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Vol. 5, Number 7 July 1, 2013 cheryl riley, editor & writer Dr. David Bearman, Gradi Jordan, Ed Glick, Paul Armentano, Sunil K Aggarwal, Amanda Reiman, Jim Greig, Joan Bello, Arthur Livermore |
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How Safe is Medicinal Cannabis? - David Bearman, M.D. With cannabis poised to be legal for medicinal use in a twentieth state, it is timely to review the safety and side effect profile of cannabis. Side Effects vs. Therapeutic Effects (Safety) When considering the clinical use of a therapeutic agent, physicians approach the decision to use any medication by comparing the therapeutic effects to the side effects. In considering recommending cannabis for therapeutic use, a physician applies the same factors as one would consider when giving patients any medical advice and/or writing any prescription. One must weigh the side effects vs. therapeutic effects, listen to the patient’s previous experience with medication for their condition, and factor in other medical conditions the patient has. We balance the agent’s side effects against its therapeutic effects. Safety Cannabis has a tremendous advantage over prescription drug options because it has a much safer side effect profile. It is a well known fact that no one, man, woman or child, has ever died from an overdose of marijuana. The scientific literature documents, that the safety and side effect profile of cannabis is amazing. That is why the DEA, in the person of Chief Administrative Law Judge Francis Young, found after a two-year rescheduling hearing in 1988, that cannabis is “one of the safest therapeutic agents known to man.” “In strict medical terms, marijuana is far safer than many foods we commonly consume. For example, eating ten raw potatoes can result in a toxic response. By comparison, it is physically impossible to eat enough marijuana to induce death. [...] Marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care.” 1 Chief DEA Administrative Law Judge Francis L. Young in September 1988, after reviewing all the evidence on rescheduling cannabis from Schedule I to Schedule II In their federally funded seminal 1999 report the Institute of Medicine concluded that while “marijuana is not a completely benign substance,” that “except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications.” 2 These side effects include the occasional dysphoria and the even rarer panic attacks. This is most likely to occur in novice users or with a high dose of THC and low dose of CBD. NOTE: As it turns out, according to a NIDA funded study done by Dr. Donald Tashkin of UCLA, the harms associated with smoking are cough, increased sputum production and bronchial irritation. He found that cannabis smokers have a lower chance of getting lung cancer than non-smokers. This is likely due to cannabis’ well-documented anti-proliferative (e.g., anti-cancer) effect. The safety of cannabis and cannabinoids is also borne out by the FDA approved warning for delta 9 THC (trade name Marinol, generic name dronabinol). Delta 9 THC is the principle euphorogen in cannabis. The FDA warning found on the package insert and in the Physicians Desk Reference (PDR), “Warning do not drive, operate heavy equipment or engage in dangerous activities UNTIL (caps mine) you determine if Marinol interferes with these activities” allows people to drive, operate heavy equipment, and engage in dangerous activity, so long as the medication (delta 9-THC) does not interfere with the performance of these activities. Just as significant the FDA approved a phase III clinical study for Sativex (tincture of cannabis). This means the FDA found tincture of cannabis safe for testing in humans. That study, done in upstate New York, demonstrated the value of tincture of cannabis in treating intractable pain. It should be no surprise that this tincture of cannabis pharmaceutical has been approved by twenty governments in the world including Canada, UK, NZ, Spain, Austria, Czech Republic, Germany, Sweden and Denmark. Sativex, tincture of cannabis, is for sale in those countries as a prescription medication. “Unlike many of the drugs we prescribe every day, marijuana has never been proven to cause a fatal overdose.” – Joycelyn Elders, M.D. (former Surgeon General of the United States Public Health Service) 3 Some worry about euphoria. While some patients do get euphoria, few get dysphoria. High CBD strains damp down the euphoria one can get from THC. As Dr. Donald Abrams, an oncologist at UCSF School of Medicine, has written and said, “In my patient population, a little euphoria isn’t a bad thing.” (1) Young 1988, op cit. (2) Joy 1999, op cit. “Executive Summary” IOM Report (3) Elders, Joycelyn, MD. “Myths About Medical Marijuana.” The Providence Journal. Providence, RI: 26 March 2004. Study: Marijuana Smoking Not Associated With Airway Cancers, COPD, Emphysema, Or Other Tobacco-Related Pulmonary Complications - Paul Armentano Pulmonary complications associated with the regular smoking of cannabis are “relatively small” and far lower than those associated with tobacco smoking, according to a recent review published in the June edition of the scientific journal Annals of the American Thoracic Society. The paper – authored by Donald P. Tashkin, MD, emeritus professor of medicine and medical director of the Pulmonary Function Laboratory at the David Geffen School of Medicine at University of California, Los Angeles – is “the most comprehensive and authoritative review of the subject ever published,” according to an accompanying commentary. Donald Tashkin conducted US-government sponsored studies of marijuana and lung function for over 30 years. His review finds that although smoking cannabis may be associated with symptoms of chronic bronchitis, studies do not substantiate claims that it is positively associated with the development of lung cancer, chronic obstructive pulmonary disease (COPD), emphysema, or bullous lung disease. “[H]abitual use of marijuana alone does not appear to lead to significant abnormalities in lung function,” Tashkin writes. “[F]indings from a limited number of well-designed epidemiological studies do not suggest an increased risk of either lung or upper airway cancer from light or moderate use. … Overall, the risks of pulmonary complications of regular use of marijuana appear to be relatively small and far lower than those of tobacco smoking.” Writing in an accompanying commentary, McGill University’s Dr. Mark Ware concludes: “Cannabis smoking is not equivalent to tobacco smoking in terms of respiratory risk. … [C]annabis smoking does not seem to increase risk of chronic obstructive pulmonary disease (COPD) or airway cancers. In fact, there is even a suggestion that at low doses cannabis may be protective for both conditions. … This conclusion will affect the way health professionals interact with patients, parents with teenagers, and policy makers with their constituents. … Efforts to develop cleaner cannabinoid delivery systems can and should continue, but at least for now, [those] who smoke small amounts of cannabis for medical or recreational purposes can breathe a little bit easier.” Full text of the study, “Effects of marijuana smoking on the lung,” appears in Annals of the American Thoracic Society.
Alabama: Considering a medical marijuana law.
Arkansas: Considering a medical marijuana law. Florida: Medical marijuana petition drive underway. Idaho: Considering a medical marijuana law.
Illinois: Considering a medical marijuana law.
Indiana: Considering a medical marijuana law. Iowa: Considering a medical marijuana law.
Kansas: Medical marijuana petition drive underway.
Maryland: Considering a medical marijuana law.
Minnesota: Considering a medical marijuana law.
Missouri: Considering a medical marijuana law.
New Hampshire: Passed a medical marijuana law.
New York: Considering a medical marijuana law.
North Carolina: Considering a medical marijuana law.
Ohio: Considering a medical marijuana law.
Pennsylvania: Considering a medical marijuana law.
South Carolina: Considering a medical marijuana law. South Dakota: Medical marijuana petition drive underway. Tennessee: Considering a medical marijuana law. Texas: Considering a medical marijuana law.
Wisconsin: Considering a medical marijuana law.
Featured Recipe - Patty Pot Peanut Butter Canny Cookies: A Delightful Snack from the Canny Bus Trip Kit by Jay R. Cavanaugh, PhD All right. No excuses now. Here’s a recipe that’s so easy, so cheap, and so potent that you have to try it. Nancy Wife and I love peanut butter cookies. For us, the chewier and more peanut buttery the cookie, the better they are. This recipe is simple but there are some tricks. Trick One: Make your cannabutter with unsalted (sweet) butter. Remember, low and slow for that emerald green butter. Check out “Better Bud Butter” for cannabutter preparation tips. Our cannabutter is derived from California Orange from the Western Sierra slopes. Obviously, our butter mentor was named Patty. Either that or we just love alliteration. Trick Two: Cannabutter does not bake the same way as dairy butter. The melting point and other physical characteristics are different. You can use all cannabutter or use a 75/25 mix of cannabutter and sweet dairy butter. If you dilute the cannabutter you obviously will have less potent cookies. Instead of diluting try adding a bit of Crisco and/or extra peanut butter. Trick Three: Depending on just how your cannabutter was made, the cookies will cook differently. Remember to check your cookies every couple of minutes after the initial nine minutes. Canny cookies generally cook in about 2/3 thirds of the time as normal. Baking temperatures should be lower. Ingredients: Method: Preheat your oven to 300 degrees and grease up or butter a nonstick cookie sheet (I like the PAM no stick spray of canola oil) In a large bowl beat the butter until soft (or use a double boiler). Add both sugars and mix until smooth. Mix in the egg and vanilla extract. We use a bowl and large rubber spatula for this. Avoid electric mixers as you may end up with paste instead of cookie dough (Nancy Wife is expert with mixers and can get away with it). A range of flour is given as sometimes you just have to eyeball the amount and use just enough flour to keep the dough from being runny. Sift together all of the dry ingredients and then mix into the butter/egg mixture. Add peanut butter to taste. We use about 20 ounces. Important Tip: Refrigerate the dough for at least three hours. Roll the dough into rounded teaspoon sized balls and arrange on the cookie sheet. Press down on each ball with a fork making a crisscross pattern. Bake for 9-12 minutes until light brown. The American Peanut Butter Cookie Association (APBCA) informs me that cookies without the traditional crisscross do not count. Optional: Add some chocolate bits to the dough when ready or place on the tops of the cookie. Warning! Depending upon the potency of your cannabutter, these little cookies can be very strong. Do not eat them like you would a bag of Chip Ahoys. One is great. Two is wonderful. Any consumption over two is strictly recreational not medical. Remember cannabis medicine is only illegal for those who enjoy it. Recommended beverage: Got milk?
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April 26-28, 2012 Tucson, AZ USA
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