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Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010

This study has found a link between medical marihuana laws and lower morality rates from opioid overdose. (JAMA Intern Med. Published online August 25, 2014. doi:10.1001/jamainternmed. 2014.4005).

According to one of the authors, Marcus A. Bachhuber, MD:

“We controlled for time-invariant differences between states using fixed effects, as well as some other time-varying policies and the unemployment rate. In our regression models, we found the average overdose death rate in states after adopting medical cannabis laws relative to years prior to adoption, and trends in states with no cannabis law during the same period. To summarize, the raw number of deaths is higher (on average) for medical marijuana states, but after implementation of the medical marijuana law, rates were about 25% lower than would be expected (based on prior years’ trends and trends in non-law states).”

According the the accompanying commentary:

“The striking implication is that medical marijuana laws, when implemented, may represent a promising approach for stemming runaway rates of nonintentional opioid analgesic–related deaths. If true, this finding upsets the applecart of conventional wisdom regarding the public health implications of marijuana legalization and medicinal usefulness.”

 

Route of administration of Cannabinoids: Prohibitionist argues “Smoked pot not medicine”

The inhumane federal policy of blindly restricting cannabis research and prohibiting use is responsible for desperate patents and their supporters collecting 786,368 signatures of registered voters for a ballot initiative.  The Florida Right to Medical Marijuana Initiative, Amendment 2 is now on the November 4, 2014 ballot in defiance of the federal cannabis prohibition.  

A debate was held about this Florida ballot initiative at the University of Tampa on February 24.  The only physician debater was Eric Voth MD. He is a University of Kansas trained internist from Topeka, who lists his specialty as pain medicine.  He has a long resume indicating he is a medical marijuana opponent.

 Dr. Voth believes:

“The reality of it is that smoked pot is not medicine. There is no other medicine that is smoked out there. And one thing that the marijuana lobby has done is to blur in your mind is the issue of cannabinoids for medical uses and cannabis which is marijuana. Keep in mind we are talking about cannabinoids, which can be identified…which can be synthesized…that can be used as medicine, versus smoked pot.”

  This stems from the propositions that:

  • Isolated cannabinoids will provide more reliable effects than crude plant mixtures
  • Oral administration is better that inhalation.
  • Burning cannabis to volatilize the active components for inhalation produces toxicity

The first of these propositions are unproven.  The fact is the FDA has approved many combination drugs because they are superior or more convenient. Sativex®, an oral spray which is an extract of the cannabis sativa plant, contains THC,  CBD  as well as other  cannabinoids.  It also contains other naturally occurring cannabis-derived terpenoids.  They act synergistically, with the principal cannabinoids- the entourage effect (Br J Pharmacol. 2011 Aug;163(7):1344-64. doi: 10.1111/j.1476-5381.2011.01238.x.).  Sativex® is approved in many countries.    Natural mixtures of cannabinoids have proven to have pharmacological effects not reproduced by a single agent such as dronabinol (THC).  For example animal research shows CBD may mitigate some of the side-effects of THC (Br J Pharmacol. 2013 Dec;170(7):1363-4. doi: 10.1111/bph.12400). 

Inhalation is a route of administration that is approved for many drugs. It has advantages. For example when vomiting prevents oral administration it can provide rapid relief of symptoms. Unlike oral administration, inhalations of volatilized natural mixtures of cannabinoids have a rapid onset of action and may allow titration to the desired drug effect–whether it is pain, spasm or nausea relief.  This is true whether or not the exact concentrations of the cannabinoids in the natural mixture are known. The correct dosage for an individual is based on symptom relief.

Burning cannabis produces multiple toxins similar to cigarette smoke. Generally the medical marijuana user will smoke less than a cigarette smoker. A recent review concludes “Medicinal use of marijuana [smoked] is likely not harmful to lungs in low cumulative doses” (Curr Opin Pulm Med. 2014 Mar;20(2):173-9. doi: 10.1097/MCP.0000000000000026). The increasing potency of cannabis today (decried by the prohibitionists as making cannabis more toxic) would be expected to result in less toxicity.  Less smoking of more potent cannabis would produce the same therapeutic effect but less combustion by-products. Super potent cannabis wax would require still less burning.  Better yet are vaporizers.  Cannabinoids will vaporize at temperatures much lower than that required for combustion of plant matter. When heated air is drawn through the cannabis, the active components will aerosolize without the generation of smoke and toxins from combustion.

The smoking route of administration has advantages and disadvantages but does not disqualify cannabis as a medicine. Vaporizers provide a safer alternative to smoking.   Bedrocan is a standardized Cannabis product registered under Dutch law. Bedrocan can be smoked but a vaporizer is recommended.  All varieties are guaranteed free of pesticides and heavy metals. It is also purged of any micro organisms.

Medicinal plants have a long tradition in medicine. In the case of cannabis it may prove to be superior to any single synthesized cannabiniod pharmaceutical.  Numerous drugs fully approved by the FDA have caused  deaths and injuries and many have been taken off the market within months.  Medical cannabis has good safety record with centuries of use.  An additional advantage of cannabis is that it has the capability of  being  produced locally and made available at low cost.

 

Letter from 18 Congressmen to Reschedule Marijuana

 

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02-12-14 Blumenauer Rescheduling Letter_Page_3Pdf of this Letter