Marijuana As Medicine -- `Caveat Emptor!' In Search For Truth About Marijuana -- Experts Urge Balanced, Objective Awareness Efforts
Special To The Times
WHEN DECIDING what to believe about the potential benefits and harms of marijuana, the old saying "Let the buyer beware!" is good advice.
Many scientific studies have been conducted in the United States and in other countries concerning marijuana's effects on health and behavior. Excellent summaries of the findings of this research have been published, but they are unfortunately written in technical language and not readily available to the public.
Information made available to the general public is often biased, particularly when it is delivered by those advocating proposed changes to the law that would either increase or decrease penalties for possession or sale.
With the initiative concerning medical uses for marijuana and other drugs (I-685) now certified for the ballot, it is "open season" for marijuana awareness campaigns in our state . . . all with the purpose of influencing voters as the November 4th election nears.
The good news about this process is that it is highly democratic, with many opportunities for expressing differing points of view. The bad news is that serious harm is done if a cause is championed by issuing incomplete, inaccurate, or unbalanced information all in the guise of facts.
Both sides mean well
Neither proponents nor opponents seek to be harmful. Indeed, on this issue their motivations are commendable.
Opponents seek to prevent an undermining of drug abuse prevention efforts, particularly in relation to children and adolescents. They argue that the only reason efforts are now being devoted to enacting medical marijuana laws is because proponents are using this as a back door strategy to legalize marijuana in general. Believing that recognizing this drug's medical potential sends the wrong message, the opponents dismiss all reports, studies, or perspectives from patients that validate its usefulness. Supporters of medical-marijuana laws seek to increase what they believe are helpful options available to patients suffering with seriously debilitating or life-threatening illnesses.
Proponents argue that voters, and not the government, must set policy because the normal procedures of developing and testing new drugs for safety and effectiveness haven't worked in the case of marijuana.
The pharmaceutical industry, unable to patent the cannabis plant and thereby insure a profit, hasn't invested funds in research on this drug. Government regulations have made it difficult for scientists to study marijuana's medical uses, seemingly because of adverse political ramifications.
In summary, supporters believe that physicians should be permitted the option of recommending marijuana as medicine to seriously ill patients when available treatments do not work, and they advocate the passage of state and federal laws to make this possible.
Inevitably, the debate turns to the question of just how potentially beneficial or harmful marijuana use might be.
Advocates on each side of the debate often answer that question by sifting through facts, figures, and quotes from experts that will support their particular stances.
Victims of misinformation
This selective use of knowledge may work well in high school and college debating contests. But, consider the harms when the public must rely on this process to become well informed about marijuana.
-- Parents. When parents are given biased information about marijuana, they are at risk for two possible outcomes.
First, the misinformed adult may fail to accurately appraise the nature and scope of the issue, with the possibility of becoming either excessively alarmed or mistakenly unconcerned and uninvolved.
Second, if parents arrive at conclusions and set rules based on misinformation, their efforts to guide their children by providing knowledge to back up family standards may backfire. Indeed, the young person may reject any aspect of the parent's efforts to educate if it appears that facts are purposefully or unintentionally being distorted.
-- Adolescents. Prevention campaigns for adolescents often heavily emphasize dangers and disregard any possible benefits of marijuana, with the premise that this emphasis is necessary to motivate young people to remain abstinent. That, in itself, is questionable.
Moreover, when the "facts" are biased, inaccurate, and clearly selected to tell only one side of the story, the adolescent may discount all warnings and advice. Then, the educational messages - even those identifying highly important risks - will be disregarded.
Most would agree that children and adolescents should not use marijuana. Parents who endorse that value will, nonetheless, also hope that if young people do use it, they will make decisions that will prevent harmful consequences.
For those who do decide to experiment, many related decisions could affect their well-being. Some examples follow.
Under what circumstances will an adolescent decide to use? What risks will be considered when deciding to not use in a specific situation? Which criteria will influence their decisions concerning how much and how often to smoke? Will they support one another in avoiding dangerous behaviors such as driving when high? Will a teenager express concern to a peer who is using the drug at school? Will a young person who needs help seek it voluntarily?
When a young person has chosen to smoke marijuana, it is not too late to influence that person's decision-making. A marijuana awareness campaign that distorts and misrepresents the facts will risk missing that opportunity.
-- Teachers. Teachers and other role models need accurate information for credibility. The educator's effectiveness is enhanced when up-to-date and scientifically accurate educational materials are available. Unfortunately, not all of the teaching products in use meet these criteria.
The Addiction Research Foundation, a prestigious scientific center located in Toronto, evaluates films, books, and other drug education resources. They have found that some of the most effectively produced materials in terms of colorful graphics and dramatic reenactments get low ratings with regard to accuracy of information.
A good example occurred in Seattle. Several years ago, a local television station aired a documentary about teenage drug abuse, followed by an in-studio panel discussion and opportunities for the public to phone in for advice and referrals.
The documentary's producers won an award for having created a program that scored high on points relating to good television. However, the Addiction Research Foundation's experts gave that same program a near-failing grade because of its distortions and misrepresentations of current knowledge. Award-winning television and good public education may not always coincide.
-- Seriously ill patients. Individuals with terminal or serious illnesses can also become victimized by misinformation campaigns.
Biased claims overstating the drug's benefits may raise false hopes about marijuana's therapeutic potential. On the other hand, refuting its having any medical effectiveness may lead those for whom there are no other options to miss the opportunity to obtain vitally needed aid. Stigma from sensationalized characterizations of marijuana likely compounds the barriers.
-- Physicians. Physicians are also affected by distorted public information about marijuana as they attempt to deliver competent medical care in a climate of almost constant hyperbole about marijuana.
For more than 20 years since the first research about THC (the major psychoactive ingredient in the cannabis plant) as an antiemetic appeared in 1975 in the New England Journal of Medicine, physicians and nurses caring for cancer patients have responded as best they could to questions about marijuana's potential usefulness.
Today's political realities have made physicians fear license suspension or even prosecution just for responding candidly to a patient's questions about whether marijuana might help.
-- Individuals with special vulnerabilities. Those who are at increased risk of experiencing adverse drug effects may be particularly vulnerable by being inadequately informed.
If persons with certain pre-existing illnesses smoke marijuana, symptoms of their diseases may be activated or made worse. This includes individuals with cardiovascular diseases (coronary artery disease, cerebrovascular disease, hypertension), respiratory illnesses (asthma, bronchitis, emphysema), schizophrenia, and alcohol or other drug dependencies.
It is probable that pregnant women who smoke marijuana will be at increased risk of giving birth to low birth weight babies. Smoking marijuana while pregnant possibly may increase the risk of birth defects in the infant.
Adolescents, particularly those already experiencing poor school performance, may suffer even greater limitations to their functioning in school because of marijuana's effects on learning, concentration, and memory. Adolescents who begin smoking marijuana in their early teens are more likely to progress to heavy marijuana use.
This summary draws from two comprehensive and well-balanced reviews of the scientific literature: a 1994 monograph titled "The Health and Psychological Consequences of Cannabis Use" that was prepared for the Australian National Task Force on Cannabis, and a 1997 report of the Ad Hoc Group of Experts commissioned to prepare a review of the medical marijuana research literature for the Director of the National Institutes of Health. This document can be accessed on the Web at www.nih.gov/news/medmarijuana/MedicalMarijuana.htm
Marijuana is used recreationally because it produces a "high," an alteration in consciousness involving mild euphoria (a sense of well-being), relaxation, and some modification in the perception of time. Ordinary sensory experiences such as eating, listening to music, watching films, and looking at the surrounding environment become intensified.
Because indications exist that smoked marijuana may be therapeutically useful for each of the following purposes, the NIH Expert Panel recommended that further studies be conducted. They acknowledged that good therapies are available for many of these purposes, but because some patients develop adverse reactions or do not benefit from conventional treatments, marijuana's medical potential is important to explore.
Analgesia. Smoked marijuana may relieve specific kinds of pain and may have an advantage over pills or injections, because the patient can carefully adjust the dosage to maximize the benefit while minimizing adverse mood effects.
Neurological disorders. Smoked marijuana may be useful in treating spasticity and night spasms associated with multiple sclerosis and spinal cord injury, various active epilepsy states, and some forms of dystonia (muscle contraction and repetitive movement disorders).
Nausea and vomiting associated with cancer chemotherapy. There is considerable evidence that smoked marijuana improves chemotherapy-related nausea and vomiting. Unlike dronabinol (the synthetic THC capsule) which the vomiting patient can find difficult to keep down, inhaling marijuana can be a more effective route of administration.
Glaucoma. Smoked marijuana may be useful in preventing progressive optic nerve damage and consequent loss of vision in persons with glaucoma.
Appetite stimulation. Smoked marijuana may be useful in treating wasting syndrome associated with cancer and AIDS.
Unpleasant psychological effects such as anxiety, panic, paranoia, or depression may be experienced, usually by novice users or those smoking highly potent strains of cannabis. Motor skills and reaction time are impaired , disrupting such skilled activities as driving a car or operating machinery.
It is uncertain whether chronic use, especially on a daily basis, produces health risks. The available evidence points to some areas of concern:
Respiratory diseases. This includes chronic bronchitis and changes to cell structure that could be associated with malignancy.
Cognitive impairment. Subtle effects, particularly of attention and memory, are likely to persist while the user remains chronically high. It's not known whether these effects are reversible after prolonged abstinence. Adults in occupations requiring high level cognitive skills may experience poorer performance. Chronic use may also contribute to impaired educational attainment in adolescents.
Addictive disorder. In a manner which parallels alcohol abuse, a significant minority of marijuana users develop addictive behavior. This is characterized by cravings, compulsion to smoke, and continued use despite adverse consequences.
Cancer. Future studies are needed to determine whether chronic marijuana smoking increases the risk of cancers of the oral cavity, pharynx, and esophagus.
Leukemia and birth defects in infants. Prenatal exposure possibly may increase risk of leukemia and birth defects in newborns.
We end with a fervent hope that both the prevention of drug abuse and an informed, compassionate, and scientifically grounded response to the medical potential of marijuana will be pursued, with neither purpose being used to sabotage the other.
The NIH Expert Panel endorsed this value when they wrote: "The scientific process should be allowed to evaluate the potential therapeutic effects of marijuana for certain disorders, dissociated from the societal debate over the potential harmful effects of nonmedical marijuana use. All decisions on the ultimate usefulness of a medical intervention are based on a benefit/risk calculation, and marijuana should be no exception to this generally accepted principle."
We owe it to one another to be more thorough, more balanced and more objective in our marijuana-awareness campaigns. Too many victims are hurt when we do otherwise.
About the authors
-- Roger Roffman, a professor of social work at the University of Washington, first studied marijuana in 1967 for the Army while in Vietnam. The Washington State Board of Pharmacy appointed him as a special advisor to assist with this state's medical-marijuana research program in the late 1970s.
-- Dr. Sandra Counts, a physician and specialist in the treatment of addictive disorders, is a fellow of the American Society of Addiction Medicine.
-- Dr. Paul Grekin, a physician and specialist in addiction psychiatry, is a clinical assistant professor of psychiatry at the University of Washington.
-- Ron Jackson, executive director of the private, nonprofit drug-treatment agency Evergreen Treatment Services in Seattle, is an affiliate associate professor of social work at the University of Washington.
-- A booklet summarizing current knowledge about marijuana has been prepared by the Marijuana Studies section of the Innovative Programs Research Group at the University of Washington.
-- Single copies may be obtained at no cost by sending a self-addressed stamped (64 cents) business-sized envelope to: Marijuana Studies, IPRG, 909 N.E. 43rd St., Suite 304, Seattle, WA, 98105.
Copyright (c) 1997 Seattle Times Company, All Rights Reserved.