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Medical Marijuana a way to legalize cannabis?

Medical Marijuana a way to legalize cannabis?. ECAD May 13-15 2013 Moscow Kerstin Käll MD, PhD Dependency C linic , University hospital, Linköping, Sweden. Is cannabis medicine or a narcotic drug ?. Is opium medicine or a narcotic drug ? How about amphetamine ?

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Medical Marijuana a way to legalize cannabis?

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  1. Medical Marijuanaa way to legalize cannabis? ECAD May 13-15 2013 Moscow Kerstin Käll MD, PhD DependencyClinic, University hospital, Linköping, Sweden

  2. Is cannabis medicine or a narcoticdrug? • Is opium medicine or a narcoticdrug? • Howaboutamphetamine? • Medicine – pharmaceuticaldrug • Another importantdistinction: • Cannabis (e.g.marijuana - flowers and haschish - resin) • Cannabinoids – extracted from cannabis (e.g. THC, CBD – morethan 60 in total), endocanabinoids (anandamide) and synthetic canabinoids (in Spice)

  3. Cannabis as medicine • Firstdocumented från China 2727 BC • Effects pain, nausea, anorexia, spasticity • There is ongoing research on extractedcannnabinoids • Thereare approved pharmaceuticals, like Marinol and Sativex

  4. Approved pharmaceuticals, 1 • Marinol (THC) • Approved by FDA already in 1985 for treatmentof • Nauseaofchemotherapy • Wastingof AIDS • Not widelyused (duetolimitedeffect and manysideeffects)

  5. Approved pharmaceuticals, 2 • Sativex (THC+CBD) • Mouth spray for spaticityof MS – approved in Sweden in December 2011 • CBD counteractshallucinogeniceffectsof cannabis (almosttotally absent in the abused marijuana dueto plant breeding)

  6. Is marijuana an approved pharmaceutical in the US? • Agenciesthatapprovepharmaceuticals like Läkemedelsverket in Sweden and Food and Drug Administration (FDA) in the US haveverystrictrequirements for approval • The substanceshould be welldefined and controlled, the same amountshouldcontain the same dose • It must safe and effective • The mode of administration must be safe • The substance must be tested on animals and humans in several steps • The production must be controlled • The profileofsideeffects must be carefullydescribed

  7. Does marijuana meettheserequirements? • THC concentrationvaries a lot (2-30%) and is usuallyunknown. Morethan 60 different cannabinoids. Morethan 400 othersubstances. • Safety is veryquestionable – a numberofserioussideeffects • Psychiatric – psychoses, depression, anxiety • Somatic – lungdeseasesincl. lung cancer • addictive • The effect on e.g. pain and nausea is not impressive • Smoking is not a safe mode of administration. E.g. 4 timesmore tar in the lungscomparedtocigarette smoking

  8. Does marijuana meettheserequirements? – cont. • Tests on animals and humans have not beenperformed • Growing and manufacturing is not at all controlled. E.g. highdosesofpeticidesthatcan harm humans areused • There is no definedprofileofsideeffects, it is sold without a proper descriptionofcontainingsubstances, doseofeachsubstance, howmuch or for how long it should be used for the conditionsinvolved, etc

  9. Has FDA approved marijuana as a pharmaceutical in the US? • The answer is: No. On the contrary. FDA discourages from recommending marijuana smoking for medical purposes • It is still illegal topossesand sell cannabis accordingto federal law in the US • It is illegal to drive while on cannabis • Companiescansack an employeewhorefusestoquit marijuana smoking althoughhe/she is a ”licenced marijuana user”

  10. Then, what has happened in the US? • 18 statesbeginningwith California in1996, havevoted on stateballotinitiativetoallow the useof marijuana for medical purposes withintheirstateborders • The campaigns in support oftheseinitiativeshavebeenwellorganized and wellfunded • E.g. TV commercialswithseverelyillpeopletestifyinghow smoking marijuana has madetheirlives endurable appealingtopeople’scompassion • The criticshave not hadanywherenear as muchfundstospendtooppose the initiatives.

  11. Organisations in support ofmedical marijuana • The Marijuana Policy Project (MPP) • The Drug Policy Alliance (DPA) • The National Organization for the Reform of Marijuana Laws (NORML) • These all havelegalization on their agenda • Twostates – Washington and Colorado in fall 2012 voted in favouroflegalization (”regulate and tax”)

  12. Howdoesmedical marijuana work? • Youobtain a ”recommendation”(not a prescription) from a medicaldoctorthat marijuana may be helpful for yourmedicalcondition • Youcanalso designate a friend or a relative as yourprimarycaregiver • Nowyoubothhavedocumentationthatallowsyoutopossess and grow marijuana för ”medicalpuposes” • Youcannowbothbuy marijuana in so called marijuana dispensaries. • The doctor’srecommendationusually lasts for a yearregardlessof the resultof the medicationand it caneasily be renewed

  13. Howdoes it work? – cont.. • There is virtually no controlofhowmuchyoubuy. Youcanbuyeveryday and in morethanonedispensary • Thereare no requirements for the doctorstofollowup the resultof the medication. • Doctorsadvertizetheir services in local media • Not all doctorsparticipate. At onedispensary >50% of all letters ofrecommendationwereissued by twodoctors

  14. Cont. • AmericanSocietyofAddiction Medicine (ASAM) advicedoctors not torecommend patients touse marijuana for medicalpurpuses • Because marijuana can harm patients • Psychiatricsideeffects (Psychosis, depression etc) • Addictive • Can cause cancer. 4x moreofsome carcinogens than in tobacco • Illegal by federal law • Doctors not protected by theirinsurance • Doctorsmay risk theirlicences

  15. Whoare the ”patients”? • No systematic registration. Onereport from somedispensaries in California revealedthat • 52% were under 30 years old • 72% were under 40 • Common diagnoses: insomnia, anxiety, depression and muscle pain • Cancer, Glauoma and AIDS patients madeupabout 2% of the peoplereceivingmedical marijuana from thesedispensaries

  16. Colorado – oneexample • Medical marijuana ballotinitiativewaspassed in 2000 • In 2010 Colorado had 99.599 registered users = about 2% of the population • 94% were registered on pain diagnosis • In Colorado therewas at thattime 809 marijuana dispensaries, morethanStarbuck’s cafés

  17. Numberof registered patients per doctor in Colorado 9% of the doctors in Coloradehad registered toissue marijuana recommendations

  18. Colorado – whathappenedamongteenagers? • A rapid increase in the numberofmedical marijuana patients occurred in 2009 • Minimum age for medical marijuana is 18 • Whathappenedamongyounger persons? • Marijuana smoking last monthamong 9-12 graders increased from 19 to 30% between 2008 and 2010 (=58% increase) • Schoolexpulsions for druguseincreased from 534 to 753 students (=44% increase)

  19. What is medical marijuana in the US? • A wellorganized, wellfundedstrategyto • Legalize all useof cannabis • With bad science • Ignorance in the general population • By appealingtopeople’scompassionwithseverelyillpeople

  20. References: • David Evans, Esq.Drug Free Schools Coalition New York • Bertha Madras, professor i psykobiologi, Harvard • Eric A. Voth, MD, The Institute of Global Drug Policy • Richard G. Soper, MD. Medical Marijuana: Clinical Considerations and Concerns. AZ Medicine, 2011. • Christian Thurstone. The Impact of MMJ legalization on Colorado’s youth. Presentation vid World Forum Against Drugs, Stockholm 22 maj 2012

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