To: Rep. Briscoe, J.,
Subject: Fwd: Marijuana
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Lamond M. Langston 973 N. 2050 E. St. George, Ut 84770 435-673-1760 E-mail above.
As a health care professional (Registered Pharmacist) and a county legislative chair, I am very disappoint that our state representatives have given any credence to using marijuana for any purposes. It is highly addictive. It cause many dangerous side effects. (Which will be shortly enumerated.) It is illegal in our country. And we have a stoned federal bureaucracy from former President Obama on down. (In Obama's book he talks about using cocaine.) Which is the only reason the federal agencies have not thwarted other states from this illegal act.
Two of the main 'purported' reasons for the passing the use of marijuana in Utah is: 1. It is safe for medical use. (It isn't) 2. It is demonstrated to show effectiveness for certain diseases. (These are only testimonials, not science) The effectiveness is still not clear and although it may work in some individuals, the analogy I use- You do not blow up a dam that supports millions of people to given a few hundred people water down stream.
The actual reason why this is being pushed so heavily is because of the abusers and sells of this dangerous drug are hoping to eventually legalize it for money and self destructive, (for a high), use. (Any self destruction destroys the society that allows it.)
Here are some current scientific date of the use of marijuana in answer to Questions 1 and 2.
Medical Marijuana: The State of the Science- From “Medscape” a professional Medical Web site.
Safety issues associated with the habitual use of smoked cannabis are discouraging. For many years, the myth of smoked cannabis being "healthier" or "no worse" than smoked tobacco was perpetuated by pro-marijuana groups. Nevertheless, clinical research has provided some answers about the comparative safety of marijuana and tobacco smoking, although certain factors may complicate their direct comparison.
Henry and colleagues noted in 2003 that both smoked cannabis and tobacco contain approximately 4000 chemicals and that these chemicals are essentially identical in both plants. However, given the ever-changing potency of cannabis and the fact that very few people smoke as much cannabis as tobacco, this direct comparison is difficult to make. Furthermore, the authors note that a high percentage of cannabis smokers are also tobacco smokers, thereby further confounding their relative safety risks.
In a recent systematic review by the American Academy of Neurology examining the cardiopulmonary impact of heavy marijuana smoking, the authors concluded that "smoking and possibly even use of vaporized preparations expose users to carbon monoxide and other respiratory toxins." Although the authors of another recent review stated that the relationship between the long-term smoking of marijuana and lung cancer is unclear, they also concluded that marijuana smoking is associated with the inflammation of large airways, increased airway resistance, and lung hyperinflation, all of which are consistent with the development of chronic bronchitis.
In a recent review of the cardiovascular, cerebrovascular, and peripheral vascular effects of smoked marijuana, Thomas and colleagues identified an association between marijuana inhalation and higher rates of acute myocardial infarction and increased cardiovascular mortality. In addition, they described published case reports that identify a safety signal between cannabis use and stroke. Of considerable concern are data indicating diminution of the volumes of the hippocampus, amygdala, and cerebellum in adult and adolescent heavy users compared with healthy controls.[27-29]
Although cannabis is not necessarily hepatotoxic, a study of 272 patients with chronic hepatitis C virus infection determined that daily marijuana smoking was a risk factor for progression of liver fibrosis. A relatively new diagnosis associated with heavy marijuana use is cannabinoid hyperemesis syndrome, which is characterized by cyclic nausea and vomiting and compulsive bathing; it is thought to be due to the rising levels of THC in marijuana. Conjunctivitis is the most common ocular adverse event associated marijuana use and may be related to an allergic response to Cannabis sativa pollen.
Several problems are associated with marijuana use during pregnancy, because prenatal exposure influences brain development and can result in permanent cognitive impairment. Cognitive deficits resulting from prenatal exposure include inattention; impulsivity; and impairment in learning, memory, and certain aspects of executive functioning. In addition, prenatal exposure to cannabis has been associated with reduction of fetal growth.
(As a health care professional I can also tell you that the oil containing cannabis will cause similar effects as smoking it. Ask Evan Vickers.)
The stratospheric rise of medical marijuana as a possible recognized treatment for epilepsy, now underway, is an example of what can be achieved through the sharing of personal stories on the Internet and social media, according to a leading expert in the field.
Daniel Friedman, MD, New York University (NYU) Langone School of Medicine, is a coauthor a review article, "Cannabinoids in the Treatment of Epilepsy," published in the September 10 issue of The New England Journal of Medicine.
"It is a very interesting mix of science, politics, and social phenomena which has moved medical marijuana to the forefront of treatment for severe drug-resistant epilepsy," he commented to Medscape Medical News. "Two years ago the epilepsy community wasn't really seriously considering this as an option. But it has now really taken off."
Dr Friedman noted that the idea that marijuana may be useful for epilepsy has been around for centuries. "It was used medicinally in ancient China and by Victorian neurologists for seizures, but it has never been properly scientifically studied. That is now happening.
"This has come about because individuals have shared anecdotal experiences about its effectiveness in children with severe intractable epilepsy on the Internet and these have spread across the globe," he added. "Once it became 'out there,' families have been clamoring for access to the product and we have had to pay attention. That is why medical marijuana is being legalized and studies are finally being done."
But in the review, Dr Friedman and his coauthor, Orrin Devinsky, MD, also from NYU Langone School of Medicine, caution that it is of the utmost importance that the double-blind, randomized studies now underway are completed.
"The use of medical cannabis for the treatment of epilepsy could go the way of vitamin and nutritional supplements, for which the science never caught up to the hype and was drowned out by unverified claims, sensational testimonials, and clever marketing," they write.
Two cannabinoid pharmaceutical products are under study in randomized trials. These are Epidiolex (GW Pharma), a purified cannabis extract containing 99% cannabidiol (the constituent believed to have the antiseizure effect) and less than 0.10% tetrahydrocannabinol (the psychoactive component) and a synthetic cannabinoid from Insys Pharmaceuticals.
Dr Friedman and Dr Devinsky are both involved in a double-blind, phase 2/3 trial of Epidiolex in children with Dravet syndrome — a treatment-resistant form of childhood epilepsy — from which initial results are expected within the next year.
"It's very much 'watch this space' at the moment," Dr Friedman commented to Medscape Medical News. "There is emerging evidence on efficacy. The preclinical evidence is reasonably strong for cannabidiol, similar to that for a new pharmaceutical for epilepsy. The clinical data are still early. So far the studies have been small and methodologically flawed, but results are encouraging."
The most recent study — presented at this year's American Academy of Neurology meeting — suggested that 40% of patients with severe epilepsy refractory to therapy had a 50% reduction in seizures with Epidiolex. "But this was an open study, so not as scientifically rigorous as we would like," Dr Friedman cautioned.
He highlighted the additional difficulties in making randomized trials happen with cannabinoid products.
"There are regulatory issues because these are all schedule I compounds they have many restrictions, so clinical trials have too many additional layers of regulatory bureaucracy," he said. "Then there is the issue of public perception: there is a disconnect between what we know about efficacy from scientific literature and what the public perceive the evidence to be. Many states have legalized medical marijuana for several conditions, including epilepsy, so there is the perception that it has been proven to work, but this is not the case. I worry about the high expectations — this could confound clinical trial results by leading to a very high placebo response."
Dr Friedman said he doesn't disagree with the legalization per se. "Families with children with severe drug-resistant epilepsy are looking for options and I don't oppose them trying medical marijuana under the care of a physician, but they need counseling that there is not a good level of scientific evidence yet."
Variability in Regulation
He also pointed out a problem with the variability in the regulation of cannabinoid products available. "In some states there is a high degree of regulation with external testing of products to verify the cannabidiol/THC content. But in other states, it is left to the individual dispensaries to stipulate the content and there is no external validation, so you can't be sure what you're getting," he said. "It's a bit like health supplements — a product may say it contains 1000 units of vitamin C but when tested it often has nowhere near this amount in it."
Dr Friedman noted that other products derived from hemp are legally available on the Internet and are touted as having a high cannabinoid content, "but a recent FDA [Food and Drug Administration] analysis of some of these products found big discrepancies in this and some contained no cannabinoids at all."
He said his advice to patients has evolved, and he now recommends that if they haven't exhausted proven effective therapies, they pursue agents that are known to work and have a well-understood benefit/risk profile. "But for patients who have exhausted such therapeutic options and can access cannabinoids, I would advise them to have a discussion with their physician about whether such an approach would be appropriate for them."
He noted that most patients can now access some form of cannabinoid product, with medical marijuana now available in 23 US states and patients everywhere able to access hemp products via the Internet.
In their review, however, Dr Friedman and Dr Devinsky conclude, "Only double-blind, placebo-controlled, randomized clinical trials in which consistent preparations of one or more cannabinoids are used can provide reliable information on safety and efficacy.
"If randomized clinical trials show that specific cannabinoids are unsafe or ineffective, those preparations should not be available," they add. "If studies show that specific cannabinoids are safe and effective, those preparations should be approved and made readily available."
Dr Friedman has received fees for serving on an advisory board for Marinus Pharmaceuticals and consulting fees from Eisai, Marinus Pharmaceuticals, SK Biopharmaceuticals, Upsher-Smith Laboratories, and Pfizer, all of which were paid to the Epilepsy Study Consortium.