04/20/15

Medical Reform or Medicinal Con?

In my home state of Pennsylvania, the legislature is considering the legalization of medical marijuana. At least one activist believes it will happen in 2015: “We have the votes for it. It’s going to happen this term.” Jon Delano of KDKA cited Jay Costa, the Democratic Senate leader, as saying the medical marijuana bill is likely to be approved this spring. Legislation has been introduced in the Senate and gone to committee. “And it is very likely over the course of the next couple of months it will pass through the Senate and make its way over to the House.”

The new governor, Tom Wolfe, has publically said he would support medical marijuana in PA: “I believe that doctors who can now prescribe some of the most potent drugs in the world should be able to prescribe medical marijuana.” The problem seems to be in the State House, which is currently holding hearings on its own legislation. Tony Romeo with CBS Philly reported that law enforcement stressed the need for strict regulatory control if medical marijuana was legalized. Republican Matt Baker, chair of the House Health Committee said:

I am very cynical and skeptical about moving forward with this. And I think there are a lot of unresolved issues, and when you talk with the medical groups and the scientific community, they’re very, very concerned about us putting on white coats and trying to play doctor here.

Polls indicate that most Americans support the legalization of medical marijuana. More than half of the US population now lives in a state where marijuana in some form (medical or recreational) is legal. But take some time to really review this compilation of surveys on marijuana legalization on PollingReport.com. Several polls by organizations like the Pew Research Center, Gallup, and CBS News show a changing trend of Americans over time to agreeing that marijuana should be legalized, when the question is put as: “Do you think the use of marijuana should be made legal, or not?” All three organizations reported results that were essentially the same as the October 2014 Gallup poll—51% said yes to legalization; 47% said no to legalization.

But now look further down at a nationwide poll by the Pew Research Center taken in February of 2014, when the question answers had more options. There the question was: “Which comes closer to your view about the use of marijuana by adults? It should be legal for personal use. It should be legal only for medicinal use. OR, It should not be legal.” The results were: 39% said marijuana should be legal for personal use; 44% said it should be legal for medicinal use; 16% said it should not be legal; 2% were unsure or refused to answer.

Then the Pew Research Center published their newest poll on legalizing marijuana on April 14, 2015. This survey reported that 53% of Americans favored legalization, while 44% opposed legalization. Millennials (18-34) had the strongest support for legalization, with 68% in favor and 29% opposed. Among those who said marijuana should be legal, 78% did not think the federal government should enforce federal laws in states that allow its use. Conversely, among those who think marijuana should be illegal, 59% said there should be federal enforcement.

The most frequently cited reasons for supporting legalization are its medicinal benefits (41%), the belief that it is no worse than other drugs (36%) and its potential for tax revenue (27%). The most frequently mentioned reasons why people oppose legalization were that it hurts society and is bad for individuals (43%), and it is a dangerous, addictive drug (30%). So it seems that the Pew Research polls suggest there is more support for the use of medicinal marijuana than recreational marijuana.

Returning now to the compilation of results on Pollingreport.com there are some further interesting results in two other polls. In a CNN/ORC Poll done in January of 2014 the legal, not legal dichotomy gets most Americans saying marijuana should be legalized. And there is support for decriminalization measures as well. However, there are two other interesting results. 88% percent of the people polled think that marijuana should be able to be legally prescribed for medical purposes by their doctor. When asked if Colorado’s legalization of recreational marijuana was a good idea, a bad idea, or if you want to wait and see what happens before deciding, 33% thought legalization was a good idea; 29% thought is was a bad idea; and 37% wanted to wait and see what happens before they decide!

A Fox News Poll taken in February of 2013 asked if you thought that most people who smoke medical marijuana truly need it for medical purposes or just want to smoke marijuana; 30% said they truly needed it; 47% thought they just wanted to smoke it; 12% said it depended upon the person; 11% were unsure. Although there aren’t many well-accepted medical uses for marijuana as this point in time, there are some.

A 2007 study in the journal Neurology showed that marijuana is effective in reducing neuropathic pain in HIV patients. Live Science also reported marijuana, when combined with opiates, led to dramatic levels of pain relief. It has been helpful in reducing stiffness and muscle spasms in MS (Multiple sclerosis). It appears useful for reducing nausea induced by chemotherapy. Medical marijuana has been touted as a treatment for glaucoma, but other drugs are more effective.

Legalizing medical marijuana now will not just legitimize its medicinal use for these generally accepted conditions, it would permit the medicinal use of marijuana whenever the individual has been given a prescription for it by a doctor. Without reliable, scientifically replicated studies of the claims for medical marijuana efficacy, we would be returning to the times of patent medicine, where medical marijuana is claimed to treat almost anything and everything. The CNN polled opinion that medical marijuana users didn’t really need it, but just wanted to smoke it would then come true.

Sensible use of medical marijuana should follow the established procedures for all medicinal substances—approval by the FDA. As the medical usefulness of marijuana for a condition is demonstrated through this process, it would then become a FDA approved medicine. I realize that once marijuana reaches this bar of approval, it would then be available for off label use for other medical conditions. But it would also then be REGULATED like all other medical treatments. The current process of state-by-state legislative approval of marijuana for medical purposes circumvents this regulative process. It was established to protect American citizens from the fiascos of past medical treatments that turned out to be ineffective at best and harmful at worst.

Reform must start at the federal level. Given that marijuana has been a Schedule I controlled substance, its availability for the kind of medical research needed to gain FDA approval has to be increased. So a first step would be changing its status from a Schedule I controlled substance to that of Schedule II. The reclassification would make it easier to do the needed research on its legitimate medical uses. I’d suggest delaying the approval of medical marijuana in Pennsylvania and the other states where it is not yet legal until research demonstrating its medical usefulness has gone through the FDA clinical trial process. This would delay the approval of medical marijuana, but it would establish a more stable path forward for the legitimate medical use of marijuana. Debates for the off label medical use could occur alongside those now going on for other classes of FDA approved drugs such as antipsychotics and antidepressants.

Incidentally, there was a bill introduced in the U.S. Senate to reclassify marijuana from Schedule I to Schedule II, the Compassionate Access, Research Expansion and Respect States (CARERS) Act. While it is gaining support, key leaders in both parties have reservations. As the Motley Fool pointed out, the proposed loosening of federal restraints comes just as a new study of the effects of heavy marijuana use on long-term memory in adolescents was published. I hope that if ongoing research demonstrates the need for further restrictions on the medicinal use of marijuana, there would be public and legislative support for that as well.

I suspect this suggestion would not be acceptable for many medical marijuana activists because their final goal is not just the medicinal legitimization of marijuana. Acceptance of medical marijuana may be the first steppingstone towards the legalization of recreational marijuana. As the polls show, there seems to be wider support for the medical use of marijuana than for the recreational use of marijuana. So press for the medical use of marijuana now, and then recreational approval at a future date.

04/6/15

Regulate Marijuana Like Alcohol?

Paul Gaita of The Fix reported that on February 20th, 2015 two bills were introduced in the House of Representatives that were aimed at legalizing marijuana for recreational purposes and taxing it like tobacco and alcohol. The Regulate Marijuana Like Alcohol Act was introduced by: Rep. Jared Polis of Colorado. The Marijuana Tax Revenue Act was introduced by: Rep.. Earl Blumenauer from Oregon. Polis and Blumenauer previously introduced similar bills in the past, but they failed to secure approval.

Polis was quoted as saying the legislation was important as the country moves toward a presidential election in 2016. “We don’t know if the next president will have the same hands-off approach that Barack Obama and Eric Holder eventually found their way towards.” Economist Jeff Miron, an advocate for legalization of marijuana, worried that a new president could order the new Attorney General to enforce federal prohibition, regardless of state law.

Tim Devaney, for The Hill, quoted Blumenauer as saying that: “A lot of people are recognizing that it’s insane to shuffle billions of dollars to Mexican drug cartels when we could just be taxing it.” His bill would initially tax recreational marijuana at 10%, gradually raising the rate to 25%. Medical marijuana would not be taxed at the federal level. Blumenauer estimated the federal government could make $10 billion dollars annually through marijuana taxes and the savings in not locking people up for possession of marijuana. “The federal prohibition of marijuana has been a failure, wasting tax dollars and ruining countless lives.”

Matt Ferner, for the Huffington Post, noted the bills would not force states to legalize marijuana. Rather, they would provide a regulatory framework for states that do decide to legalize it. Despite the four states and the District of Columbia who have made recreational marijuana use legal, “the sale, possession, production and distribution of marijuana all remain illegal under federal law.” Existing jurisprudence (Gonzales v. Raich 2005) holds that federal law trumps state law when it comes to marijuana. Only because of the current “hands off” guidance from the current administration has this legalization movement been able to move forward.

Congressman Blumenauer said, “It’s imperative the federal government become a full partner in building a workable and safe framework.” You can review a copy of the “Regulate Marijuana Like Alcohol Act” here. You can review a copy of the “Marijuana Tax Revenue Act” here. The summary of the “Regulate Marijuana Like Alcohol Act” made the following points.

It directs the Attorney General to remove marijuana “in any form” from ALL schedules of controlled substances under the Controlled Substances Act.
It will revise the definition of “felony drug offense” to exclude conduct relating to marijuana; and eliminate marijuana from “provisions setting forth penalties applicable to prohibited conduct” under the Act.
It prohibits the shipment of marijuana from outside the United States into any jurisdiction in the U.S. where its possession, use or sale is prohibited.
It will grant the FDA the same authorities with respect to marijuana as it currently has for alcohol. Functions currently under the Drug Enforcement Administration would be transferred to the Bureau of Alcohol, Tobacco, Firearms and Explosives, which will be renamed as: the Bureau of Alcohol, Tobacco, Marijuana, Firearms and Explosives. The Alcohol and Tobacco Tax and Trade Bureau will be renamed as Alcohol, Tobacco and Marijuana Tax and Trade Bureau.

There are several points to raise about the above proposed legislation and statements made by Polis and Blumenauer in support of them. First is Blumenauer’s assertion of a $10 billion dollar annual income for the federal government. If the states are to be allowed to decide to legalize recreational marijuana, how can an annual federal income even be estimated with any accuracy? Federal savings on incarcerations for marijuana possession would only be in federal facilities. Were the savings projections based on ONLY individuals incarcerated in federal prisons for marijuana possession?

Colorado does have a promising new tax income base with marijuana. The state reported that in January of 2015, its total income from all marijuana taxes, licenses and fees for fiscal year 2014-2015 to date was $61,372,000. Would the proposed federal increase in marijuana tax at 10% to 25% be added to the existing tax of states like Colorado? Colorado currently has 2.9% retail and medical marijuana sales tax, 10% retail marijuana special sales tax, 15% marijuana excise tax, and retail/medical marijuana application and license fees. Additional taxes would drive up the price and promote even greater price inequities between legal and black market marijuana, which is already a problem in both Colorado and Washington.

This doesn’t seem to be a way to simply divert income from the Mexican drug cartels into the state and federal treasuries. A future post, “The Economics of Heroin,” will indicate that instead of planting marijuana, the cartels are simply having their drug farmers plant opium poppies. And if cartel marijuana is cheaper than the state approved kind, it will still have a market.

Marijuana is currently a Schedule I Controlled Substance, according to the DEA. That means it is considered to have no currently accepted medical use and a high potential for abuse. While its harm potential is lower than many other drugs, including alcohol, completely removing it from classification in the Controlled Substance Act is an unrealistic expectation. Reclassifying it into a lower Schedule would increase its availability for research—and legitimize its medical use.

The potential harm and benefit of marijuana could be looked at in future research. With what we already know about the harmful effects of alcohol on the human body, would we want to remove all restraint on marijuana at the federal level before we know more about it? Isn’t it likely that similar to tobacco, we could see an increasing consensus of the public health problems with widespread marijuana use and then look to institute a similar public health program to address them? How many countless lives would be ruined if marijuana was regulated as alcohol is currently?

There also seems to be a hidden trap in making the proposed changes on the federal level by the “Regulate Marijuana Like Marijuana Act.” While the legislation may not force states to legalize marijuana, if existing jurisprudence, such as Gonzales v. Raich 2005, has been used to hold that federal law trumps state law when it comes to marijuana, could the “Regulate Marijuana Like Alcohol Act” be used to undermine and challenge any existing state laws with more restrictive laws on marijuana than the federal government? No, I don’t think we should regulate marijuana like we do alcohol.

01/5/15

E-Cigarettes and E-Joints

E-cigarettes were marketed as safer alternatives to regular cigarettes and even smoking cessation aides. Now they are being modified and marketed as THC delivery systems—an e-joint, if you will. Sound strange? I found several YouTube videos on using or converting e-cigarettes for use with marijuana products like hash oil. Here is a short “how to” video. If you prefer more professional vaporizers, you can try the Wacky Puffer and other commercial products.

It didn’t take too long to get from the first e-cigarette to the e-joint. In was only in 2003 that a Chinese pharmacist developed the first e-cigarette. They were introduced to Europe in 2006 and to the U.S. soon after. In 2008, the WHO said it did not consider the e-cigarette to be a legitimate smoking cessation aid. The first Vapefest was held in March of 2010 in Richmond Virginia. In April of 2011, the FDA announced that e-cigarettes would be regulated like traditional tobacco products under the Food Drug and Cosmetic Act. Any e-cigarette product claiming to help stop smoking or that it provides any other health benefit will be strictly regulated as a drug or medical device.

A July 2014 report by the World Health Organization (WHO) suggested a variety of restrictions for e-cigarettes, including a ban on indoor use of e-cigarettes until “exhaled vapor is proven to be not harmful to bystanders and reasonable evidence exists that smoke-free policy enforcement is not undermined.” The Fix pointed out how the tobacco industry is entering the e-cigarette industry. Phillip Morris International has purchased the UK company Nicocigs, an e-cigarette maker. The Fix has several articles on e-cigarettes available, including pro and con sounding titles.

In October of 2014, six U.S. senators signed a letter to the FDA urging companies to label e-cigarettes, “listing all of the health threats the products pose.” Then there is Dr. Nathan Cobb, an assistant professor of medicine at Georgetown School of Medicine who thinks e-cigarettes could bring down traditional smoking and save thousands of lives in the process. However, Dr. Stanton Glantz, doesn’t believe that e-cigarettes are as effective in helping people quit smoking as marketing claims they are.

This commentary assumes that e-cigarettes, as currently in the marketplace, will help people quit smoking and ignores the consistent evidence from population-based studies that smokers who use e-cigarettes are about one-third less likely to quit smoking.

There is growing concern that e-cigarettes aren’t really that safe. Ryan Aliapoulios on the AfterPartyChat website noted the obvious problem, “they still deliver the same addictive chemical at the root of so many other health problems: nicotine.” He mentioned a study, “A Molecular Basis for Nicotine as a Gateway Drug,” that said while e-cigarettes eliminate some of the morbidity from combustible tobacco, they are “pure nicotine-delivery devices.” They have the same effects on the brain as smoking tobacco and they pose the same risk of addiction.

The authors said the use of e-cigarettes is rapidly increasing among adolescents and young adults. “Our society needs to be concerned about the effect of e-cigarettes on the brain, especially in young people, and the potential for creating a new generation of persons addicted to nicotine.”

In “E-Cigarettes Are Not As Harmless As We’ve Been Told,” The Fix reported that Dr. Glantz and his research team found that e-cigarettes produced greater risk than initially thought, “delivering high levels of nano particles which can trigger inflammation and have been linked to asthma, stroke, heart disease, and diabetes.” Glantz was furthered quoted as saying that e-cigarettes are rapidly increasing in popularity with kids. While they are promoted by tobaccos companies that have purchased e-cigarette companies as a way to quit smoking, a safer less polluting alternative to regular cigarettes, “What the evidence to date shows is that while a puff on an e-cigarette isn’t as dangerous as a puff on a regular cigarette, the main effect they seem to be having is to keep people smoking cigarettes.”

So what about e-joints? They actually exist, according to Scientific American. There is a Dutch company, E-Njoint, BV that has released what it says is the first electronic joint—the E-njoint Disposable. It is battery-powered and vaporizes a liquid vegetable-glycerin and polypropylene-glycol with added flavoring. Polypropylene-glycol is the “e-liquid” used in e-cigarettes. Glycerin is colorless and odorless liquid that is widely used in pharmaceutical formulations.

The next version of the E-Njoint will be both rechargeable and capable of being filled with cannabis or a derivative. “Once the cartridges are empty, users are able to fill these cartridges with a liquid. Those liquids may be standard liquids bought at any store around the world or it could be an extract of a cannabis plant.” The company also plans to release an e-joint that can be used with “dry herbs,” like marijuana.

Pamela Ling of the Tobacco Control Policy Fellowship at the University of California, San Francisco’s Center for Tobacco Research and Education said that while the Dutch company is the first to call its product an ‘electronic joint,’ “the idea of using electronic vaporizers for THC or marijuana is not new, and this company is far from the first. ”

An NPR report on “vape pens,” handheld vaporizers for marijuana, noted how they are reshaping the marijuana business and culture. Two years ago, one man was selling vape pens out of the trunk of his car. Now his company, Grenco Science, has a 6,000 square foot headquarters in central Los Angeles.

The concentrates used in vape pens can be very strong. As I noted in a previous, article, “A Little Dab Will Do Ya,” hash oil concentrations can reach 90 percent THC, while the most potent marijuana is usually no more than 20 percent. These high THC levels are even a concern for Allen St. Pierre, the executive director of NORML, the National Organization to Reform Marijuana Laws:

Between the fact that you can potentially pass out with a single inhalation, or you can have such property damage and potential bodily harm just producing it … these [issues of the vape pen] definitely need to be addressed. . . . This is a screaming call for regulation if there ever was one.

11/17/14

The Improbable Truth of Sudden Death with Marijuana

A study by German researchers, “Sudden Unexpected Death Under Acute Influence of Cannabis,” has stirred up a firestorm of controversy as a result of their conclusion that two unexplained deaths were the result of marijuana use. High Times ridiculed the study as another round of “Pot Kills” propaganda. They claimed that news sources like Mail Online were “bastardizing” the story and spreading a certain level of fear. High Times and other news sources then quoted the head of the German Association for Drugs and Addiction (FDR) as saying that cannabis does not paralyze the breathing of the heart. “Deaths due to cannabis use are usually accidents that are not caused by the substance, but to the circumstances of the use.” But let’s take a look at what the study and the researchers actually said.

The case report (here and here) described two young, healthy men who died unexpectedly under the acute influence of cannabinoids (THC). “To our knowledge, these are the first cases of suspected fatal cannabis intoxication where full postmortem investigations, including autopsy, toxicological, histological, immunohistochemical, and genetical examinations, were carried out.” After excluding other possible causes of death, they assumed the men died from “arrhythmias evoked by smoking cannabis.” HOWEVER, “this assumption does not rule out the presence of predisposing cardiovascular factors.”

They noted the absolute risk of cannabis-related cardiovascular effects was low and that the cannabis-induced changes were transient. Yet they cited two studies indicating that the risk of myocardial infarction was elevated almost 5 times in the first hour after smoking marijuana; then it declined rapidly afterwards. “Consequently, the relative risk of cardiovascular effects is most probably increased within this period.”

The Mail Online article cited the research claims of the German study, namely that cannabis can kill, but also stated that: “it remains unclear how it can trigger heart problems.” They pointed to more significant risks associated with marijuana use and quoted David Raynes of the UK National Drug Prevention Alliance as saying about the study’s findings: “These deaths are rare and will remain rare. The real risks are from long-term effects on the young brain.”

There was another alleged case of unexplained death from THC, a young woman named Gemma Moss. A Colorado doctor who works with medical marijuana patients in that state said: “There’s no history of any reports of a death from cannabis ever.” He admitted that it could cause an increased heart rate, so there was a potential problem with someone with a pre-existing heart disease. “But there’s no known dose of cannabis that could kill a human.”

Well, there does seem to be a known dose of THC that would kill a human. The above noted report cited a 2009 study in American Scientist on the toxicity of recreational drugs suggested that using more than 1,000 times the effective dose of THC in marijuana would have to occur for possible fatalities. This fact—that typical doses of THC are well below the supposed lethal dose—was also noted by the German researchers. But they suggested further study of the potential issue and cautioned against individuals who are at high risk of cardiovascular disease to avoid the use of cannabis.

It is impossible to predict how certain individuals respond to cannabis smoke, as underlying illnesses and complicating factors may be unknown. The presented case highlights the potentially hazardous cardiovascular effects of cannabis in putative healthy young persons.

The researchers had an approach that Sherlock Holmes would have been proud of. They said: “After exclusion of other causes of death we assume that the young men died from cardiovascular complications evoked by smoking cannabis.” Holmes famously said: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” It seems to me that pro-marijuana individuals and organizations are dismissing the results of the study out-of-hand for their own propaganda purposes.

10/20/14

Pandora’s Box is Now Open

A drinkable form of marijuana called Legal is now available at eight of Washington State’s recreational marijuana stores. The drink comes in five different flavors and is infused with 22 milligrams of THC: “enough to know you’re high, but not so much as to overwhelm.” Each flavor is supposed to give you a slightly different high. The Company’s founder, Adam Stites said that “drinakables” don’t carry as much of a taboo as other forms of marijuana, “It’s more approachable” to ask your parents if they want a Legal instead of a joint. Stites sees “green” beverages as an amazing, untapped new market:

It’s an opportunity to make an amazing, unique, unusual, and delicious product while also making history. . . . I think my grand-kids will be amazed to know that people used to go to jail for having a plant.

At the same time that Denver and Seattle city officials are denying that legal marijuana is bringing in pot tourists (here and here), travel websites have reported an increase in searches for both destinations. Taylor Cole, who handles public relations for Hotels.com said: “We’ve seen that searches for both destinations have spiked dramatically.”

Year-after-year, there has been a 73 percent increase in traffic at Hotels.com for Denver rooms during its 4/20 festivities. And there was a 68 percent increase among travelers looking for Seattle rooms during July, the first month of legal marijuana sales in that state.

My 420 Tours of Denver Colorado offers a variety of pot-based tour packages. You can take a cannabis cooking class; a Dispensary & Grow Tour, a Sampler Vacation package. You can book a 420 friendly luxury hotel room in the heart of downtown Denver. “Enjoy vaping in your room or smoking freely on 420 smoking deck overlooking downtown Denver.”

You can take a six-hour ride on the My 420 Tours Cannabus, stopping at some of Denver’s top retail marijuana stores. A tour of a professional grow facility, a cannabis friendly lunch, and a 4:20 pm smoke out are all included. There is also free sampling of cannabis edibles on the bus throughout the tour. In a 2½ hour cooking class you will learn “how to make and use various cannabis oils and a variety of organic cannabis-infused treats.” Oh, and you get free samples during class and to take home.

Along with the new edible products and tourism destinations, marijuana legalization is having some potentially harmful and far-reaching consequences. On March 10th, a college student from Wyoming bought four marijuana cookies for herself and her three friends and returned to their Denver hotel. A few hours later, her 19-year old friend leapt over the fourth-floor railing into the lobby.

The woman who bought the cookies said she believed it was the first time her friend had ingested marijuana. They began eating their cookies around midnight. Levy Thamba said he wasn’t feeling anything, so he ate the rest of his cookie. Later that night Levy was “screaming, speaking in French, apologizing for criminal behavior that he had not committed, smashing fixtures and finally jumping off the balcony.” They had been advised to split the cookie into six pieces and eat one piece at a time.

In May of 2014, the governor of Colorado signed legislation to tighten controls on edible and concentrated forms of marijuana. The first law created a task force to devise packaging for cannabis-infused edibles to make those products readily distinguishable from regular foods. Why? Because Colorado Children’s Hospital reported they had treated 13 children, six who became critically ill from edible marijuana.

The hospital’s medical director of the emergency room reported that a number of children had been admitted for “for sedation or agitation and one child suffered breathing problems that required a respirator.” A Colorado study reported in JAMA Pediatrics found there has been an increase of unintentional ingestion of marijuana by children since the modification of drug enforcement laws for marijuana possession in 2009. State Senator Mike Johnston said: “By improving labeling and giving kids a way to tell the difference between a snack and a harmful substance, we can keep kids … out of the emergency room.”

The second law regulates the amount of concentrated marijuana that can be sold to an individual. Marijuana edible companies were encouraged to make products containing no more than 10 mg of THC. If they do, these products will be tested less often for potency than other edibles.

Another incident of suspected marijuana intoxication involved a Denver man shooting his wife to death as she was on the phone with an emergency dispatcher. She told the dispatcher her husband had use pot and was hallucinating and frightening her and their three children.

Under emergency rules that were adopted on August 1, if a marijuana edible is more than 10 mg and up to 100 mg, “you have to score it or demark it in such a way that it is intuitively obvious to the consumer how to break off a serving size of that edible.”

Like opening Pandora’s box, the increased availability of marijuana as a medicinal and recreational drug is having some unanticipated detrimental consequences. Children are being poisoned and people are dying after unintentional ingestions and overdoses of THC. And we are only at the beginning of the medicalization and legalization movement. Where will we be in five or ten years from now? Hopefully the corrections mentioned here will minimize what we’ve seen so far. But like Pandora, I’m afraid that it is already too late to close the container. The genie is already out of the bottle.

09/29/14

Psychoactive Science or Sideshow

© Randomshots | Dreamstime.com - Medicine Wagon Photo — © Randomshots | Dreamstime.com – Medicine Wagon Photo

There is a growing call to permit research into the therapeutic benefits of a variety of psychoactive drugs currently classified by the DEA as Schedule 1 controlled substances. The editors of Scientific American called for the U.S. government to move LSD, ecstasy, marijuana and others into Schedule 2, with cocaine, methamphetamine, fentanyl and Ritalin. They point out that such a move would not lead to decriminalization, “but it would make it much easier for clinical researchers to study their effects.”

Schedule 1 controlled substances are “drugs with no currently accepted medical use and a high potential for abuse.” They are seen as the most dangerous drugs, “with potentially severe psychological or physical dependence.” Schedule 2 controlled substances are “drugs with a high potential for abuse, less abuse potential than Schedule 1 drugs, with use potentially leading to severe psychological or physical dependence.”

British researchers have also called for greater access to “classical hallucinogens” such as psilocybin (magic mushrooms, another Schedule 1 drug) and LSD for research into treating depression.

Classical hallucinogens alter the functioning of this system [serotonergic], but not in the same way current medications do: whilst there are identified receptors and neurotransmitter pathways through which hallucinogens could therein produce therapeutic effects, the neurobiology of this remains speculative at this time.

These drugs are all caught in a catch-22, de facto ban on their use in medical research because of their Schedule 1 placement. “These drugs are banned because they have no accepted medical use, but researchers cannot explore their therapeutic potential because they are banned.” Three United Nations treaties extend similar prohibitions to rest of the globe, further complicating their reclassification as Schedule 2 drugs.

British psychiatrist David Nutt has argued that the U.N. charters are outdated and restrict doctors and scientists from studying hundreds of drugs. He likened this “research censorship” to the Catholic Church banning Galileo from teaching or defending heliocentric ideas in the 1600s. Nutt suggested the Catholic Church banned the telescope, but the ban was actually on books that taught Copernican beliefs.

Nevertheless, he called the laws, which do not discriminate between research and recreational drug use relics of another age. “These laws serve no safety value. . . . The licenses and bureaucracy surrounding them can increase the costs of research tenfold, further limiting what is done.” Dr. Nutt commented on how LSD and other hallucinogens like psilocybin had potential to explore and treat the brain. “Other therapeutic targets for psychedelics are cluster headaches, OCD and addiction.”

The argument for reclassifying psychoactive substances like marijuana, LSD, ecstasy and psilocybin from Schedule 1 to Schedule 2 has its pros and cons for me. The above discussion presents the case for reclassification, permitting future research into these substances. IF the ideal of rigorous, methodical research into the therapeutic potential of these drugs is followed, all is well.

But we are now in the midst of an epidemic of prescription drug abuse that came through the very same gauntlet of review and approval that these known recreational drugs would pass through to become medicinal agents once they were reclassified. And while there are potential therapeutic applications for marijuana, the current state of medical marijuana looks more like the older sideshow of patent medicines, where you could get cocaine toothache drops, heroin for cough relief, and Mrs. Winslow’s Soothing Syrup (which contained morphine) for teething discomfort.

If special interest groups can be held off from bringing about a new age of snake oil salesmanship, then reclassifying these substances and permitting legitimate scientific research makes sense. Done correctly, it might even demonstrate that some of the existing curative claims for medical marijuana and other substances were false. But if these psychoactive substancess achieve FDA approval for any reason, they could be prescribed “off label” as is currently the case with other FDA approved drugs.

09/8/14

A Little Dab Will Do Ya

"Drop of cannabis oil" by Ryan Bushby(HighInBC) - http://upload.wikimedia.org/wikipedia/en/e/e2/Drop_of_cannabis_oil.jpg. Licensed under Creative Commons Attribution 2.5 via Wikimedia Commons - — Drop_of_cannabis_oil.jpg. Licensed under Creative Commons Attribution 2.5 via Wikimedia Commons –

In the 1950s, the ad slogan “A little dab will do ya,” referred to a hair cream called Brylcreem that was supposed to tame a man’s wild hair and make him instantly attractive to women. These days, with the growing acceptance of medical and recreational marijuana, the slogan also applies to a byproduct of marijuana called Butane hash oil (BHO) or wax.

BHO is made by mixing butane with marijuana, and then processing the mixture so that the plant’s cannabinoids are stripped away by the butane from the plant debris. The end result can look like honey or wax. If the amateur chemist doesn’t evaporate their BHO correctly, a lot of impurities are left behind. Johnny Green, a marijuana activist said: “I’m not a doctor, but I can’t imagine that smoking poorly purged butane hash oil is good for your health.”

If the BHO is properly purged, the end result is far purer than raw marijuana. Green said that the highest concentration he has ever heard of THC in marijuana was in the high 20%s. “I have seen a lot of butane hash oil that has ranked in the 80%s and even the 90%s according to reputable testing laboratories.” Concentrations of THC at these levels can cause psychosis and even brain damage, according to DEA special agent Gary Hill. But there is another serious health problem here—butane is extremely flammable.

image credit: Therapeutic Health Center. BHO shatter, Permafrost wax — image credit: Therapeutic Health Center.
BHO shatter, Permafrost wax

The Seattle Times reported: “Federal and state authorities in Washington state have filed charges against seven people in connection with a series of suspected hash-oil explosions and fires.” Two of the men injured in the explosion had previously denied to the police that they were making hash oil. They also had medical marijuana cards. The Times article mentioned a separate suspected hash oil explosion that knocked a building SIX INCHES off its foundation.

In Colorado, the burn unit at the University of Colorado only had two previous admissions for hash oil injuries in 2012 when Wayne Winkler was admitted. In 2013, the burn unit admitted 11 burn patients from hash oil fires. By May of 2014, they had admitted ten. At this rate, they will triple their 2013 burn admissions in the first year that recreational use of marijuana is legal in Colorado. You can see a video report on hash oil explosions in Colorado and hear Wayne’s tearful testimony of what happened to him here.

This danger even has marijuana activists like Johnny Green concerned. In addition to the risk that rookies bring to themselves and others, he said it makes the entire movement look bad. In a blog post to “The Weed Blog,” he said:

Consider this a public service announcement. I don’t know if I have hammered this point home enough, but if you are not an expert at making butane hash oil (BHO), PUT EVERYTHING DOWN, TURN OFF THE STOVE, GET YOUR HEAD OUT OF YOUR BUM, AND EXIT THE KITCHEN. Making BHO is a very dangerous thing, and if you slip up in any way, you will no doubt light something on fire, including yourself.

The emphasis above was in the original article. Embedded in the Weed Blog article is a short YouTube video of a homemade attempt to make hash oil gone wrong.

Legalizing marijuana for either medicinal or recreational use will mean easier access to marijuana and lead to a pattern of hash oil explosions like those noted here. States being lobbied by pro marijuana interests should slow down and simply watch what happens in Colorado and Washington state. At the very least, they can learn from the mistakes these earlier “progressive” states have made in drafting their marijuana legislation.

One excellent example is in Colorado. Colorado’s marijuana law allows adults 21 and over to grow up to six plants at home; and hash oil cooks will often use their own plants to make it. Brian Vicente, who helped write the marijuana law in Colorado, said the law’s vague wording that allows processing marijuana plants permits home hash oil production. He did add that he thought the hash oil fires would decline as people realize the dangers and start going to pot shops instead of trying to make their own hash oil at home. That sure was reassuring.

06/30/14

Is Legalizing Reefer Madness?

iStock_000029797266XSmall — image credit: iStock

The Pew Research Center found that for the first time since 1969, more Americans favor legalizing the use of marijuana (52%) than those who oppose it (45%). The change started after 1991, when 78% of Americans opposed legalization and merely 17% supported it. The greatest support for legalization was found within youngest age group, individuals born since 1980. Sixty-Five percent of these Millennials favor legalizing marijuana.

The past three years have seen a rapid shift in support of legalization. In 2010 only 41% were in support of legalization. “Since then, support for legalization has increased among all demographic and political groups.” Boomers, born between 1947 and 1964, have seen their support for legalizing marijuana increase from 24% in 1994 to 50% in 2013.

Along with the increased support for marijuana legalization, there has been a corresponding decline in negative attitudes about marijuana. Currently, 32% believe that smoking marijuana is morally wrong, an 18 point decline since 2006 (50%). Over that same period, the percentage of people who said that smoking marijuana was not a moral issue rose 15 points from 35% in 2006 to 50% in 2013.

Over the past three decades, attitudes on whether or not marijuana was a gateway drug have shifted as well. A 1977 Gallup survey found that 60% of people believed that marijuana was a gateway drug. In 2013, only 38% believed so. Most of this shift is the result of generational change. Gen X and Millennials were far less likely to say that marijuana use leads to the use of hard drugs (36% of Gen X and 31% of Millennials).

The efforts of organizations like NORML and the Marijuana Policy Project seems to be paying off. They have been working to “legalize the responsible use of marijuana,” so that marijuana is “legally regulated similarly to alcohol.”

But I wonder if the momentum towards legalization is moving in right direction. NORML and the Marijuana Policy Project cited various studies on the safety profile of cannabis, the therapeutic potential of cannabis and how long-term cannabis use does not cause permanent cognitive impairment. But there seems to be an opposing consensus on the potential harmful effects of marijuana use. Just a few of these concerns are noted below.

The potency of marijuana has doubled since 1998; tripled in the past 20 years.
In 2010, marijuana was involved in more than 461,000 ER visits nationwide.
In 2011 around 872,000 individuals received treatment for marijuana use.
In 2012 4.3 million individuals could be diagnosed as dependent upon or abusing marijuana.

There is also clear evidence of an association between marijuana use and psychosis. NORML gave a summary of the 1995 Lancet study that said smoking cannabis, even long-term use, was not harmful. Yet they ignored the Lancet’s retraction of that support published in the July 2007 edition of the Lancet:

In 1995, we began a Lancet editorial with the since much-quoted words: “The smoking of cannabis, even long term, is not harmful to health.” Research published since 1995, including Moore’s systematic review in this issue, leads us now to conclude that cannabis use could increase the risk of psychotic illness. Further research is needed on the effects of cannabis on affective disorders. The Advisory Council on the Misuse of Drugs will have plenty to consider. But whatever their eventual recommendation, governments would do well to invest in sustained and effective education campaigns on the risks to health of taking cannabis.

A web site, Cannabis & Psychosis, was recently launched to “increase awareness and understanding of the relationship between cannabis use and psychosis from the perspective of youth.”

Public support for the legalization of marijuana is growing. The potency of marijuana is increasing. And the evidence for the harmful effects, especially psychosis and other mental health issues is becoming clearer. Marijuana will likely surpass alcohol and tobacco as a public health concern once it is legalized. For more information on the health concerns with marijuana go to “Marijuana Research Findings” on this website.

06/2/14

Marijuana as a “Gateway” Drug

13744586_s — samtheartman1 / 123RF Stock Photo

Marty O’Rourke, who discipled me when I was young in the Christian faith, would sometimes tell others that when he first met me, I was smoking a joint. Technically, I had just taken a toke and was passing the joint to another person. Yes, I did sometimes smoke marijuana in the 1970s and I did inhale. But I never went on to try harder drugs. There was no “gateway effect” with my marijuana use.

There has been a back-and-forth debate for years about whether or not marijuana is a “gateway” drug. Typically three truths support the idea:

Marijuana users are more likely than nonusers to progress to hard-drug use.
Almost all the individuals who have used both marijuana and hard drugs first used marijuana.
A higher frequency of marijuana use raises the likelihood of using hard drugs at a later time.

But like me, the overwhelming majority of marijuana users do not progress to other drugs. The 2012 National Survey on Drug Use and Health found marijuana was the most commonly used illicit drug, with 18.9 million users in the month prior to the survey. This constituted 79 percent of all the reported illicit drug use. About two thirds (62.8%) of illicit drug users had used only marijuana in the past month.

Sociologists say marijuana is typically used within a specific social context. So the progression to more dangerous drugs happens as a result of the person associating with a subculture that condones drug experimentation. The social group, not marijuana, is the “gateway.”

Similarly, Andrew Morral suggested there was a common factor explanation for the gateway effect with marijuana. The individual’s opportunities and inclination determine the risk of future hard drug use, not prior marijuana use. He commented that his research did not disprove the gateway theory. But it showed another plausible explanation for the association of marijuana use and hard drug use.

The Marijuana Policy Project listed several articles (i.e., Is Marijuana a “Gateway Drug”?) that challenged the marijuana gateway theory. However, the articles tended to conclude there was a common factor explanation or a mediating factor, like stress or genetics, to the gateway effect with marijuana. They debunked the notion of marijuana use as a causative factor leading to harder drug use, but they do not effectively challenge the above three facts supporting the marijuana gateway theory.

Counseling people with drug and alcohol problems has shown me that they often experimented with marijuana before trying harder drugs. The three statements above have been true time and time again. Marijuana use may not be a causative gateway to future experimentation with more dangerous drugs, but it was often a stepping stone taken before an individual tried the cocaine, heroin, or prescription drug high. And a recent study by researchers at Yale concluded that previous alcohol, cigarette and marijuana use were each associated with the current abuse of prescription opioids. “Previous marijuana use was 2.5 times more likely than no previous marijuana to be associated with subsequent abuse of prescription opioids.”

The executive director of the Connecticut chapter of NORML, Erik Williams, said the Yale study failed to show a strong link between marijuana and the use of harder drugs. “This is just another propaganda study that tries to turn a casual link into a causal relationship.” The Yale’s study lead author agreed there wasn’t proof of a concrete connection between opioid abuse and prior marijuana use. But, she said, “It’s a red flag.” It suggests there is a potential association there.

Marijuana does not seem to be a “gateway” that leads to experimentation with more dangerous drugs. But it often is a stepping stone taken on the path to harder drugs in a person’s addictive career.

05/19/14

Remembering Reefer Madness

Sometime around 1975, I went to see the film “Reefer Madness.” I was probably stoned, because that was what you did. You smoked pot and went to see the movie. But that was a long time ago. These days I’m on the other side of the movement to legalize marijuana. Being a drug and alcohol counselor for over thirty years and seeing the negative consequences of drug use and abuse can do that to you.

A few years ago I taught a Sociology of Deviant Behavior course at Grove City College, and showed the film to my class. The students didn’t express concerns; I didn’t think they would. But I heard that while some of their parents thought it was “cool” that a professor at a conservative Christian college would show the film, others weren’t pleased.

“Reefer Madness” was released as “Tell Your Children” in 1936. Financed by a small church group, it was supposed to inform parents of the dangers of smoking marijuana. During filming, the cast was asked to “hoke” it up—be campy and melodramatic. Scenes like the one pictured here where the character Ralph demands that the piano be played “Faster … Faster!” come to mind.

Soon after the film was completed, it was purchased by Dwain Esper, who renamed it “Reefer Madness” and put it on the exploitation cinema circuit. Several new movies each year would travel from town to town on the circuit. Each addressed a socially problematic behavior. Films like “Reefer Madness” and “Cocaine Fiends” would be announced in a town with huge posters that screamed, “THE MOST VITAL PICTURE OF ALL TIME” and “YOU MUST SEE IT.”

Theater lobby displays for movies warning of the dangers of drugs contained hypodermic needles, simulated reefers, and other drug paraphernalia. “Esteemed” lecturers would tell of the dangers of drugs, venereal disease, or whichever problem behavior related to the film—and then urge filmgoers to buy their educational booklets.

Amidst this onslaught of hype, the movie itself almost became an afterthought. After a brief release, “Reefer Madness” was forgotten for decades. Neither Esper nor the original filmmakers bothered to copyright the movie and it eventually fell into the public domain. Watch a version of “Reefer Madness” here on YouTube.

In 1971, Keith Stroup, the founder of NORML (National Organization for Reform of Marijuana Laws), bought a print of Reefer Madness for $297. He cleaned it up and started showing it at pro-pot festivals. Robert Shaye, the head of the newly formed New Line Cinema film company, saw the film and recognized its potential as a campy classic. Shaye booked the film onto the college and midnight movie circuits, where it was huge hit. That’s where I first saw it.

I was reminded of the theatre surrounding “Reefer Madness” recently when I read an article on The Huffington Post about the first hemp harvest in Colorado: “This is What the End of Hemp Prohibition Looks Like.” The farmer, Ryan Loflin, had volunteer harvesters from five different state and two different countries. They received a t-shirt and a free lunch for their efforts.

It does seem that the tide has changed, as the legalization of marijuana and hemp continues to gain political support. But it’s not necessarily heading to a better world. “Reefer Madness” was hokey and melodramatic, but it had a core of truth to it. A 2007 study found an increased risk of psychosis later in life from using cannabis. I’ve also gathered and summarized additional studies showing the negative consequences of cannabis use in “Marijuana Research Findings.” Hmmm … Maybe someone needs to make an updated, less hokey “Reefer Madness” film.

Faith Seeking Understanding

Charles Sigler, D.Phil.

Tag: Marijuana