03/16/00- Updated 12:00 PM ET
March 16, 2000
By A.J.S. Rayl
With medical adviser Stephen A. Shoop, M.D.
A Doctor In Your House.com
Depending on how you look at it or who you talk to, marijuana is either on the comeback trail or is coming back on trial.
But regardless of perspective, the presence of marijuana in the popular media is hard to ignore.
Movies - In decades past, celluloid marijuana use was relegated to "doper flicks" or low-budget countercultural efforts. But in several current high-profile films, major stars - Kevin Spacey in American Beauty, Leonardo DiCaprio in The Beach, and Michael Douglas in Wonder Boys - are seen smoking the weed and extolling its benefits.
Magazines - The March issue of Talk magazine blithely reports that marijuana is the drug of choice among "yetties" - young entrepreneurial tech-based types - who get it "delivered to them by a dealer they contact via pager."
Politics - Al Gore admits to having smoked dope in his youth, and George W. Bush conveniently can't remember anything before 1974 - perhaps the longest case of short-term memory loss on record. Ever since Bill Clinton's disingenuous "I never inhaled," any candidate's history with the herb is news.
Medicine - Fanning flames for decades, the medical marijuana initiative is beginning to burn down the opposition. Since the first legislation legalizing its medicinal use passed in California, five other states - Arizona, Oregon, Washington, Alaska, Nevada - and Washington, D.C. have passed similar measures. But medical pot is still controversial, users are still being arrested, and the movement is a hot-button issue.
Science - During the past year alone, no fewer than a dozen studies investigating various aspects of marijuana and the effects of tetrahydrocannabinol - more simply known as THC, the primary psychoactive chemical of the plant - have been published by researchers around the world, often making headlines.
Why all the attention? Because a lot of people are smoking marijuana. And a lot more who have quit are wondering whether they've damaged their health. Add to this the legions of parents who wonder what to tell their kids about pot.
The Center for National Health Statistics estimates that 5% of the U.S. population over the age of 12 currently smokes hybrid versions of the weed, botanically known as cannabis sativa. The accuracy of this figure is suspect because there are undoubtedly many cannabis smokers who won't admit to their indulgence.
"I would call that number extremely conservative," says Dean Latimer, news editor for High Times. "Besides, I know how statistics are so easily jimmied that I don't trust them even when we put them out."
Whether you believe the figures or not, there's a lot of information regarding the health aspects of marijuana use that needs evaluation.
"There are really two different questions here: Is there anything good we can learn from marijuana? And is smoking marijuana bad for you?" says Dr. Daniele Piomelli, professor of pharmacology at the University of California, Irvine (UCI), who has conducted a number of the marijuana and pain studies and has followed the research.
"In response to the first question, there is a wealth, a richness in this whole area," he continues. "Marijuana has a lot of pharmaceutical and pharmacological potential. The potential now is becoming very, very clear." Many decades-old prejudices are being lifted and that is reflected by the considerable funding that the federal government is giving to research marijuana.
"I would be very surprised that if in the next 10 years there isn't an important new medicine developed from our better understanding of the cannabis system in the body," says Piomelli.
Piomelli contends that perhaps the single most remarkable aspect of marijuana is its painkilling power. Because a whole spectrum of pain syndromes, including cancer and chronic and neuropathic pain, are resistant to morphine or similar opiates, there is a strong need now for better painkillers.
A number of pain studies in animals conducted in the mid- to late 1990s support the long-held notion that marijuana is effective for treating pain, and countless anecdotal reports also recommend its use to combat nausea. Consequently, marijuana has become one of the most popular drugs used by cancer patients undergoing chemotherapy.
A related effect of the drug is the stimulation of appetite. For AIDS patients or others who suffer from wasting syndrome, this is a major plus. But for most healthy tokers, marijuana-induced "munchies" are a negative, especially with obesity now a major health problem.
Another apparent negative effect is the short-term memory loss that can occur as the byproduct of marijuana use. But something good may actually come from studying this phenomenon. Researchers are working now to understand the memory-blocking mechanism in hopes of increasing our knowledge about the body's and brain's dumping of data. This may prove helpful in developing medications that can block damaging thought patterns associated with behavioral disorders and other conditions.
Several recent studies spotlight additional promising effects.
Cancer - Spanish researchers reported last month that THC may be an effective treatment for a type of fatal brain cancer, malignant glioma.
Hyperactivity - An animal model study, slated for publication in the May 2000 issue of the Journal of Neuroscience, reports that synthetic compounds developed to block the way anandamide - the body's own cannabis-like compound or cannabinoid - is inactivated or broken down could correct forms of hyperactivity, such as attention deficit disorder.
MS symptoms - In a study on human multiple sclerosis (MS) patients, researchers reported last year that marijuana used illicitly by their patients temporarily reduced spasticity - the involuntary and painful contracting and stiffening of the muscles - better than currently available legal treatments.
Non-Hodgkin's lymphoma - A study last year out of the University of California, San Francisco (UCSF) revealed that marijuana could reduce one's risk of developing non-Hodgkin's lymphoma, a deadly cancer of the lymphatic system. Marijuana provides protection, the UCSF researchers believe, by slowing down the overproduction of B cells.
On the negative side of the ledger are the harmful effects of marijuana, starting with the fact that users most often smoke it.
"There is no question that it is dangerous," Piomelli says adamantly. "Smoking is not a natural way of consuming any substance. Heavy smoking of marijuana has been shown exhaustively to be as dangerous or more dangerous than smoking tobacco."
Like any type of smoke, marijuana smoke is pharmacologically active. "It can do a lot of things to the body," notes Piomelli. "The smoke itself, the tar and irritants and toxins and all sort of different things that have nothing to do with the reason why people smoke marijuana, which is for the euphoria, the 'high' - they're all problematic."
Several studies spotlight other problems associated with marijuana use:
Infection - Researchers at the recent American Association for the Advancement of Science meeting in Washington presented findings from animal studies that showed cannabinoids markedly altered helper T cell production of cytokines, which are important to resistance of infection. More disturbing, they provided strong experimental evidence that marijuana and other opiates may be co-factors in the progression of infectious diseases.
Head and neck cancers - In a study conducted last year at New York City's Memorial Sloan-Kettering Cancer Center, researchers determined that current and past marijuana smokers are at an increased risk of developing cancers of the head and neck. The first study to scientifically make the connection between pot and cancer, it indicated that the risk of head and neck cancer was 2.6 times greater among pot smokers than among those who had never smoked marijuana.
Lung cancer and emphysema - A study last summer out of UCLA offered up evidence that THC kills cells in the lining of the lungs. The researchers found that marijuana smoke is as strong if not stronger than tobacco smoke in generating free radicals, those naturally occurring chemicals that damage and eventually destroy cells. This report followed on the heels of another study that provided evidence that marijuana smoke was just as dangerous as tobacco smoke in promoting lung cancer and emphysema.
Heart attacks - In what was deemed a first-of-its-kind study, researchers found that the risk of a heart attack for middle-aged people is five times higher than usual one hour after smoking marijuana. THC speeds up the heart by about 40 beats per minute.
Before this information itself gives you a coronary, understand that the baseline risk of heart attack for a 50-year-old male is one chance in a million per hour. After smoking a joint, the odds increase to five in a million. Several hours later, the risk recedes. Even so, some scientists maintain that smoking a joint is twice as likely to cause a heart attack as having sex or working out on a treadmill.
Latimer, who is not a doctor but has followed marijuana research for High Times since 1968, dismisses most of these negatives as government-sponsored disinformation. Moreover, he adds, the new scientific studies are "not comprehensive and are not on an epidemiological scale," but are anecdotal and animal studies. "This is what the government does every time it wants to declare war on pot," he charges. He cites contradictory evidence.
"In 1997, Kaiser-Permanente in California published a large broad-based epidemiological study in which they gathered statistics on 65,000 clients, the use of cannabis, and the incidence of cancer. They found no indication of increased cancer as a result of smoking cannabis."
The study population was comprised of Kaiser Permanente Medical Care Program enrollees, aged 15-49, who completed questionnaires about their smoking habits between 1979 and 1985. Mortality follow-up was conducted through 1993.
The authors of the study, published in the American Journal of Public Health in 1997, concluded: "Marijuana use and cancer were not associated in overall analyses." However, they did note that "associations in nonsmokers of tobacco cigarettes suggested that marijuana use might affect certain site-specific cancer (prostate, cervical) risks."
As for lung cancer, Latimer says: "Once again, you have epidemiological evidence showing that people who smoke marijuana have no higher incidence of lung damage than people who don't smoke marijuana and only smoke tobacco," he says, referring once more to the 1997 Kaiser Permanente study.
One thing everyone seems to agree on is that marijuana/cannabis has a bad image.
While marijuana/cannabis has been known for millennia to have medicinal value and despite the fact that modern medicine is bearing out many of those indications, there has been a lot of resistance in developing clinical studies with marijuana derivatives.
"One reason is that until recently we didn't have a lot of the pharmacological tools available - the clean, synthetic compounds that we can give to people to replace marijuana smoke," says Piomelli. "We need to make chemical tools that are clean and selective and produce the effect of THC without all the other effects of various components of marijuana smoke."
Another obstacle has been marijuana's "cultural attributions," as Piomelli puts it. "The issue is that cannabis produces inhibition of movement, relaxation, sexual arousal, sensory heightening, a euphoria," he offers. "All these are phenomena that are not in line with the work ethics of our society."
"This explanation may be simplistic, but cocaine and nicotine are the drugs of Wall Street, of the active figures in our world," he continues. "When taken in moderation - which is very hard to achieve of course - they don't impair these people. Marijuana, meanwhile, has been associated with the munchies, with the silliness and giggling, and all this is not considered by our culture as serious. In a way, that explains why even as a drug marijuana not considered as serious as cocaine or even nicotine."
But scientists are now working seriously on new delivery systems. The only FDA-approved marijuana derivative right now is a synthetic compound called dronabinol (Marinol), which is most often prescribed to cancer patients. "There are other ways that you can get the benefits of marijuana, and all sorts of things can and are being developed," says Piomelli.
The American Cancer Society (ACS) has put up more than $350,000 to develop a patch to help cancer patients bear the pain and nausea of chemotherapy. At the University of Mississippi, federal researchers are working on a marijuana suppository. An aerosol spray is also in the discussion stages.
"There's good evidence that suppositories are effective in a number of patients, particularly in MS patients suffering spasticity. And it appears to be effective without producing the psychotropic effects," says Piomelli.
Some research is being conducted into the possibilities of removing the 'high' from marijuana-derived medications. For the time being, however, particularly with terminal cancer patients, the high is not that much of a concern, and in some instances may be welcomed.
"It's an important question," says Piomelli. "If the life of the person is at stake, the question of the accompanying 'high' becomes a moot point. It is my personal opinion that in situations like these - terminal cases - concerns about the 'high' should be set aside."
While there's still much more to be learned about marijuana, perhaps the most important take-home message for aging baby boomers who still hanker for that occasional joint and young yetties and others just coming onto the scene is this:
"Anything done in excess is bad for you," says Piomelli. "If you compare different evils, marijuana is probably one of the least and probably should still be considered as such. That is not to say that marijuana is harmless. It is a drug. All drugs - legal and illegal - can be harmful."
"Everything that is potentially pharmacologically active can be potentially harmful and must be consumed with a certain degree of intelligence," he continues. "No amount of scientific study will justify immoderation. There are always people who will use the latest finding to justify their weakness, but that doesn't work."
So if you choose to continue risking the health and legal consequences of marijuana use, here are a few things to remember - if you can - after smoking marijuana.
Don't drive a car.
Don't go to the grocery store.
Don't forget to take additional supplements of vitamins C, E and other antioxidants to combat free radicals.
And, suggests Latimer - "Don't go anywhere the police are likely to be."