Medical Marijuana
ENG 215
By

Medical Marijuana, the use of marijuana for medicinal purposes is an extremely controversial subject. There are many supporters, as well as many that are in opposition to the use of marijuana in any situation. Parties on both sides of the issue are regularly bringing forth new information to endorse their case. Marijuana, made from an Indian hemp plant that bears the name cannabis sativa, is a mixture of stems, leaves, and flowering tops. The flowering tops are smoked for the tetrahydrocannabinol, or THC, that is concentrated there. THC is the main psychoactive ingredient in marijuana. The use of marijuana as folk medicine began in Central Asia as far back as 3000 B.C. It’s use as a pleasure-inducing drug began in the 1900’s, becoming widespread in the 1960’s and 1970’s. In the 60’s and 70’s, marijuana became the second most popular drug, alcohol being the first. This trend continues today (Berger). Throughout the 1970s, public opinion about marijuana was mixed. A growing number of people were smoking marijuana to cope with medical problems that were not responsive to conventional medicine— particularly the pain and nausea associated with cancer and chemotherapy. Moderate politicians in both political parties began to argue in favor of marijuana decriminalization, which would waive serious penalties for possession of small amounts of marijuana for personal use. By the late 1970s, the American Medical Association, the American Bar Association, and the National Council of Churches all endorsed decriminalization, and eleven states had passed statutes that decriminalized marijuana use. But during the 1980 presidential campaign, Ronald Reagan took a hard line against marijuana, arguing that it was “probably the most dangerous drug in America today.” According to journalist Eric Schlosser, the national War on Drugs, which began in 1982 under the Reagan administration, began as a war on marijuana: “Reagan’s first drug czar, Carlton Turner, blamed marijuana for young people’s involvement in ‘anti-big business, anti-authority demonstrations.’ Turner also thought that smoking pot could transform young men into homosexuals.” (Moltsky) In 1972, the US Congress placed marijuana in Schedule I of the Controlled Substances Act because they considered it to have "no accepted medical use." Since then, 16 of 50 US states and DC have legalized the medical use of marijuana. Many current supporters of marijuana’s Schedule I status grant that the twentieth century’s anti-marijuana campaigns too often resorted to misinformation and bigotry, which ultimately proved to be counterproductive. Yet they also cite a growing body of scientific evidence that documents the health risks associated with marijuana use—risks which they believe warrant the continued criminalization of the drug. According to the National Institute on Drug Abuse (NIDA), acute marijuana intoxication induces euphoria accompanied by confusion, distorted perception, and coordination problems; high doses can cause delusions and paranoia. Short-term health effects of the drug include memory loss, anxiety, an increased heart rate, and decreased cognitive skills; long-term consequences for chronic smokers include a weakened immune system and an increased risk of cancer, respiratory diseases, and heart problems. In addition, marijuana opponents argue that many users become psychologically dependent on the “high” the drug creates. Such dependence can result in stunted emotional and social maturity as these users lose interest in school, work, and social activities. Marijuana is also viewed by some analysts as a “gateway” drug that can lead to the abuse of other dangerous and illegal substances, including cocaine and heroin. According to Joseph Califano, chair of the National Center of Addiction and Substance Abuse, “Twelve-to-seventeen-year-olds who smoke marijuana are eighty-five times more likely to use cocaine than those who do not. Among teens who report no other problem behaviors, those who used cigarettes, alcohol, and marijuana at least once in the past month are almost seventeen times likelier to use . . . cocaine, heroin, or LSD.” Califano notes that while most youths who smoke marijuana may not move on to harder drugs, the fact that a certain percentage of smokers will try heroin or cocaine suggests that the best strategy in preventing drug abuse is to maintain strong social sanctions against marijuana. (Moltsky)
Marijuana as a "Gateway" Drug
Patterns in progression of drug use from adolescence to adulthood are strikingly regular. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana usually before they are of legal age. In the sense that marijuana use typically precedes rather than follows initiation of other illicit drug use, it is indeed a "gateway" drug. But because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, "gateway" to illicit drug use. There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs. An important caution is that data on drug use progression cannot be assumed to apply to the use of drugs for medical purposes. It does not follow from those data that if marijuana were available by prescription for medical use, the pattern of drug use would remain the same as seen in illicit use. Finally, there is a broad social concern that sanctioning the medical use of marijuana might increase its use among the general population. At this point there are no convincing data to support this concern. The existing data is consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential. Present data on drug use progression, neither support nor refute the suggestion that medical availability would increase drug abuse. However, this question is beyond the issues normally considered for medical uses of drugs and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids.

Joycelyn Elders, MD, former US Surgeon General, wrote the following in a Mar. 26, 2004 article titled "Myths About Medical Marijuana," published in the Providence Journal:
"The evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS -- or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day." Mar. 26, 2004 - Joycelyn Elders, MD

John Mendelson, an internist and pharmacologist at the University of California, San
Francisco (UCSF) Pain Management Center, surveyed 100 members of the SFCCC who were using marijuana at least weekly. Most of the respondents were unemployed men in their forties. Subjects were paid $50 to participate in the survey; this might have encouraged a greater representation of unemployed subjects. All subjects were tested for drug use. About half tested positive for marijuana only; the other half tested positive for drugs in addition to marijuana (23% for cocaine and 13% for amphetamines). The predominant disorder was AIDS, followed by roughly equal numbers of members who reported chronic pain, mood disorders, and musculoskeletal disorders.
Among the 42 people who spoke at the public workshops or wrote to the study team, only six identified themselves as members of marijuana buyers' clubs. Nonetheless, they presented a similar profile: HIV/AIDS was the predominant disorder, followed by chronic pain. All HIV/AIDS patients reported that marijuana relieved nausea and vomiting and improved their appetite. About half the patients who reported using marijuana for chronic pain also reported that it reduced nausea and vomiting. Note that the medical conditions referred to are only those reported to the study team or to interviewers; they cannot be assumed to represent complete or accurate diagnoses.
Michael Rowbotham, a neurologist at the UCSF Pain Management Center, noted that many pain patients referred to that center arrive with incorrect diagnoses or with pain of unknown origin. At that center the patients who report medical benefit from marijuana say that it does not reduce their pain but enables them to cope with it.
Most, not all, people who use marijuana to relieve medical conditions have previously used it recreationally. An estimated 95% of the LACRC members had used marijuana before joining the club. It is important to emphasize the absence of comprehensive information on marijuana use before its use for medical conditions.
Frequency of prior use almost certainly depends on many factors, including membership in a buyers' club, membership in a population sector that uses marijuana more often than others (for example, men 20—30 years old), and the medical condition being treated with marijuana (for example, there are probably relatively fewer recreational marijuana users among cancer patients than among AIDS patients). Patients who reported their experience with marijuana at the public workshops said that marijuana provided them with great relief from symptoms associated with disparate diseases and ailments, including AIDS wasting, spasticity from multiple sclerosis, depression, chronic pain, and nausea associated with chemotherapy. Marijuana plants have been used since antiquity for both herbal medication and intoxication. The current debate over the medical use of marijuana is essentially a debate over the value of its medicinal properties relative to the risk posed by its use.
Marijuana's use as an herbal remedy before the 20th century is well documented. However, modern medicine adheres to different standards from those used in the past. The question is not whether marijuana can be used as an herbal remedy but rather how well this remedy meets today's standards of efficacy and safety.
We understand much more than previous generation about medical risks. Our society generally expects its licensed medications to be safe, reliable, and of proven efficacy; contaminants and inconsistent ingredients in our health treatments are not tolerated. That refers not only to prescription and over-the-counter drugs but also to vitamin supplements and herbal remedies purchased at the grocery store. For example, the essential amino acid ltryptophan was widely sold in health food stores as a natural remedy for insomnia until early 1990 when it became linked to an epidemic of a new and potentially fatal illness (eosinophilia-myalgia syndrome). When it was removed from the market shortly thereafter, there was little protest, despite the fact that it was safe for the vast majority of the population. The 1,536 cases and 27 deaths were later traced to contaminants in a batch produced by a single Japanese manufacturer. Although few herbal medicines meet today's standards, they have provided the foundation for modern Western pharmaceuticals. (enotes) Most current prescriptions have their roots either directly or indirectly in plant remedies.
At the same time, most current prescriptions are synthetic compounds that are only distantly related to the natural compounds that led to their development. Digitalis was discovered in foxglove, morphine in poppies, and taxol in the yew tree. Even aspirin (acetylsalicylic acid) has its counterpart in herbal medicine: for many generations, American Indians relieved headaches by chewing the bark of the willow tree, which is rich in a related form of salicylic acid. Although plants continue to be valuable resources for medical advances, drug development is likely to be less and less reliant on plants and more reliant on the tools of modern science.
In 1997, 46 percent of Americans sought nontraditional medicines and spent over 27 billion unreimbursed dollars; the total number of visits to alternative medicine practitioners appears to have exceeded the number of visits to primary care physicians. Recent interest in the medical use of marijuana coincides with this trend toward self-help and a search for "natural" therapies. Indeed, several people who spoke at the IOM public hearings in support of the medical use of marijuana said that they generally preferred herbal medicines to standard
Pharmaceuticals. However, few alternative therapies have been carefully and systematically tested for safety and efficacy, as is required for medications approved by the FDA (Food and Drug Administration).

Reference: Marijuana and Medicine Assessing the Science Base
Janet E. Joy, Stanley J. Watson, Jr., andJohn A. Benson, Jr., Editors
Division of Neuroscience and Behavioral Health

Division of Neuroscience and Behavioral Health
INSTITUTE OF MEDICINE (Institute Of Medicine)

N.Y Times Article Aug 31 1999 By Irvin Molotsky- (Molotsky)

http://www.enotes.com/marijuana-article-(enotes)
Bibliography Works Cited Berger, Philip A. "Marijuana." Microsoft Encarta 98-(Berger)