Wednesday, March 30, 2011

ASAM Medical Marijuania Task Force White Paper

The American Society of Addiction Medicine has called a halt to medical marijuania.  Quoting the "hippocratic oath"  for physicians to 'do no harm' the paper strongly questions the prescription of "medical marijuania' when "All major medical organizations support the FDA approval process" and "Federal law prohibits, and federal agencies do not support, the distribution of cannabis by dispensaries.

Smoking is clearly unhealthy. In 1997 the experts suggested that "a smoke free delivery system" was necessary to eliminate the negative health effects of smoking noted in research trials.

In 2008 the American College of Physicians Health and Public Policy Committee urged an evidence based review of marijuania's status. It is noted that while other medications are required to be scientifically studied and have evidence based validity the medical research on marijuania is mostly historic, anecdotal and political.

In 2006, the FDA rejected the contention that smoked herbal cannabis is safe and effective medication.

In discussion of "Medical Marijuana" and the Modern Medication Model it is noted that the status of "medical marijuana contrasts sharply with the modern medication model. Crude herbal cannabis is homogenous material. This herbal material varies depending on strain, cultivation, storage and harvesting .  Quality control mechanisms are absent.   Distribution is not through regulated channels, the product is not labelled with content information, warnings, and instructions despite this being required for medical products by state and federal law. Appropriate physician supervision is virtually unavailable.  The increased potency heightens the risk of addiction.  This is especially important as adolescents are increasingly obtaining 'cards'.

The ASAM white paper quotes the Canadian Medical Association "CMA does not support physicians controlling access to substances for which routine pre-market regulatory review of safety, purity and efficacy, as required for current prescription drugs, has not occurred."  It also quotes Physicians for Smoke-Free Canada expressing their concern about the 'risks of smoking'.

In regards to research on cannabinoid agents

Oral Cannabinoid Preparations - Dronabinol - studied for nausea and vomitting, not compared against more recent anti emetic medication, noted beneficial in cancer therapy

Marinol - studies of it as an analgesic and antispasmodic have been mixed. It was found efficacious in reducing cancer pain but side effects were promiment. It was found effective in central neuropathic pain in multiple sclerosis but not post operative pain.

Cesamet (Nabilone) synthetic cannabinoid analoque believed more potent than thc approved for nausea and vomitting associated with cancer therapy. It has been beneficial in treatment of spasticity and post surgical pain.

Smoked/vaporized herbal Cannabis - studied for neuropathic pain

Oromuscosal/sublingual derived Cannabis Preparations - Sativex (nabiximols) sprayed on mouth membranes - show positive results with adjunctive therapies in treatment of neuropathic pain, spasticitity, Rheumatoid arthritis, cancer pain .  In contrast to other cannabinoids , intoxication remained low and sympton relief was maintained in long - term studies. It is approved in Canada for neuropatic pain treatment in Multiple Sclerosis and advanced cancer pain

Cannabis is NOT a "harmless herb."  It is a "powerful drug with a variety of effects."  It affects performance and risk in driving and operating machinery. Acute effects involve intoxication, anxiety, panic attacks, hallucinations, psychosis, somnolence, confusion, psychomotor impairment, cognitive impairment, dizziness, orthostatic hypotension, dry mouth, tachycardia.  In clinical research of cannabinoid products patients with pre-existing mental disorders, hepatic and renal impairment, epilepsy, cardiac conditions or prior substance abuse/dependence are typically excluded. There is no doubt that chronic cannabis smoking is harmful to the lungs.  Heavy cannabis use in adolescence is associated with a number of neurocognitive deficits.

Allowing cannabis to circumvent the FDA sets a dangerous precedent given 'herbal products' "Spice", "Skunk" and "Sence" are becoming popular in US and Europe. These are 'enriched' herbal products with synthetic canabinoids such as HU210 , much more potent than THS.

"Cognitive dissonance" is a term that aptly describes the current approach to "medical marijuana"





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