SMOKING POT KILLS... NOT.

For the health-conscious pothead who can't afford or can't get motivated to
use a vaporizer, the mother of all questions has to be: does smoking
cannabis lower life expectancy? A recent editorial in the British Medical
Journal generated ominous headlines, attributing some 30,000 deaths
annually in the UK to cannabis smoking. But you can relax a little, dear
reader: the authors simply extrapolated from the number of deaths caused by
cigarette smoking (120,000) and assumed that pot smoking was 1/4 as common
and equally dangerous.

In the Sept. 20 BMJ, Stephen Sidney, MD -the associate director of clinical
research for Kaiser Permanente, who has conducted the most relevant
studies-explains how to approach the question scientifically:

"Firstly, we need to examine published data regarding use of cannabis and
mortality. These data come from two large studies. The first study done in
a cohort of 45,450 male Swedish conscripts, age 18-20 when interviewed
about the use of cannabis, reported no increase in the 15-year mortality
associated with the use of cannabis after social factors were taken into
account.

"The second study was performed in a cohort of 65,171 men and women age
15-49, who were members of a large health maintenance organization in
California, United States. [Sidney is referring to the Kaiser study on
which he was principal investigator. His paper describing the results,
'Marijuana and Mortality,' was published in the American Journal of Public
Health in 1997.] They completed a questionnaire assessing their use of
cannabis, and reported no increase in mortality associated with use of
cannabis over an average of 10 years of follow up, except for AIDS-related
mortality in men. A detailed examination showed that the mortality link
between cannabis and AIDS was not a causal one. Thus published data do not
support the characterization of cannabis as a risk factor for mortality.

"Secondly, we need to consider the time course of exposure to cannabis and
its potential relation to mortality. No acute lethal overdoses of cannabis
are known, in contrast to several of its illegal (for example, cocaine) and
legal (for example, alcohol, aspirin, acetaminophen) counterparts.

"Deaths due to chronic diseases resulting from substance misuse generally
result from the use of that substance (for example, tobacco and alcohol)
over a long time. Importantly, and in contrast to users of tobacco and
alcohol, most cannabis users generally quit using cannabis relatively early
in their adult lives. The proportion of older adults who use cannabis is
only 18% that of younger adults, much lower than the comparable proportions
for alcohol (89%) and tobacco cigarettes (60%).

"Moreover since the use of cannabis in young adults declined steadily
between 1979 and 1998, whereas use in older adults remained stable, the
observed low prevalence in older adults is unlikely to increase in the
foreseeable future. Therefore, even diseases that might be related to long
term use of cannabis are unlikely to have a sizeable public health impact
because most people who try cannabis do not become long term users. This
observation is relevant to lung cancer, which, although strongly related to
cigarette smoking, typically only occurs after at least 20 years of smoking.

"Also, a typical regular cannabis user smokes the equivalent of one
marijuana cigarette or less per day, whereas consumption of 20 or more
tobacco cigarettes is common. Exposure to smoke is therefore generally much
lower in cannabis than in tobacco cigarette smokers, even taking into
account the larger exposure per puff.

"A third issue to consider is the potential relation of the use of cannabis
to diseases that contribute the most to total mortality. For example, in
the United States and the United Kingdom the leading cause of death is
diseases of the heart, predominantly coronary heart disease, which is
strongly associated with smoking tobacco cigarettes and accounts for nearly
one third of all deaths. Mittleman et al noted the quadrupling of risk
found in one study when cannabis was smoked within one hour before a
myocardial infarction [heart attack]. However, since only 0.2% of the
patients with myocardial infarction reported this exposure, the number of
myocardial infarctions attributable to the use of cannabis is extremely small.

"Cannabis does not contain nicotine, a component of tobacco that
contributes importantly to the risk of coronary heart disease. Use of
cannabis in a young adult population was not associated with the presence
of calcium in coronary arteries -an indicator of coronary atherosclerosis-
and a cohort study conducted in a large health maintenance organization
showed no association between the use of cannabis and admission to hospital
for myocardial infarction and all coronary heart disease. [Sidney was lead
investigator on the two studies cited.]

"Two caveats must be noted regarding available data. Firstly, the
longer-term follow up of cohorts of cannabis users may still show an
increased risk of cancers, chronic diseases, and mortality if enough
members of the study cohort continue to smoke cannabis often enough and for
long enough. The cohorts to date have not followed cannabis smokers into
later adult life so that it might be too early to detect an increased risk
of chronic diseases that are potentially associated with the use of
cannabis. Secondly, the low rate of regular use of cannabis and the high
rates of discontinuation during young adulthood in the United States may
reflect the illegality and social disapproval of the use of cannabis. This
means that we cannot assume that smoking cannabis would continue to have
the same small impact on mortality (as it probably does with current
patterns of use) if its use were to be decriminalized or legalized."

"Although the use of cannabis is not harmless, the current knowledge base
does not support the assertion that it has any notable adverse public
health impact in relation to mortality. Common sense should dictate a
variety of measures to minimize adverse effects of cannabis. These include
discouraging the use by teenagers, who seem to be most at risk of future
problems from drug use, not using before or during the operation of
automobiles or machinery, not using excessively, and cautioning people with
known coronary heart disease."

Some Comments

Some of the harm-reduction measures recommended by Sidney are indeed
"common sense;" but some are at odds with findings reported by Tom
O'Connell and Tod Mikuriya, two doctors who have made a specialty of
monitoring their patients' cannabis use. O'Connell's data indicate that
cannabis use as a teenager predisposes against problematic use of hard
drugs later in life. And according to Mikuriya, "Cannabis does not have an
adverse effect on cardiac functioning. It decreases stress with its
resultant cardiac problems."

Sidney assumes that cannabis use would increase if Prohibition were ended.
He's almost certainly right, but who would start using, and would they be
smoking the crude plant? There are millions of older Californians who have
not availed themselves of the right to use marijuana medicinally but might
do so if access became easier. And they'd almost certainly prefer
sublingual extracts or vaporization... Sidney's paper seems like a strong
argument to get a vaporizer. It would be almost like quitting, lung-wise.
Unfortunately, the only really cool one, the German-made Volcano, costs
around $550.

The rate at which teenagers use cannabis probably wouldn't change
significantly if the Prohibition eased -they have access to it now. The
only longterm way to reduce drug use by teenagers is to create a society in
which they have skills, purpose, freedom, and dignity. We could start by
calling off the dogs and getting rid of the bottles they're made to pee in.

Potshots

"Ferris Fain was the one who grew the clones for the local professional
growers," according to a Georgetowner who knew him slightly in his final
decade. "That's why he had to do time -he had thousands of plants." Our
source was under the impression that Fain, when he'd met him, had been
using marijuana to ease his aches and pains. What a shame that marijuana
could become an "issue" between him and a loved one. How many
parent-vs.-kid and kid-vs.-parent tensions have been exacerbated by
Prohibition?

The Med Board v. Mikuriya hearing resumes and is expected to conclude on
Wednesday, Sept. 24. The dignified Berkeley psychiatrist has spent five
hours on the stand defending his treatment of 16 patients. He has yet to be
cross-examined. The lawyers will have three or four weeks to submit briefs
to Administrative Law Judge Jonathan Lew, who will then have three or four
weeks to make his "recommended decision" to the Medical Board, which will
then have three or four weeks to publish it and as much time as they want
to act on it. The Board can depart from the ALJ's recommended decision in
either direction -punishment or leniency.

Upton Sinclair on medical care: "I number many doctors among my friends,
and the better they know me, the more freely they admit the unsatisfactory
state of their work. Leo Buerger, a college mate who became a leading
specialist in New York, summed the situation up when I mentioned the
osteopaths, and remarked that they sometimes made cures. Said my eminent
friend: 'they cure without diagnosing, and we diagnose without curing.'"