Medical marijuana: Voodoo or legitimate therapeutic choice?

by Barbara Bronson Gray, Healthday Reporter
Medical marijuana: voodoo or legitimate therapeutic choice?
Doctors weigh wisdom of prescribing drug in hypothetical case involving woman with advanced breast cancer.

(HealthDay)—Imagine a 68-year-old woman with advanced breast cancer, looking for a better way to ease her chronic pain, low appetite, fatigue and nausea. Should she or shouldn't she be prescribed marijuana?

That's the question physicians debate in the "" section of the released online Feb. 20.

According to the hypothetical case study in the journal, a woman named Marilyn has metastatic that has spread to her lungs and spine. She's taking chemotherapy and two anti-nausea drugs that just aren't working. Despite taking 1,000 milligrams (mg) of acetaminophen, such as Tylenol, every eight hours, she's in pain. At night, she sometimes takes 5 to 10 mg of oxycodone, a narcotic pain reliever similar to morphine, to help relieve the pain so she can sleep.

Marilyn lives in a state where marijuana is legal for personal medicinal use, and her family stands ready to grow it for her.

Why not let Marilyn try it?

One reason not to, in the view of one of the "con" argument's authors, Dr. Robert DuPont, is that it probably wouldn't help her. "Although marijuana probably involves little risk in this context, it is also unlikely to provide much benefit," said DuPont, a clinical professor of psychiatry at Georgetown Medical School in Washington, D.C., and the first director of the National Institute on Drug Abuse under Presidents Nixon, Ford and Carter.

Marijuana is a dry, shredded mix of flowers, stems, seeds and leaves of the hemp plant Cannabis sativa. People usually smoke it as a cigarette or in a pipe. It's the most commonly abused illegal drug in the United States, according to the U.S. National Library of Medicine.

In an interview, DuPont said that because smoked marijuana has not been reviewed and approved by the U.S. for safety, effectiveness and purity, it would be inappropriate for a physician to prescribe it. "It would divert the attention away from an effective medical treatment and get her into something that's at best voodoo," he said.

The cannabis (marijuana) plant contains hundreds of pharmacologically active compounds that could interact with the medications Marilyn's now taking, DuPont said. It's impossible to know the chemical make-up or potency of a given dose, he noted, adding, "Medical marijuana has no dose. There is nothing else in medicine like that."

DuPont said it's also uncertain how Marilyn might react to the experience of smoking marijuana. He said the drug could affect her ability to think effectively. And just the act of smoking, coupled with the impact of the cancer on her lungs, could reduce her ability to get oxygen to her brain, he added.

Rather than offering Marilyn marijuana that is smoked, DuPont would prefer she be offered drugs that have been shown to be highly effective for treating nausea and vomiting caused by chemotherapy, such as dexamethasone and aprepitant. Should these not work, he said, he would opt for one of two prescription "cannabinoid" pills that are available: dronabinol (Marinol) or nabilone (Cesamet), which are both approved by the FDA for the same purpose.

DuPont argued that with the oral cannabinoids, the precise dosages have been established and the medications take effect more gradually than does smoked marijuana, and thus would be less likely to cause anxiety or panic.

Dr. J. Michael Bostwick wrote the "pro" argument for offering Marilyn marijuana. Bostwick, a professor in the department of psychiatry and psychology at the Mayo Clinic College of Medicine, in Rochester, Minn., said he told the editors at the New England Journal of Medicine that he could have made the case for either side. He had a family member with substance-abuse issues involving marijuana. "I kept hearing marijuana is harmless and doesn't cause any problems, and yet I was seeing addiction," he said.

Still, Bostwick said he would give marijuana to Marilyn.

"If it would help, why not? I say that, knowing that much of what we do in medicine is empirical, but knowing there are arguments for exploring the possibilities the whole endocannabinoid system might offer," he said. Bostwick explained that there are receptors for cannabinoids in the brain, the gastrointestinal system and immune tissues—which suggests the body may be designed to accommodate or benefit from marijuana.

"The downside of trying is small. If she did not have a recent experience with [marijuana], she might not even like it," he said.

Bostwick believes the federal government should make , which is now illegal in the United States, a "schedule II" drug, thereby allowing researchers to study its safety and effectiveness. Schedule II drugs are considered to have a high abuse risk but also have safe and accepted medical uses. Schedule II drugs include morphine, cocaine, oxycodone (Percodan), methylphenidate (Ritalin) and dextroamphetamine (Dexedrine).

Bostwick argues that Marilyn's situation is a clear case for the need to apply clinical judgment: "In the context of an ongoing relationship, as one more treatment in a wide pharmacopeia, it's up to the doctor," he said.

More information: To learn more about marijuana, visit the U.S. National Library of Medicine.

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Oxensraiser?
3.9 / 5 (7) Feb 21, 2013
There have been of 60 yrs of research and over 10,000 seperate studies done on marijuana, more than any other drug including all the legal ones combined. What more can they want to know? This is just another propaganda paper designed to muddy the waters.
Roland
4.4 / 5 (7) Feb 21, 2013
If it's not effective, why would the US Govt hold a patent on it? The DuPont family and company have been big backers of the WoD since the invention of synthetic fibers. And pills for nausea/vomiting? They come right back up. Keep the govt out of such decisions. Just legalize it. Stop wasting tax dollars on regulation/enforcement.

JRi
2.2 / 5 (5) Feb 22, 2013
You can always eat cookies, seasoned with marijuana. No damage to lungs. Or just bite leaves like Indians used to do.
Shootist
1.7 / 5 (3) Feb 23, 2013
Biting leaves is a waste of time and there was no cannabis in the new world prior to the arrival of the European.

Smoke it. Make a tincture in various distillates (alcohol, butane, acetone), or cook (saute) at low temperatures in fat (butter, oil, lard), discard plant material, then consume the fat.

Marijuana, it does a body good™
rick_steeb
1 / 5 (2) Feb 23, 2013
Voodoo? Really? Cannabis was featured in the United States Pharmacopoeia from the time of O'Shaughnessy up until the time of Anslinger. Is there a substance on Earth nearer to a literal panacea? Name it! "Storm Crow's List". End of controversy.
freethinking
1 / 5 (3) Feb 24, 2013
Lets be honest. Medical marijuana is a joke and a con game, no one needs it, and it is not used for medical reasons.

That said, If you want to legalize it, then say so bluntly. I do not think that it should be illegal.
daggoth
3 / 5 (1) Feb 24, 2013
The vast majority don't use it for "medicinal" reasons, just to get high and relaxed. It does the opposite for me and ramps up my anxiety. To each their own, but don't hide behind lies. It has medicinal uses for some people, but most just wanna get high.
MandoZink
5 / 5 (2) Feb 25, 2013
Lets be honest. Medical marijuana is a joke and a con game, no one needs it, and it is not used for medical reasons.

I really hope you are capable of doing a bit more investigating and not just taking an uninformed stand.

When I had cancer in 2007, I found cannabis had medical properties that were totally non-evident from casual or recreational use. Cannabinoids act as an agonist and bind to CB1 and CB2 receptors in the stomach. This completely eliminates the devastating nausea brought on by chemotherapy, which provides an extraordinary degree of relief. It allows a measure of healthy appetite to persist, preventing the deteriorating physical condition that normally accompanies the chemo treatment. This particular medical effect is not in any way apparent to one not under chemotherapy, as I discovered.

I went 2 days dealing with extreme, serious flu-like nausea, barely able to get out of bed. All I had been able to consume was half a large strawberry. I was in hell.

(cont'd)
MandoZink
5 / 5 (2) Feb 25, 2013
I had a prescription for Marinol, an oral synthetic THC analog, but it was ineffective. In desperation I decided to try smoking some very good marijuana which was brought to me. With only took 2 deep tokes the nausea decreased profoundly. Within 25 minutes my appetite returned and I easily ate without vomiting.

I was both delighted and angry as hell. The effect it had was so dramatic that I could not believe it was NOT the primary medically established treatment. I quickly learned from my oncologist that the overwhelming benefits cannabis produces has been apparent to most cancer doctors for decades. My oncologist and I had a number of good discussions on why it works and why it has become the principal remedy of choice by the medically well-informed.

Since I was able to eat and stay healthy, I returned to work, surprising my boss. When I informed him how I was able to stay healthy, he removed me from the list of people to be drug tested for the duration of my treatment.

(cont'd)
MandoZink
5 / 5 (2) Feb 25, 2013
As I researched further, I found that cannabis affects CB1, CB2 and other receptors in ways that help to suppress or prevent other physical maladies as well. I am always aghast that people assert there is no merit to cannabis. It can only be because they have no clue whatsoever.

You can always eat cookies, seasoned with marijuana. No damage to lungs. Or just bite leaves like Indians used to do.

For chemo relief in particular, the effects of oral ingestion is delayed and insufficient. Not to mention anything eaten can be immediately expelled before any possible effect could occur. Inhalation brings immediate relief.

People who have smoked cigarettes heavily for decades can reverse that damage if they quit soon enough. To imply that taking a few tokes of marijuana for the duration of cancer treatment is in any way comparable to that is totally out of proportion and absurd.
freethinking
1 / 5 (1) Feb 25, 2013
Hey, I'm all for legalizing POT for the idiots who want to use it. But the truth is, medical uses are just an excuse for the legalization, and I am someone who wants people to speak the truth and not lie. The ENDS do not justify the MEANS.

My reasons to legalize it is ONLY because it can be grown and I don't believe government should control what is grown. There is my justification to legalize it.

If you use POT, go ahead. If you want the excuse that its for medical reasons, go ahead. However the truth is it is bad for your health and wrecks your brain.
MandoZink
5 / 5 (1) Feb 25, 2013
Freethinking:
It is a characteristic of a slacker-type personality that they choose an intoxicant to accompany their lifestyle. You are mistaken to think it works the other way around, and your misconception is with good reason. It is a given that the multitude of dynamic and intellectual pot smokers you might meet would quickly recognize your stance and simply not tell you they do.

My lifelong friends are now in their late 40's to early 60's. Their professions range from architect, doctor, lawyer, engineer, researcher, teacher, musician and other technical proficiencies. We are all are still very physically active. At 59, I no longer ride a bicycle 30 miles a day, but I still can. Every one of us has been perpetually active in the arts and/or civic causes.

My own blood lymphoma aside, all of us are very healthy and none of us waste our lives. We are optimistic, positive people. We care for this planet.

And to the point of this discussion, we have smoked pot for most of our life.