Chat With Author of New Federal Report
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Mar. 18 - A report commissioned by U.S. drug czar Barry McCaffrey has found that marijuana's active components appear to have medicinal value. But smoking the stuff is still harmful.One of the main authors of that report was Dr. John Benson, a dean and professor emeritus of the Oregon Health Sciences University School of Medicine. He joined us today to take your questions about the report, and about medical uses for marijuana.
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Moderator at 2:03pm ET
Thanks for joining us online today. Our first question comes from Ron:
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ron from mot.com at 2:04pm ET
1. What are the medicinal benefits identified at this point?
2. What further work has been outlined for further research?
3. What are the risk factors? (I would bet they are no worse than cigarettes
and alcohol.)
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Dr. John Benson at 2:11pm ET
Marjiuana has within it at least 10 active compound cannabinoids. The most psychoactive is THC, marketed and approved as a capsule Marinol. These substances are powerfully active in various ways. They really treat only symptoms and they are modestly effective, particularly when compared to approved available patients.
The three main symptoms where marijuana and its component compounds
have been shown to work are the pain, nausea and vomiting from chemotherapy
and cancer patients; for AIDS patients on multiple medicines; and for patients
with advanced AIDS or cancer suffering from poor appetite, weight loss
and wasting. Controlled trials, have to the study's satisfaction, showed
these benefits. Another symptom where the study found promise was for the
use of these agents in muscle spasticity in patients with multiple sclerosis.
Those are the main established convincing benefits.
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Dr. John Benson at 2:16pm ET
There are two main risk areas. The study team feels that smoke is risky in terms of lung disease and when smoking during pregnancy low birth weight. Like tobacco, smoke marijuana contains carcinogenic substances like tar. We need better data on that risk. But there are cellular changes in marijuana smokes that are found in tobacco smokers. Therefore we advocate an inhaled form without smoke, such as the nebulizers used for asthma. That means nebulizing a component compound rather than the whole leaf.
The other risk area is progression to apt use of hard drugs, the so-called
"gateway" phenomenon. The study wishes to distinguish between medical use
and uncontrolled or recreational substance abuse. There is no convincing
evidence that drugs used for medical purposes progress to the use of other
drugs, to abuse, or to increased use in the population.
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Dr. John Benson at 2:20pm ET
Clinical trials of active cannabinoid drugs for symptom management should
be conducted in parallel with the development with reliable and safe delivery
systems such as an inhaler. Studies of those who have smoked marijuana
chronically should be carried out to learn the risks of lung cancer and
progression of HIV positive patients to AIDS. There are any number of detailed
basic science experiments with these agents, not marijuana, that are recommended
in the report.
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Jim from [199.35.160.200], at 2:21pm ET
A friend of mine with the AIDS virus (low t-cell count, high viral load)
smokes marijuana every day just to avoid nausea from his various medications,
and to keep an appetite. I have two questions:
1) Would Marinol achieve the same effect as smoking the marijuana?
2) He is lately having episodes of TIA, or transitory ischemia attacks.
Could this be related in any way to the marijuana smoking? Thank you.
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Dr. John Benson at 2:23pm ET
Smoke marijuana is effective for Jim's friend's nausea from his medication.
But there are far more effective approved medications that are available
to him - for example, 90% effective. I know of no association between marijuana
smoking and TIAs.
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Keith from [209.0.20.226], at 2:23pm ET
Regarding marijuana and depression: My sister suffers from severe depression.
She has worked with many therapists and tried many antidepressants. However,
the only drug that has consistently helped her, especially when she is
suicidally depressed, is marijuana. Is there any experimental evidence
or research regarding marijuana as treatment for depression?Where might
I learn more?
Keith
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Dr. John Benson at 2:25pm ET
I know of no good evidence of the value of marijuana in depression. That is not to say that there are data that show that marijuana does not work, but rather that appropriate studies have not been done.
Marijuana obviously creates a euphoric "high" which may be beneficial
and its side effects such as the high or sedation should not be overlooked.
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Randall Watkins from [12.7.195.67], at 2:26pm ET
I know a child in Northern California who is severely disabled from
birth defects. She is a medical marijuana recipient because it seems to
help with her multiple daily seizures. She gets Marinol and leaf marijuana.
Is there something in your study that may support this finding?
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Dr. John Benson at 2:27pm ET
No, the evidence for benefit in seizure disorders is lacking and the
study found no reason to recommend either marijuana or Marinol.
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IndigosGrrl from remote.mun.ca at 2:27pm ET
I find that marijuana eases the pain of my migraines and of my lower
back pain. Has there been any research done to support this?
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Dr. John Benson at 2:29pm ET
There is insufficient evidence to recommend the marijuana compounds
for migraines. In some instances, migraines have followed marijuana withdrawal.
Muscle spasms may be relieved by these drugs ... so perhaps the patient
is benefiting in that regard.
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Jane Weirick from [209.66.84.174], at 2:30pm ET
Are you aware of any documented cases of lung cancer specifically caused
by marijuana smoking?
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Dr. John Benson at 2:34pm ET
Smoke does worry us as potentially leading to lung cancer, but specific cases have not been reported in the literature, Jane. The problem is that most marijuana smokers have used tobacco over many years, so it is hard to sort out which smoke has done the damage. Furthermore, smoking marijuana has been a relatively recent phenomenon.
Earlier in this century, most marijuana use was through teas or other
means of ingesting marijuana such as cookies. So perhaps there has not
been sufficient time to lead to lung cancer from smoking marijuana. But,
as I have suggested, there are very clear cellular changes in the lungs
of marijuana smokers that do not use tobacco that frighten doctors like
me.
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Dave G. California from tnt18.sfo3.da.uu.net at 2:35pm ET
Dr. Benson, I have used this drug for about twenty five years to control
temper and anger. It works well for this. Did your study indicate success
in this area?
Thank you.
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Dr. John Benson at 2:35pm ET
Dave, I know of no studies to prove its value for your condition.
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Danielle Field from tafensw.edu.au at 2:36pm ET
Does smoking pot harm the growth of the brain in any way? Does it make
people who smoke it slow or dumb?
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Dr. John Benson at 2:38pm ET
Danielle, marijuana does interfere with acute memory and judgement as
well as coordination, so that people may seem to be living in another world
and unable to drive or operate heavy machinery. But I know of no long term
effect on brain size or intelligence. There is one worrisome study of children
whose mothers smoked marijuana during pregnancy. These children at ages
8-12 showed poor executive function on psychological testing. So there
may be long term latent effects on critical judgement.
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Hillary White from [168.191.22.172], at 2:39pm ET
In the report about medicinal uses of marijuana' I've noticed that Parkinsons disease was also mentioned. I would like to know if there has been any study on this subject, and what kind of relief can be obtained by Parkinsons patients from medical use of marijuana? Would it relieve twitching of the muscles, for example?
Would there be any drawbacks for those patients who have already slow
and rigid movements? I am taking care of a patient who has Parkinsons and
glaucoma at the same time, and I would appreciate any information on this
subject.
Thank you.
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Dr. John Benson at 2:42pm ET
Hillary, there are better drugs for movement disorders like Parkinson's
disease. In general, there are poor studies to indicate its value, even
thought the sites of effect of marijuana and its compounds in the brain
are in areas controlling movement. There is one clinical trial of only
five patients where there was no improvement in tremor after marijuana
although all five benefited in standard medications.
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Dr. John Benson at 2:46pm ET
Marijuana and its component drugs have been used in glaucoma and do reduce the increased pressure within the eyeball, whether smoked or taken by mouth. Unfortunately the compounds are too irritating to be used as eye drops but there is no evidence that these compounds or marijuana slow the natural progression of glaucoma or the visual acuity.
Furthermore, the effects of marijuana or THC last for only 3 or more
hours, so frequent dosing over the lifetime of the patient increases the
risk of smoke. Again there are eye drops and operations that do a better
job.
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Dan Berkes from galenalink.com at 2:47pm ET
What do you see as the future potential of marijuana in medical treatment?
Will new prescription medicines made from plant derivatives be developed
for specific conditions, or will doctors prescribe the plant in whole for
patients?
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Dr. John Benson at 2:49pm ET
Dan, the study team much prefers research on the separate cannabinoid
compounds, either alone or in combination or as adjuncts to standard therapy,
to smoked marijuana. Future research should be directed at those distinct
measurable, quantifiable agents and the development of a safe delivery
system rather than to produce a future for smoked marijuana.
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Dave from [146.96.173.90] at 2:52pm ET
In your opinion, has there been a lack of medical marijuana research
because of the political stigma? Who funded your research? Is there ample
funding available for the research?
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Dr. John Benson at 2:55pm ET
Dave, the Institute of Medicine study was funded by the White House
of National Drug Control Policy to try to establish whether or not science
shows the risks or benefits of marijuana use. Various studies of using
smoked marijuana have been funded by the National Institutes of Health
and federal funding was largely responsible for the development and early
approval in the early 80s of Marinol. The study teams hopes that good clinical
trials are sought by responsible investigators and that if peer review
finds them scientifically sound they will be funded.
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John Mc from snfc21.pacbell.net at 2:56pm ET
News reports of your study said that because of the worries about smoke,
you recommended developing oral ingestion (pills I guess) as well as developing
inhalers. How would you expect new pills to differ from Marinol, which
is largely seen as ineffective or at least much less effective by users?
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Dr. John Benson at 2:59pm ET
John, Marinol has been proven to be effective for various symptoms in
excellent studies. Patients seem to prefer the high"
as a way of titrating their dose of smoked marijuana and are reluctant
to switch to oral medication. They also complain about the long term effects
of oral dosing, particularly unpleasant feelings called dysphoria. In addition
to inhaled delivery nasal sprays, oral lozenges and combinations in capsule
form should be studied.
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Patrick Curran from [192.9.25.22], at 3:00pm ET
Hi Doctor. I heard the report released yesterday indicated there was
little evidence to back up the long held theory that marijuana is a "gateway
drug", that is that it leads to use of cocaine and marijuana. Can you talk
about this more?
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Dr. John Benson at 3:03pm ET
Patrick, the study team strongly wishes to separate the MEDICAL use of cannabinoids from substance abuse. We are worried about the statistics of progression from marijuana from the apt use of stronger drugs or hard drugs, particularly in teenagers. To that extent, there is a gateway phenomenon. But there is no evidence that it is due to the drug itself in some effect on the brain, but probably more related to the person's social environment.
There is no convincing evidence of progression to other drugs from the
MEDICAL use of psychoactive drugs like marijuana and THC. And there is
no convincing evidence of progression from MEDICAL use to substance abuse.
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Moderator at 3:05pm ET
Thanks again for joining us today Dr Benson. Any final thoughts?
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Dr. John Benson at 3:07pm ET
Finally, the study team feels that its attitudes and information come
down in the middle between the assertions that marijuana and its components
have no medical value on the one hand, and the assertions that it is a
widely effective, harmless agent.
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Moderator at 3:08pm ET
Thank you all for joining us.
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