chemotherapy-induced nausea and vomiting in 1981.
It's use extends to treating chronic pain syndromes. It's
side-effects (akin to marijuana) are reversible. It is not
carcinogenic and does not cause the myriad of health problems
associated with smoking marijuana. it may have applications for other
medical conditions.

Most physicians will prescribe a drug that has been through thorough
patient safety testing and clinical efficacy trials. Patients must
chose their own treatment plan using all credible evidence. I and
many other physicians choose not to prescribe marijuana for long-term
chronic illness based upon this evidence. I cannot prescribe a
medication that has the potential over years of use to cause more
known harm and health complications in addition to the patient's
original condition.