Should marijuana be legalized? Why and why not?
Charles Frederick Tolbert EdD
Candidate For U. S. Senate Florida 2016
P. O. Box. 23935
Ft. Lauderdale Fl 33307
This paper is written to present the pros and cons of legalization of medical marijuana. The intent is to present both sides without taking a position on either. The writer believes that the voters have a right to make an informed decision before the 2014 election. Although the required signatures were gotten it is questionable of those who signed the petition had researched both sides of legalization of medical marijuana such as the long term effect, short term effect, the medical benefits and withdraw issue. This paper is presented with data for the informed voter to vote, based on informed decision rather than emotional. The writer will in the summary and conclusion represent both sides. Www.cfabamerica.com
Charles Frederick Tolbert EdD
For U.S. Senate Florida 2016 CFABANP
Vranken (2009) defined Marijuana as the most widely used illegal drug in the United States. It is a dry, shredded green/brown mix of flowers, stems, and leaves of the plant Cannabis sativa. A stronger form of marijuana called hashish (hash) looks like brown or black cakes or balls. The many street names for marijuana include pot, herb, weed, grass, Jane, reefer, dope, and ganja.
At best readers might be better educated after reading this article, and even though, first as some being Democrat or Republican regardless who are running, the same may hold true for the voters who vote for or against LMM. It is the writer’s intent not to influence the voters’ swift of vote for or against but to educate and inform the voters. In the final analysis the informed voter should decide, not politician. The income discerned from LMM could be the major reasons why certain states are approving “LMM” notwithstanding the benefits or lack thereof. After the readers educate themselves, the writer’s hope that they, “the voters of Florida” make the right decision.
According to Deem (2012) “In 1997, the British newspaper The Independent began a campaign to decriminalize marijuana use, describing it as a relatively harmless drug, eventually leading to the British Government downgrading the legal status of the drug. Ten years later, the same newspaper published another article entitled “Cannabis: an apology,” reversing its campaign for marijuana decriminalization because, there is increasing evidence that marijuana use is far from harmless.
Marijuana (cannabis) is the most widely used illegal drug in many developed countries. Medical studies have shown that the active ingredient in marijuana, delta-9-tetrahydrocannabinol (THC), might provide some medical benefits in some patients. Under the impression that these benefits were substantial, voters in California and Arizona approved initiatives allowing the use of “medical” marijuana by patients under certain circumstances. This paper represents a current review of the medical literature regarding the benefits and drawbacks of using marijuana for medical or recreational purposes.
Medical benefits of marijuana
Anecdotal evidence for the beneficial effects of marijuana eventually led to the design of controlled scientific studies to examine the benefits of marijuana compared to other treatments. A 1997 review of 6059 marijuana-related articles in the medical literature revealed 194 titles on antiemetic properties, 56 on glaucoma, 10 on multiple sclerosis, 23 on appetite, and 11 on palliative or terminal care. Numerous studies have been performed since that time, with most concentrating on the analgesic properties of cannabis and its derivatives.
Antiemetic (anti-nausea) use
Early on, THC had been shown to be effective for some patients who suffered nausea from cancer chemotherapy treatments. However, the narrow window between the anti-emetic dose and that which caused unwanted psychic effects made THC difficult to use. In some studies, negative side effects occurred in up to 81% of patients. In one of the few studies using smoked marijuana, 20% of patients dropped out of the study, while another 22% reported no relief of nausea symptoms. The advent of serotonin 5-HT3 receptor antagonists as new and more powerful anti-emetic drugs that were free of unwanted psychic effects has made cannabinoid use less attractive. For this reason, physicians virtually never prescribe marijuana or THC as an antiemetic for use by chemotherapy patients.
Studies have shown that cannabis can relieve muscle pain and spasticity in patients suffering from multiple sclerosis and can control tremors in multiple sclerosis animal models. However, a study in ten patients with spastic multiple sclerosis showed that smoking marijuana further impaired posture and balance in those patients. In addition, MS patients who used marijuana had a greater number of psychiatric diagnoses and a slower mean performance time on standard neurological tests. Some randomized, double-blind, placebo-controlled, parallel group crossover trials have found no significant improvement of MS symptoms during cannabis plant extract use. However, in some trials patients did show an increase in aggressive behavior and paranoiac tendencies in a standard psychological test. Another placebo-controlled study, examining the effect of a cannabis extract on spasticity in MS, found a positive partial relief of symptoms in 40% of patients. A 10-week, placebo-controlled study of MS patients found that 42% withdrew due to lack of efficacy, adverse events and other reasons. Patients reported 292 unwanted effects, of which 251 were mild to moderate, including oral pain, dizziness, diarrhea, nausea. Three patients suffered five serious adverse events, including two seizures, one fall, one aspiration pneumonia, one gastroenteritis. Four patients had first-ever seizures. A minority of patients received some relief of symptoms. So, overall, studies show that a minority of multiple sclerosis patients can receive some symptom relief through the use of marijuana extracts or THC, although a significant percentage of patients suffer unwanted adverse effects.
THC has been shown to reduce intraocular pressure in laboratory animals and humans who have glaucoma. However, it was found that intraocular pressure was reduced only when patients stayed under the effects of THC almost continuously. Since the early studies, more effective medications, such as 13-blockers and prostaglandins, have been developed to control intraocular pressure. Obviously, glaucoma medications that don’t require one to be continuously high are preferable to those that have unwanted side effects.
Regular marijuana users are aware of the phenomenon known as the “munchies.” Laboratory studies have shown that THC does increase the appetite (not a good thing for most of us). However, for those suffering from debilitating diseases, such as AIDS-related wasting syndrome, THC has been shown to be effective in maintaining body weight.
Analgesia (pain relief)
Some clinical studies have indicated that THC has some analgesic activity in patients with cancer. However, there is a narrow therapeutic window between doses that produce useful analgesia and those that produce unacceptable central nervous system effects. Several studies have shown improvement of pain at higher doses, while others have shown no effect or a negative effect at higher doses compared with placebo.
Medical marijuana summary
The use of marijuana or cannabis extracts for medical treatment has been extensively studied over the last 20 years. Initial enthusiasm for THC as an antiemetic or to reduce intraocular pressure has waned with the advent of new medications that provide superior medical benefits with fewer adverse effects. The main success of THC has been found in patients suffering from AIDS-related wasting syndrome and in some cases in which patients are suffering from intractable pain. However, nearly all of these studies involved the use of controlled doses of purified cannabinoids, bypassing the adverse effects associated with smoking marijuana. Dr. Robert L. DuPont, Georgetown University School of Medicine, says that most opponents of the medical use of smoked marijuana are not hostile to the medical use of THC, while “most supporters of smoked marijuana are hostile to the use of purified chemicals from marijuana, insisting that only smoked marijuana leaves be used as ‘medicine,’ revealing clearly that their motivation is not scientific medicine but the back door legalization of marijuana.
Detrimental effects of marijuana
Studies examining the efficacy of “medical” marijuana have found that a significant percentage of patients suffer from some form of adverse side effects. However, these studies have been limited to a duration of a few weeks to months. Another series of studies have examined the long-term effects of recreational marijuana use.
One of the main problems with the use of crude “medical” marijuana is that the amount of THC in the preparations varies up to 10-fold, depending upon if the marijuana is made from the flowers or the whole plant. Those who can afford the “good stuff” usually get a substantially higher dose of THC than those who buy the “cheap stuff.” In addition, studies demonstrate a trend for increasing concentration of THC over the last ten years. Because of dosage problems, crude marijuana as a medical “treatment” has proved problematic, despite California’s assertion that there is such a thing as “medical” marijuana.
A recent study using an MRI technique, diffusion tensor imaging, mapped the structural integrity of brain tissue in eleven heavy marijuana users and eleven age matched controls. The study found impaired structural integrity affecting the fibre tracts of the corpus callosum, suggesting the possibility that the structural abnormalities in the brain may underlie cognitive and behavioral consequences of long-term heavy marijuana use. Another MRI study found that heavy cannabis users had an averaged 12 per cent volume reduction of the hippocampus, and a 7 per cent reduction of the amygdala compared to controls. In addition, the study found that long-term cannabis users suffered from psychotic experiences, such as persecutory beliefs and social withdrawal, in addition to the loss of memory equivalent to 15 additional years of aging. Another study measured slow brain potentials in response to Go and No Go conditions before, during and after marijuana smoking. The study found normal responses both before and during smoking, but severely disrupted responses 20-40 minutes later, during the period of peak intoxication, resembling those found in patients with lateral prefrontal cortex lesions. Another study utilized BOLD fMRI to examine the brain activation patterns in chronic marijuana users and matched control subjects during a set of visual attention tasks.27 Although all subjects demonstrated similar task and cognitive test performance, active and abstinent marijuana users showed decreased activation in the right prefrontal, medial and dorsal parietal, and medial cerebellar regions (regions affected by THC), but greater activation in various frontal, parietal and occipital brain regions. Investigators hypothesized that marijuana users had lost some functionality in parts of the brain affected by marijuana use, which was compensated in other regions of the brain. The long-term consequences of such damage was not assessed, since the average age of marijuana users was less than 30. Another study examined the ability of 25-day abstinent marijuana users to perform decision-making tasks, simultaneously measuring brain activity using PET H215O. The marijuana group showed greater activation in the left cerebellum and less activation in the right lateral orbitofrontal cortex (OFC) and the right dorsolateral prefrontal cortex (DLPFC) compared with the control group. The investigator concluded that heavy marijuana users had persistent decision-making deficits and alterations in brain activity.
Short term memory
Marijuana usage severely impacts short term memory, probably by interfering with the hippocampus Impairment is especially noted in tests that depend heavily on attention. Specifically, marijuana intoxication causes deficits in spatial learning tasks, delays in matching or non-matching tests, and impaired performance in a radial arm maze in rodents
Long term cognitive function
Studies have found that regular cannabis use can cause small but significant impairments in cognitive function that may persist after drug use stops. Heavy cannabis use in adolescence may induce subtle changes in the adult brain circuits resulting in altered emotional and cognitive performance and enhanced susceptibility for more harmful drugs of abuse in certain individuals. Several studies have found deficits in attention and memory in heavy marijuana users. However, normalization of cognitive function has been found with prolonged abstinence (after 28 days), although other studies have observed persistent cognitive deficits Another study found that chronic cannabis use had little effect on cognitive function except for possible decrements in the ability to learn and remember new information A 38-year study of more than 1,000 New Zealanders found that adolescents who used marijuana at least four days per week lost an average of eight IQ points between the ages of 13 and 38. Those people who began heavy smoking of marijuana only in adulthood did not suffer a loss of IQ. Loss of IQ was not reversible once marijuana use was ceased.
Some marijuana users can suffer from cannabis psychosis when they take large doses over a period of time, with symptoms characteristic of paranoid schizophrenia. A recent study found that marijuana use significantly increased the risk of developing mental health problems among those young people who possessed a genetic high risk for schizophrenia (familial risk factors). Among cannabis users who developed cannabis-induced psychosis, 44.5% developed schizophrenia-spectrum disorders, with about half of those being diagnosed more than a year after seeking treatment for their cannabis-induced psychosis A study using a sample of 880 adolescents in Melbourne, Australia found that lifetime cannabis use and the frequency of cannabis use in the last year were associated with psychotic-like experiences (primarily the experience of auditory and visual hallucinations) Another study examined the association between cannabis use and psychosis in 3,800 participants involving a subset analysis of 228 sibling pairs over a 21-year period of time. The results show that early use of marijuana was associated with psychosis-related outcomes in young adults.
Another study examined the associations between cannabis use and the development of mood and anxiety disorders. The study found no association between cannabis used and the development of anxiety disorders, although there was a significant correlation with the development of depression and bipolar disorder. Another study found an association between cannabis use and the development of panic attacks.
Marijuana abuse and withdrawal
Although originally believed not be addictive, marijuana studies have shown that a substantial percentage of users suffer from abuse or dependence. An Australian studied found that 10.7% of marijuana users users suffered from substance abuse and another 21% suffered from substance dependence. Another study, in the USA, found that 46% of those interviewed had ever used marijuana and 9% of those users became dependent. In addition, studies have shown that addicted individuals suffer a clinically significant withdrawal syndrome, which includes craving for cannabis, decreased appetite, sleep difficulty and weight loss, and sometimes anger, aggression, increased irritability, restlessness and strange dreams. A study of teens showed that the overall severity of withdrawal was correlated with irritability, depression, twitches and shakes, perspiring, and thoughts and cravings for cannabis. Animal studies have shown that THC withdrawal leads to physiological symptoms similar to those seen in animals suffering from opiate withdrawal. The symptoms of withdrawal can be lessened by using the CB1 receptor agonist THC, demonstrating that cannabis use results in true addictive withdrawal. A recent study has shown that the withdrawal symptoms are comparable to those seen in tobacco withdrawal.
There is a tendency for marijuana users to go on to use other addictive drugs, following their initial experience with marijuana. Whether marijuana use predisposes individuals to drug abuse as a “gateway drug” or whether it is just the most easily available illicit drug, is not completely known. However, a study of 311 pairs of same-sex twins found that the twins with earlier marijuana use (before age 17 years) were 2–5 times more likely to use other illicit drugs, especially psychostimulants.
Concomitant drug use
A large percentage of Ecstasy/MDMA users (90-98%) also use marijuana. Studies have found that each drug is functionally damaging, and polydrug users generally display cumulative neurobiological impairments. Another study found that those who use both drugs suffer from immunological impairments characterized by a significant decrease in interleukin-2 and an increase in anti-inflammatory transforming growth factor-β1, along with a decrease in the number of total lymphocytes, CD4+ and natural killer cells. Probably as a result of these immunological impairments Ecstasy/cannabis users suffered a significantly higher rate of mild infections.
Driving & cannabis
In Europe, three million people use cannabis every day and more than two thirds of those drive after having smoked cannabis. Over 50% of drivers in Austria, Belgium, Germany, Switzerland and the United Kingdom suspected of driving under the influence of drugs have been found to have THC in their bloodstream. Numerous studies have shown that driving under the influence of marijuana use results in a significant increase in motor vehicle accidents especially those resulting in fatalities or serious injuries, even with low blood concentrations of THC. These studies have been done around the world, including Canada, Norway, and France.
Use during pregnancy
A study conducted in the Netherlands found that 2.9% of women used cannabis both before and during pregnancy. Factors coincident with cannabis use included use by the biological father, being single, childhood trauma, delinquency, and lower educational level. The reason why cannabis use is of concern is because it has been shown that THC crosses the placenta, thus entering the fetus during development. It has also been found that THC is secreted in breast milk, so it would fed to the newborn during breast feeding.
A study at the University of Pittsburg examined the effect of prenatal marijuana exposure on subsequent child intelligence. Heavy marijuana use (one or more cigarettes per day) during the first trimester was associated with lower verbal reasoning scores on the Stanford-Binet Intelligence Scale at age 6. Heavy use during the second trimester predicted deficits in the composite, short-term memory, and quantitative scores. Third-trimester heavy use was negatively associated with the quantitative score, indicating that prenatal marijuana exposure has a significant effect on subsequent school-age intellectual development. Another study found that prenatal marijuana exposure in the first and third trimesters predicted significantly increased levels of depressive symptoms in 10-year olds. A 2006 survey of the literature revealed that cannabis use during pregnancy was associated with a number of negative outcomes in the child, including symptoms of inattention, impulsivity, deficits in learning and memory, and a deficiency in aspects of executive functions. Another study found no effect of marijuana on IQ, but did find that prenatal use negatively impacted executive functions, influencing the application of these skills in problem-solving situations requiring visual integration, analysis, and sustained attention
Use during adolescence
Adolescent exposure to cannabinoid compounds has been shown to affect the postnatal development of opioid neurons. These alterations are likely to produce important long-lasting functional changes in these neurons in the adult brain, including alterations in neuroendocrine control, pain sensitivity, and reward processes. Animal studies have shown that cannabis exposure during adolescence can produce lasting memory deficits and hippocampal alterations that affect memory and social interaction.
Since THC affects the hypothalamus, which directly or indirectly modulates anterior pituitary function, it has been hypothesized that it might affect human endocrine function. Animal and human studies have shown that THC suppresses the reproductive hormones, prolactin, growth hormone, and the thyroid axis, while the hypothalamic pituitary-adrenal axis is activated. However, it appears that in humans many of these effects are transitory, likely due to the development of tolerance with continued use of the drug.
Although smoking marijuana doesn’t have the same degree of risk as smoking tobacco (because of the frequency of usage), smoking anything over long periods of time does add to risks of contracting forms of cancer of the respiratory tract. Studies have suggested that smoking marijuana increases the risk of both oral cancers and lung cancer. This is because marijuana smoke contains carcinogenic materials, including vinyl chlorides, phenols, nitrosamines, reactive oxygen species, and various polycyclic aromatic hydrocarbons, including Benzo[a]pyrene, which is present in marijuana tar at a higher concentration than in tobacco tar. Ammonia was found in marijuana smoke at levels up to 20-fold greater than that found in tobacco. Hydrogen cyanide, NO, NO x , and some aromatic amines were found in marijuana smoke at concentrations 3-5 times those found in tobacco smoke However, absolute correlation of marijuana smoking with cancer risks are complicated by concomitant tobacco smoking and increased alcohol use among marijuana users
Adverse cardiovascular events
Some studies have suggested that marijuana might be a trigger for adverse cardiovascular events, including tachyarrhythmia, acute coronary syndrome, and vascular complications, especially in older users, and may be a risk factor in congenital heart defects for their children. Mixing marijuana with cocaine can cause cardiac problems, including the death of an otherwise healthy 31 year old male and an acute myocardial infarction in a 21-year old male.
Ischemic stroke is found almost exclusively in people of advanced age. However a number of reports have shown an association between cannabis abuse and ischemic stroke in young people (one at the age of 15). Using Doppler sonography scientists were able to determine that cerebrovascular resistance and systolic velocity were significantly increased in marijuana abusers compared to the control subjects and that cerebral perfusion observed in 18-30 year old marijuana abusers was comparable to that of normal 60 year-olds. Another study showed that 6 of 10 subjects experienced reduced cerebral blood velocity and dizziness following marijuana use One heavy cannabis user was found to have a right temporal lobe hemorrhage, which was cleared within three months by reducing cannabis use from 2–6 cannabis cigarettes per day to 3–4 cigarettes per week.
Marijuana users generally have poorer oral health than non-users, with an increased risk of dental caries (cavities) and periodontal diseases, along with dysplastic changes and pre-malignant lesions within the oral mucosa. In addition, users are prone to oral infections, possibly due to immunosuppressive effects
Medical Marijuana Survey 1998-2008
In any review of the literature, it is possible that reviewer bias can enter the picture and distort the overall impact and conclusions of the review. To mitigate potential reviewer bias, the author initiated a complete Ovid-Medline search of marijuana/cannabis research in February 2009 for the years 1998-2008. Studies were categorized as being “Very Negative,” “Mostly Negative,” “Neutral,” “Mostly Positive,” or “Very Positive.” Data was collated and is presented in the figure to the right. The data shows that research on the medical effects of marijuana is becoming increasingly negative and decreasingly positive over the last 11 years of medical research. In addition, the number of studies examining the medical aspects of marijuana has increased markedly over the last 5 years, dramatically expanding our knowledge of the mostly negative aspects of marijuana usage (see original data). The United States Department of Justice has examined studies on medical marijuana us and abuse and has concluded, “At present, there are no FDA-approved marijuana products, nor is marijuana NDA evaluation at the FDA for any indication. Marijuana does not have currently accepted medical use in in the United States or a currently medical use with severe restrictions.
The California state legislature, in its infinite wisdom, is considering a bill (AB 390 to legalize the growing of cannabis, its use, and sale. In return, the state expects to get over a billion dollars from the sale of permits and taxes. Besides the revenue, they expect to save millions of dollars from not having to enforce marijuana laws. And, of course, we know that all the people who grow marijuana will do so legally by paying the several thousand dollar permit fee! Although the sale of marijuana is restricted to those 21 years old and older, the penalties for selling to underage persons is $100 or less. As a result of such lenient penalties, it is clear that adolescents will be able to obtain marijuana more easily, leading to increased use, which is especially troublesome given its effect upon the maturing brain. What the legislature seems to have ignored in its financial analysis is the almost astronomical costs that will be incurred through increased health care and mental health costs that will result from increased marijuana use in the population of California. In addition, the number of people driving under the influence of marijuana will increase dramatically, as it has in Europe, since its legalization there. The cost in terms of increased deaths from automobile accidents could be in the hundreds to thousands of lives lost
The vast majority of studies show that there is no such thing as “medical marijuana.” In general, physicians in the United States are not thrilled with the idea that marijuana should be allowed to be prescribed, since only 36% take that stance. The act of smoking marijuana is fraught with so many adverse side effects that it really isn’t useful in treating symptoms in any specific disease for the vast majority of sufferers. However, the active ingredient in marijuana (THC) has been shown to be useful for some patients who suffer from chronic pain, especially in refractory cases of multiple sclerosis, and in patients who are suffering from AIDS-related wasting syndrome. Even in those diseases, a minority of patients actually derive a benefit that is without unwanted side effects. THC’s use as an anti-emetic for patients suffering nausea from cancer chemotherapy or as a way to lower intraocular pressure for glaucoma has been replaced by far superior new medicines that don’t have the negative side effects.
As a recreational drug, marijuana is not quite as benign as most of its proponents would claim. Heavy marijuana use results in long-term effects on the brain, including lower responses in those areas which are affected by THC. Although users are able to compensate somewhat through the use of other brain areas, the long term effects of this damage, as users age, has not been determined. This damage may be responsible for impairments noted in short-term and long-term memory, along with a host of possible other psychiatric illnesses. A proportion of marijuana users become addicted and suffer from classic withdrawal symptoms upon abstinence. For a minority of users, marijuana is a gateway drug, and they proceed to use and abuse more powerful psychostimulants. Besides its effects upon the brain, marijuana use can lead to increased risks for respiratory cancers and may have some adverse cardiovascular and cerebrovascular effects in some users. Marijuana use during pregnancy has been shown to result in lower child intelligence, while increasing the incidence of mental health problems. According to the DOJ, “In sum, at present, marijuana lacks an acceptable level of safety even under medical supervision. The idea that marijuana is a harmless recreational pastime has been disproved through continuing scientific research.
Medicinal Cannabis and Painful Sensory Neuropathy
There is increasing evidence that cannabis may represent a useful alternative or adjunct in the management of painful peripheral neuropathy, a condition that can markedly affect life quality.
According to Grant, MD (2013) Painful peripheral neuropathy comprises multiple symptoms that can severely erode quality of life. These include allodynia (pain evoked by light stimuli that are not normally pain-evoking) and various abnormal sensations termed dysesthesias (e.g., electric shock sensations, “pins and needles,” sensations of coldness or heat, numbness, and other types of uncomfortable and painful sensations). Common causes of peripheral neuropathy include diabetes, HIV/AIDS, spinal cord injuries, multiple sclerosis, and certain drugs and toxins. Commonly prescribed treatments come from drugs of the tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressant classes, anticonvulsants, opioids, and certain topical agents. Many patients receive only partial benefit from such treatments, and some either do not benefit or cannot tolerate these medications. The need for additional treatment modalities is evident.
Animal studies and anecdotal human evidence have for some time pointed to the possibility that cannabis may be effective in the treatment of painful peripheral neuropathy. Recently, the Center for Medicinal Cannabis Research (CMCR) at the University of California completed five placebo-controlled phase II clinical trials with smoked or inhaled cannabis. Another study reported from Canada . Patients included people with HIV neuropathy and other neuropathic conditions, and one study focused on a human model of neuropathic pain. Overall, the efficacy of cannabis was comparable to that of traditional agents, somewhat less than that of the tricyclics, but better than SSRIs and anticonvulsants, and comparable to gabapentin.
The concentrations of tetrahydrocannabinol (THC) in these studies ranged from 2 to 9 percent, with a typical concentration of 4 percent resulting in good efficacy. Side effects were modest and included light-headedness, mild difficulties in concentration and memory, tachycardia, and fatigue. Serious side effects (e.g., severe anxiety, paranoia, psychotic symptoms) were not observed. Mild cognitive changes resolved within several hours of drug administration.
While these were short-term trials with limited numbers of cases, the data suggest, on balance, that cannabis may represent a reasonable alternative or adjunct to treatment of patients with serious painful peripheral neuropathy for whom other remedies have not provided fully satisfactory results. Because oral administration of cannabinoids (e.g., as dronabinol, marketed as Marinol) can result in inconsistent blood levels due to variations in absorption and first-pass metabolism effects, inhalational (or potentially sublingual spray, e.g., nabiximols, marketed as Sativex) administration remains preferred to oral administration.
Cannabis as a smoked cigarette, while demonstrating efficacy, poses a number of challenges, inasmuch as it remains illegal under federal law, even though it is permitted in an increasing number of jurisdictions on physician recommendation. Figure 2 provides a schematic approach for physician decision making in jurisdictions where medicinal cannabis is permitted. This decision tree suggests key points that a physician should consider in making a determination. In the case of a patient assumed to have persistent neuropathic pain, the first determination to be made is that the patient’s signs and symptoms are indeed consistent with a diagnosis of neuropathy. Assuming a patient does not respond favorably to or cannot tolerate more standard treatments (e.g., antidepressants, anticonvulsants) and is willing to consider medicinal cannabis, the physician proceeds to compare risk and benefit. Among these considerations is whether the patient has a history of substance abuse or a serious psychiatric disorder that might be exacerbated by medicinal cannabis. Even the presence of such a risk does not necessarily preclude the use of medicinal cannabis; rather, coordination with appropriate substance abuse and psychiatric resources is necessary, and, based on that consultation, a risk-benefit ratio can be formulated. In patients for whom the ratio appears favorable, the physician should discuss modes of cannabis administration including oral, smoked, or vaporized. Once risks and benefits are evaluated and discussed with the patient, cannabis treatment may commence as with other psychotropic medications, with attention being paid to side effects as well as efficacy. Attention must also be paid to possible misuse and diversion, which can then trigger a decision to discontinue the treatment.
There is still a great deal of research to be done concerning the effects of marijuana on the health of humans due to the fact that widespread marijuana use has only become prevalent in this country within the last three decades, so the effects of long-term use are just beginning to become apparent.
Marijuana has often been touted as one of the safest recreational substances available. This is perhaps true; many reputable scientific studies support the conclusion that cocaine, heroine, alcohol, and even cigarettes are more dangerous to the users’ health than marijuana. In addition, the celebrated pharmacological properties of cannabis have led thirty-six states to permit its use as a therapeutic drug for, among others, those suffering from AIDS; various painful, incurable and debilitating illnesses; the harmful side effects of cancer chemotherapy, and glaucoma. Additional research is being conducted concerning the use of marijuana on the treatment of anxiety and mental disorders.
Nonetheless, it would be fallacious to conclude that because the chemicals in marijuana have been found to present fewer dangers than some very harmful substances, the medical or recreational use of marijuana may be perfectly safe. In a recreational context, marijuana has been shown to affect health, brain function, and memory. And in a medical context, marijuana is like any other powerful prescription drug: it has potentially dangerous side effects, and the decision to use it to treat patients must involve the same balancing test as the one required for chemotherapy or AZT: do the therapeutic effects of the drug outweigh its harmful effects? Though there are many more studies to be done on this issue, current data shows that the answer to this question may not always be “yes.”
Effects of Habitual Marijuana use on the Immune System
The most potent argument against the use of marijuana to treat medical disorders is that marijuana may cause the acceleration or aggravation of the very disorders it is being used to treat.
Smoking marijuana regularly (a joint a day) can damage the cells in the bronchial passages which protect the body against inhaled microorganisms and decrease the ability of the immune cells in the lungs to fight off fungi, bacteria, and tumor cells. For patients with already weakened immune systems, this means an increase in the possibility of dangerous pulmonary infections, including pneumonia, which often proves fatal in AIDS patients.
Studies further suggest that marijuana is a general “immunosuppressant” whose degenerative influence extends beyond the respiratory system. Regular smoking has been shown to materially affect the overall ability of the smokers body to defend itself against infection by weakening various natural immune mechanisms, including macrophages (a.k.a. “killer cells”) and the all-important T-cells. Obviously, this suggests the conclusion, which is well-supported by scientific studies, that the use of marijuana as a medical therapy can and does have a very serious negative effect on patients with pre-existing immune deficits resulting from AIDS, organ transplantation, or cancer chemotherapy, the very conditions for which marijuana has most often been touted and suggested as a treatment. It has also been shown that marijuana use can accelerate the progression of HIV to full-blown AIDS and increase the occurrence of infections and Kaposis sarcoma. In addition, patients with weak immune systems will be even less able to defend themselves against the various respiratory cancers and conditions to which consistent marijuana use has been linked, and which are discussed briefly under “Respiratory Illnesses.”
The main respiratory consequences of smoking marijuana regularly (one joint a day) are pulmonary infections and respiratory cancer, whose connection to marijuana use has been strongly suggested but not conclusively proven. The effects also include chronic bronchitis, impairment in the function of the smaller air passages, inflammation of the lung, the development of potentially pre-cancerous abnormalities in the bronchial lining and lungs, and, as discussed, a reduction in the capabilities of many defensive mechanisms within the lungs.
Marijuana smoke and cigarette smoke contain many of the same toxins, including one which has been identified as a key factor in the promotion of lung cancer. This toxin is found in the tar phase of both, and it should be noted that one joint has four times more tar than a cigarette, which means that the lungs are exposed four-fold to this toxin and others in the tar. It has been concretely established that smoking cigarettes promotes lung cancer (which causes more than 125,000 deaths in the US every year), chronic obstructive pulmonary disease (chronic bronchitis and emphysema) and increased incidence of respiratory tract infections. This implies, but does not establish, that smoking marijuana may lead to some of the same results as smoking cigarettes. It is notable that several reports indicate an unexpectedly large proportion of marijuana users among cases of lung cancer and cancers of the oral cavity, pharynx, and larynx. Thus, it appears that the use of marijuana as a medicine has the potential to further harm an already ill patient in the same way that taking up regular cigarette smoking would, particularly in light of the fact that those patients for whom marijuana is recommended are already poorly equipped to fight off these infections and diseases.
For more information, please see the Tashkin website mentioned at the end of the section on immune disorders. See also:
• www.sarnia.com/GROUPS/ANTIDRUG/mrr/ 21.96.10.html, for information on the link between chemicals contained in marijuana and lung cancer.
• http://www.marijuananews.com/latest_research_finds_that_heavy.htm, for an article concerning the link between marijuana and cancer, with commentary
Mental Health, Brain Function, and Memory
It has been suggested that marijuana is at the root of many mental disorders, including acute toxic psychosis, panic attacks (one of the very conditions it is being used experimentally to treat), flashbacks, delusions, depersonalization, hallucinations, paranoia, depression, and uncontrollable aggressiveness. Marijuana has long been known to trigger attacks of mental illness, such as bipolar (manic-depressive) psychosis and schizophrenia. This connection with mental illness should make health care providers for terminally ill patients and the patients themselves, who may already be suffering from some form of clinical depression, weigh very carefully the pros and cons of adopting a therapeutic course of marijuana.
In the short term, marijuana use impairs perception, judgment, thinking, memory, and learning; memory defects may persist six weeks after last use. Mental disorders connected with marijuana use merit their own category in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, published by the American Psychiatric Association. These include Cannabis Intoxication (consisting of impaired motor coordination, anxiety, impaired judgment, sensation of slowed time, social withdrawal, and often includes perceptual disturbances; Cannabis Intoxication Delirium (memory deficit, disorientation); Cannabis Induced Psychotic Disorder, Delusions; Cannabis Induced Psychotic Disorder, Hallucinations; and Cannabis Induced Anxiety Disorder.
In addition, marijuana use has many indirect effects on health. Its effect on coordination, perception, and judgment means that it causes a number of accidents, vehicular and otherwise.
• www.sarnia.com/GROUPS/ANTIDRUG/mrr/21.96.10.html, for more information on the indirect effects of marijuana on health
• http://www.adf.org.au/drughit, the Australian Drug Foundation�s website
• http://marijuananews.com/a_safe_ high_.htm, a reprint of New Science magazine�s “Marijuana Special Report: A Safe High?” with commentary
• http://marijuananews.com/claim_four.htm, an article about the similarity of long-term marijuana use�s effect on the brain to that of “hard” drugs, with commentary
• www.drugs.indiana.edu/publications/iprc/misc/smokescreen.html, for general information on the health risks of marijuana.
• http://www.health.org, the homepage of the National Clearinghouse on Alcohol and Drug Information, for general information on marijuana.
Marijuana: Cultivation, Distribution and Possession
According to Ronfola (2013.The legalization of marijuana in California and across the United States is an extremely unsettled area of law. California allows each jurisdiction to establish local cultivation and distribution guidelines. State law, however, is in conflict with federal law regarding the legalization of marijuana. Federal authorities have been aggressive in their pursuit and prosecution of distributors and cultivators of marijuana.
At the Law Office of John Runfola, we are available to counsel you so that you may legally navigate the ever-changing network of federal and local guidelines surrounding cultivation, possession and distribution of marijuana. A consultation with John Runfola before beginning to plant and grow marijuana can help a client avoid future prosecutions. Although possession, cultivation and distribution continued to be a violation of federal law, a basic understanding of California marijuana law follows.
Does Using Marijuana Lead to Other Drugs?
Answer: Long-term studies of high school students and their patterns of drug use show that very few young people use other drugs without first trying marijuana, alcohol, or tobacco. Though few young people use cocaine, for example, the risk of doing so is much greater for youth who have tried marijuana than for those who have never tried it.
While research has not fully explained this association, growing evidence suggests a combination of biological, social, and psychological factors are involved.
Researchers are examining the possibility that long-term marijuana use may create changes in the brain that make a person more at risk of becoming addicted to other drugs, such as alcohol or cocaine (16). While many young people who use marijuana do not go on to use other drugs, further research is needed to determine who will be at greatest risk.
Researchers Find Clues to Marijuana Effects
Lowers Body Temperature, Impairs Functions
Scientists have been studying cannabinoids, substances that are chemically related to the ingredients found in marijuana, for more than two decades, hoping to learn more about how the drug produces its effects — both therapeutic and harmful.
Marijuana has been reported effective in the treatment of multiple sclerosis, glaucoma, nausea caused by chemotherapy and wasting caused by AIDS. However, like all drugs, it also causes numerous unwanted side effects, including hypothermia, sedation, memory impairment, motor impairment and anxiety. Research on cannabinoids could someday yield new, more effective drugs or drug combinations.
At Temple University’s School of Pharmacy and Center for Substance Abuse Research (CSAR), one of only a few centers in the nation focused on the basic science of substance abuse, several researchers are investigating how cannabinoids produce pharmacological effects in rats.
One such study, “L-NAME, a nitric oxide synthase inhibitor, and WIN 55212-2, a cannabinoid agonist, interact to evoke synergistic hypothermia,” published in the February 2004 issue of the Journal of Pharmacology and Experimental Therapeutics, reveals how cannabinoids produce one of the drug’s most robust actions, hypothermia, or decreased body temperature.
According to lead author Scott Rawls, Ph.D., assistant professor of pharmacodynamics at Temple’s School of Pharmacy, “To operate at maximum efficiency, the body needs to maintain a stable, normal temperature. When the body’s temperature is altered, as in hypothermia, normal body functions, such as blood pressure and circulation, are impaired.”
Marijuana operates via two receptors in the body. One receptor, called CB1, is located in the brain and produces the drug’s psychoactive effects, including euphoria and dizziness. The other receptor, CB2, is found throughout the body and impacts the immune system. Substances in marijuana bind to one of these receptors and set off a chemical process that leads to an effect, such as hypothermia. Scientists have focused on this chemical process at the molecular level to pinpoint the exact molecules involved.
Knowing that the molecule nitric oxide (NO) plays an important role in the regulation of body temperature, the Temple researchers set out to determine what role it might play in cannabinoid-induced hypothermia. By combining a cannabinoid with a substance that blocked NO synthesis, they found that cannabinoid-induced hypothermia increased more than two-fold.
“This demonstrates the possibility that NO plays a part in regulating the impact of cannabinoids on body temperature and other cannabinoid-mediated actions,” said Rawls. “These findings could be helpful in determining the mechanisms that underlie some of the pharmacological actions of marijuana,” he added.
Rawls’ research team is currently investigating the impact of cannabinoids on other physiological systems, such as analgesia and movement, and the brain neurotransmitters that mediate those systems.
Other Possible Problems
In addition to the long-term and short-term side effects, you may have heard that using marijuana may lead to other drug use. Although it is not certain that marijuana is the direct cause, people who have used marijuana are eight times more likely to have used cocaine, 15 times more likely to have used heroin, and five times more likely to need treatment for substance abuse.
There are also legal aspects to marijuana use: Every state except Colorado and Washington has laws against growing, possessing, and selling marijuana. Penalties vary from state to state, but they usually involve fines and/or jail time for those caught using or distributing marijuana. People who use marijuana may end up with criminal records that can hurt plans for college or finding a job.
Speaking of jobs, more and more places test for drug use as part of the hiring process. It can take several weeks for marijuana to leave someone’s body. So people who use marijuana may find they don’t get a job they want — or, if their place of work does ongoing drug tests, they may lose their jobs.
Marijuana is typically smoked in cigarettes (joints or spliffs), hollowed-out cigars (blunts), pipes (bowls), or water pipes (bongs). Some people mix it into food or brew it as a tea.
The main active chemical in marijuana is THC (delta9tetrahydrocannabinol). When smoked, THC passes from the lungs into the bloodstream, which transports it to the brain and other organs. When it reaches the brain, THC connects with a certain type of receptor on nerve cells in areas that affect coordination, thought, memory, concentration, sensory and time perception, and pleasure. This causes the marijuana “high.”
Marijuana users can experience these short-term effects:
difficulty in thinking and problem solving
problems with memory and learning
loss of coordination
Medical Use of Marijuana
The U.S. Food and Drug Administration (FDA) has approved pills that contain THC (the active ingredient in marijuana) to help relieve nausea in people who have cancer and help people with AIDS regain their appetite. There’s still debate over the medical use of marijuana, though, so the THC pill is only available in certain states and requires a doctor’s prescription.
Long term research has found that side effects from using marijuana frequently over a long period of time include:
Changes in the brain. Marijuana can affect the areas of the brain that play a part in response to stress, motivation, and reward.
Fertility implications. Animal studies suggest that heavy users may experience disruptions in ovulation or produce less sperm. So it’s possible people who use a lot of marijuana might have difficulty having children as they get older. Studies also show that babies born to women who use marijuana when they are pregnant may be more likely to have developmental and behavioral problems.
Respiratory problems. People who smoke marijuana have more respiratory problems — such as having more mucus, a chronic cough, and bronchitis (irritated breathing passages).
Changes in blood pressure. Over time, continued use of marijuana can lead to decreased blood pressure, which may cause dizziness. It also seems to impair the body’s ability to fight off infections and some other diseases.
Emotional problems. Heavy users are more likely to report symptoms of depression than nonusers. They can also feel more anxiety, have more personality disturbances, and are at an increased risk of developing schizophrenia, a severe form of mental illness.
At present, not enough data exist for scientists to determine whether smoking marijuana is any more helpful than taking its active ingredient in pill form. Studies into this are ongoing.
What If I Want to Quit?
People who try to give up marijuana after using it frequently over a period of time may experience withdrawal symptoms. These can include irritability, sleeplessness, anxiety, depression, and lack of appetite. As with caffeine addiction, symptoms of marijuana withdrawal are usually worse a day or two after someone stops using marijuana. They gradually decrease and are usually gone a week or two after the person no longer uses the drug.
If you or someone you know would like to kick the habit, talking to a counselor can help. Studies suggest that a combination of individual counseling and group therapy sessions is
the best approach for getting off marijuana.
These effects can make activities like driving dangerous while under the influence of the drug.
In summary, there is increasing evidence that cannabis may represent a useful alternative or adjunct in the management of painful peripheral neuropathy, a condition that can markedly affect life quality. Our society should be able to find ways to separate the medical benefits of making a treatment available to improve lives when indicated from broader social policy on recreational use, marijuana legalization, and unsubstantiated fears that medicinal cannabis will lead to widespread cannabis addiction.
On the other side further information is needed before Florida’s voters can determine the long term effects, concerning positive or negative, health issue due to long term use. If in fact states pass LMM only for the financial rewards due to taxation revenue yet do not discuss adverse side effects this could do more harm than good.
In conclusion, it seems that the potential dangers presented by the medical use of marijuana may actually contribute to the dangers of the diseases which it would be used to combat. Therefore, it is suggested until a more conclusive research has been completed concerning its debilitating effect on the immune system, which the voters might want to reconsider their vote.
Waiting for the results of studies done by the 20 state (see annex website at end of this session) who have currently approved LMM. If a limit number of patients should be approved for LMM in the state of Florida, individuals should be followed for the long term effect if positive or negative. The medical swift physician, mental and emotional behavior be tracked, record and presented in medical journals to be evaluated by the legislators.
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