October 25, 2010 – With eight states looking to legalize medical marijuana through legislative initiatives or ballot measures this November (Arizona, Illinois, Massachusetts, New York, North Carolina, Ohio, Pennsylvania and South Dakota)(1), I wanted to review some of the pros and cons, as I see them, of marijuana use and abuse.

I’ve considered myself particularly qualified to weigh in on the subject ever since my philosophy professor pointed out to me as a college freshman that the Italian derivation of my name, Mal-erb-a, can be interpreted to mean “bad weed.” I’d like to think that my medical degree and some experience in the field of psychiatry help a little bit, too. To sum up my argument I’ll need to borrow a line from Eric Clapton, “It’s in the way that you use it.”

Medical Marijuana:
The medical benefits of marijuana (cannabis) are pretty well established. There is voluminous scientific research on the subject(2) that verifies its efficacy when applied to a variety of medical conditions, and plenty of first-hand evidence that it works for those who use it for their own health problems. While this first-hand testimony that comes from real patients is usually the type of evidence that scientific purists disparage as “anecdotal,” it is, in my opinion, the type of real-life experiential information that we should trust at least as much as the abstract statistical analyses of scientific studies.

The medicinal use of marijuana is well known to be of benefit in the treatment of nausea and other side effects from chemotherapy. It also helps improve the diminished appetite that patients undergoing cancer treatment can experience. It lowers intraocular pressure in glaucoma patients, decreases spasticity and other neurologic symptoms in multiple sclerosis, and there is evidence that it is useful in a variety of additional medical conditions.

Some tend to assume that marijuana first appeared on the scene in the 1960′s. However, history tells us that the medicinal properties of cannabis have been recognized for centuries. The medical use of marijuana is documented in Egyptian papyri dating back to 1,550 BCE. It was used in ancient India to treat insomnia, headaches and labor pains. And the ancient Greeks used cannabis for tapeworms, nosebleeds and ear infections.(3)

Both Cannabis indica and Cannabis sativa have been used worldwide in homeopathic practice since as far back as the early 1800′s when detailed information regarding their clinical effects was published.(4) Homeopathic dilutions of these substances have since been found to be particularly effective in treating a wide range of mental/emotional problems including anxiety disorders and attention deficit hyperactivity disorder, in addition to urinary tract infections like cystitis and prostatitis.

As far as I am concerned, its value in medical practice in allopathic, herbal and homeopathic forms is an open-and-shut case. Any resistance to its medical use from the mainstream medical community is likely to be a function of political expediency because to reject it on scientific grounds is just plain silly. When we consider that physicians legally prescribe powerful and addictive drugs like morphine, codeine, oxycodone (OxyContin) and hydromorphone (Dilaudid), to name just a few, it is hard to see the justification for outlawing medical cannabis. Nevertheless, there are a number of other contexts in which marijuana is used that we still need to consider.

Ritual Use of Marijuana:
The marijuana plant has likewise been used for centuries in the religious rituals of diverse cultures. Marijuana is just one of many entheogens (en-theo-gen = “within-god-creates”). Entheogenic substances are psychoactive substances used to enhance spiritual experience in religious, shamanic or other spiritual contexts. Cannabis oil was used by early Christians in a number of rites including the anointing with oil at baptisms. The ancient Chinese Taoists used cannabis as incense, and many Hindu practices included offerings of cannabis to their deities. (5)(6)

Some similar but more powerfully hallucinogenic substances used in such rituals include peyote, psilocybin mushrooms, ayahuasca and mescaline. Their common characteristic is their ability to open one up to an experience of the non-physical dimensions of existence. Marijuana users from the sixties generation are quick to point to its consciousness expanding capabilities. Shamans, healers and priests have used and continue to use marijuana in their healing practices and spiritual ceremonies. It is understood to act as a vehicle that provides easier access to and an enhanced experience of the “other side,” or the spiritual realm. It opens the consciousness to new possibilities and is a powerful catalyst for spiritual exploration and development. However, once the “doors of perception”(7) have been opened and spiritual insight has been achieved, I do not believe that it is productive or desirable to repeat the process endlessly, since a variety of other means (prayer, meditation, shamanic journeying, chant, etc.) can yield comparable results.

It is interesting to note that the proper use of these entheogenic substances under the guidance of an experienced elder or spiritual adept does not usually result in drug abuse, destructive tendencies or mental illness. The take-home message here is that it is the context within which marijuana is used that is determinative as to its effect. Given that the United States was founded on principles of religious freedom, citizens’ rights to use marijuana for spiritual purposes should be a no-brainer.

Recreational Use and Prohibition:
Research indicates that nearly 50 percent of Americans have tried marijuana at least once in their lives. Many find that it enhances creativity, and there is no doubt that it heightens one’s aesthetic sensibilities, and one’s experience of music in particular. By my count, at least the last three U.S. presidents are known to have tried it. Despite overwhelming evidence that most recreational users of marijuana come away unscathed from their experiences, we are living in a historical period of inordinately harsh laws that prohibit its use.

Criminalization has made countless criminals out of otherwise ordinary citizens. We have allowed fear to motivate us to such an extent that we are willing to throw our kids in jail for something that many of us did during our own periods of youthful indiscretion. The hypocrisy of the contrast between the public face of our collective societal stance against marijuana and our true private attitudes toward the same is unconscionable. Even if young offenders manage to avoid jail sentences, their lives are often stigmatized in such a way as to seriously hamper them from pursuing productive lives as adults. We are two-faced about the issue and kids see right through that. Furthermore, prohibition of popular substances like alcohol and marijuana will always fail because people who desire them will find ways to get their hands on them anyway.

The Hazards of Marijuana Use and Abuse:
Understandably, those who wish to promote the benefits of marijuana can sometimes downplay the negatives. But they shouldn’t be glossed over because there are some potential problems that must be named for what they are. Although no one has ever died from a marijuana overdose(8) and its overall track record is remarkably safe, there are some hazards that, again, are largely a function of context. In other words, medical use in the context of professional medical care makes good sense, and ritual use performed with right intent and conscious purpose–ideally under the supervision of an experienced elder–can be an enlightening experience, but recreational use is potentially more problematic because it does have its pitfalls.

We all know the classic stereotype of the burnout pothead wasting his life away contemplating his navel while munching on potato chips. As is often the case, there is some validity to the stereotype. Used in excess, marijuana has a clear tendency to diminish motivation, blunt ambition and generally stunt normal emotional growth. While it can stimulate the mind it seems to interfere with emotional maturation in some individuals. It can also cause confusion and disorganized thought patterns. No doubt, some individuals can waste away good portions of their lives in a marijuana haze.

Marijuana is well known to be able to induce anxiety disorders, including panic attacks. More rarely, when used by the wrong individuals, it may serve as a trigger for psychotic states, including schizophrenia. I don’t believe that it “causes” psychoses as much as it can be the straw that breaks the camel’s back for individuals already predisposed to developing such conditions.

The problem with recreational use is that it usually happens in uncontrolled situations with no serious purposeful agenda other than to get “high.” Mature experienced individuals can enjoy the benefits of recreational marijuana while avoiding the dangers, especially when used in moderation and with discretion. Many adults similarly engage in responsible social alcohol consumption. As with alcohol, marijuana certainly shouldn’t be served to minors.

Where do we go from here?
We have become an irrationally fearful nation that can make some very poor choices regarding our own best interests. As a society, we have abdicated personal responsibility regarding marijuana by inappropriately turning it into a legal issue. In attempting to solve the very complex issues surrounding cannabis use by means of a very black/white, right/wrong legalistic framework, we have created far more problematic issues. Prohibition encourages crime and guarantees a black market, and the casualties of this misguided effort have become our very own children. Decriminalization and/or legalization would go a long way toward crime reduction.

Abusers are not criminals in my opinion; they are persons in need of our help, guidance and compassion. As with alcohol, we must establish reasonable taboos with compassionate responses. (Although I do have strong reservations about the way beer commercials promote their products with messages containing images of wild parties, sexual objectification and fantasies of athletic heroism.) There is a reason that alcohol is not sold to those under the age of 21, and the same should apply to marijuana. Offenders should face firm but reasonable penalties and should be offered treatment and support, similar to the way in which a variety of alcohol programs are available to alcohol abusers.

One of my pet theories is that as the adults of my generation have tightened the reigns on alcohol and drug use by instituting much harsher punishments than we experienced as kids, it has left little room for modern kids to push the limits and sow their wild oats. The message is clear: partake of the forbidden at your own peril because the consequences can be severe. Since this has become such a risky option, so my theory goes, kids not surprisingly are turning to the final frontier of rebellion, that of sexual promiscuity. And with such easy access in the age of the internet, our kids are placing themselves in great danger at the hands of sexual predators and in terms of the harm that can come to body, mind and soul as a result of so many indiscriminate, casual sexual encounters.

By setting up more reasonable taboos with less dire consequences, there will be room for our children to occasionally experiment with those boundaries and, when they cross the line, we as a society and as individuals can be there to set them back on course before it is too late. Is it a foolproof strategy? No; there will always be casualties, but they will be far fewer in number. This overall approach is in keeping with the current cries against governmental overreach and allows us to return to the basic principles of freedom of choice and personal responsibility. And as Clapton intones, “So don’t you ever abuse it…” By Larry Malerba, D.O. – Practicioner, educator and leader in the field of holistic medicine.
Source.

References:

(1) Medical Marijuana, ProCon.org
(2) Research Findings on Medicinal Properties of Marijuana, MarijuanaLibrary.org

(3) Medical Cannabis, Wikipedia
(4) Timothy F Allen, MD, The Encyclopedia of Pure Materia Medica, Vol. II, Boericke & Tafel, New York, 1875. p. 448
(5) Entheogens, Wikipedia
(6) Religious and spiritual use of cannabis, Wikipedia

(7) The Doors of Perception, Wikipedia
(8) Annual Causes of Death in the U.S., DrugWarFacts.org

May 4, 2010 – In about a dozen states, you can smoke a joint if you have cancer or HIV and meet certain conditions, like having a doctor’s note.

In California, you can light up if you have just about anything — headaches, anxiety, epilepsy — and a physician’s OK.

Illinois could join these states as legislators consider a bill that would allow patients to use marijuana as medicine as long as they have one of 14 conditions and illnesses, including cancer and Crohn’s disease.

But interviews with scientists and physicians and a review of medical literature reveal scant evidence that marijuana is a safe and effective treatment for most of those 14.

A handful of uses in the bill — such as pain suffered by people with HIV and cancer — are supported by some solid scientific evidence. But none meet the standards, such as multiple large, well-designed clinical trials, required by the U.S. Food and Drug Administration in approving new drugs.

“What defines a medicine? And how do we bring medicines to market?” said Dr. Eric A. Voth, chairman of the Institute on Global Drug Policy. “And we do not bring them through the legislative vote process and say: ‘Here, we deem this as medicine.’”

And yet the momentum across the U.S. leans toward legalizing medical marijuana, with bills being weighed from Pennsylvania to Ohio. On Tuesday, the District of Columbia Council passed a measure that legalizes medical cannabis. Advocates also are championing a change in federal law.

In the world of medicine, there’s nothing quite like pot. It’s a medicine sold with names like Haze ($160 an ounce at one California dispensary) and Grand Daddy Purple ($300 an ounce), and descriptions like “get lifted and be happy”; a stigmatized plant with therapeutic promise that few want to study because it remains illegal on the federal level and a drug that raises concerns because it often is smoked.

“We need more science and we need to treat it like a medicine,” said Allan Young, a professor of psychiatry at the University of British Columbia who is conducting a trial examining the effect of chemicals in marijuana on bipolar disorder.

Advocates say they are only trying to decriminalize use of the plant by sick people who have failed to gain relief from pharmaceutical drugs. Under the Illinois bill, patients with permission from the state and a physician would be able to possess 2 ounces of dried marijuana or grow a small number of plants.

“These sick people are looking for compassion,” said Dan Linn, executive director of the Illinois Cannabis Patients Association. “And if treatment includes cannabis, in Illinois, should we consider these people criminals?”

Illinois Rep. Lou Lang, a sponsor of the Illinois bill, said: “We have to think of this as a product, not a drug. Not as a menace. Nobody has ever died from an overdose of marijuana.”

But there is reason to worry that marijuana could actually prove harmful for patients with some of the conditions it is supposed to treat.

Take glaucoma, a disease listed in the Illinois bill and often cited by advocates because marijuana can lower the pressure inside the eye. Increased eye pressure is a common feature of glaucoma, and can lead to damage of the optic nerve and blindness.

“They think that even if this unconventional therapy doesn’t work that it can’t possibly hurt their disease,” said Dr. James Tsai, chairman of the Department of Ophthalmology and Visual Science at Yale University School of Medicine and chairman of the medical advisory board at The Glaucoma Foundation. “However, studies suggest that it might be, in fact, damaging to do so.”

Marijuana only lowers pressure for several hours, requiring patients to continuously medicate day and night, glaucoma experts said. Failing to do so can lead to a rebound spike in eye pressure, which can be damaging. Marijuana also can lower blood pressure, which can damage the optic nerve.

In February, the Journal of Glaucoma ran an editorial warning against using pot to treat glaucoma.

Epilepsy is another disease commonly cited by advocates as treatable because marijuana is suspected to have anti-seizure properties. But ask epilepsy experts and they will tell another story.

“Statistically, there is no evidence that it is effective when used as a therapeutic agent and, besides, it has more side effects than other anti-seizure medications available,” said neurologist Dr. Stephan Schuele, medical director of the Northwestern University Comprehensive Epilepsy Center.

There are serious concerns, said neurologist Dr. Alan Ettinger, epilepsy director of Neurological Surgery in Rockville Center, N.Y., and a member of the executive board of the national Epilepsy Foundation. First, he said, withdrawal among chronic users with epilepsy can cause severe exacerbations of the seizures.

And, he said, some individuals with epilepsy are struggling with depression, sleepiness and cognitive difficulties to begin with. Marijuana can compound these problems, he said.

Like glaucoma and epilepsy, research is mixed when it comes to another commonly cited medical use of marijuana — spasticity in people with multiple sclerosis, according to experts in the field.

One trial in Europe found that objective measures showed cannabis did not affect spasticity, even though patients thought it did, said neurologist Dr. Carlo Pozzilli, director of the Multiple Sclerosis Center in Rome, who has conducted research on cannabis and multiple sclerosis. It did, however, affect pain.

“This is the gap between what the patients say and what the doctor sees in terms of objectivity,” Pozzilli said. “This is the big problem of cannabis as a therapeutic.”

Advocates say marijuana can be a safe and effective alternative to FDA-approved pharmaceuticals, which can come with their own addiction problems and side effects. Mike Graham, a 47-year-old former restaurant manager from Manteno, Ill., said his degenerative disc disease left him bedridden with horrible nerve pain. “It is like getting hit by a baseball bat every time my heart beats,” he said. “Boom. Boom. Boom. It doesn’t stop.”

The painkillers he was taking, including a morphine pump, failed to manage the pain but caused nausea and vomiting, he said. A hospice nurse suggested he try pot. He said it worked. Now he takes several puffs every three hours. “There is no euphoric feeling, but I can have a semblance of a life,” said Graham, co-director of the Illinois chapter of Americans for Safe Access.

His story echoes that of the Rev. Wayne Dagit, a Michigan minister who runs a cannabis smokers club in Williamston, Mich., and is pushing for the Illinois bill.

Dagit said he awakens some mornings in so much pain that he can barely move. He has been prescribed oxycodone, a strong painkiller that can become addictive and takes 30 minutes to take effect. “But,” he said, “if I can scoot up to the edge of the bed and do one hit (of marijuana), I wait four minutes and it is a euphoric effect and that is all I need.”

Researchers long have been intrigued by marijuana’s possibilities. Could cannabinoids, which affect areas of the brain that control movement, help people with multiple sclerosis control spasticity? Could the chemicals, which affect areas of the brain associated with stress, help veterans suffering from post-traumatic stress disorder?

In 1999, the Institute of Medicine released a report citing the promise of cannabinoids, recommending short-term use of marijuana for debilitating conditions like intractable pain or vomiting if, among other conditions, all other treatments have failed.

The report mostly calls for more research on uses of cannabis. But since that report, relatively little work has been done. Marijuana’s status as an illegal drug, not just in the United States but across much of the world, has stymied researchers.

Marijuana, especially smoked marijuana, as a target of research faces serious obstacles, said internist Dr. Eric Larson, a co-author of the 1999 Institute of Medicine report. “It is an orphan drug, there is no U.S. company that is going to promote it and then there’s the stigma,” he said.

Larson said the social advocacy groups — pro and con — also make marijuana an unpopular choice for researchers. “Many traditional scientists will say, ‘I don’t want to have to deal with this sort of wild advocacy group where my science runs the risk of being expropriated for an agenda that isn’t about discovery but rather about advocating a point of view.’” Source.