March 4, 2010

Question 5 based on 'false and dangerous' assumptions about marijuana

— PORTLAND — The Maine Marijuana Policy Initiative, Question 5 on the Nov. 3 ballot, will change state law to permit opening ''marijuana dispensaries'' throughout the state.

The initiative is based on false and dangerous assumptions about marijuana's therapeutic benefits and its safety, and minimizes the social harm that such dispensaries will create.

As Question 5 is specifically designed to increase access to cannabis for medical use, it is important to discuss the issues central to any medicine.

1. Is it safe? Advocates for medical marijuana describe it as a ''benign weed.'' On the contrary, its harmful effects greatly outnumber the few conditions where it is thought to be beneficial. Often, its effects are favorably compared to those of alcohol. This assumes that cannabis smokers, including those who use it for medical purposes, do not drink. Smoking exposes others, including children in the household of marijuana users, to the danger of second-hand smoke.

Health problems with cannabis use abound:

Psychiatric: Large population studies of chronic marijuana smokers have shown a greatly increased risk of depression, anxiety and panic disorders, depression and psychosis.

Heart: there is a well-established increase in heart attacks nearly five-fold within an hour of smoking.

Lungs: Marijuana contains more carcinogens than tobacco, and, because users hold the smoke in longer, they are far more likely to develop pre-cancerous changes. Marijuana smokers are more likely to develop bronchitis and chronic lung disease. Marijuana is believed to be more harmful to the lungs than tobacco.

Immune system: Marijuana is an immune-suppressant drug. In combination with its inflammatory effect on the lungs, it can actually harm people with prior immune-related diseases, such as HIV.

Cancers: Again, there are no clinical trials that show any benefit, while there are many that demonstrate harm. Studies have shown that someone who smokes five joints a day is inhaling as many cancer-causing chemicals as someone who smokes a pack a day.

2. Is it effective? Marijuana is purported to treat up to 250 conditions. Obviously, no medication can treat more than a handful of disorders. There are no clinical trials that compare cannabis to standard therapies.

While research has begun to demonstrate therapeutic benefits for some of the chemical components of marijuana, this does not mean that smoking it confers these potential benefits. The initiative would expand the current covered conditions to include Hepatitis C and Alzheimer's.

In fact, research in Hepatitis C has shown increased rates of liver scarring in infected patients, increasing the risk of cirrhosis. It would also allow practitioners to recommend marijuana for pain not adequately controlled by other treatments, opening the door to a virtually unlimited number of disorders, without evidence of cannabis' effectiveness.

In Alzheimer's disease, there have been no human trials; the proposed benefit is extrapolated from one rat study and from autopsy findings on cannabis receptors. There are no studies to demonstrate that marijuana slows the progression of the disease. Obviously, a drug that causes memory disturbance should not be given to patients suffering from a disease that impairs memory.

3. Is it addictive? My patients in treatment for opiate and alcohol addiction find it difficult to abstain from cannabis. The elements of addiction are all present: compulsive use, craving, failure to perform important social functions, tolerance and dependence with withdrawal.

4. Does it cause impairment? Marijuana impairs driving by causing distorted perception, problems with memory and learning, loss of coordination, trouble with problem-solving and increased reaction time. These problems are compounded when alcohol is added. Do medical marijuana users drive? If so, should they drive with children on board?

5. Will dispensaries lead to diversion? The leading source of diverted prescription opioids and alcohol are from parents and friends. How could increased availability and acceptance of marijuana as a safe drug not lead to increased non-medical abuse?

Recent news stories from other states document the enormous problems that dispensaries create, including diversion and robberies. Los Angeles alone has more than 900 dispensaries; there are no limits on them in Maine.

The first law of medicine is ''Primum non nocere:'' First, do no harm. Medical treatments must first be shown to safe and effective. There is no evidence that either of these conditions has yet been met by research.

Dispensaries are the wrong answer. Instead, let's advocate for more basic science and clinical research for cannabis.

— Special to the Press Herald

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