True Compassion-The Science
True Compassion About Marijuana: The Science
Is there medicinal value to marijuana?
Yes – research to date has found limited clinical value in one compound of its FDA approved form, not in its smoked or raw form
What about for cancer and AIDS patients?
The pill form of the active chemical in marijuana, dronabinol, can be helpful for the nausea associated with chemotherapy or the wasting disease that appears with AIDS, but even dronabinol is a third tier medicine with unpleasant side effects, including increased susceptibility to depression. Source: www.fda.gov/medwatch/safety/2006/Jun_PIs/Marinol_PI.pdf
Many other medicines that have been tested as safe and more effective are preferred by oncologists. Below is a list of the medications currently available for chemotherapy and for all those who suffer from glaucoma, multiple sclerosis, and other ailments.
Serotonin Antagonists Ondansetron Graniserton (Kytril)
Tropisetron (Navoban) Dolasetron Phenothiazines
Prochlorperazine (Compazine Chlorpromazine (Thorazine) Corticosteroids
Thiethylperazine (Torecan) Perphenazone (Trilafon) Anticholinergics
Promethazine (Phenergan) Dexamethasone (Decadron) Butyrophenones
Methylprednisolone (merdrol) Scopolamine (Trans Derm Scop)
Droperidol (Inapsine) Haloperidol (Haldol) Benzodiazenpines
Domperidone (Motilium) Lorazepam (Ativan) Antilhistamines
Alprazolam (Xanax) Substituted Benzamides Alizapride (Plitican)
Metoclopramide (Reglan) Trimethobenzambie (Tigan) Cisapride (Propulsid)
Source: 2001 WL 30659 (Appellate Brief) Brief of the Institute on Global Drug Policy of the Drug Free America Foundation; National Families in Action; Drug Watch International; Drug-free Kids: America's Challenge, et al., as Amici Curiae in Support of Petitioner (Jan. 10, 2001, ), U.S. v. Oakland Cannabis Buyers' Cooperative, 121 S.Ct. 1711 (2001)
List reconfirmed on May 14, 2006 by Dr. Eric A. Voth, Fellow of the American College of Physicians
Smoking or ingesting marijuana damages the immune system – an intolerable side effect for an end of life or immune-suppressed patient. Source: Zhu LX, Sharma S, Stolina M, Gardner B, Roth MD, Tashkin DP, Dubinett SM. Delta-9-Tetrahydrocannabinol inhibits antitumor immunity by a CB2 Receptor-Mediated, Cytokine-Dependent Pathway. The Journal of Immunology 2000;165:373-380 (Intermittent administration of THC 5mg/kg four times weekly for 4 weeks led to accelerated growth of tumor implants compared to placebo treatment. Tumors used were murine Lewis lung carcinoma and lie 1 alveolar cell carcinoma. Lymphocytes from THC-treated mice transferred the effect to normal non-THC treated mice which accelerated the tumor growth in the normal mice similar that seen in the THC treated mice. Use of an antagonist of the CB2 cannabinoid receptor blocked the effects of THC.)
Inhaling marijuana impairs lung function, increases the risk of bronchitis, causes premalignant cellular changes in the lungs, inflames the lining of the lungs and leaves the patient more vulnerable to bacterial and viral infection. Source: Cocita-Baldwin G, Tashkin DP, Buckley DM, Park AN, Dubinett SM, Roth MD. Marijuana and cocaine impair alveolar macrophage function and cytokine production. Am J Respir Crit Care Med 1997;156:1606-1613. (Marijuana and cocaine severely limit the ability of alveolar macrophages to kill bacteria and tumor cells. Marijuana smokers smoked at least 5/d for 5yrs. Ave 17.9 jts/wk and 54 jt/yrs)
Does it help those with Multiple Sclerosis?
Studies show that spasticity is made worse, not better. Source: Killestein, J, Hoogervorst, E, Reif, M, Kalkers, N, Van Leonen, C, Staats, P, Gorter, R, Yitdehaag, B, Polman, C. Safety, tolerability and efficacy of orally administered cannabinoids in MS. Neurology 2002;58: 1404-1407.
Patients may perceive their spasticity to be partially relieved, but medicine has a higher standard – to actually get better not just to feel as though you are getting better.
Does it help people with chronic pain?
Not in its raw form with its undesirable side effects. Source: Bonner, R. Marijuana rescheduling petitions.57 Federal Register. (1992):10499-10508.Campbell FA, Tamer MR, Carroll D, Reynolds DJ, Moore RA, McQueen HJ. Are Cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. British Journal of Medicine 2001; 323: 13-16 [systematic review of the available literature on cannabinoids and pain. Concluded that cannabinoids are no more effective than codeine in controlling pain and have depressant effects that limit usefulness. Should not be used in acute pain. Widespread introduction into clinical pain practice is undesirable.]
There are hopeful studies in animals that suggest a molecule similar to the cannabinoids in marijuana could be isolated and used to help alleviate pain. The lead researcher cautions: “It is a big step to go from a successful animal model to treating humans in pain.” Source: Mathias, R. Novel cannabinoid appears promising for treatment of chronic pain. NIDA Notes 2004; 19: 2.
What about glaucoma patients?
Raw marijuana has never been shown to be better or even just as good as existing drugs for relieving eye pressure, and it brings with it many more side effects than the approved medicines. Source: Flash AJ. Delta-9-tetrahydrocannabinol (THC) in the treatment of end-stage open-angle glaucoma. Trans Am Ophthalmo Soc 2002;215-222. [a study of ophthalmologists were treated with either oral THC or inhaled marijuana in addition to their regimen. Only nine patients were ultimately enrolled. Although there was an initial decrease in intraocular pressure, the goal was met in only 4 of 9 patients, and the decreases in pressure were not sustained. All patients chose to discontinue treatment within 1 to 9 months for various reasons.]
Aren’t there patients who smoke their medicine because they need a different delivery system besides taking pills?
Dr. Robert DuPont, former director of NIDA, says – “There is no acceptable role in modern medicine for using burning leaves as a drug delivery system because smoke is inherently unhealthy.” Source: Letter to New Jersey legislature, January 19, 2006.
Smoking is an ineffective and illogical way to deliver medicine – dosage cannot be regulated, and tar and other harmful compounds are delivered directly to the lungs along with any helpful cannabinoids.
The lining of the lungs is inflamed by inhalation of the toxic substance. Source: Taylor RD, Fergusson DM, Milne BJ, Harwood LJ, Moffitt TE, Sears MR, Poulton R. A longitudinal study of the effects of tobacco and cannabis exposure on lung function in young adults. Addiction 2002;97:1055-1061 (Use of marijuana reduced the lung function parameters FEV1/VC in young people who used marijuana on 900 or more occasions by 7.2%, 2.6%, and 5.0% over non users at ages 18,21,26 respectively. Tobacco was additive to the effect.)
Marijuana cigarettes have no filter, and the smoke must be held in the lungs longer, increasing the exposure to the lungs and resultant inflammation from smoking. Source: Fligiel SEG, Roth MD, Kleerup EC, Barsky SH, Simmons MS, Tashkin DP. Tracheobronchial histopathology in habitual smokers of cocaine, marijuana, and/or tobacco. Chest 1997;112:319-326 (smokers of cocaine, marijuana, or tobacco had greater abnormalities than controls and the effects were additive. The effects of marijuana were greater than tobacco.)
Are vaporizing or eating safer ways to get the benefits of marijuana?
No - Vaporizing does not filter marijuana – it still delivers the same cancer-causing tar and chemicals directly to the lungs. Source: Grim, R. What’s the best way to take medical marijuana? Slate; May 5, 2006.
Eating delivers the same damaging compounds as well as the insecticides and fungi found in unmonitored marijuana crops. Source: Verwej PE, Kerremans JJ, Voss A. Fungal contaminants of tobacco and marijuana JAMA 2000;284:2875 (Several species of Aspergillus and penicillium were cultured from tobacco and marijuana plants. Conclusion: tobacco and marijuana should be eliminated from patients with high risk to fungal spores.)
★ Note – Clinical research is being conducted into a controlled, tested, safe delivery system (that doctors can prescribe and manage) of the helpful cannabinoids of marijuana without any of the harmful chemicals or dangerous side effects.
Are there specific physical harms of smoking marijuana?
Yes - Respiratory damage. Source: see above
Cardiovascular damage – it can dramatically increase heart rate. Source: Mittlemen MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering of Myocardial Infarction by Marijuana Circulation 2001;103:2805 (Risk MI within one hour of use the risk of MI increased 4.8 compared to periods of non-use.)
Reproductive damage in men and women. Source: Barnett G, Chiang CN. Effects of marijuana on testosterone in male subjects. J. Theor Biol. 1983;104:685-692.Mendelson, J.H., et al. Marijuana smoking suppresses leuteinizing hormone in women. Journal of Pharm. Exp. Therapeutics. 1986;237:862-866.
Immunosuppression. Source: Klein TW, Newton C, Widen R, Friedman H. Delta-9-THC injection induces cytokine mediated mortality of mice infected with legionella pneumophila. Journal of Pharmacology and Experimental Therapeutics 1993;267:635-640. (THC injection increases blood levels of acute phase cytokines in infected animal were at least in part responsible for increased mortality.)
Does smoking marijuana cause psychological problems?
Paranoia. Source: Deas D, Gerding L, Hazy J. Marijuana and Panic Disorder J. Am Acad Child Adolesc. Psychiatry 2000;39:1467 (Case of male adolescent with marijuana abuse who developed panic disorder after marijuana use.)
Emotional disorders. Source: Lynskey, M.T., et al. Major depressive disorder, suicidal ideation, and suicide attempt in twins discordant for cannabis dependence and early onset cannabis use. Archives of General Psychiatry 61(10):1026-1032, 2004.
Increased risk of schizophrenia and other neuropsychiatric disorders. Sources: Van Os J, Bak M, Hanssen M, Bijl RV, De Graaf R, Verdous H. Cannabis use and psychosis: A longitudinal population-based study. American Journal of Epidemiology 2002;156:319-27 (Study of 4045 psychosis-free and 59 individuals exhibiting psychosis at baseline assessment. Use of marijuana predicted 2.76 times greater likelihood of any psychotic symptoms, predicted 24.17 times higher incidence of severe psychotic symptoms, and predicted 12 times higher need for clinical assessment and care for psychotic symptoms. Conclusion was that marijuana increases the risk of both psychosis in non-psychotic people as well as poor prognosis for those with risk or vulnerability to psychoses.) Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G. Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts 1969: historical cohort study. BMJ 2002;325:1199-1201 [This is a re-examination of the Swedish conscript study looking at confounding variables, etc. Conclusion is that there is an association with increased risk of developing schizophrenia consistent with a causal relationship. This association was not explained by personality traits or use of other psychoactive drugs.]
Memory loss. Sources: Bolla KI, Brown K, Eldreth D, Tate K, Cadet JL. Dose-related neurocognitive effects of marijuana use. Neurology 2002;59:1337-1343 (marijuana users termed as “heavy” who used marijuana an average of 7 days per week and 13 joints per day demonstrated changes in memory, executive functioning, psychomotor speed, and manual dexterity that persisted even after 28 days of abstinence. The more marijuana joints used per week, the greater the neurological impairment. Duration of marijuana use had little effect on results) Solowij N, Stephens RS, Roffman RA, Babor R, Kadden R, Miller M, Christiansen K, McRee B, Vendetti J. Cognitive function of long-term heavy cannabis users seeking treatment. JAMA2002;287:1123-1131 [long term use was an average of 23.9 years, Long term users showed problems with memory and attention, word retention, learning. These findings persist beyond the period of intoxication and worsen with increasing years of use.]
Loss of ability to concentrate. Source: Block RI, O’Leary DS, Hichwa RD, Augustinack JC, Boles-Ponto LL, Ghoneim M M, Arndt S, Ehrhardt JC, Hurtig RH, Watkins GL, Hall JA, Nathan PE, Andreasen NC. Cerebellar hypoactivity in frequent marijuana users. NeuroReport 2000;4:749-753. (PET scanning of subjects mean use of marijuana 17 times per week for last 2 years. Found lower blood flow in a large region of the posterior cerebellum. Not only does this have implications on motor coordination and function, but also cognition, timing, processing sensory information, and attention.)
Increased tolerance to intoxication. Source: Chabrol H, Callahan S, Fredaigue N. Cannabis use by French adolescents. Journal of American Academy of Child and Adolescent Psychiatry 2000;39:399-400 (Survey of French adolescents demonstrated that 41.4 % reported using marijuana occasionally or regularly. Among regular or occasional users, 47.2% fulfilled substance dependence criteria. Eighty two percent of dependent subjects reported higher levels of drug abuse than recreational users.)
Addiction. Source: Budney AJ, Hughes JR, Moore BA, Novy PL. Marijuana Abstinence Effects in Marijuana Smokers Maintained in Their Home Environment Arch Gen Psych 2001;58:917-924 [upon cessation of marijuana use, withdrawal symptoms were identified including drug craving, decreased appetite, sleep disturbance, weight loss, and less consistently aggression, anger, irritability, restlessness, and strange dreams. Clearly marijuana use and cessation results in a withdrawal syndrome]
Leads to much higher use of other illegal drugs. Source: Lynsky MT, Heath AC, Bucholz KK, Slutske WS, Madden PAF, Nelson EC, Statham DJ, and Martin NG. Escalation of drug use in early onset cannabis users vs co-twin controls. JAMA 2003;289: 427-433. [311 young adults median age 30 years, monozygotic and dizygotic same sex twins demonstrated that individuals who had used cannabis by age 17 demonstrated 2.1 to 5.2 times greater likelihood of drug or alcohol abuse or dependence.
Linked to more violent behavior. Sources: Friedman AS, Glassman K, Terras. Violent Behavior as Related to Use of Marijuana and Other Drugs. Journal of Addictive Diseases 2001;20:49-70 [Marijuana/ crime. Frequency of use of marijuana was found to be associated with greater likelihood to commit weapons offenses, and the only other drug this was found with was alcohol. Marijuana was associated with commission of attempted homicide/reckless endangerment offenses, and marijuana along with cocaine were the only drugs associated with frequency of being involved in selling drugs. ]Friedman AS, Terras A, Glassman K. The differential disinhibition effect of marijuana ause on violent behavior: A comparison of this effect on a conventional, non-delinquent group vs a delinquent or deviant group. J Addict Dis. 2003;22:63-78 [Marijuana had a greater effect on increasing the degree of violent behavior in non-delinquent individuals than in delinquent individuals. This effect is even more prominent than the effect of cocaine, amphetamine, or tranquilizer/sedative use. There appears to be more reduction of inhibition toward violent behavior in this non-delinquent group]
Is marijuana prescribed by medical professionals?
Doctors cannot prescribe a non-FDA approved substance; in medical excuse marijuana states, they can recommend it. None of the major medical associations recommends smoked or raw marijuana. Smoked marijuana as medicine has been rejected by the: American Medical Association, National Multiple Sclerosis Society, American Glaucoma Society, American Academy of Ophthalmology, American Cancer Society, American Society of Addiction Medicine
SOURCE: Bonner, R., Marijuana Rescheduling Petitions, 57 Federal Register 10499-10508; Alliance for Cannabis Therapeutics v. DEA and NORML v. DEA, 15 F.3d 1131 (D.C. Cir 1994)
Recently, the federal Institute of Medicine also conducted research on this issue and they see "little future in smoked marijuana as a medicine." SOURCE: John A. Benson, Jr., Co-Principal Investigator, in releasing Marijuana and Medicine: Assessing the Science Base, Institute of Medicine, National Academy of Sciences, 1999.
Why should marijuana remain a Schedule I Drug?
Inter-Agency Advisory Regarding Claims That Smoked Marijuana Is a Medicine
Claims have been advanced asserting smoked marijuana has a value in treating various medical conditions. Some have argued that herbal marijuana is a safe and effective medication and that it should be made available to people who suffer from a number of ailments upon a doctor's recommendation, even though it is not an approved drug.
Marijuana is listed in schedule I of the Controlled Substances Act (CSA), the most restrictive schedule. The Drug Enforcement Administration (DEA), which administers the CSA, continues to support that placement and FDA concurred because marijuana met the three criteria for placement in Schedule I under 21 U.S.C. 812(b) (1) (e.g., marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision). Furthermore, there is currently sound evidence that smoked marijuana is harmful. A past evaluation by several Department of Health and Human Services (HHS) agencies, including the Food and Drug Administration (FDA), Substance Abuse and Mental Health Services Administration (SAMHSA) and National Institute for Drug Abuse (NIDA), concluded that no sound scientific studies supported medical use of marijuana for treatment in the United States, and no animal or human data supported the safety or efficacy of marijuana for general medical use. There are alternative FDA-approved medications in existence for treatment of many of the proposed uses of smoked marijuana.
FDA is the sole Federal agency that approves drug products as safe and effective for intended indications. The Federal Food, Drug, and Cosmetic (FD&C) Act requires that new drugs be shown to be safe and effective for their intended use before being marketed in this country. FDA's drug approval process requires well-controlled clinical trials that provide the necessary scientific data upon which FDA makes its approval and labeling decisions. If a drug product is to be marketed, disciplined, systematic, scientifically conducted trials are the best means to obtain data to ensure that drug is safe and effective when used as indicated. Efforts that seek to bypass the FDA drug approval process would not serve the interests of public health because they might expose patients to unsafe and ineffective drug products. FDA has not approved smoked marijuana for any condition or disease indication.
A growing number of states have passed voter referenda (or legislative actions) making smoked marijuana available for a variety of medical conditions upon a doctor's recommendation. These measures are inconsistent with efforts to ensure that medications undergo the rigorous scientific scrutiny of the FDA approval process and are proven safe and effective under the standards of the FD&C Act. Accordingly, FDA, as the federal agency responsible for reviewing the safety and efficacy of drugs, DEA as the federal agency charged with enforcing the CSA, and the Office of National Drug Control Policy, as the federal coordinator of drug control policy, do not support the use of smoked marijuana for medical purposes.
In states with marijuana dispensaries, the vast majority of users are not terminally ill. Confiscated patient records from San Diego note that only 2 percent of marijuana users reported having AIDS, glaucoma or cancer. Sources: Murphy, D. Officials say drug raids found clubs were a front. New York Times; June 24, 2005. Authorities raid eleven San Diego dispensaries. 10News.com; July 7, 2006.
Doctors are liable and not covered by insurance for recommending a non-FDA approved drug.
Patients’ rights are negatively impacted.