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AAP reports study whether marijuana has useful purpose

Reports from the Academy oppose the legalization of marijuana while supporting investigation into the potential for its use in medicine.

Greg McConnell Correspondent

AAP News Vol. 24 No. 6 June 2004, p. 296 © 2004 American Academy of Pediatrics

The 1960s ignited a debate in the United States that remains heated to this day: What should be the legal status of marijuana?

Some say to keep prohibition, while others want to legalize it for adults; and yet a third group favors decriminalization, which would keep marijuana illegal, but reduce the penalties and lower the priority of enforcing the laws.

Complicating matters is the issue of medical marijuana. While no doctor wants to deprive an ill patient of a beneficial drug, many are not convinced that marijuana should have a place in medicine. However, proponents of medical marijuana say that the Chinese have used it to treat pain for 5,000 years and claim that cannabinoids (marijuana compounds) are safer than narcotics or amphetamines.

The Academy has weighed in on the subject with a new policy statement ( Pediatrics. 2004;113:1825-1826)and technical report ( Pediatrics. 2004;113:e632-e638), both titled Legalization of Marijuana: Potential Impact on Youth. The policy concludes that: 1) The Academy opposes the legalization of marijuana and 2) the Academy supports rigorous scientific research regarding the use of cannabinoids for the relief of symptoms not ameliorated by existing legal drug formulations.

Youthful experimentation

Marijuana abuse negatively affects short-term memory, concentration, motivation, coordination and judgment, which can impair a person’s ability to learn, make sound decisions or drive safely.

The technical report focuses on how changing the legal status of marijuana could increase its availability and decrease the perceived health risk, resulting in more adolescents using it recreationally. "If we provide some legalization for marijuana in any way, the potential is that we will increase the availability to teenagers," said W. Samuel Yancy, M.D., FAAP, co-author of the policy statement and past member of the AAP Committee on Adolescence, who also noted that alcohol and tobacco are the most frequently abused drugs by adolescents, despite the fact that they are legal for adults only.

Nevertheless, some states and countries have moved to decriminalize marijuana.

"As important as this topic is, it’s amazing how little research has actually been done on the potential impact (of marijuana decriminalization), and the studies that have been done are somewhat conflicting," said Alain Joffe, M.D., M.P.H., FAAP, member of the AAP Committee on Substance Abuse and co-author of the technical report and policy statement.

According to the report, the Dutch virtually ceased prosecuting marijuana-related offenses from 1984–’96, and use among Dutch youth increased steadily. In contrast, from 1984-’92, marijuana use among youth in the United States and several European countries that were enforcing marijuana laws decreased or remained the same. However, from 1992–’96, marijuana use among Dutch, Norwegian and U.S. youths climbed.

The report also cites data that show marijuana use among U.S. 12th-graders peaked in 1978 and again in 1997, the same years the perceived health risk was at its lowest in this country.

Marijuana is everywhere now and kids, as part of their risk-taking behavior, will try it if it’s available and if they think they won’t get caught, according to Peter D. Rogers, M.D., M.P.H., FAAP, a former member of the AAP Committee on Substance Abuse, who is board-certified in addiction medicine.

"Some kids will try it once or twice and then not go back to it again," said Dr. Rogers. "Other kids smoke it once or twice and they fall in love with it; and you never know if you’re going to be that kid who’s going to fall in love with it or not."

Dr. Rogers adds that kids who are in emotional pain often turn to marijuana for an emotional anesthetic. "For example, if you’re watching Dad beat up Mom a couple times a week, you’re not going to talk to your friends about that, and that’s a very painful thing to live through. You realize if you smoke marijuana, you don’t think about it. It doesn’t bother you so much."

Bad medicine?

The U.S. Drug Enforcement Agency lists marijuana (a.k.a. cannabis) as a Schedule I drug, which means the federal government says marijuana meets the following three criteria: 1) The drug or other substance has a high potential for abuse. 2) The drug or other substance has no currently accepted medical use for treatment in the United States. 3) There is a lack of accepted safety for use of the drug or other substance under medical supervision.

But Claudia J. Jensen, M.D., of Ventura, Calif., recently testified before Congress that marijuana has multiple medicinal uses and patients should be able to use it under the supervision of a knowledgeable physician.

"Cannabis does not damage; it doesn’t cause liver or kidney failure, there’s no known lethal dose and the side effect of it is euphoria.

"Yes, (people) can get bronchitis and increased risk of pneumonia, but depending on how they use (cannabis) determines whether or not they’re at risk for those problems," Dr. Jensen said.

California’s 1996 Compassionate Use Act enacted in 1996 allows Dr. Jensen to recommend marijuana to her patients. She has dozens of patients with attention-deficit/hyperactivity disorder (ADHD), including three adolescents, for whom she recommends marijuana. All of her patients, save two adults, already were using marijuana before they ever consulted her.

When Dr. Jensen recommends marijuana for a patient, she advises them to take it orally because it has a longer half-life and no particulate matter gets lodged in the lungs. For her to renew a patient’s "prescription," she requires proof that they are living a productive life (pay stubs, employer evaluations, report cards, etc.).

Dr. Rogers disagrees with that practice. "I’ve worked with close to 3,000 substance abusing teenagers since 1985, and the kids who are most prone to abusing marijuana are untreated ADHD kids ... They self medicate with marijuana and when they do that, they are not giving themselves a fair chance at life. ... Marijuana just takes away their enthusiasm. It takes away their intellectual energy. It takes away their motivation. It takes away their memory, and those kids uniformly go down the drain."

The future

While doctors may disagree about medical marijuana’s proper place, most seem to agree that more research is needed.

Dr. Jensen is looking forward to the results of studies being performed by the University of California’s Center for Medicinal Cannabis Research. "Previous to this, you could not get an investigational drug permit from the (Drug Enforcement Agency) unless your study was designed to prove that marijuana was bad."

Dr. Yancy acknowledges that some data suggest there might be benefits from medical marijuana, though he says further research is needed to define what they are and the route of administration used.

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CBS5.com Staff

06-01-2004

At least three medical marijuana clubs in Oakland faced closure Tuesday.

The city denied permits to three clubs, including the 420 Cafe in Oakland. The order to close was to take effect Tuesday, but the owner of the 420 says he plans to ignore it.

"We're defying it," said Ken Estes. "I want them to arrest me if that's what they think the proper thing to do is to arrest me for this. I'll be arrested."

The Oakland City Council passed an ordinance in February limiting the city to four medical marijuana clubs. Seven applied for permits, and the city denied three. But an estimated 14 cannabis clubs operate in Oakland. The city said it would send warnings, issue citations, and then board up the clubs if they don't close voluntarily.

I have a copy so let me know.

We need your help to convince members of Congress to end federal attacks on medical marijuana patients. ASA is joining with a coalition of drug reform organizations to call for a National Day of Action this Friday, June 4. Join hundreds of other activists around the country and help pass out literature in front of unsupportive US representatives district office, urging them to change their votes. If you cannot be on the streets, call your Congressperson at 1-800-839-5276 on Friday and educate them about the need for federal raids on patients to end.

Last year on June 4, medical marijuana activist Ed Rosenthal was sentenced in federal court for marijuana cultivation charges that could have earned him 20 years in prison. Rosenthal had been convicted despite the fact that he had complied with state law and, in fact, had been working directly with the City of Oakland. After the jury who had convicted him learned of the facts that had been withheld from the trial, they stood with Ed Rosenthal and his family and asked for a new trial. On June 4, the federal judge surprised everyone by sentencing him to just one day of time served, calling on Congress to resolve the conflict over medical marijuana.

One year later, the federal government is still wasting taxpayer money on raiding, arresting, and prosecuting medical marijuana patients and their caregivers.

This needs to stop, and there's a winnable way to do it this summer. Last year, a medical marijuana amendment to the Commerce-Justice-State Appropriations bill, sponsored by Rep. Maurice Hinchey (D-NY), received 152 votes on the floor of the U.S. House of Representatives. The Hinchey Amendment would bar the Justice Department -- including the Drug Enforcement Administration -- from spending any money to interfere with state medical marijuana laws. This would effectively end the federal government’s attacks on medical marijuana patients and providers.

This year, on the anniversary of Ed’s sentencing and continued agitating, ASA is joining a National Day of Action, with the purpose of educating targeted members of Congress about the Hinchey amendment. We only need 66 more votes to pass the amendment, and we need your help to get them.

On June 4, hundreds of volunteers from around the country will converge on their U.S. representatives’ district offices to hand out literature urging members of Congress to support ending federal attacks on sick and dying patients in medical marijuana states. Please help us convince Congress to protect patients from arrest and prison by taking part in this grassroots lobbying campaign. To see how your member of Congress voted, visit Where Does Your U.S. Representative Stand? If they voted No on the Hinchey Amendment last year, please join in on flyering outside their closest district office on June 4.

If you don't know who your representative is, enter your zipcode at: http://www.house.gov

Then contact Aaron at 202-462-5747 to find out what time activists will be converging at your local district office.

Thank you in advance for taking action in support of medical marijuana patients and providers and please forward this email to your friends and family who believe in protecting the sick and dying.

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American Academy of Pediatrics

http://aapnews.aappublications.org/cgi/content/full/24/6/296