MARIJUANA NOT A GOOD CHOICE AS MEDICINE

In my work as an emergency physician and as a county coroner, I
frequently order tests to determine whether a person has illicit
drugs in their blood or urine. While I am not naive enough to think
that all people will turn out to be clean and sober, I am amazed at
how many people have a positive test for cannabinoids, which are the
active ingredients in marijuana (Cannabis sativa).

I recognize that there are some legitimate medical uses for
cannabinoids. However, the people with the positive tests are
generally not suffering from nausea, vomiting, pain, loss of
appetite, asthma, glaucoma, nor spasticity. They have been consuming
marijuana for other reasons.

Although 14 states in the U.S. (Alaska, California, Colorado, Hawaii,
Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon,
Rhode Island, Vermont and Washington) now permit, or soon will
permit, some medical use of marijuana, Indiana still does not
recognize it for legal medical use.

In some states, by prescription, licensed facilities dispense
marijuana grown in controlled settings. In others, limited
self-cultivation (grow your own) is permitted for medical use.

Nationally, the marijuana plant itself is a Drug Enforcement Agency
(DEA) schedule I controlled substance (high abuse potential with no
legitimate medical use).However, it may be both eaten and smoked to
relieve nausea, vomiting and pain and to treat many other ailments as
noted above.

It appears to be fairly effective, depending on the dose, for some of
these disorders. But there are no really good studies large enough
and standardized enough to be convincing.

On the other hand, two cannabinoid-like drugs, dronabinol (Marinol)
and nabilone (Cesamet), have been FDA-approved since 1985.

Both of these drugs are effective for prevention and treatment of
nausea and vomiting due to mild or moderate side effects of
anticancer drugs. However, they are less effective with the more
severe side effects of drugs such as cisplatin, where other
available drugs such as ondansetron (Zofran, and others) and
aprepitant (Emend) appear to be more effective and better tolerated.

There is even a drug to spray in the mouth called Nabiximols
(Sativex), which is a liquid extract containing constituents of
marijuana. This is approved in Canada for treatment of central
nervous system pain in multiple sclerosis (MS). It is also in phase
III trials in the U.S. for treatment of uncontrollable cancer pain.

A small study in healthy young adults of the effects of active
chemicals from marijuana on sleep found no significant effect on the
ability to fall asleep, length of time sleeping, or the quality of
sleep. Subjects who took only one of the components called
tetrahydrocannabinol (THC) reported difficulty with memory the next
morning.

Although death from acute overdose of marijuana alone has not been
reported, there are many possible side effects. Dry mouth,
drowsiness, low blood pressure when sitting or standing, difficulty
standing or walking, and dizziness do occur frequently with medical
use of both natural marijuana and synthetic products. Anxiety, rapid
heartbeat, agitation and confusion are also common, especially in
older patients, and driving may be impaired.

In 2008, an article was published in a prestigious British medical
journal, The Lancet, which indicated that individuals who used
marijuana on a weekly or daily basis had up to three times more risk
for developing psychosis later in life compared to non-users.

The authors carefully looked at dozens of previous studies and found
the evidence to be strong enough to advise everyone, particularly
young people, that the use of marijuana does potentially have some
health risks, especially if they are using it on a regular basis.

Although an individual's lifetime risk of developing a serious
psychotic illness is only about two or three percent, the use of
medical marijuana may increase that risk.

Since there are other drugs available to treat the problems for which
medical marijuana is suggested, I see no need to add it to my
prescribing choices if it becomes legal in Indiana.

However, I note that Michigan is among the 14 states listed above. If
someone shows up in the ER with a prescription bag of marijuana, I am
not sure what I will do about it.

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Editor's note: Past columns by Dr. Gaff as well as reader comments
and Dr. Gaff's responses can be found at kpcnews.com/special/health.