September 3, 2016
During the political season I often watch CNN or FOX news with the sound off, just to see the non-political headlines on the “crawl” at the bottom of the screen.
Today, another marijuana item caught my eye. New York legislators are considering increasing the number of Medical Marijuana dispensaries to 40, state-wide; allowing nurse-practitioners to prescribe marijuana; and widening the acceptable medical indications to include “chronic pain”.
As I asked in my previous post, is there anyone in the world who does not think “medical” marijuana is merely s subterfuge to make marijuana available to anyone who wants it, circumventing or ignoring the federal and state proscriptions against its use?
The Medical Marijuana Myth
It is possible that herbal marijuana may prove to have some few medicinal benefits, but at present that assertion remains merely anecdotal and informal. It has never been subjected to the well-established formal and legal methodology by which such beliefs are forged into scientific medical judgments, has never undergone the process that protects the public against magical or delusional theories, and against fraud in the form of medical quackery. Several decades ago a study done inLos Angeles found that 50% of marijuana sold on the street was adulterated in order to give it a more palpable kick. At the time the most common adulterant was phencyclidine (PCP). Now the vendors have many more choices and the buyers have even less of an idea what they are smoking.
It is a sad irony that the vast majority of people protected by the intricate and careful process of bringing a medication to market haven’t a clue what it is, why it exists or how it works. As a result of which they fail to offer it the respect it is due. Only this week the FDA ordered the removal of 19 ingredients from antibacterial soaps marketed for nearly half a century, on the basis that their makers have failed to offer scientific proof of their possessing any greater efficacy than plain soap and water, and that, moreover, the substances may contribute to the development of antibiotic-resistant strains of pathogenic bacteria.
The only promising indication I have seen of a major and unique medical benefit of marijuana is in the treatment of children with nearly a hundred seizures a day, by the Charlotte’s Web strain.
From Discover science magazine:
A new strain of marijuana has motivated hundreds of families with epileptic children to pack up and move to Colorado to legally obtain the drug. The jury is still out on whether this special pot strain does indeed have measurable benefits, or if it’s even safe, but drug companies are racing to replicate its effects in pill form.
The therapeutic pot strain, called Charlotte’s Web, is bred not have THC—the active ingredient in marijuana. Its namesake is 5-year-old Charlotte Figi, a Colorado girl who has Dravet’s syndrome. Charlotte reportedly went from having 300 seizures a week in 2010 to being virtually seizure-free two years later after connecting with a nonprofit that grows and produces an oil infused with the special marijuana strain.
Charlotte’s story has renewed curiosity among researchers in a particular chemical in pot, cannabidiol (CBD), which could have anti-epileptic properties in humans.
Marijuana is also reputed to be an effective anti-nauseant in people receiving cancer chemotherapy. This is a very narrow usage, and might not be as attractive as a some pill form of the active ingredient to those who do not smoke, or who do not smoke marijuana. See the pros and cons of this indication.
In particular, odansetron is more effective than marijuana and is readily absorbed if placed between lip and gum, important when comparing with inhaled marijuana because swallowed medications and those administered by rectal suppository are likely to be expelled before they are absorbed when the patient is vomiting and having diarrhea.
Earlier reports of shortened gestational duration (0.8 weeks) in marijuana users have been questioned, and later studies have not found any significant adverse effects, but some study designs may not have detected anything less than a five-fold increase in birth defects. Therefore, caution is still indicated, recalling that thalidomide for nausea and vomiting of pregnancy made it all the way through FDA testing and to the market before it was discovered that babies were being born with flippers instead of arms and legs.
Chronic Pain and the Harm Reduction Philosophy
The New York state proposal to include chronic pain may add to a big problem.
Between three and four decades ago, a medical advocacy, consisting of a small number of loud voices, arose to “stop under-treating” people with chronic pain. Because many physicians were reluctant to treat pain for which they could find no medical cause or reason, this imperative gave rise to special “pain clinics”, operated by the few physicians who did believe that chronic pain was usually a real entity. (The alternate belief being that persistent pain was often the result of treating acute pain for too long a period and with too high doses of opioid pain medications and other addicting substances.)
The result, over the past thirty years, has been a huge and ever-growing increase in the number of opiate addicts, leading to a warning last week by the Centers for Disease Control and Prevention of the Department of Health and Human Services, for physicians to be far more careful in prescribing medications for pain. The general conclusion has been that physicians, and “pain clinics” have been responsible for the dramatic 30-year increase in prescription pill addictions.
All I can say is that this conclusion comports with my own observations during forty-plus years of medical practice, in which I personally treated many patients carelessly and unnecessarily addicted to opiates by their physicians. Within a number of days or a very few weeks of treatment with opiates, a pain patient will re-expeience the pain whenever an attempt is made to reduce the dose of the opiate… long, long after any physical cause for the pain has completely healed.
Along with the prescription of opiates for pain, a major industry has developed, based upon the theory of “harm reduction”, that treats heroin addiction with maintenance methadone and buprenorphine, both synthetic opiates. The problem with the “harm reduction” theory is that by removing adverse consequences, motivation of both patient and physician to end the addiction are reduced or removed, if not reversed. The patient keeps the pain in order to obtain a drug he wants. The physician keeps the patient in order to pay for his new sailboat.
I see the growing movement by cynical marijuana users and growers: to circumvent the law by arguing, without any consensus of medical opinion, that marijuana has medicinal benefits, as analogous to the corrupting influence of the “chronic pain” and “harm reduction” theories of its predecessors. This is a thinly disguised political ploy that is bad enough for that reason alone, but also corrupts and sacrifices the integrity and honesty of the medical profession as “collateral damage” to its cause. We have created a small army of doctors who have become content to make a very good living writing prescriptions for methadone, buprenorphine and pot. They make no ‘good faith’ examination of the “patients”, and are content, in the case of opioids, to create or maintain an addiction that keeps their patients coming in like clockwork to get their drug of choice. Ca-ching!
In the case of marijuana, though the addiction rate is arguably far smaller than with opioids, the people who will let nothing stand between them and their drug, and who are willing to pay some ‘wink-wink, nod-nod’ practitioner to write them a script for it, are gradually expanding their control, state by state, over the health policies and once-proud health care system of a nation. By their very actions, those people are displaying some of the identifying characteristics of addiction. And as a community, we are increasingly enabling the inmates to run the asylum, with predictable results.