MEDICAL MARIJUANA? IT'S A BAD IDEA

This column is about medical marijuana, not the issue of the
legalization of marijuana. These are different issues.

The concept of medical marijuana differs from anything else in the
field of medicine. A physician is required to write a prescription
for a drug that meets none of the criteria of other prescription medications:

1. There is no knowledge by the physician of the dosage of the active
ingredients in the drug being prescribed.

2. There is no knowledge by the physician of the purity of the product.

3. There is no standardization of manufacturing.

4. There is no protection offered by sealed, certified containers.

5. There is absolutely no quality evidence of effectiveness or risk
as is required for every other drug he writes.

In my opinion, writing a prescription for marijuana represents a
deviation from standards and ethics, regardless of the legality. I
wouldn't want to be the physician who writes a prescription for
marijuana that turns out to contain a dangerous substance.

In the 1970s, marijuana was shown to lower the intra-ocular pressure
in some patients. Since then, it has been touted as a miracle drug
for glaucoma. In fact, there has never been a study that shows the
dosage of marijuana that must be consumed to achieve a beneficial
level or that marijuana use has resulted in good control of glaucoma.

On the contrary, the American Academy of Ophthalmology has cited
numerous studies over 30 years that do not show evidence of the value
of marijuana for primary open-angle glaucoma (the most common type).
Their findings include the fact the marijuana only controls pressure
for 3-4 hours and only when a high level of euphoria is achieved.
They also express concern that the blood pressure-lowering property
of marijuana may compromise blood flow to the optic nerve, damage to
which is the cause of vision loss in glaucoma.

Just as important, the adverse effects of marijuana are not being considered.

The list of adverse effects is very long. One of the most studied is
memory and executive (higher) function. There is strong evidence that
marijuana damages memory for up to 28 days in low-moderate users, but
in chronic heavy users, it may be permanent.

An excellent large-scale recent review shows the nature of the
functional impairments of marijuana used at various levels:
www.nature.com/npp/journal/v31/n10/full/1301068a.html

The ophthalmology academy also points out the most critical issue ?"
there are safe, highly effective topical drugs that control glaucoma
without turning someone into a spaced-out cartoon character.

What Good Is It?

But, of course, there are other uses.

One of these is the nausea of chemotherapy. This is a valid use, as
nausea is a subjective symptom and dosing can be controlled by the
user. However, long-term use, beyond the treatment period, is not
appropriate nor is the use of this drug for someone claiming need
without documenting the chemotherapy drugs. I fully support the use
of marijuana for cancer patients.

Then there is the anorexia with advanced AIDS. This, again, is a
valid use. However, there is clear evidence it is being used for
HIV-positive patients who do not have evidence of the weight loss
that accompanies AIDS.

A Question of Pain

But the big use is "pain management." What nonsense. Pain is a purely
subjective complaint. Marijuana is not an effective medication for
controlling pain. It gets you high. There are pain receptors that
respond to cannabis ?" CB1 and CB2. However, affecting these pain
receptors gives only a low level of pain reduction. Comparing pain
control with marijuana to that of the use of opioids and/or proper
behavioral intervention and exercise is ludicrous for chronic pain.
In California, it is estimated that more than 98 percent of medical
marijuana prescriptions are given for highly questionable pain diagnoses.

The inventing of medical marijuana is not for true medical reasons.

In California, the "licenses" are given by doctors who simply sit in
their office a few days a week, write down a patient's story, charge
$200-400 for a 6-12 month license. The 25-year-old patient who goes
to his regular doctor with repeated requests for narcotics for back
pain has enough "evidence" to satisfy the marijuana doctor's
requirement for a license.

Despite this being an easy, highly lucrative source of income that
requires little time, there are amazingly few California doctors who
hold themselves as "marijuana doctors." The ethics of the profession
stays instilled in the overwhelming majority of my colleagues.

One more thing. I always hear people talk about liquor and cigarettes
being allowed, but these are not being called medicines that require
prescriptions. Also, the old logical fallacy of "two wrongs don't
make a right" comes into play.

Next week, I may write about the issue of legalizing marijuana, an
area that does have some valid points.