United States cannabis laws. States with medical cannabis laws States with decriminalization laws States with both
If you've clicked on this link, you've probably already made up your mind about medical marijuana (ie: you've either visited Amsterdam, read High Times, visited the NORML website, voted for medical marijuana, read the book Reefer Madness or watched the original propaganda video of the same name... OR you have never inhaled, have always passed on the joint, or view your body as a temple). Kidding aside - it appears that medical marijuana views are very personal and are not always based on scientific evidence.
By looking at specific state's marijuana regulations versus those for gay marriage (a striking example is Maine's recent overturning of a gay rights initiative, while voting to expand medical marijuana - See Ref 1), it appears that the general public may find medical marijuana rights more acceptable than equal rights for homosexual relationships - and personally, I'm unsure where these voters are getting their scientific information (or if science is even a factor in these decisions). While looking at this assertion would require two blog posts, I'll focus this post on medical marijuana (but I've included some links below for sources of evidence for homosexuality being biological).
Marijuana research (in the controlled, peer-reviewed sense) has been ongoing for decades. Probably few of you are familiar with integrative physician Andrew Weil's original research on marijuana (published as a peer-reviewed research article in the prestigious journal Science) while he was a medical student at Harvard. His book, The Natural Mind, goes a long way in the interpretation of the discrepencies between scientific evidence about the health effects (benefits or ill effects) of marijuana versus the political assertions being used to keep the plant's use illegal. His research was one of the first unbiased, well-controlled, peer-reviewed studies on the effect of marijuana as a drug (in the pharmaceutical, not recreational sense).
But I think Weil has already made up his mind, too - so, let's start with some scientific and medical factoids about marijuana (cannabis sativa):
- There are five general indications for medical marijuana: (1) severe nausea and vomiting associated with cancer chemotherapy or other causes, (2) weight loss associated with debilitating illnesses, including HIV infection and cancer, (3) spasticity secondary to neurologic diseases, such as multiple sclerosis, (4) pain syndromes, and (5) other uses, such as for glaucoma. (Ref 2)
- Marijuana contains more than 460 active chemicals and over 60 unique cannabinoids (Ref 2)
- Delta(9)-tetrahydrocannabinol (THC) is the main active ingredient of Cannabis. THC seems to be responsible for most of the pharmacological and therapeutic actions of cannabis. In a few countries THC extracts (i.e. Sativex(R)) or THC derivatives such as nabilone, and dronabinol are used in the clinic (Ref 3)
- A recent meta-analysis concluded (Ref 4):
"Short-term use of existing medical cannabinoids appeared to increase the risk of nonserious adverse events. The risks associated with long-term use were poorly characterized in published clinical trials and observational studies. High-quality trials of long-term exposure are required to further characterize safety issues related to the use of medical cannabinoids."
- However as early as 1991 another article had concluded (Ref 5):
"This survey demonstrates that oncologists' experience with the medical use of marijuana is more extensive, and their opinions of it are more favorable, than the regulatory authorities appear to have believed."
In October, the Obama administration and the Justice Department released new guidelines telling federal prosecutors not to target people involved in the medical use of marijuana where state laws permit it. In a similar move earlier this month, the American Medical Association (AMA) requested this:
"Our AMA urges that marijuana's status as a federal Schedule I controlled substance be reviewed with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines, and alternate delivery methods."
So, the question at the top of this blog remains - if medical marijuana continues to be legalized across the country (see the map above), should marijuana be regulated by the FDA? Or are the risks similar to drugs currently provided 'over-the-counter' (OTC)?
Currently, many prescription drugs are being switched to OTC. Usually, this can happen if the drug is safe, effective, has relatively few side effects, is used to treat a self-diagnosable condition (Ref 6). However, given the historical and political implications of medical marijuana, how easily can the scientific and medical community objectively assess these factors?
From my perspective as a scientist, the objectivity and availability of the research is increasing, and public awareness and resistance to non-scientific or political claims are also increasing. I'm seeing this with the issue of medical marijuana and the acceptance of homosexuality as a biologically based phenomena. So, I'll stay tuned. And I hope you will too.
Some abstracts of recent scientific publications related to this issue:
J Pain Palliat Care Pharmacother. 2009;23(1):4-25.
Medical marijuana: the conflict between scientific evidence and political ideology. Part one of two.
Georgetown University Law Center, USA. ccohenp@aol.com
Whether "medical marijuana" (Cannabis sativa used to treat a wide variety of pathologic states) should be accorded the status of a legitimate pharmaceutical agent has long been a contentious issue. Is it a truly effective drug that is arbitrarily stigmatized by many and criminalized by the federal government? Or is it without any medical utility, its advocates hiding behind a screen of misplaced (or deliberately misleading) compassion for the ill? Should Congress repeal its declaration that smoked marijuana is without "current medical benefit"? Should cannabis be approved for medical use by a vote of the people as already has been done in 13 states? Or should medical marijuana be scientifically evaluated for safety and efficacy as any other new investigational drug? How do the competing--and sometimes antagonistic--roles of science, politics and prejudice affect society's attempts to answer this question? This article examines the legal, political, policy, and ethical problems raised by the recognition of medical marijuana by over one-fourth of our states although its use remains illegal under federal law. Although draconian punishment can be imposed for the "recreational" use of marijuana, I will not address the contentious question of whether to legalize or decriminalize the use of marijuana solely for its psychotropic effects, a fascinating and important area of law and policy that is outside the scope of this paper. Instead, the specific focus of this article will be on the conflict between the development of policies based on evidence obtained through the use of scientific methods and those grounded on ideological and political considerations that have repeatedly entered the longstanding debate regarding the legal status of medical marijuana. I will address a basic question: Should the approval of medical marijuana be governed by the same statute that applies to all other drugs or pharmaceutical agents, the Food, Drug, and Cosmetic Act (FD&C Act), after the appropriate regulatory agency, the Food and Drug Administration (FDA), has evaluated its safety and efficacy? If not, should medical marijuana be exempted from scientific review and, instead, be evaluated by the Congress, state legislatures, or popular vote? I will argue that advocacy is a poor substitute for dispassionate analysis, and that popular votes should not be allowed to trump scientific evidence in deciding whether or not marijuana is an appropriate pharmaceutical agent to use in modern medical practice.
J Pain Palliat Care Pharmacother. 2009;23(2):120-40.
Medical marijuana: the conflict between scientific evidence and political ideology. Part two of two.
Georgetown University Law Center, USA. ccohenp@aol.com
In Part I of this article, I examined the role of the Food and Drug Administration (FDA) in drug approval and then detailed the known risks of medical marijuana (any form of Cannabis sativa used--usually by smoking--to treat a wide variety of pathologic states and diseases). Part II of the article will begin by reviewing the benefits of Cannabis sativa as documented by well designed scientific studies that have been published in the peer-reviewed literature. I will then propose that ability of scientists to conduct impartial studies designed to answer the question of marijuana's role in medical therapy has been greatly hampered by political considerations. I will posit that in spite of the considerable efforts of policymakers, it is becoming apparent that marijuana's benefits should be weighed against its well-described risks. I will conclude that political advocacy is a poor substitute for dispassionate analysis and that neither popular votes nor congressional "findings" should be permitted to trump scientific evidence in deciding whether or not marijuana is an appropriate pharmaceutical agent to use in modern medical practice. Whether or not marijuana is accepted as a legitimate medical therapy should remain in the hands of the usual drug-approval process and that the statutory role of the Food and Drug Administration should be dispositive.
Lancet. 2009 Oct 17;374(9698):1383-91.
Adverse health effects of non-medical cannabis use.
School of Population Health, University of Queensland, Herston, QLD, Australia. w.hall@sph.uq.edu.au
For over two decades, cannabis, commonly known as marijuana, has been the most widely used illicit drug by young people in high-income countries, and has recently become popular on a global scale. Epidemiological research during the past 10 years suggests that regular use of cannabis during adolescence and into adulthood can have adverse effects. Epidemiological, clinical, and laboratory studies have established an association between cannabis use and adverse outcomes. We focus on adverse health effects of greatest potential public health interest-that is, those that are most likely to occur and to affect a large number of cannabis users. The most probable adverse effects include a dependence syndrome, increased risk of motor vehicle crashes, impaired respiratory function, cardiovascular disease, and adverse effects of regular use on adolescent psychosocial development and mental health.
Clin Toxicol (Phila). 2009 Jul;47(6):517-24.
Chronic toxicology of cannabis.
Medical School, University of Queensland, Highgate Hill, Brisbane, QLD, Australia. sreece@bigpond.net.au
INTRODUCTION: Cannabis is the most widely used illicit drug worldwide. As societies reconsider the legal status of cannabis, policy makers and clinicians require sound knowledge of the acute and chronic effects of cannabis. This review focuses on the latter. METHODS: A systematic review of Medline, PubMed, PsychInfo, and Google Scholar using the search terms "cannabis," "marijuana," "marihuana," "toxicity," "complications," and "mechanisms" identified 5,198 papers. This list was screened by hand, and papers describing mechanisms and those published in more recent years were chosen preferentially for inclusion in this review. FINDINGS: There is evidence of psychiatric, respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use. Cannabis has now been implicated in the etiology of many major long-term psychiatric conditions including depression, anxiety, psychosis, bipolar disorder, and an amotivational state. Respiratory conditions linked with cannabis include reduced lung density, lung cysts, and chronic bronchitis. Cannabis has been linked in a dose-dependent manner with elevated rates of myocardial infarction and cardiac arrythmias. It is known to affect bone metabolism and also has teratogenic effects on the developing brain following perinatal exposure. Cannabis has been linked to cancers at eight sites, including children after in utero maternal exposure, and multiple molecular pathways to oncogenesis exist. CONCLUSION: Chronic cannabis use is associated with psychiatric, respiratory, cardiovascular, and bone effects. It also has oncogenic, teratogenic, and mutagenic effects all of which depend upon dose and duration of use.
J Opioid Manag. 2009 May-Jun;5(3):153-68.
Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions.
Aggarwal SK, Carter GT, Sullivan MD, ZumBrunnen C, Morrill R, Mayer JD.
Medical Scientist Training Program, University of Washington, Seattle, WA, USA.
Cannabis (marijuana) has been used for medicinal purposes for millennia, said to be first noted by the Chinese in c. 2737 BCE. Medicinal cannabis arrived in the United States much later, burdened with a remarkably checkered, yet colorful, history. Despite early robust use, after the advent of opioids and aspirin, medicinal cannabis use faded. Cannabis was criminalized in the United States in 1937, against the advice of the American Medical Association submitted on record to Congress. The past few decades have seen renewed interest in medicinal cannabis, with the National Institutes of Health, the Institute of Medicine, and the American College of Physicians, all issuing statements of support for further research and development. The recently discovered endocannabinoid system has greatly increased our understanding of the actions of exogenous cannabis. Endocannabinoids appear to control pain, muscle tone, mood state, appetite, and inflammation, among other effects. Cannabis contains more than 100 different cannabinoids and has the capacity for analgesia through neuromodulation in ascending and descending pain pathways, neuroprotection, and anti-inflammatory mechanisms. This article reviews the current and emerging research on the physiological mechanisms of cannabinoids and their applications in managing chronic pain, muscle spasticity, cachexia, and other debilitating problems.
REFERENCES AND ADDITIONAL RESOURCES:
1. http://www.nytimes.com/2009/11/05/us/politics/05maine.html
2. Seamon et al, 2007
3. Gerra et al. 2009
4. Wang et al. CMAJ 2008
5. Doblin et al, J. Clin Oncol
6. Mahecha, Nature Reviews Drug Discovery 2006.
7. Great coverage of Weil's marijuana research:
http://www.psychologytoday.com/blog/sex-dawn/200910/fascinating-figures-andrew-weil
7. General resources on this topic:
http://www.oregon.gov/DHS/ph/ommp/index.shtml
http://www.cdphe.state.co.us/hs/medicalmarijuana/
http://www.mpp.org/legislation/state-by-state-medical-marijuana-laws.html
8. The biology of homosexuality:
- 1997 coverage by The Atlantic:
http://www.theatlantic.com/doc/199706/homosexuality-biology
- Many animals (including our close mammal relatives) regularly perform homosexual acts:
sheep: http://www.sciencedaily.com/releases/2004/03
/040309073256.htm
- a prestigious 1998 brain scan study on homosexual and heterosexual humans in Sweden:
http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pubmed/18559854?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1
- Genetics of homosexuality (Bryn Mawr College):
http://serendip.brynmawr.edu/exchange/node/1925
- a 2006 review of the literature:
http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pubmed/16870186?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=4
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Michael Steinberg
doctorwascher
Paul Hinrichs
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Salon.com
Comments
The propaganda against marijuana originally had a basis in it's potential market effects in competetion with existing pharmaceuticals, as well as separate (but not equal) hemp products in competetion with existing and powerful logging and fuel industrial giants.
The primary force behind continued criminalizaiton is in the prison lobby. Privatized prisions are a growing business, and non-violent drug users are a rapidly growing prision population.
Follow the money.
One day we may live in a world where science and rationality rule the day.
Until then we have mobs, madness, greed, paranoia and corruption to guide us forward.
At this rate I'll never have my martian mining colony...or a legal doobie in a public park while reciting the works of Emmerson.
(sigh)
Rated for exhaustive research and good links.