MARIJUANA SMOKING DOES NOT CAUSE LUNG CANCER, TASHKIN CONCLUDES;

Protective Effect "Not Unreasonable"

Marijuana smoking -"even heavy longterm use"- does not cause cancer of the
lung, upper airways, or esophagus, Donald Tashkin reported at this year's
meeting of the International Cannabinoid Research Society. Coming from
Tashkin, this conclusion had extra significance for the assembled
drug-company and university-based scientists (most of whom get funding from
the U.S. National Institute on Drug Abuse). Over the years, Tashkin's lab
at UCLA has produced irrefutable evidence of the damage that marijuana
smoke wreaks on bronchial tissue. With NIDA's support, Tashkin and
colleagues have identified the potent carcinogens in marijuana smoke,
biopsied and made photomicrographs of pre-malignant cells, and studied the
molecular changes occurring within them. It is Tashkin's research that the
Drug Czar's office cites in ads linking marijuana to lung cancer. Tashkin
himself has long believed in a causal relationship, despite a study in
which Stephen Sidney examined the files of 64,000 Kaiser patients and found
that marijuana users didn't develop lung cancer at a higher rate or die
earlier than non-users. Of five smaller studies on the question, only two
- -involving a total of about 300 patients-concluded that marijuana smoking
causes lung cancer. Tashkin decided to settle the question by conducting a
large, population-based, case-controlled study. "Our major hypothesis," he
told the ICRS, "was that heavy, longterm use of marijuana will increase the
risk of lung and upper-airways cancers."

The Los Angeles County Cancer Surveillance program provided Tashkin's team
with the names of 1,209 L.A. residents aged 59 or younger with cancer (611
lung, 403 oral/pharyngeal, 90 laryngeal, 108 esophageal). Interviewers
collected extensive lifetime histories of marijuana, tobacco, alcohol and
other drug use, and data on diet, occupational exposures, family history of
cancer, and various "socio-demographic factors." Exposure to marijuana was
measured in joint years (joints per day x years that number smoked).
Controls were found based on age, gender and neighborhood. Among them, 46%
had never used marijuana, 31% had used for less than one joint year, 12%
had used for 1-10 j-yrs, 5% had used 10-30 j-yrs, 2% had used for 30-60
j-yrs, and 3% had used for more than 60 j-yrs.

Tashkin controlled for tobacco use and calculated the relative risk of
marijuana use resulting in lung and upper airways cancers. A relative risk
ratio of .72 means that for every 100 non-users who get lung cancer, only
72 people who smoke get lung cancer. All the odds ratios in Tashkin's study
turned out to be less than one! Compared with subjects who had used less
than one joint year, the estimated odds ratios for lung cancer were .78 for
1-10 j-yrs [according to the abstract book and .66 according to notes from
the talk] .74 for 10-30 j-yrs; .85 for 30-60 j-yrs; and 0.81 for more than
60 j-yrs. The estimated odds ratios for oral/pharyngeal cancers were 0.92
for 1-10 j-yrs; 0.89 for 10-30 j-yrs; 0.81 for 30-60 j-yrs; and 1.0 for
more than 60 j-yrs. "Similar, though less precise results were obtained for
the other cancer sites," Tashkin reported. "We found absolutely no
suggestion of a dose response."

The data on tobacco use, as expected, revealed "a very potent effect and a
clear dose-response relationship -a 21-fold greater risk of developing lung
cancer if you smoke more than two packs a day." Similarly high odds
obtained for oral/pharyngeal cancer, laryngeal cancer and esophageal
cancer. "So, in summary" Tashkin concluded, "we failed to observe a
positive association of marijuana use and other potential confounders."

There was time for only one question, said the moderator, and San Francisco
oncologist Donald Abrams, M.D., was already at the microphone: "You don't
see any positive correlation, but in at least one category, it almost
looked like there was a negative correlation, i.e., a protective effect.
Could you comment on that?" [Abrams was referring to Tashkin's lung-cancer
data for marijuana-only smokers, 1-10 j-yrs.]

"Yes," said Tashkin. "The odds ratios are less than one almost
consistently, and in one category that relationship was significant, but I
think that it would be difficult to extract from these data the conclusion
that marijuana is protective against lung cancer. But that is not an
unreasonable hypothesis."

Abrams had results of his own to report at the ICRS meeting. He and his
colleagues at San Francisco General Hospital had conducted a randomized,
placebo-controlled study involving 50 patients with HIV-related peripheral
neuropathy. Over the course of five days, patients recorded their pain
levels in a diary after smoking either NIDA-supplied marijuana cigarettes
or cigarettes from which the THC had been extracted. About 25% didn't know
or guessed wrong as to whether they were smoking the placebos, which
suggests that the blinding worked. Abrams requested that his results not
be described in detail prior to publication in a peer-reviewed medical
journal, but we can generalize: they exceeded expectations, and show
marijuana providing pain relief comparable to Gabapentin, the most widely
used treatment for a condition that afflicts some 30% of patients with HIV.

After Abrams's presentation, a questioner bemoaned the difficulty of
"separating the high from the clinical benefits." Abrams responded: "I'm an
oncologist as well as an AIDS doctor and I don't think that a drug that
creates euphoria in patients with terminal diseases is having an adverse
effect." His study was funded by the University of California's Center for
Medicinal Cannabis Research.

The 15th annual meeting of the ICRS was held at the Clearwater, Florida,
Hilton, June 24-27. Almost 300 scientists attended. R. Stephen Ellis, MD,
of San Francisco, was the sole clinician from California. Medical student
Sunil Aggarwal, Farmacy operator Mike Ommaha and therapist/cultivator Pat
Humphrey showed up to audit the proceedings... Some of the younger European
scientists expressed consternation over the recent U.S. Supreme Court
ruling and the vote in Congress re-enforcing the cannabis
prohibition. "How can they dispute that it has medical effect?" an
investigator working in Germany asked us earnestly. She had come to give a
talk on "the role of different neuronal populations in the pharmacological
actions of delta-9 THC."

For most ICRS members, the holy grail is a legal synthetic drug that exerts
the medicinal effects of the prohibited herb. To this end they study the
mechanism of action by which the body's own cannabinoids are assembled,
function, and get broken down. A drug that encourages production or delays
dissolution, they figure, might achieve the desired effect without being
subject to "abuse..." News on the scientific front included the likely
identification of a third cannabinoid receptor expressed in tissues of the
lung, brain, kidney, spleen and smaller branches of the mesenteric artery.
Investigators from GlaxoSmithKline and AstraZeneca both reported finding
the new receptor but had different versions of its pharmacology. It may
have a role in regulating blood pressure.

Several talks and posters described the safety and efficacy of Sativex,
G.W. Pharmaceuticals' whole-plant extract containing high levels of THC and
CBD (cannabidiol) formulated to spray in the mouth. G.W. director Geoffrey
Guy seemed upbeat, despite the drubbing his company's stock took this
spring when UK regulators withheld permission to market Sativex pending
another clinical trial. Canada recently granted approval for doctors to
prescribe Sativex, and five sales reps from Bayer (to whom G.W. sold the
Canadian marketing rights) are promoting it to neurologists. Sativex was
approved for the treatment of neuropathic pain in multiple sclerosis, but
can be prescribed for other purposes as doctors see fit.

A more detailed report on the ICRS meeting will appear in the upcoming
issue of O'Shaughnessy's, a journal put out by California's small but
growing group of pro-cannabis doctors. To get on the mailing list, send a
contribution of any amount to the CCRMG (California Cannabis Research
Medical Group) at p.o. box 9143, Berkeley, CA 94709. It's a 501c3
non-profit and your correspondent's main source of income.

Meanwhile, Back in California...

The California contingent was en route to the ICRS meeting when Marian Fry,
M.D. and her husband, attorney Dale Schafer, were arrested on federal
charges of conspiring to provide marijuana to a patient. On the same day,
June 22, three San Francisco cannabis clubs were raided by the DEA and 19
people -all Asians and a few Latinos-charged with conspiracy to cultivate
and distribute more than 1,000 marijuana plants. Affidavits allege that
they grew cannabis in rented houses in S.F., the East Bay and the Peninsula
for sale to dispensaries and on the black market. The alleged leader, Vince
Ming Wan, is one of several defendants who have not yet been apprehended or
turned themselves in.

Three men -Enrique Chan, Richard Wong, and Thy Quang Nguyen-were also
charged with intent to sell ecstasy. (An undercover agent allegedly had
purchased 1,000 tabs from Chan. During the raids on 26 locations, a total
of 50 tabs were found on one individual.) Wong and Phat Van Vuong were also
charged with money laundering. Defense lawyers say the alleged money
laundering consisted of using dispensary proceeds to underwrite the grow
ops. At a July 1 detention hearing, bail for Wong was set at $2 million.

Former district attorney Terence Hallinan is representing Sergio Alvarez,
who hired him months ago after police raided a Hunters Point warehouse
where Alvarez was allegedly cultivating marijuana. "I didn't know at the
time that that would become part of a conspiracy case," Hallinan said after
the detention hearing. Alvarez's bail was set at $500,000; his
working-class parents are putting up their modest Sunnyvale home as surety.
Hallinan says that every cannabis dispensary has links to a network of
growers, and that the decision to take down these three was an attempt to
exploit anti-Asian sentiment. "They asked themselves, 'Who will we start
with now that we've been given permission [by the U.S. Supreme Court's
ruling in the Raich case]? Let's go after the Chinese!' San Francisco has
more than a hundred-year history of anti-Chinese attitudes and policies,
from 'String 'em up by their pigtails' to restricting them to the ghetto of
Chinatown."

Contemporary resentments towards Asians in San Francisco center around
their apparent economic successes. It's an impossibly expensive housing
market, and one occasionally hears non-Asians say, with mixed admiration
and envy, things like: "How can they arrive from Hong Kong in 1995 and buy
a house in the Sunset in 1996?" The answer is: by pooling resources
(conspiring) with friends and family to make the down payment.

The Inner Sunset

I used to have the real estate knack

But all that I gaineth, I giveth back

Only to wind up with you in this cozy

Old shack in the Inner Sunset years

Obviously I did everything wrong

Except one or two that strung me along

The road to the club called Chez Nancy Wong

A shack in the Inner Sunset years

Where there's noodles at midnight

If you are in need of a treat

Where the Judah car makes an 'N'

'n careens down the streeeeet

I still believe that it's all within reach

A big enough place between here and the beach

And from each and according to each

A shack in the sunset in the sunset years

The blood orange sunset years...

The cool gray sunset years...