Medical pot: how safe?

David Sack Published:

The Los Angeles City Council voted last Tuesday to ban medical marijuana dispensaries in the city, the culmination of years of controversy over the sale of pot. Meanwhile, in Oakland, a federal crackdown closed the nation’s largest dispensary amid protests and demonstrations. But authorities rarely seem to address the real issue about marijuana in California: Is it good medicine?

Some proponents of medical marijuana argue that pot is “natural” and therefore better, or at least no worse, than legally prescribed drugs, which may be addictive and may carry dangerous side effects. But natural is not the standard for whether a drug is safe and effective.

Marijuana advocates also say that physicians who warn against marijuana merely want to push prescriptions. But just because some doctors practice bad medicine with legal drugs doesn’t make marijuana good medicine. In most cases, it isn’t.

Anyone who wants to get a medical marijuana card knows there are unscrupulous doctors who will give you a recommendation with few questions asked. Without doubt, medical marijuana hands a get-out-of-jail-free card to people who just want to get high. Those who get a card and indulge in the infrequent use of marijuana will probably experience few problems. But the situation is different with chronic marijuana use.

Marijuana acts on cannabinoid receptors in the brain. These receptors, which are the most prevalent in the nervous system, influence just about every bodily function, including memory, attention, disposition, arousal, motivation, perception, appetite and sleep.

Many chronic marijuana users insist that marijuana is not addictive the way alcohol and other drugs are. However, neuroscience, animal studies, clinical reports of withdrawal in humans and epidemiology all show that marijuana is potentially addictive.

As to its benefits, controlled clinical studies show they exist, but they are limited. Marijuana can effectively treat neuropathic pain, and it has been shown to improve appetite and reduce nausea in cancer and AIDS patients.

But other generally accepted ideas about marijuana’s effectiveness don’t hold up.

The Glaucoma Research Foundation disputes the idea that medical marijuana is good medicine for the disease. “The high dose of marijuana necessary to produce a clinically relevant effect,” the foundation’s website explains, makes it a poor choice for the treatment of glaucoma, especially given its “significant side effects” and the availability of safer effective drugs.

In addition, those who use marijuana to treat mental health symptoms might be surprised to learn that studies show it not only may not help such symptoms, it may cause them.

Increased funding for research may lead to a better understanding of the impact cannabis has on our bodies, but for now the claims that the drug is effective in the treatment of multiple disorders as distinct as lupus and anxiety seem far-fetched at best. It seems more likely that for some people, getting high just makes them feel better, the way a drink or two might. You would be shocked, however, if in response to a diagnosis of lupus, your doctor suggested you “take two drinks and call me in the morning.”

And pot’s general ineffectiveness is only part of picture. It is not a neutral substance. Chronic marijuana use is associated with a number of well-documented health problems, including a variety of cancers in adults as well as in children who were exposed to the drug in utero.

As to its mental health effects, marijuana is linked to long-term psychiatric problems such as depression, anxiety and psychosis. “Marijuana often is regarded as a ‘soft drug’ with few harmful effects,” says Dr. Joseph M. Pierre, co-chief of the Schizophrenia Treatment Unit at the Department of Veterans Affairs’ West Los Angeles Healthcare Center. “However, this benign view is now being revised, along with mounting research demonstrating a clear association between cannabis and psychosis.”

If the lack of health benefits and manifest risks aren’t enough to raise doubts about medical marijuana, consider basic questions of quality and dose. Although medical marijuana sometimes comes from “cleaner” sources than say a drug cartel, independent labs have found mold, synthetic insecticides and other toxins in pot. Molds such as Aspergillus can be highly dangerous to immune-compromised patients. And there is no way to accurately judge what a proper dose of dispensary marijuana would be.

Habitual marijuana use is helpful for very few medical conditions. It can cause insidious changes in personality and attitude that are clear to everyone but the users themselves. There are nearly 400,000 emergency room visits per year due to marijuana use. Before we advocate for medical marijuana, and before another person doses himself with it, we have to ask: Is medical marijuana making us sick?

David Sack is a psychiatrist and addiction specialist. He is chief executive of Promises Treatment Centers and Elements Behavioral Health in Southern California. He wrote this for the Los Angeles Times.

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  • Even if ALL of the myths that they Editor lists in making the case against legalization were to be true (NOT!), the negative externalities associated with the prohibition of marijuana far outweigh them. The prohibition of marijuana was a major cog in the creation and the continued funding of the violent criminal element of organized crime in our society. Our police are preoccupied with investigating and pursuing low-level users and distributors of marijuana while a "serious crime" is committed in KY every 2 minutes and 38 seconds. Our court dockets and prisons are filled with non-violent drug offenders, forcing the early release of violent criminals to make room for the steady stream of "druggies". And all for what? Protecting people from themselves for ingesting a substance that may or may not be good for them, all while turning a blind eye on the real health care problems such as obesity, tobacco and alcohol use. The hypocrisy is astounding, and sadly, our Federal Government is one of the worst culprits. Mr. Editor, now that you have gone through this "critical analysis" process with all of the myths, why not try it with the facts. You may be surprised at how it changes your conclusions. An excellent source book, Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence, is available: http://books.google.com/books/about/Marijuana_Myths_Marijuana_Facts.html?id=pbHSWEjyBzYC

  • Mr. Editor, tell it to Steve Jobs, the last 3 Presidents, and a cast of thousands of very successful people.

  • Mr. Editor, tell it to Steve Jobs, the last 3 Presidents, and a cast of thousands of very successful people.

  • While the cartoon is just plain insulting, the 'editorial' (and I use that term loosely), skips over several benefits of medical cannabis, including, but not limited to cancer reduction and potential cure (emerging research) and MS symptoms (highly documented). You mention marijuana being linked to cancer? Where is your documentation? Emerging research is showing quite the opposite as cannabinoids bonding with the cb2 receptors in cancer cells releases toxins that make the cancer cells self-destruct (in layman's terms). The AMA also just recently posted in their journal that a 20 year study revealed that marijuana smoke has negligible effect upon lung function even in chronic users. You only give vague references to 'mounting research', well where is it? You mention of possible 'pathogen contamination' that may harm immune compromised smokers. Well our glorious FDA and USDA standards routinely miss E.Coli and Salmonella contaminations in the food supply that not only harm, but kill immune compromised people. I don't hear you slamming that do I? As far as setting a 'safe' dose of marijuana, please be advised that there is no 'unsafe' dose and that an 'overdose' is impossible.There has never been a death attributed to marijuana alone. THC has been proven to be one of the least toxic substances known to man and there is plenty of documentaion to back that up. In closing, it appears that you have a vested interest in keeping marijuana illegal in all forms to keep your highly profitable business booming. I see little credibility in your editorial. Thank you.

  • Steve_Fry, I have been unable to verify that 400,000 "visits" number except in other newspaper's editorials of the same general theme...and no source was ever mentioned. I have to wonder if the numbers have any validity at all. But even if it were so, how many of those emergency room visits were due to the police taking in suspected DUI violators to draw blood for drug tests. Assuming that this 400,000 visits to emergency rooms is valid, let's put this into a little perspective by examining annual causes of deaths in the US. Keep in mind, that NONE of those visits for marijuana use were for an actual health threat to the patient, much less had an outcome of death. Relatively speaking, look at the National Center for Health Statistics, 2009, the US annual cause of death by cause: Tobacco....................................435,000 Poor Diet and Physical Inactivity..........365,000 Alcohol.....................................85,000 Microbial Agents............................75,000 Toxic Agents................................55,000 Motor Vehicle Crashes.......................26,347 Adverse Reactions to Prescription Drugs.....32,000 Suicide.....................................30,622 Incidents Involving Firearms................29,000 Homicide....................................20,308 Sexual Behaviors............................20,000 All Illicit Drugs incl. rel. homicides......17,000 Non-Steroid Anti-Inflam. like Aspirin........7,600 Marijuana........................................0 There are lots of causes of death that are more threatening than accidental prescription medicine poisonings, and resources should be allocated to them accordingly. But they don't push the same buttons as illicit pot smokers...and don't garner the same number of votes come election time either. Considering that Kentucky is one of the nation's most "medicated states", with a per capita of 15.8 retail prescriptions for each and every one of us, is it any wonder that there are these accidental poisonings? If we really are serious about reducing accidental prescription drug poisonings, shouldn't we first look at our doctors who are prescribing all of those 15.8 prescriptions for each of our citizens (per capita)? In comparison, in Kentucky the tobacco related deaths in 2001 were 378.1 deaths per 100,000 population, or 25 times the deaths of prescription drug poisonings. Twenty five times!!! Senator McConnell concludes that "We must do everything we can to end the plague of drug abuse." Funny, but he isn't really calling for us to do ANYTHING about the tobacco related deaths, which are 25 TIMES those of accidental prescription drug poisonings.

  • what a piece of crap article - where is the links to all these so called facts - what a JOKE

  • I'm curious about the "400,000 emergency room visits per year due to marijuana use." What would the complaint be? "I got so high I felt I needed to go to the E.R.?"

  • David Hack-- Sorry I mean Sack, has so badly slanted the facts about cannabis, that I can barely acknowledge them all. I admit curiosity about how an alleged California substance abuse counselor (with great enthusiasm towards furthering his career, and it winds up in your dinky Kentucky newspaper. You must be so proud of how well you report the news as well. My story is a little different. I'm 52 and 100% disabled. Sometimes I have so much pain that I literally cry about it. I refuse to take opiates or other addictive substances that will further damage my organs. When I smoke pot the pain subsides, and I just feel generally better. Not great but better. Because of the small and selfish position of Mr. Sack and his ilk, I suffer doubly-- as a unresolved patient and as a criminal. The majority of this people can see right through all your double talk. Cannabis has a place in our society either today or tomorrow.

  • I know this artical has the word of opinion above it, but it should have read "Opinion of uninformed". Sir, I do suggest you do some reaserch before you write a artical. When you don't, many people might think you failed your GED test. Because if you had done the research, you would not have wrote this artical and shared it to anyone. Because it is slowly becoming common knowledge just how wrong you are. So those that don't know yet, how irresponsible AND FOOLISH you was to be publishing this with such ignorant information. Will know in the near future. The numbers of Cannabis supporters are growing everyday. It's because the truth is now being passed around. The fact is, Cannabis is less harmful than your cup of coffee. So think how foolish you will look. I would do research before I tried to write again if I was you.

  • This article is inaccurate, biased and misleading throughout. Tired, old propaganda to shore up the crumbling facade of Prohibition held in place by greed and cruelty. The National Cancer Institute has updated information on cannabinoids as of mid-July this year. CannabisScience.com has documented progression in the treatment of melanoma with several patients. Does your newspaper deal in facts or fantasy?

  • I'm for legalization...

  • I must be cornfused, but are ye' fer' it, or agin' it, moore_r_2000? Or is it the Glaucoma foundation that yer' agin? One word for them, vaporization.Also, let's see that peer reviewed study on dain bramage...

  • I am so outraged at this article I can't think of all the things I want to say. I thought that after the last hatchet job your publication did we could get a fair debate but this article and the accompanying cartoon is so insulting all I could do was check to see what the Glaucoma foundation actually said and now I'm even more enraged... Treatment Alternative? One of the commonly discussed alternatives for the treatment of glaucoma is the smoking of marijuana, because smoking marijuana does lower the eye pressure. Less often appreciated is the fact that marijuana's effect on eye pressure only lasts 3-4 hours, meaning that to lower the eye pressure around the clock it would have to be smoked 6-8 times a day. Furthermore, marijuana's mood altering effects prevent the patient who is using it from driving, operating heavy machinery, and functioning at maximum mental capacity. Marijuana cigarettes also contain hundreds of compounds that damage the lungs, and the chronic, frequent use of marijuana can damage the brain." http://www.glaucoma.org/treatment/should-you-be-smoking-marijuana-to-treat-your-glaucoma-1.php

  • Quoting a comment from the original source of this "editorial": Interesting how the LA Times brings this guy out to blast medical cannabis, yet they published an article in 2007 that points out serious flaws in his company's business practices: http://articles.latimes.com/2007/oct/09/local/me-rehab9 Read more here: http://www.thenewstribune.com/2012/07/29/2232076/medical-marijuana-might-not-be.html?storylink=rss&storylink=mrc#storylink=cpy And again in 2009... Promises and pitfalls of celebrity rehab http://articles.latimes.com/2009/may/13/entertainment/et-promises13

  • Who you callin' a hyper bole, Willis?

  • How about a joke? A hyperbole totally ripped into the bar and literally obliterated everything!

  • SJ quote: "Some proponents of medical marijuana argue that pot is “natural” and therefore better, or at least no worse, than legally prescribed drugs, which may be addictive and may carry dangerous side effects. But natural is not the standard for whether a drug is safe and effective." How about non-toxic...you can't get ANY safer than that. You can overdose and die from ingesting pure, clean water, but there is no toxic dose for marijuana. None. Nobody has EVER died from ingesting marijuana. What else can you say that about? Nothing. Is that "safe" enough for you? The editors don't seem quite to be able to grasp that the scientists who have and are currently conducting peer reviewed studies on medical marijuana are experts in their fields and not "proponents", but independent and unbiased researchers. That is the way real science works, as opposed to media pontification and speculation, where any old opinion will do. The is little doubt that science has already determined the efficacy of marijuana's medicinal value, which includes promising evidnece as a treatment for cancer. Is that "effective" enough for you? Notfromhere, don't blame the cartoonist, she is merely following the direction of the editors...what are THEY smoking.

  • Not only is Boileau amateurish, she is uninformed. Absolutely the worst cartoonist to be employed by a newspaper.

  • "Promises Treatment Centers and Elements Behavioral Health in Southern California" will "cure" you of your addiction for around $2000 per day. If you can afford $2000 a day, you don't have a problem yet. Quote a JAMA article where the link between pot and psychosis has been correlated to be taken seriously, not this suspect self-promoting advertisement for an over-the-top expensive "for-profit" treatment center. As a business model, they would brand oxygen as a drug to get treatment money if allowed. Psychosis is a loss of contact with reality. I would suggest posts to the editorial section, on this topic anyway, border on psychosis.