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Marijuana use has reached new highs in Canada and Europe, but not in the U.S.  While the pro-marijuana lobby is strong and growing, it would have us believe that law enforcement doesn't work and that marijuana is harmless.  Both are untrue.  While law enforcement could be done much better, many studies show that it does work.  Although marijuana is officially illegal in Canada and Europe, enforcement is very rare.  Also, as marijuana use has doubled in Canada and Europe in the last 10 years in high school students and adults, heroin and other drug use have also increased to record levels exceeding those of the U.S.  AIDS is also spreading more rapidly in those countries because of needle-sharing which continues despite the ready availability of clean needles very cheaply at the corner pharmacies.

Marijuana is much more addictive and dangerous than the drug abuser community would like you to believe.  I have seen dozens and dozens of patients who have become seriously mentally ill thanks to the brain damage caused by marijuana.  It is a major cause of depression and schizophrenia in our society as well as a factor in preventing our psychiatric treatments from working effectively.  It changes the personality, damages the memory, seriously impairs school performance, and causes auto crashes and death for far too many individuals.  Marijuana is by far the most prevalent illicit drug and a major gateway drug to cocaine and heroin abuse.  Oddly enough, since marijuana use starts so early, it is also a gateway drug leading to tobacco cigarette smoking for a small percentage but large number of youth.

Marijuana is also a very poor drug for medical treatments although it has some very powerful forces promoting its use.  The studies for marijuana and schizophrenia, depression, and intellectual impairments can be found by clicking above.  Research using marijuana as medicine is below.

Current governmental enforcement techniques are inefficient and only modestly effective.  They keep illicit drugs from becoming rampant without ever eliminating the problem.  My own research has found that the average drug dealer gets arrested once every 18 years!  With better enforcement techniques, dealers could get arrested much more quickly, and penalties could actually be decreased considerably at a great cost savings to the public.  More importantly, illicit drugs could almost certainly be eliminated at a tremendous cost savings.  We would still be stuck with alcohol and tobacco, but even tobacco use is decreasing.

I strongly support school and work drug testing programs.  While hair-cuttings at the cost of $60 each are probably the best deterrent since they cover a couple month period of time, a simple marijuana urine test is much faster and can be purchased from my office for $3 each.  Since marijuana is by far the most common illicit drug and since it stays in the body and urine for one to several weeks, urines tests are fairly good detection methods.  Unfortunately, alcohol is out of the system in 12 hours, so tests are of more limited value.   

Adolescent Cannabis Dependece Not Unusual: A representative sample of 2446 young adults ages 14-24 was followed up over a period of 4 years. 30% of the sample were cannabis users. Among all users, 35% met at least one dependence criterion: withdrawal (17%), tolerance (15%), loss of control (14%) and continued use despite a health problem (13%). Even without concomitant use of other illicit drugs, 22% of low frequency users and 81% of high frequency users met at least one dependence criterion. The occurrence of a dependence syndrome or of specific dependence criteria could not be attributed to the use of other illicit drugs or to comorbid nicotine and alcohol dependence. Dependence symptoms in young cannabis users? A prospective epidemiological study. Nocon A, et al. Max-Planck-Institute of Psychiatry, Munich, Germany. J Psychiatr Res. 2005 Sep 14

Car Crashes Tripled for Driver's When High: A French nationwide study of over 10,000 fatal accidents for which blood levels were available has found that 3% of driver's were high on marijuana and that they were 3 times more likely to be involved in an auto accident while high after controlling for alcohol consumption compared to drivers without drugs or alcohol in their system. Alcohol was still several times more dangerous, causing 29% of all fatal car crashes. Cannabis intoxication and fatal road crashes in France: population based case-control study. Bernard Laumon, et al. Brit Med J 2005;331:1371 (10 December). 

Withdrawal Syndrome Document Marijuana's Addictiveness Again: Alan Budney, University of Vermont APA 5/03. Using DSM-IV criteria to rate the dependency heavy marijuana users had on average 6.3 out of 9 criteria compared with 7.7 for cocaine users. Only need three to meet dependence. A previous short-term study by his lab revealed that daily users who quit for as few as three days displayed numerous withdrawal symptoms, including cravings, irritability, restlessness, headaches, loss of appetite, and depression. New study total of 18 regular users and 12 control patients completed the study. The users smoked between one to eight times daily and were not seeking treatment to quit. Subjects were encouraged to quit for the study period by being paid increasing amounts of cash for the increasing number of days they were abstinent from the drug. For five days prior to the quit period, smokers were told to smoke "as usual" (subjects were not given any drug by the researchers). Baseline physiology and psychological features were measured for both groups. The smokers then ceased use of marijuana for the next 45 days. Study participants phoned in almost daily to report symptoms. Key findings revealed that the smokers had a peak of classic withdrawal symptoms by day two or three and stayed elevated significantly out to two or three weeks. There were no changes in the control group. After about three weeks, symptom levels of users were similar to those of control patients.

Weekly Use Predicts Later Addiction: A representative sample (n=2032) of secondary students in the State of Victoria, Australia, six times between 1992 and 1995. Cannabis dependence was assessed in 1998, at age 20-21 years. Of 1601 young adults, 115 met criteria for cannabis dependence. Male gender (OR=2.6, P < 0.01), regular cannabis use (weekly: OR=4.9; daily: OR=4.6, P=0.02), persistent antisocial behavior (linear effect P=0.03) and persistent cigarette smoking (linear effect P=0.02) independently predicted cannabis dependence. Adolescent precursors of cannabis dependence: findings from the Victorian Adolescent Health Cohort Study. Coffey C, Carlin JB, Lynskey M, Li N, Patton GC. Br J Psychiatry. 2003 Apr;182:330-6

Europe Marijuana, Drug Use, AIDS Steadily Increasing: In the European Union, 15% of 15-16 year olds are heavy cannabis users, (Paul Griffiths, Program Co-ordinator of the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), 11/25/04 Reuters Brussels). The EMCDDA fears about a stronger version of cannabis now on the market which can cause panic attacks, and concern about "severe" drug problems in the new EU countries which joined the bloc in May. Ecstasy, frequently consumed by young people at all-night dance parties known as raves, is emerging as the second most commonly used drug in Europe, overtaking amphetamines. The EU is one of the world's largest ecstasy producers. The Russian Federation, Ukraine and some of the central Asian republics are developing very nasty and severe drug use problems, particularly for heroin and opiates. These states are facing an AIDS epidemic as a consequence of drug users sharing dirty needles. Drug use in Baltic EU states is also fueling an AIDS epidemic in the region. Canadian high school marijuana use doubled between 1993 and 2003.

31% English 15-year-olds Use Pot & Heavy Drinking, too: Alcohol consumption has jumped 100% for 15-year-olds from 1990-2000 from 5 to 10 drinks per week with 50% drinking within the past week. 66% of 15-year-olds report being offered drugs. National Center for Social Research and the National Foundation for Educational Research survey of 9000 from 285 schools. Reuters 3/17/02

US College Use Increased From 1993 to 1999: Use of marijuana and other illicit drugs has increased on campuses across the United States in most student subgroups and all types of colleges. This may reflect earlier increases in middle schools and secondary schools among this cohort. However, nearly one-third of students initiated marijuana use in college and one of three began to use it regularly. Intervention efforts should be directed at college students, as well as secondary school students. Increased use of marijuana and other illicit drugs at US colleges in the 1990s: results of three national surveys. Gledhill-Hoyt J, Lee H, Strote J, Wechsler H. Harvard School of Public Health; Addiction 2000 Nov;95(11):1655-67. representative sample of 15,403 randomly selected students in 1993, 14,724 students in 1997 and 14,138 students in 1999. prevalence of past 30-day marijuana use rose from 12.9% to 15.7% between 1993 and 1999, an increase of 22%. Almost all of this change occurred by 1997. An increase was observed at 66% of the 119 colleges. The prevalence of 30-day and annual marijuana use increased in nearly all student demographic subgroups except for Hispanic students, and at all types of colleges except for colleges with low binge drinking rates. Rates of illicit drug use in the past 30 days increased slightly for other illicit drugs in the 4-year interval except for LSD.

Marijuana Leads to Other Drugs in Twin Study: Individuals who used cannabis by age 17 years had odds of other drug use, alcohol dependence, and drug abuse/dependence that were 2.1 to 5.2 times higher than those of their co-twin, who did not use cannabis before age 17 years. Controlling for known risk factors (early-onset alcohol or tobacco use, parental conflict/separation, childhood sexual abuse, conduct disorder, major depression, and social anxiety) had only negligible effects on these results. These associations did not differ significantly between monozygotic and dizygotic twins. Mono- & di-zygotic same-sex twin cross-sectional study 311 individuals 30yo in Australia. Associations between early cannabis use and later drug use and abuse/dependence cannot solely be explained by common predisposing genetic or shared environmental factors. The association may arise from the effects of the peer and social context within which cannabis is used and obtained. In particular, early access to and use of cannabis may reduce perceived barriers against the use of other illegal drugs and provide access to these drugs. JAMA. 2003;289:427-433

School Drug Programs Donít Work: Health Education Research 8/3/02, University of North Carolina, D.A.R.E., Here's Looking at You 2000 and McGruff's Drug Prevention and Child Protection havenít worked despite years of use. Funding often low and research-based programs not correctly implemented.

Dutch Psychotics Use Marijuana: 33% Netherland psychotics used cannabis in month before admission and 32% used monthly all year with 26% having daily usage for at least two weeks. Only 10% general 16-24yos used in previous month. Acta Psychiatr Scand í02;105:440-3

In a country with a liberal drug policy like The Netherlands, cannabis use is associated with aggression and delinquency, just as in other countries. Cannabis use was not associated with internalising problems. Alcohol use and regular smoking were strong confounding factors. Br J Psychiatry 2006 Feb;188:148-53.

Sperm Damages by Marijuana: Men who smoke marijuana frequently have significantly less seminal fluid, a lower total sperm count and abnormally behaving sperm. Lani Burkman, State University of New York at Buffalo, obstetrician compared 22 frequent smokers (averaging 14 times/week) to 59 non-users. American Society for Reproductive Medicine meeting 10/13/03 Reuters.

Worse Than Cigarettes for Lungs: British Lung Foundation is calling for a public health campaign to warn of the health dangers of cannabis. It says that the lung damage caused by smoking three cannabis cigarettes a day equals that of 20 cigarettes. Cannabis is the most widely consumed illegal drug in the UK. In 2000, almost 45 per cent of 16 to 29 year olds in the UK said they had used cannabis at some point. Tar from cannabis cigarettes contains up to 50 per cent higher concentrations of carcinogens benzathracenes and benzpyrenes than tobacco smoke. THC, the primary psychoactive ingredient of cannabis, decreases the function of immune system cells that help protect the lungs from infection. The average cannabis cigarette smoked in the 1960s contained about 10 milligrams of tetrahydrocanabinol (THC), the primary psychoactive ingredient. Today, it may contain 150 mg. This means that the modern cannabis smoker may be exposed to greater doses of THC than in the 1960s or 1970s," says the report. "This in turn means that studies investigating the long-term effects of smoking cannabis have to be interpreted cautiously. BMJ 11/15/02

Progression from Early Use Not Genetic: Over 300 pairs of same sex twins, both identical and non-identical, in which one twin started using cannabis before his or her 17th birthday and the other did not. Michael Lynskey, at Washington University School of Medicine in St Louis, Missouri, found that the early user was two to five times more likely to go on to use harder drugs or become dependent on alcohol - regardless of whether they were an identical twin or not. The fact that identical twins, who share all their genes, did not differ from non-identical twins, who share half, suggests that the progression is not the product of genes. JAMA 289, p 427, 482

Medical Treatment

Dronabinal, synthetic THC, has long been available as a prescription medication.  It is very expensive, costing $310 for thirty 5 mg tablets or $464 for 10 mg tablets. It has been approved by the FDA for treating the nausea of chemotherapy and for the anorexia of AIDS patients.  However, it is rarely used in clinical practice since so many other medications work better with far fewer side-effects for both indications.  For instance, doxepin is a very inexpensive anti-depressant which has a powerful appetite stimulating effect far stronger than dronabinal.  Dronabinal is ranked fifth or sixth best in a list of six different approaches to treating the nausea of chemotherapy.  Medical marijuana is little more than a heavily financed movement to get marijuana legalized as a recreational drug as is the case in the Netherlands.  

Researcher says Marijuana Not Good for Glaucoma: It is true that smoking marijuana decreases the intraocular pressure in users. However, continued use at a rate needed to control glaucoma would lead to substantial systemic toxic effects. The author recommends development of drugs based on the cannabinoid molecule or its agonists and notes that smoking marijuana is ill-advised in view of its toxicological profile. Keith Green, Med Coll Georgia, Arch Ophthalmology 116:1433-7, í98.

Pain Helped by Cannabinoid in Poor Study: A small German study reports that a cannabinoid medication helped chronic neuropathic pain.  However the study appears highly defective in that the study lasted only 7 days and cannabinoids are quite addictive meaning that their benefits are likely to disappear with the passage of time as the addiction grows.   Of course, then the patient will have both the neuropathic pain and the withdrawal anxiety and discomfort between doses of the cannabinoid.  Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial. Karst M, Salim K, Burstein S, Conrad I, Hoy L, Schneider U. JAMA. 2003 Oct 1;290(13):1757-62.

Very Poor Quality Marijuana Study Claims Its Good for Alzheimer's: Joel Ross, a physician at Monmouth Medical Center in New Jersey presented a study at the American Society of Consultant Pharmacists' 34th annual meeting 11/18/03. In the phase II, open label, 8-week randomized, parallel-group study, 54 community-dwelling agitated and demented patients (mean age = 81) were randomized to dronabinol 2.5 mg bid or dronabinol 5 mg bid. The Cohen-Mansfield Agitation Inventory (CMAI), Caregiver's Burden Inventory (CBI), CGI Severity of Alzheimer's disease (CGI-S AD), Instrumental Activities of Daily Living Scale (IADL) and MMSE were serially measured. At eight weeks, significant reductions of CMAI scores occurred in both groups. There also a trend toward a decrease in CBI scores and increase in IADL scores in both groups, without a statistical difference between the two doses. The 5 mg bid group experienced a trend toward a decrease in CGI-S AD scores. (Ed: It is incredible that the FDA sanctions such a worthless study. There is no control group, no alternative treatment group, a very small number of participants, and no blinding of patients or raters despite the fact that dronabinol is a C-III restricted addictive drug with a high rate of side-effects.  The claims of Dr. Ross go far beyond any findings from his research and are simply unethical.  It is also sad to see such news releases put out before any publication in a refereed research journal, but that has become commonplace. In fact, there are many medications that are much better for Alzheimer agitation, HIV anorexia, or chemotherapy nausea. Marinol is an extremely expensive medication with the cost of 5 mg bid exceeding $500 for a one month's supply.  Despite its being on the market for many years and despite many physicians having given it a try, it is infrequently used because so many better alternatives are available.) For more studies, see Agitated Dementia

Marijuana No Benefit for Spasticity of MS, But Reviewers Sing Praises to Pot: In the largest study ever done exploring possible medical benefits for marijuana, 33 neurology clinics in England did a PC DB study of 600 multiple sclerosis patients who had oral THC, the active ingredient in marijuana, or placebo added to their usual treatment for 15 weeks.  Researchers could find no objective evidence of any benefit on spasticity from marijuana despite the huge size of the study.  The most powerful finding of the study was that those receiving the THC capsules were considerably more likely to correctly guess that they were on THC and not placebo capsules.  This finding unfortunately makes any of the findings of the subjective secondary measures highly questionable.  Of the secondary measures, marijuana led to no increase in overall well-being or general disability.  It is true that slightly more patients (60% vs. 46%) thought they felt like they had less spasticity. Also, 54% reported some pain relief compared with 37% with placebo.  The study did report a high placebo effect.  One-quarter of marijuana patients actually thought their spasticity got worse.  These small difference were touted by reviewers Luanne Metz and Stacey Page, Univ. Calgary: "We now have as much evidence to support the use of these oral cannabinoids - as we do for many standard therapies for spasticity." (Ed: This is simply not true.  If it were, it would only mean that there is no objective evidence that any therapy helps MS spasticity! Even the subjective advantage over placebo was very minor and certainly doesn't support prescribing an addictive drug that frequently causes depression and psychosis.)  Lancet 362:1517, 11/7/03.

Marijuana Oral Spray Minimally Beneficial on Subjective Measure of Spasticity, But Not on Primary Symptoms or Other Measures: In a 160-patient DB PC study of oromucosal sprays of matched placebo, or whole plant marijuana containing equal amounts of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) at a dose of 2.5-120 mg of each daily, in divided doses using a subjective visual analogue measure for each patient's most troublesome symptom. Following CBME the primary symptom score reduced from mean of 74 to 49 following CBME and from 74 to 55 following placebo [ns]. Spasticity VAS scores were significantly reduced by CBME (Sativex) in comparison with placebo (P =0.001). Results on measures of disability, cognition, mood, sleep and fatigue were gathered but not reported in the abstract. There were no significant adverse effects on cognition or mood and intoxication was generally mild. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Wade DT, Makela P, Robson P, House H, Bateman C. Oxford, UK. Mult Scler. 2004 Aug;10(4):434-41. Ed: It is extremely unlikely that the patients were effectively blinded. There is no report asking patients to guess whether they received the real drug or placebo. Since the only benefit was a subjective one where a much larger study found no impact on objective measures of spasticity, blindedness is very important to report.

Marijuana Claimed Helpful in Very Odd Study Showing Minimal if Any Benefit: In a small, poorly designed DB PC crossover study of 57 MS patients with poorly controlled spasticity, all received cannabis-extract capsules standardized to 2.5 mg tetrahydrocannabinol (THC) and 0.9 mg cannabidiol (CBD) each for 14 days.  Only 50 patients were included into the intention-to-treat analysis. There were no statistically significant differences associated with active treatment compared to placebo, but trends in favor of active treatment were seen for spasm frequency, mobility and getting to sleep. No differences were present in objective measures of a 10-m timed walk, nine-hole peg test, paced auditory serial addition test (PASAT), and the digit span test. The authors state, "In the 37 patients (per-protocol set) who received at least 90% of their prescribed dose, improvements in spasm frequency (P = 0.013) and mobility after excluding a patient who fell and stopped walking were seen (P = 0.01)." Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Vaney C, Heinzel-Gutenbrunner M, Jobin P, Tschopp F, Gattlen B, Hagen U, Schnelle M, Reif M. Switzerland. Mult Scler. 2004 Aug;10(4):417-24. Ed: A crossover study with marijuana is absolutely senseless.  Virtually every patient is going to be able to tell the difference of the marijuana and the placebo.  This was essentially an "open-label study." The authors apparently never asked patients to see if they could tell the placebo from the real stuff, but it appears obvious. The authors then really massage their data to draw exaggerated claims of benefit. 

Pain Relief: Marijuana No Value: Morphine Very Little Added Benefit: From folk medicine and anecdotal reports, it is claimed that Cannabis reduces pain. In a DB PC crossover study of 12 healthy volunteers given single doses of THC (20 mg), morphine (30 mg), THC-morphine (20 mg THC+30 mg morphine), or placebo in pain tests with heat, cold, pressure, single and repeated transcutaneous electrical stimulation, THC did not significantly reduce pain. In the cold and heat tests it even produced hyperalgesia, which was completely neutralized by THC-morphine. A slight additive analgesic effect could be observed for THC-morphine in the electrical stimulation test. No analgesic effect resulted in the pressure and heat test, neither with THC nor THC-morphine. Psychotropic and somatic side-effects (sleepiness, euphoria, anxiety, confusion, nausea, dizziness, etc.) were common, but usually mild. The analgesic effect of oral delta-9-tetrahydrocannabinol (THC), morphine, and a THC-morphine combination in healthy subjects under experimental pain conditions. Naef M, et al. University of Bern, Switzerland. Pain. 2003 Sep;105(1-2):79-88.

Thomas E. Radecki, M.D., J.D.

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