---------- Forwarded message ----------
From: Richard Lake <rl...@mapinc.org>
Date: Tue, Jan 19, 2010 at 12:25 AM
Subject: [mmjlist] US: Is Marijuana a Medicine?
To: mmjl...@cannabismd.org

Newshawk: chip
Pubdate: Tue, 19 Jan 2010
Source: Wall Street Journal (US)
Webpage: http://mapinc.org/url/NpbYzKaz
Copyright: 2010 Dow Jones & Company, Inc.
Contact: wsj.l...@wsj.com
Website: http://www.wsj.com/
Author: Anna Wilde Mathews
Bookmark: http://www.mapinc.org/find?253 (Cannabis - Medicinal - U.S.)

IS MARIJUANA A MEDICINE?

Charlene DeGidio never smoked marijuana in the 1960s, or afterward. But a
year ago, after medications failed to relieve the pain in her legs and feet,
a doctor suggested that the Adna, Wash., retiree try the drug.

Ms. DeGidio, 69 years old, bought candy with marijuana mixed in. It worked
in easing her neuropathic pain, for which doctors haven't been able to
pinpoint a cause, she says. Now, Ms. DeGidio, who had previously tried
without success other drugs including Neurontin and lidocaine patches,
nibbles marijuana-laced peppermint bars before sleep, and keeps a bag in her
refrigerator that she's warned her grandchildren to avoid.

"It's not like you're out smoking pot for enjoyment or to get high," says
the former social worker, who won't take the drug during the day because she
doesn't want to feel disoriented. "It's a medicine."

For many patients like Ms. DeGidio, it's getting easier to access marijuana
for medical use. The U.S. Department of Justice has said it will not
generally prosecute ill people under doctors' care whose use of the drug
complies with state rules. New Jersey will become the 14th state to allow
therapeutic use of marijuana, and the number is likely to grow. Illinois and
New York, among others, are considering new laws.

As the legal landscape for patients clears somewhat, the medical one remains
confusing, largely because of limited scientific studies. A recent American
Medical Association review found fewer than 20 randomized, controlled
clinical trials of smoked marijuana for all possible uses. These involved
around 300 people in all--well short of the evidence typically required for
a pharmaceutical to be marketed in the U.S.

Doctors say the studies that have been done suggest marijuana can benefit
patients in the areas of managing neuropathic pain, which is caused by
certain types of nerve injury, and in bolstering appetite and treating
nausea, for instance in cancer patients undergoing chemotherapy. "The
evidence is mounting" for those uses, says Igor Grant, director of the
Center for Medicinal Cannabis Research at the University of California, San
Diego.

But in a range of other conditions for which marijuana has been considered,
such as epilepsy and immune diseases like lupus, there's scant and
inconclusive research to show the drug's effectiveness. Marijuana also has
been tied to side effects including a racing heart and short-term memory
loss and, in at least a few cases, anxiety and psychotic experiences such as
hallucinations. The Food and Drug Administration doesn't regulate marijuana,
so the quality and potency of the product available in medical-marijuana
dispensaries can vary.

Though states have been legalizing medical use of marijuana since 1996, when
California passed a ballot initiative, the idea remains controversial.
Opponents say such laws can open a door to wider cultivation and use of the
drug by people without serious medical conditions. That concern is
heightened, they say, when broadly written statutes, such as California's,
allow wide leeway for doctors to decide when to write marijuana
recommendations.

But advocates of medical-marijuana laws say certain seriously ill patients
can benefit from the drug and should be able to access it with a doctor's
permission. They argue that some patients may get better results from
marijuana than from available prescription drugs.

Glenn Osaki, 51, a technology consultant from Pleasanton, Calif., says he
smokes marijuana to counter nausea and pain. Diagnosed in 2005 with advanced
colon cancer, he has had his entire colon removed, creating digestive
problems, and suffers neuropathic pain in his hands and feet from a
chemotherapy drug. He says smoking marijuana was more effective and faster
than prescription drugs he tried, including one that is a synthetic version
of marijuana's most active ingredient, known as THC.

The relatively limited research supporting medical marijuana poses practical
challenges for doctors and patients who want to consider it as a therapeutic
option. It's often unclear when, or whether, it might work better than
traditional drugs for particular people. Unlike prescription drugs it comes
with no established dosing regimen.

"I don't know what to recommend to patients about what to use, how much to
use, where to get it," says Scott Fishman, chief of pain medicine at the
University of California, Davis medical school, who says he rarely writes
marijuana recommendations, typically only at a patient's request.

Researchers say it's difficult to get funding and federal approval for
marijuana research. In November, the AMA urged the federal government to
review marijuana's position in the most-restricted category of drugs, so it
could be studied more easily.

Gregory T. Carter, a University of Washington professor of rehabilitation
medicine, says he's developed his own procedures for recommending marijuana,
which he does for some patients with serious neuromuscular conditions such
as amyotrophic lateral sclerosis, or Lou Gehrig's disease, to treat pain and
other symptoms. He typically urges those who haven't tried it before to
start with a few puffs using a vaporizer, which heats the marijuana to
release its active chemicals, then wait 10 minutes. He warns them to have
family nearby and to avoid driving, and he checks back with them after a few
days. Many are "surprised at how mild" the drug's psychotropic effects are,
he says.

States' rules on growing and dispensing medical marijuana vary. Some states
license specialized dispensaries. These can range from small storefronts to
bigger operations that feel more like pharmacies. Typically, they have
security procedures to limit walk-in visitors.

At least a few dispensaries say they inspect their suppliers and use labs to
check the potency of their product, though states don't generally require
such measures. "It's difficult to understand how we can call it medicine if
we don't know what's in it," says Stephen DeAngelo, executive director of
the Harborside Health Center, a medical-marijuana dispensary in Oakland,
Calif.

Some of the strongest research results support the idea of using marijuana
to relieve neuropathic pain. For example, a trial of 50 AIDS patients
published in the journal Neurology in 2007 found that 52% of those who
smoked marijuana reported a 30% or greater reduction in pain. Just 24% of
those who got placebo cigarettes reported the same lessening of pain.

Marijuana has also been shown to affect nausea and appetite. The AMA review
said three controlled studies with 43 total participants showed a "modest"
anti-nausea effect of smoked marijuana in cancer patients undergoing
chemotherapy. Studies of HIV-positive patients have suggested that smoked
marijuana can improve appetite and trigger weight gain.

Donald Abrams, a doctor and professor at the University of California, San
Francisco who has studied marijuana, says he recommends it to some cancer
patients, including those who haven't found standard anti-nausea drugs
effective and some with loss of appetite.

Side effects can be a problem for some people. Thea Sagen, 62, an advanced
neuroendocrine cancer patient in Seaside, Calif., says she expected
something like a pharmacy when she went to a marijuana dispensary mentioned
by her oncologist. She says she was disappointed to find that the staffers
couldn't say which of the products, with names like Pot 'o Gold and
Blockbuster, might boost her flagging appetite or soothe her anxiety. "They
said, 'it's trial and error,' "she says. "I was in there flying blind,
looking at all this stuff."

Ms. Sagen says she bought several items and tried one-eighth teaspoon of
marijuana-infused honey. After a few hours, she was hallucinating , too
dizzy and confused to dress herself for a doctor's appointment. Then came
vomiting far worse than her stomach upset before she took the drug. When she
reported the side effects to her oncologist's nurse and her primary-care
physician, she got no guidance. She doesn't take the drug now. But with
advice from a nutritionist, her appetite and food intake have improved, she
says.

Other marijuana users may experience the well-known reduction in ability to
concentrate. At least a few users suffer troubling short-term psychiatric
side effects, which can include anxiety and panic. More controversially, an
analysis published in the journal Lancet in 2007 tied marijuana use to a
higher rate of psychotic conditions such as schizophrenia. But the analysis
noted that such a link doesn't necessarily show marijuana is a cause of the
conditions.

Long-term marijuana use can lead to physical dependence, though it is not as
addictive as nicotine or alcohol, says Margaret Haney, a professor at
Columbia University's medical school. Smoked marijuana may also risk lung
irritation, but a large 2006 study, published in Cancer Epidemiology,
Biomarkers & Prevention, found no tie to lung cancer.

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