MEDICAL MARIJUANA

Still Another Drug Of Abuse, So Weigh The Consequences

Marijuana certainly has been in the news lately. My goal here is not
to question whether marijuana should be legalized, or to claim that
it has no medical benefits or to suggest that I have the answers to
the many problems that it poses. There are some reasonable arguments
for legalization of marijuana. It is still, however, another drug of
abuse. Many supporters of marijuana legalization claim it is safer
than cigarettes and causes fewer problems than alcohol abuse.
Marijuana may be safer and cheaper than opiates and other medications
used for cancer patients.

Many of the medical benefits of marijuana have been overstated, as is
the case with many herbs and supplements. Many of the claims for
marijuana's value in illnesses such as MS, glaucoma, Crohn's disease,
Parkinson's disease or the agitation of Alzheimer's disease have not
borne out. It does, however, appear to have some value in patients
with weight loss due to chronic disease and disease-related nausea
problems.

We don't have a lot of good data on the use of marijuana as a
medicine. We have little knowledge of its safety profile when used
alone or along with other medicines.

Can it make other medicines weaker and less effective or possibly
more potent? What will happen when patients use it as a medicine,
using it more often, for longer periods? Its availability will surely
encourage individuals to use it for its many unproven disorders. It
is being used already to treat autism, though no studies support such
a usage.

In California, we hear of doctors recommending medical marijuana for
teenagers with psychiatric conditions including attention-deficit
hyperactivity disorders. For such patients, it ought to be a concern,
using a drug like marijuana that is known to disrupt attention,
memory and concentration. We have no clue as to what will be the
long-term complications of marijuana use for these young people.

Marijuana smoke contains some of the same cancer causing toxins found
in tobacco.

Recent studies have shown that long-term marijuana use increases the
risk of lung cancer in young adults. Cigarette smoking, common among
marijuana users, further increases the risk. It is just recently that
we discovered the increased heart attack rate among people exposed
to secondhand tobacco smoke. We have no idea if the same might be
true with marijuana smoke exposure.

According to the National Institute of Health, marijuana (like
heroin) has a similar structure to chemical messengers, called
neurotransmitters, which are naturally produced by the brain. Because
of this similarity, these drugs are able to "fool" the brain's
receptors and activate nerve cells to send abnormal messages.

Most people today smoke marijuana only occasionally. A small percent
smoke it on a daily basis. Another small percentage of marijuana
smokers develop dependence on it. This is even more likely if they
use tobacco products.

We need to consider whether better availability of marijuana, loss of
its stigmatization, designation as a legal substance and lower cost
will result in more marijuana users, more frequent usage, and greater
usage in younger individuals with the eventual detection of more
individuals whose genetic, social or environmental constitution makes
them more prone to dependency and withdrawal reactions. Marijuana
often has been called a "gateway drug," though supporters of its use
often reject this and claim tobacco and alcohol might easily fit
into that same category. According to the NIH, long-term studies of
high school students and their patterns of drug use show that very
few young people use other illegal drugs without first trying
marijuana. It may be that using marijuana puts children and teens in
contact with people who are users and/or sellers of other drugs. So,
there is more of a risk that a marijuana user will be exposed to and
urged to try more drugs.!

For me, the greatest concern about the ready availability of
marijuana is the effect it will have on our youth.

In California and several other states, adults can acquire "medical
marijuana" for the most insignificant problems. A segment of the
physician population has become "marijuana providers" (writing
prescriptions for patients they don't know and have not examined) at
great personal profit.

Parents who smoke and/or drink heavily and now abuse marijuana
definitely will have a negative impact on their children and their
early experiments with drugs of abuse.

One recent study tells us that 40 percent of high school students
have tried marijuana. Marijuana use - at 11 percent of eighth
graders, 23.9 percent of 10th graders and 32.4 percent of 12th
graders - had been slowly declining until recently when it appears to
have leveled off.

Another recent study of first-year college students at a large
Eastern university found marijuana use disorders in over 9 percent of
first-year students and 26.6 percent among past-year marijuana users.
Such use disorders for those using marijuana over five times over
the past year, included concentration problems (40 percent), driving
while high (18.6 percent) and missing class (13.9 percent).

Marijuana has played a role in car accidents. A study conducted in
Memphis, Tenn., showed that of 150 reckless drivers who were tested
for drugs at the arrest scene, 33 percent tested positive for
marijuana and 12 percent tested positive for both marijuana and cocaine.

Studies also have shown that while smoking marijuana, people show the
same lack of concentration on standard "drunk driver" tests as people
who have had too much to drink.

Again one wonders what will happen when marijuana becomes more
accessible and cheaper for adult as well as teen drivers.

Certainly for adults, but especially for young people, is the problem
of marijuana withdrawal.

A recent study out of Columbia University, describing frequent users
of marijuana as those using it three or more times per week, found
withdrawal symptoms in over one-third of users. These withdrawal
symptoms included such problems as weakness, sleepiness, psychomotor
retardation, anxiety, restlessness, depression and difficulty sleeping.

Marijuana withdrawal symptoms are very similar to the picture seen
with nicotine discontinuation. Those withdrawal symptoms caused some
users significant distress and led them to use other substances to
relieve or avoid the withdrawal symptoms.

Another recent study from the University of Minnesota found
significantly elevated marijuana use disorders at each of the teenage
years (ages 12 to 18) when compared to older recent onset users (ages
22 to 26) suggesting that adolescence is a particularly vulnerable
period for developing a substance abuse disorder.

In summary, as we are pondering the programs to make marijuana more
available for medical use, we need to consider:

For what medical disorders has marijuana been scientifically proven
effective?

What is the safety profile for medical marijuana? Will it interfere
with other medications? What is its long term safety profile?

Are there proven drugs of equal or better efficacy and proven safety
that can accomplish the same therapeutic goals?

Are there oral forms of marijuana that are just as effective, and
which avoid the toxic compounds in the smoke and the secondhand smoke
component?

Who will determine whether physicians are indiscriminate in
prescribing, or prescribing marijuana for questionable medical purposes?

Who will control the number of "pot" dispensaries? It has been
suggested that there are as many pot dispensaries as there are
Starbucks in parts of California. Won't this make it difficult to
oversee and regulate these dispensaries and their activities?

Who will look out for the illegal pot ventures that pot dispensaries
are known to spawn?

And, most important, what safeguards can be achieved that will
prevent the increased flow of marijuana from pot dispensaries from
reaching our children?

We need to ask if our parents, educators and community leaders are
ready to meet the challenge presented by the greater availability of
still another drug of abuse.

Dr. Carl E. Bartecchi, a Pueblo physician, is clinical professor of
medicine at the University of Colorado School of Medicine.