Medical Marijuana – Medical marijuana in california
Marijuana is the most commonly used illicit drug in the United States, with nearly 17 million Americans age 12 and older reporting past‐month use, and 374,000 people entering an emergency room annually with a primary marijuana problem. The downward trend in youth marijuana use during the late 1990s has ended. According to the 2009 National Survey on Drug Use and Health, past‐month marijuana use among 12‐ to 17‐year‐olds climbed 9 percent from 2008 (6.7%) to 2009 (7.3%), as shown in figure 1.
Not surprisingly, this increase coincides with a softening of youth attitudes about the risks of marijuana (figure 1). Among 12‐ to 17‐year‐olds, the perception of great risk in smoking marijuana once a month declined from 2008 (33.9%) to 2009 (30.7%).
Recently, there have been increasing efforts to legalize marijuana. The Obama Administration has consistently reiterated its firm opposition to any
form of drug legalization. Together with Federal partners and state and local officials, the Office of National Drug Control Policy is working to reduce the use of marijuana and other illicit drugs through development of strategies that fully integrate the principles of prevention, treatment, recovery, and effective supply reduction efforts. Proposals such as legalization that would promote marijuana use are inconsistent with this public health and safety approach.
In the highly charged debate over legalization, many troubling misperceptions have gained currency. It is critical these false assumptions be addressed and clarified using the best evidence available. A careful examination of the facts leads to the following conclusions about the dangers of marijuana use and the likely consequences of legalization:
Marijuana use is harmful and should be discouraged
- Marijuana use is associated with dependence, respiratory and mental illness, poor motor performance, and impaired cognitive and immune system functioning, among other negative effects.
- Marijuana intoxication can cause distorted perceptions, difficulty in thinking and problem solving, and problems with learning and memory.
- Studies have shown an association between chronic marijuana use and increased rates of anxiety, depression, suicidal thoughts, and schizophrenia.
- Other research has shown marijuana smoke to contain carcinogens and to be an irritant to the lungs. Marijuana smoke, in fact, contains 50‐70 percent more carcinogenic hydrocarbons than does tobacco smoke.
Legalization would lower price, thereby increasing use
- A recent report from the RAND Corporation, “Altered State,” discusses how legalization would cause the price of marijuana to plummet, triggering increases in use of the drug.
- Illegality helps keep prices higher. And because drug use is sensitive to price, especially among young people, higher prices help keep use rates relatively low.
- Use of the legal substances alcohol and tobacco far outpaces the use of marijuana (figure 2), a strong indication that laws reduce the availability and acceptability of substances.
- Our experience with even tightly regulated prescription drugs, such as Oxycontin, shows that legalizing drugs widens availability and misuse, even when controls are in place.
Tax revenue would be offset by higher social costs
- The costs to society of alcohol and tobacco – substances that are legal and taxed – are much greater than the revenue they generate.
- Federal excise taxes collected on alcohol in 2007 totaled around $9 billion; states collected around $5.5 billion. Combined, these amounts are less than 10 percent of the estimated $185 billion in alcohol‐related costs to health care, criminal justice, and the workplace in lost productivity.
- Tobacco does not yield net revenue when taxed. Each year, Americans spend more than $200 billion on the social costs of smoking, but only about $25 billion is collected in taxes.
Legalization would further burden the criminal justice system
- Legalizing marijuana would increase use of the drug and, consequently, the harm it causes, thus adding to the burden on the criminal justice system. Arrests for alcohol‐related crimes, such as violations of liquor laws, public drunkenness, and driving under the influence, totaled nearly 2.7 million in 2008. Marijuana‐possession arrests under current laws in 2008 totaled around 750,000.
- Most people whose only crime is marijuana possession do not go to prison. A survey by the Bureau of Justice Statistics showed that 0.7% of all state inmates were behind bars for marijuana possession only (with many of them pleading down from more serious crimes). Other independent research has shown that the risk of arrest for each “joint,” or marijuana cigarette, smoked is about 1 arrest for every 12,000 joints.
Legalization would do little, if anything, to curb drug violence
- Marijuana accounts for only a portion of the proceeds gained by criminal organizations that profit from drug distribution, human trafficking, and other crimes, so legalizing marijuana would not deter these groups from continuing to operate.
- Under the most commonly proposed legalization regime – one that imposes high taxes on marijuana – violent drug cartels would simply undercut legal prices to keep their market share. With increased demand for marijuana resulting from legalization, these groups would likely grow stronger.
The genus Cannabis contains two species which produce useful amounts of psychoactive cannabinoids. Cannabis indica produces a higher level of Cannabidiol (abbreviated CBD) relative to THC (the primary psychoactive component in medical and recreational cannabis). Cannabis sativa, on the other hand, produces a higher level of THC relative to CBD.
Medical use of sativa is associated with a cerebral high, and many patients experience stimulating effects. For this reason, sativa is often used for daytime treatment. It may cause more of a euphoric, “high” sensation, and tends to stimulate hunger, making it potentially useful to patients with eating disorders or anorexia. Sativa also exhibits a higher tendency to induce anxiety and paranoia, so patients prone to these effects may limit treatment with pure sativa, or choose hybrid strains.
Cannabis indica is associated with sedative effects and is often preferred for night time use, including for treatment of insomnia. Indica is also associated with a more “stoned” or meditative sensation than the euphoric, stimulating effects of sativa, possibly because of a higher CBD-to-THC ratio
Many strains of cannabis are currently cultivated for medical use, including strains of both species in varying potencies, as well as hybrid strains designed to incorporate the benefits of both species. Hybrids commonly available can be heavily dominated by either Cannabis sativa or Cannabis indica, or relatively balanced, such as so-called “50/50” strains.
Cannabis strains with relatively high CBD-to-THC ratios, usually indica-dominant strains, are less likely to induce anxiety. This may be due to CBD’s receptor antagonistic effects at the cannabinoid receptor, compared to THC’s partial agonist effect. CBD is also a 5-HT1A receptor agonist, which may also contribute to an anxiolytic effect. This likely means the high concentrations of CBD found inCannabis indica mitigate the anxiogenic effect of THC significantly.
The Facts about Medical Marijuana
Medical marijuana (or medical cannabis) refers to the use of marijuana as a physician-prescribed therapy to reduce the pain or discomfort associated with some medical conditions or to lessen the side effects of some traditional medical treatments.
Medical marijuana is used for a variety of ailments and conditions, including
Easing nausea and vomiting.
Stimulating appetite in chemotherapy and/or AIDS patients.
Reducing eye pressure in glaucoma patients.
Managing chronic pain.
Treating gastrointestinal illnesses.
Recent research has also suggested that some of the compounds in marijuana may have beneficial qualities for patients suffering from a variety of other conditions, such as multiple sclerosis (MS), Alzheimer’s disease, breast cancer, brain cancer, Lou Gehrig’s Disease, insomnia, and even asthma.
Medicinal compounds in marijuana
Cannabis contains almost 500 compounds, of which about 80 are used for medicine and science. Five of these compounds are used frequently in medicine:
Tetrahydrocannabinol (THC) is the chemical in marijuana that produces its psychoactive effects. This chemical has been proven to also be a mild pain reliever and sleep inducer, as well as an antioxidant.
Cannabidiol (CBD) is one of the primary compounds extracted for medical marijuana. CBD has been provent to relieve convulsion, inflammation, anxiety, cough, congestion, and nausea, and it inhibits cancer cell growth.
Cannabinol (CBN) is thought to inhibit the spread of cancer cells.
β-caryophyllene is used to reduce inflammation.
Cannabigerol relieves intraocular pressure of the eye, so it’s used in the treatment of glaucoma.
States that have legalized medical marijuana use
Currently, medical marijuana is legal in 18 of the 50 states, plus the District of Columbia.
|District of Columbia||Oregon|
The laws regarding medical marijuana vary from state to state. For example, the amount of marijuana a person is allowed to possess ranges from one ounce to 24 ounces. The fee to obtain a medical marijuana ID card ranges from state to state as well (from $25 to $200). Most states require proof of residency for a person to qualify for a medical marijuana prescription, while other states accept registry ID cards from any state.
Several states that have legalized medical marijuana have received letters from the U.S. Attorney General’s office stating that despite state laws, the federal government still considers the growth, distribution, or possession of marijuana to be a federal crime. In some cases, the Department of Justice has raided dispensaries of state-sanctioned medical marijuana, while the IRS and other federal agencies have targeted banks and landlords who do business with them. The discrepancy between state and federal laws will probably be played out in court in the coming years.
Public opinion of medical marijuana
The outcome of future court cases could be influenced by public opinion, which is changing. Recent polls indicate that about 83% of Americans are in favor of allowing doctors to prescribe marijuana for patients suffering from serious illnesses, up from just 62% in 1997. But opposition to the drug remains strong.
One of the biggest criticisms of medical marijuana has to do with an implied perception that the drug is administered by smoking. Decades of conventional wisdom have led people to believe that “smoking pot” is taboo — not to mention that smoking, whatever the substance, has been proven to be unhealthy. However, medical marijuana is often administered to patients in alternative ways, including inhalers, pills, and even edible baked goods. These means of dispensation have proven to be healthier and sometimes more effective in relieving patients’ pain or discomfort.
Marilyn is a 68-year-old woman with breast cancer metastatic to the lungs and the thoracic and lumbar spine. She is currently undergoing chemotherapy with doxorubicin. She reports having very low energy, minimal appetite, and substantial pain in her thoracic and lumbar spine. For relief of nausea, she has taken ondansetron and prochlorperazine, with minimal success. She has been taking 1000 mg of acetaminophen every 8 hours for the pain. Sometimes at night she takes 5 mg or 10 mg of oxycodone to help provide pain relief. During a visit with her primary care physician she asks about the possibility of using marijuana to help alleviate the nausea, pain, and fatigue. She lives in a state that allows marijuana for personal medicinal use, and she says her family could grow the plants. As her physician, what advice would you offer with regard to the use of marijuana to alleviate her current symptoms? Do you believe that the overall medicinal benefits of marijuana outweigh the risks and potential harms?
There is burgeoning interest in the therapeutic potential of targeting the endocannabinoid system. Although most of the research into this system involves the use of specific cannabinoids, a small body of high-quality research shows evidence of clinically significant analgesia from smoked marijuana, primarily for neuropathic pain. There is little evidence to support the use of smoked marijuana for Marilyn’s nociceptive pain, and less still for her other symptoms.
Smoked marijuana is a nonmedical, nonspecific, and potentially hazardous method of drug delivery. The cannabis plant contains hundreds of pharmacologically active compounds, most of which have not been well characterized. Each dispensed quantity of marijuana is of uncertain provenance and of variable and uncertain potency and may contain unknown contaminants.
There are other questions to consider in Marilyn’s case. Could marijuana’s cognitive side effects, particularly its effects on memory, promote or exacerbate chemotherapy-induced cognitive dysfunction? If Marilyn’s pulmonary disease includes lymphangitic spread, could smoking cause hypoxemia? What effects will marijuana’s potential immunologic hazards (e.g., chemical constituents, pyrolized gases, viable fungal spores, or pesticide residues) have on her health during periods of immunocompromise?7 How will marijuana, alone or in combination with other medications associated with potential cognitive and psychomotor impairment, affect her ability to safely operate a motor vehicle?8 What are the possible effects of marijuana on tumor progression? The putative cannabinoid receptor GPR55 (G-protein–coupled receptor 55) is expressed in human breast cancers, with higher levels of expression correlated with more aggressive phenotypes.9 The marijuana constituent Δ9-THC has been shown in some studies to act as a GPR55 agonist, raising the possibility that it can promote cancer-cell proliferation.10
Two prescription cannabinoids are available, dronabinol (Marinol) (a synthetic Δ9-THC) and nabilone (Cesamet) (a Δ9-THC congener), which are FDA-approved for the treatment of chemotherapy-induced nausea and vomiting. These medications have shown efficacy in the management of pain and distress. In contrast to smoked marijuana, they feature oral administration, chemical purity, precise dosages, and a slower onset but sustained duration of action. They may be less likely than smoked marijuana to induce anxiety, panic, and negative mood states,11 but they have otherwise similar side-effect profiles.
Cannabinoids, however, should be used only as lower-tier therapies for chemotherapy-induced nausea and vomiting, since other medications, such as 5-hydroxytryptamine3-receptor antagonists, dexamethasone, and aprepitant, have superior efficacy and fewer side effects.12
Assure Marilyn — and follow through on the assurance — that throughout her illness she will be accompanied, cared for, and helped to live as well and as long as possible. Reassure her that meticulous attention will be paid to symptom relief. Discuss the patient-specific potential risks and benefits of smoked marijuana and of the administration of pharmaceutical cannabinoids. There is little scientific basis for recommending that she smoke marijuana for symptom control. As Bernard Lown remarked, “Caring without science is well-intentioned kindness, but not medicine.”13
1 Marijuana grows naturally. Making something that is natural illegal is unnatural.
2 Marijuana is discriminated against by legislators that are too scared of being referred to as a druggie. Legislators won’t stand up for what they believe in, only the self interest of the corporations they represent.
3 Marijuana does not cause death.
4 Marijuana’s active ingredient THC is less toxic than nicotine.
5 Marijuana is not addictive.
6 Marijuana can be used to make hemp and other products such as paper (no more tree chopping) clothing, and rope. We can also make marijuana oil which can be used as a renewable fuel.
7 Legalizing marijuana will cause a sudden drop in need for beer. Wine won’t be affected as much as beer. Beer consumption will plummet.
8 There are more people in jail for drugs then there are other criminals.
9 Marijuana is an issue of public health, not the police.
10 Billions of dollars are spent on the war on drugs each year. IT destroy families and ruins lives.
11 Marijuana being legal will cause a sudden drop in using other harder drugs such as methamphetamines, barbiturates, heroin, alcohol and cocaine.
12 Alcohol and cigarettes kill more people a year than war.
13 People still drink and smoke regardless of the warnings.
14 Teenagers and children are lied to about marijuana by uninformed uneducated parents and propaganda.
15 anti marijuana legislation and TV propaganda are funded by the lobbyists that have interest in alcohol and timber.
16 cultivating marijuana will cause a spike in economic growth for more and more plantations of marijuana.
17 the cultivation of marijuana will create jobs for low income families.
18 the price of marijuana will plummet form 100 an ounce to 5 dollars an ounce
19 The US government is losing billions in tax revenue.
20 The US has more people in prison than any other country
21 The US is a few trillion dollars in debt
22 Marijuana can help HIV victims eat and sleep.
23 Marijuana can reverse the effects of crystal meth by making the person hungry and tired.
24 Marijuana does not impair your ability to drive as much as alcohol, however operating machinery driving and using power tools isn’t a good idea while using the plant.
25 Congress was lied to by yellow journalism
26 Marijuana is legal in Amsterdam and is on the way of being legal in Canada. Both countries have far less crime than the US.
27 Marijuana can be fermented into alcohol which burns cleaner than oil.
28 Africa can be the world’s largest supplier of hemp.
29 The US can spend the tax dollars generated by marijuana to fund a universal public health care system
30 Treatment of marijuana should increase instead of sending people to jail.
31 Mandatory minimum sentences should be outlawed. MMS only hurt the innocent while protecting the self interest of corporations.
32 Marijuana grows in the privacy of peoples homes ?
33 Marijuana’s fibers are an economical god send.
34 Marijuana use is in the bible. Genesis gave mankind the power over every land, sea, and animal. Not to mention every seed bearing plant. (Marijuana is a seed bearing plant)
35 Marijuana is not a gateway drug.
36 Marijuana does not cause cancer
37 Tobacco users will still get their nicotine from cigarettes.
38 By definition, Nicotine, Aspirin, Alcohol and THC are drugs. There are more drug users then there are non drug users.
39 Marijuana and alcohol cause short term memory loss. Alcohol destroys your liver, THC doesn’t.
40 Marijuana can be used to help alleviate pain and suffering humanely.
41 People who don’t want marijuana legal have a drug of choice.
42 No one cares about other peoples problems.
43 Your teenager will try marijuana no matter what you do.
44 Your teen has a better chance of dieing from alcohol or becoming pregnant then they do messing up their lives form marijuana.
45 using marijuana does not support terrorism.
46 Jamestown, Virginia had a law enacted stating that framers shall produce marijuana and sow the seeds everywhere.
47 Jamestown, Virginia was created 20 years before the Puritans sailed to New England.
48 It is human nature to seek pleasure.
49 There are more people using marijuana than people know.
50 Marijuana is used in world religions. Jesus Christ himself used the plant.
51 Christians don’t know Jesus was a stoner.
52 It is a plant. It is no more harmful than dandelions.
53 There are anti marijuana commercials but never commercials for anti drinking nor are their commercials for anti cocaine.
54 Cigarette companies are putting more nicotine in their products since more and more people are being killed and are quitting.
55 It cost more to smoke cigarettes than it does to smoke marijuana.
56 Marijuana can cure insomnia.
57 Marijuana does not kill brain cells, it only blocks receptors.
58 Marijuana will not hurt a fetus; it is not a good idea to have a child. Get an abortion and light up a joint.
59 Marijuana does not lower your immune system.
60 Marijuana smoke isn’t as bad as Cigarette smoke. Cigarettes have more carcinogens.
61 You can not overdose on marijuana.
62 Marijuana does not make you lazy
63 It is rare to cause toxic psychosis, but this is rare and usual stops in an hour or so.
64 Marijuana has the same potency as it does in the 60’s
65 There is no supporting evidence to date that shows drug prevention is working. So far it seems to only increase curiosity.
66 Marijuana increases heart rate and blood pressure more than cigarettes do. This is true. It doesn’t harden arteries like cigarettes however.
67 Marijuana is offered to people by their friends or people they know. It is ok for these kids to say no and still be socially accepted. Most kids who try marijuana like it. Some shit their pants. Parents should talk to their kids at early stages.
68 Pot brownies accidentally convert people to pot smokers. This is true in my case. I’m fat I will never turn down a brownie. I didn’t know it had ganja in it! Oh man I was missing out.
69 Your parents tried marijuana!
70 So did your grandparents!
71 According to the NIDA, 1 in 6 10th grades use marijuana, 1 in 4 seniors of high schoolers use marijuana.
72 Marijuana smokers normally hang out with other smokers. People pay a premium and party; the owners collect the benefits and have a great time. This is normal.
73 Marijuana ranges in potency, it can be American skunker (grown in basements) or it can be white widow (the strongest known). White Widow is the rarest of weed, but if smoked, you will need a wheel chair.
74 Marijuana can grow in most climates.
75 Marijuana inspires painters to pain, writers to write, and musicians to music… or sing.
76 Marijuana is fibrous meaning that its fibers can be used to manufacture textiles.
77 There are patented machines that were designed to cultivate hemp which now remain useless since they are obsolete.
78 Marijuana will make the US less materialistic.
79 Marijuana is biodegradable.
80 Marijuana is a renewable resource that can help us prevent global warming.
81 Marijuana, if legal, will create a less of demand for harder drugs, thus eliminating cocaine.
82 With a nationwide health care plan, and marijuana being legal, GSK and other pharmaceutical monopolies will lose billions!
83 Marijuana can eliminate hostility in aggressive people. For example, if you were to give hostile criminals marijuana, they won’t be hostile.
84 Psychologists could study deeper human motives while the patient was high on marijuana. This has since been stopped since the marijuana ban.
85 The US government could have an economic overhaul if they legalized marijuana.
86 how can people criticize something they never tried?
87 Marijuana can create an agriculture spike in demand for labor, thus allowing more jobs for immigrants.
88 Indoor growth in peoples houses will stop since technically it is not worth growing indoors if it were legal.
89 The price of marijuana will drop allowing drug dealers to do something else.
90 The US state stores, where they sell alcohol can sell marijuana as well.
91 With the sudden drop in people in jail for non-violent crimes will cause states to have more revenue since they don’t have to pay to keep innocent people in jail.
92 the extra funding grated to states will allow for increase treatment for addiction to harder drugs.
93 If legalized marijuana will become the drug of choice over Cigarettes and alcohol.
94 States with the extra revenue can place more funding into schools telling people not to do drugs.
95 Job training can be provided to low income families with zero expense to the tax payers. All funded by the taxation of marijuana.
96 States can make legislation stating that cultivation of marijuana should be regulated with a license to grow. Licenses will allow people to pay taxes on the marijuana they produce.
97 Tax stamps can also produce revenue on states that are too large or to populated to regulate cultivation.
98 Marijuana is an excellent party drug. For thousands of years mankind used marijuana as an intoxicant.
99 Marijuana, despite what you heard, is a lot of fun.
100 Marijuana is the only drug that, if made stronger, still can not kill you.
101 Marijuana can create stronger family ties by relieving stress form the work environment.