2890. Medical Marijuana Could Save Many Addicted to Opioids

By Sanjy Gupta, M.D., CNN, April 24, 2018

Dear Honorable Jeff Sessions,

I feel obligated to share the results of my five-year-long investigation into the medical benefits of the cannabis plant. Before I started this worldwide, in-depth investigation, I was not particularly impressed by the results of medical marijuana research, but a few years later, as I started to dedicate time with patients and scientists in various countries, I came to a different conclusion.

Not only can cannabis work for a variety of conditions such as epilepsy, multiple sclerosis and pain, sometimes, it is the only thing that works. I changed my mind, and I am certain you can, as well. It is time for safe and regulated medical marijuana to be made available nationally. I realize this is an unconventional way to reach you, but your office declined numerous requests for an interview, and as a journalist, a doctor and a citizen, I felt it imperative to make sure you had access to our findings.

Mr. Sessions, there is an added urgency, as we are in the middle of a deadly opioid epidemic that has been described as the worst self-inflicted epidemic in the history of our country.

close dialog

Receive Fareed Zakaria's Global Analysis

including insights and must-reads of world news

By subscribing you agree to our

privacy policy.

The drug overdose scourge claimed about 68,000 US lives in 2017, just over 45,000 of them from opioids alone. Every day, 115 Americans die from opioid overdoses. It has fueled a decline in an entire country's life expectancy and will be remembered as a sad and tragic chapter in our collective history.

These are desperate times, and while some may consider making medical marijuana widely available to be a desperate measure, the evidence has become increasingly clear of the important role cannabis can have.

We have seen real-world clues of medical marijuana's benefits. Researchers from the Rand Corp., supported by the National Institute on Drug Abuse, conducted "the most detailed examination of medical marijuana and opioid deaths to date" and found something few initially expected. The analysis showed an approximately 20% decline in opioid overdose deaths between 1999 and 2010 in states with legalized medical marijuana and functioning dispensaries.

It's not the first time this association between medical marijuana and opioid overdose has been found. Though it is too early to draw a cause-effect relationship, these data suggest that medicinal marijuana could save up to 10,000 lives every year.

The science of weed

Cannabis and its compounds show potential to save lives in three important ways.

Cannabis can help treat pain, reducing the initial need for opioids. Cannabis is also effective at easing opioid withdrawal symptoms, much like it does for cancer patients, ill from chemotherapy side effects. Finally, and perhaps most important, the compounds found in cannabis can heal the diseased addict's brain, helping them break the cycle of addiction.

Mr. Sessions, there is no other known substance that can accomplish all this. If we had to start from scratch and design a medicine to help lead us out of the opioid epidemic, it would likely look very much like cannabis.

A better, and safer, way to treat pain

The consensus is clear: Cannabis can effectively treat pain. The National Academies of Sciences, Engineering, and Medicine arrived at this conclusion last year after what it described as the "most comprehensive studies of recent research" on the health effects of cannabis.

Furthermore, opioids target the breathing centers in the brain, putting their users at real risk of dying from overdose. In stark contrast, with cannabis, there is virtually no risk of overdose or sudden death. Even more remarkable, cannabis treats pain in a way opioids cannot. Though both drugs target receptors that interfere with pain signals to the brain, cannabis does something more: It targets another receptor that decreases inflammation -- and does it fast.

I have seen this firsthand. All over the country, I have met patients who have weaned themselves off opioids using cannabis. Ten years ago, attorney Marc Schechter developed a sudden painful condition known as transverse myelitis, an inflammation of the spinal cord. After visiting doctors in several states, he was prescribed opioids and, according to our calculations, consumed approximately 40,000 pills over the next decade. Despite that, his pain scores remained an eight out of 10. He also suffered significant side effects from the pain medication, including nausea, lethargy and depression.

Desperate and out of options, Schechter saw Dr. Mark Wallace, head of University of California, San Diego Health's Center for Pain Medicine, where he was recommended cannabis. Minutes after he took it for the first time, Schechter's pain was reduced to a score of two out of 10, with hardly any side effects. One dose of cannabis had provided relief that 40,000 pills over 10 years could not.

Using marijuana to get off opioids

For Schechter, as with so many others, the seemingly insurmountable barrier to ending his opioid use was the terrible withdrawal symptoms he suffered each time he tried. When a patient stops opioids, their pain is often magnified, accompanied by rapid heart rate, persistent nausea and vomiting, excessive sweating, anorexia and terrible anxiety.

Here again, cannabis is proven to offer relief. As many know, there is longstanding evidence that cannabis helps chemotherapy-induced symptoms in cancer patients, and those symptoms are very similar to opioid withdrawal. In fact, for some patients, cannabis is the only agent that subdues nausea while increasing appetite.

Why we can't 'just say no' to opioids

Finally, when someone is addicted to opioids, they are often described as having a brain disease. Yasmin Hurd, director of the Addiction Institute at Mount Sinai in New York City, showed me what this looks like in autopsy specimens of those who had overdosed on opioids. Within the prefrontal cortex of the brain, she found damage to the glutamatergic system, which makes it difficult for neural signals to be transmitted. This is an area of the brain responsible for judgment, decision-making, learning and memory.

Hurd told me that when an individual's brain is "fundamentally changed" and diseased in this manner, they lose the ability to regulate opioid consumption, unable to quit despite their best efforts -- unable to "just say no."

It is no surprise, then, that abstinence-only programs have pitiful results when it comes to opioid addiction. Even the current gold standard of medication-assisted treatment, which is far more effective, still relies on less-addictive opioids such as methadone and buprenorphine. That continued opioid use, Hurd worries, can cause ongoing disruption to the glutamatergic system, never allowing the brain to fully heal. It may help explain the tragic tales of those who succeed in stopping opioids for a short time, only to relapse again and again.

This is precisely why Hurd started to look to other substances to help and settled on nonpsychoactive cannabidiol or CBD, one of the primary components in cannabis. Hurd and her team discovered that CBD actually helped "restructure and normalize" the brain at the "cellular level, at the molecular level." It was CBD that healed the glutamatergic system and improved the workings of the brain's frontal lobes.

This new science sheds lights on stories like the one I heard from Doug Campbell of Yarmouth, Maine. He told me he had been in and out of drug rehab 32 times over 25 years, with no success. But soon after starting cannabis, he no longer has "craving, desire and has not thought about (opioids) at all, period."

For the past 40 years, we have been told that cannabis turns the brain into a fried egg, and now there is scientific evidence that it can do just the opposite, as it did for Campbell. It can heal the brain when nothing else does.

I know it sounds too good to be true. I initially thought so, as well. Make no mistake, though: Marc Schechter and Doug Campbell are emblematic of thousands of patients who have successfully traded their pills for a plant.

These patients often live in the shadows, afraid to come forward to share their stories. They fear stigma. They fear prosecution. They fear that someone will take away what they believe is a lifesaving medication.

Where do we go from here?

Mr. Sessions, Dr. Mark Wallace has invited you to spend a day seeing these patients in his San Diego clinic and witness their outcomes for yourself. Dr. Dustin Sulak could do the same for you in Portland, Maine, as could Dr. Sue Sisley in Phoenix. Staci Gruber in Boston could show you the brain scans of those who tried cannabis for the first time and were then able to quit opioids. Dr. Julie Holland in New York City could walk you through the latest research. All over the country, you will find the scientists who write the books and papers, advance the science and grow our collective knowledge. These are the women and men to whom you should listen. They are the ones, free of rhetoric and conjecture, full of facts and truth, who are our best chance at halting the deadly opioid epidemic.

Making medicinal marijuana available should come with certain obligations and mandates, just as with any other medicine. It should be regulated to ensure its safety, free of contamination and consistent in dosing. It should be kept out of the hands of children, pregnant women and those who are at risk for worse side effects. Any responsible person wants to make sure this is a medicine that helps people, not harms.

Recently, your fellow conservative John Boehner changed his mind after being "unalterably opposed" to marijuana in the past. If you do the same, Mr. Attorney General, thousands of lives could be improved and saved. There is no time to lose.

2699. Legalize Marijuana: The Case of a Wounded Veteran

By Thomas James Brennen, The New York Times, September 1, 2017

The explosion that wounded me during a Taliban ambush in Afghanistan in 2010 left me with a traumatic brain injury and post-traumatic stress. In 2012 I was medically retired from the Marine Corps because of debilitating migraines, vertigo, and crippling depression. After a nine-year career, I sought care from the Department of Veterans Affairs.

At first, I didn’t object to the pills that arrived by mail: antidepressants, sedatives, amphetamines and mood stabilizers. Stuff to wake me up. Stuff to put me down. Stuff to keep me calm. Stuff to rile me up. Stuff to numb me from the effects of my wars as an infantryman in Iraq and Afghanistan. Stuff to numb me from the world all around.

The T.B.I. brings on almost daily migraines, and when they come, it’s as if the blast wave from the explosion in Afghanistan is still reverberating through my brain, shooting fresh bolts of pain through my skull, once again leaving me incapacitated. Initially, the prescriptions helped — as they do for many veterans. But when I continued to feel bad, the answers from my doctors were always the same: more pills. And higher dosages. And more pills to counteract the side effects of those higher dosages. Yet none of them quite worked.One thing did. In 2013, a friend rolled a joint and handed it to me, urging me to smoke it later. It will relieve your symptoms, he promised. That night I anxiously paced around my empty house. I hesitated to light it up because I’d always bought into the theory of weed as a “gateway drug.” But after a few tokes, I stretched out and fell asleep. I slept 10 hours instead of my usual five or six. I woke up feeling energized and well rested. I didn’t have nightmares or remember tossing or turning throughout the night, as I usually did. I was, as the comedian Katt Williams puts it, “hungry, happy, sleepy.”

With the help of my civilian psychiatrist, I began trading my pill bottles for pipes and papers. I also began to feel less numb. I started to smile more often. I thought I had found a miracle drug. There was just one problem: That drug was illegal.

In 21 states, including North Carolina, where I live, any use of marijuana is forbidden under state law. The current punishments for those who possess or cultivate cannabis — even for medical purposes — may include a felony conviction and imprisonment, loss of child custody and permanent damage to their livelihood. The V.A. encourages veterans to discuss their cannabis use with their doctors, but because cannabis is also prohibited under federal law, the V.A. cannot prescribe it in any form — thereby denying countless veterans relief to many mental health symptoms and other service-connected disabilities.

The medical benefits of marijuana for the more than 360,000 post-Sept. 11 veterans who have brain injuries are not universally recognized. (As many as one in five veterans are thought to have post-traumatic stress.) But medical experts like Dr. Frank Ochberg, a psychiatrist and former associate director of the National Institute of Mental Health, believe that “medical marijuana absolutely belongs in the pharmacy for post-traumatic stress and brain injury treatment.” The V.A., Dr. Ochberg said, “is failing veterans by not making cannabis a treatment option.”

In recent years, the V.A. has worked to reduce the number of opioids prescribed to veterans and increase the promotion of alternative therapies such as yoga and mindfulness, and it has made significant improvements in access to health care. Dr. David Shulkin, the V.A. secretary, has publicly supported the evaluation of emerging cannabis research, acknowledging that patients may benefit from marijuana use. But the department is prohibited from prescribing medical cannabis for veterans even in states where it is legal. (In those states, veterans can get prescriptions from private doctors, but at their own expense.)

Most of the major veterans groups, including the American Legion, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Disabled American Veterans, support regulated research into the medical uses of cannabis. But the research is slow in coming: Since 1968, the University of Mississippi has been home to the only licensed facility to produce cannabis for clinical research. In March it was reported that the university’s cannabis was contaminated with lead, yeast and mold — substances that jeopardize research efficacy and patient safety.

What I know is that it works for me. If I hadn’t begun self-medicating with it, I would have killed myself. The relief isn’t immediate. It doesn’t make the pain disappear. But it’s the only thing that takes the sharpest edges off my symptoms. Because of cannabis, I’m more hopeful, less woeful. My relationship with my wife is improving. My daughter and I are growing closer. My past is easier to remember and talk about. My mind is less clouded. More than anything, it feels good to feel again. My migraines and depression don’t control my life. Neither do pills.

But I live in fear that I will be arrested purchasing an illegal drug. I want safe, regulated medical cannabis to be a treatment option. Just like the sedatives and amphetamines the V.A. used to send me by mail. And the opioids they still send to my friends.

Thomas James Brennan, a former sergeant in the Marine Corps, is the founder of The War Horse, a veterans’ news site, and a co-author of “Shooting Ghosts : A U.S. Marine, a Combat Photographer, and Their Journey Back from War.”

1780. Seeking the Facts on Medical Marijuana

By Claudia Dreifus, The New York times, March 23, 2015

Twenty-three states and the District of Columbia have legalized medical marijuana, but scientific research into its appropriate uses has lagged. Dr. Mark Ware would like to change that.

Dr. Ware, 50, is the director of the Canadian Consortium for the Investigation of Cannabinoids and the director of clinical research of the Alan Edwards Pain Management Unit of McGill University Health Center. Medical marijuana has been legal in Canada for 16 years, and Dr. Ware, a practicing physician, studies how his patients take the drug and under what conditions it is effective.

We spoke for two hours at the recent meeting of the American Association for the Advancement of Science and later by telephone. Our interviews have been condensed and edited for space.

Q. How did you become interested in the medical possibilities of cannabis?

A. In the late 1990s, I was working in Kingston, Jamaica, at a clinic treating people with sickle cell anemia. My British father and Guyanese mother had raised me in Jamaica, and I’d attended medical school there.

One day, an elderly Rastafarian came for his annual checkup. I asked him, “What are your choices of medicines?” He leaned over the table and said, “You must study the herb.”

That night, I went back to my office and looked up “cannabis and pain.” What I found were countless anecdotes from patients who’d obtained marijuana either legally or not and who claimed good effect with a variety of pain-related conditions.

There were also the eye-opening studies showing that the nervous system had specific receptors for cannabinoids and that these receptors were located in areas related to pain. Everything ended with, “More studies are needed.”

So I thought, “This is what I should be doing; let’s go!”

Was getting started that easy?

Actually, not.

That summer, I went to England and considered working with a British pharmaceutical concern researching cannabinoids. But just then, a Canadian court took up the case of an epileptic who’d been arrested when he used cannabis for his seizures. The court essentially legalized medical marijuana throughout Canada.

When I heard that, it seemed like Canada was the place I should be going to. I packed up my young family and moved to Montreal. What I proposed to McGill was a clinic where we might evaluate the claims of patients about medical marijuana.

So much of what we knew about the drug was anecdotal. Some of it was folkloric. My idea was to listen to the patients’ stories and put them to a clinical evaluation.

When you first moved to Canada in 1999, what was known about medical marijuana?

We certainly knew that cannabinoids were analgesic in animal models. There were case reports floating around of people with multiple sclerosis who’d been helped.

In California, people with H.I.V. were using it for appetite stimulation, nausea and pain. Cancer patients sometimes used it to curb nausea from chemotherapy.

Since then, there have been at least 15 good-quality trials around the world. Cannabinoids are reported to help with H.I.V.-associated neuropathy, traumatic neuropathy, multiple sclerosis, pain from diabetes. There have also been a few small studies on fibromyalgia and PTSD.

When you talk about translational medicine, a drug usually moves from “bench to clinic.” But cannabis has had this unique trajectory: The patients were using it on their own, and then you had these papers, often based on a few case studies. And sometimes, you had later trials which led to drugs — like with H.I.V. patients’ using cannabis, which led to Marinol.

Tell us about some of your own research.

One investigation we published in the Canadian Medical Association Journal in 2010 studied 23 patients who used three slightly different levels of cannabis preparations and one placebo for two months. They had one puff three times a day. We found that the 9.4 percent THC level was superior to the placebo in terms of its effect on pain.

We also found that it helped with anxiety and sleep. Interestingly, our patients appeared to actually use very small quantities of the drug to control their symptoms, a lot less than recreational users.

Later this spring, we hope to take this research further by launching what we think will be the first ever longitudinal study of medical marijuana patients. We’ll follow the long-term effects of those of our regular patients who’ve been using it for chronic conditions. We’ll look at safety over the years.

Why do you think cannabis use has been generally so under-researched?

The fundamental answer is that the illegality of the drug has stigmatized most research. In Canada, people are sometimes afraid because of the perception that they are working with illegal substances, even when that’s no longer the case.

In the United States, it’s a different matter, because on the federal level, cannabis is listed as a Schedule I drug, like heroin. That means that the medical community is quite restricted in gaining access to research materials.

At the same time, there are more than 20 states where medical marijuana, to differing degrees, is legal. However, the plants grown in Colorado may be quite different from those grown elsewhere. Moreover, the medically eligible conditions vary from state to state.

This lack of standardization has been another factor making research difficult, because when you’re talking about cannabis in one state and cannabis in another, you may not be talking about the same thing.

You’ve said that physicians call you frequently for practical advice about the drug. What do they ask?

The most common question is, “How do I make the distinction between patients who want it for medical or recreational use?” The other call I get is from a clinician who wants me to take his patient and explain whatever I can.

Actually, I wish those doctors would inform themselves better; a lot of information does exist, though we need more. I believe that by not informing themselves, physicians aren’t fully serving their patients.

In Canada, for instance, we’ve noticed that our oncologists generally don’t tell their patients about medical marijuana. It’s the nurses who’ll go, “Dear, why don’t you go outside and have a puff.”

Your own Canadian Medical Association reminds its members that they are not obligated to write marijuana prescriptions because there is “insufficient evidence on clinical risks and benefits.” What is your take on their stance?

Well, I agree with them, at least on this: We need more research.

I think the time has come for us as a global community to agree on what we want to know and then go get it. And our patients need to move away from self-experimenting with substances and derivatives we don’t know about, and move to a situation where we know what they are using and where we can better help them. This isn’t going away.

1779. Marijuana: U.S. Ban Is Rooted in Myth and Xenophobia

By The Editorial Board, The New York Times, July 29, 2014

The federal law that makes possession of marijuana a crime has its origins in legislation that was passed in an atmosphere of hysteria during the 1930s and that was firmly rooted in prejudices against Mexican immigrants and African-Americans, who were associated with marijuana use at the time. This racially freighted history lives on in current federal policy, which is so driven by myth and propaganda that it is almost impervious to reason.

The cannabis plant, also known as hemp, was widely grown in the United States for use in fabric during the mid-19th century. The practice of smoking it appeared in Texas border towns around 1900, brought by Mexican immigrants who cultivated cannabis as an intoxicant and for medicinal purposes as they had done at home.

Within 15 years or so, it was plentiful along the Texas border and was advertised openly at grocery markets and drugstores, some of which shipped small packets by mail to customers in other states.

The law enforcement view of marijuana was indelibly shaped by the fact that it was initially connected to brown people from Mexico and subsequently with black and poor communities in this country. Police in Texas border towns demonized the plant in racial terms as the drug of “immoral” populations who were promptly labeled “fiends.”

As the legal scholars Richard Bonnie and Charles Whitebread explain in their authoritative history, “The Marihuana Conviction,” the drug’s popularity among minorities and other groups practically ensured that it would be classified as a “narcotic,” attributed with addictive qualities it did not have, and set alongside far more dangerous drugs like heroin and morphine.

By the early 1930s, more than 30 states had prohibited the use of marijuana for nonmedical purposes. The federal push was yet to come.

The stage for federal suppression of marijuana was set in New Orleans, where a prominent doctor blamed “muggle-heads” — as pot smokers were called — for an outbreak of robberies. The city was awash in sensationalistic newspaper articles that depicted pushers hovering by the schoolhouse door turning children into “addicts.” These stories popularized spurious notions about the drug that lingered for decades. Law enforcement officials, too, trafficked in the “assassin” theory, under in which killers were said to have smoked cannabis to ready themselves for murder and mayhem.

1778. Marijuana: Repeal, Prohibition, Again

By The Editorial Board, The New York Times, July 27, 2014

It took 13 years for the United States to come to its senses and end Prohibition, 13 years in which people kept drinking, otherwise law-abiding citizens became criminals and crime syndicates arose and flourished. It has been more than 40 years since Congress passed the current ban on marijuana, inflicting great harm on society just to prohibit a substance far less dangerous than alcohol.

The federal government should repeal the ban on marijuana.

We reached that conclusion after a great deal of discussion among the members of The Times’s Editorial Board, inspired by a rapidly growing movement among the states to reform marijuana laws.

There are no perfect answers to people’s legitimate concerns about marijuana use. But neither are there such answers about tobacco or alcohol, and we believe that on every level — health effects, the impact on society and law-and-order issues — the balance falls squarely on the side of national legalization. That will put decisions on whether to allow recreational or medicinal production and use where it belongs — at the state level.

We considered whether it would be best for Washington to hold back while the states continued experimenting with legalizing medicinal uses of marijuana, reducing penalties, or even simply legalizing all use. Nearly three-quarters of the states have done one of these.

But that would leave their citizens vulnerable to the whims of whoever happens to be in the White House and chooses to enforce or not enforce the federal law.

The social costs of the marijuana laws are vast. There were 658,000 arrests for marijuana possession in 2012, according to F.B.I. figures, compared with 256,000 for cocaine, heroin and their derivatives. Even worse, the result is racist, falling disproportionately on young black men, ruining their lives and creating new generations of career criminals.

There is honest debate among scientists about the health effects of marijuana, but we believe that the evidence is overwhelming that addiction and dependence are relatively minor problems, especially compared with alcohol and tobacco. Moderate use of marijuana does not appear to pose a risk for otherwise healthy adults. Claims that marijuana is a gateway to more dangerous drugs are as fanciful as the “Reefer Madness” images of murder, rape and suicide.

There are legitimate concerns about marijuana on the development of adolescent brains. For that reason, we advocate the prohibition of sales to people under 21.

Creating systems for regulating manufacture, sale and marketing will be complex. But those problems are solvable, and would have long been dealt with had we as a nation not clung to the decision to make marijuana production and use a federal crime.

In coming days, we will publish articles by members of the Editorial Board and supplementary material that will examine these questions. We invite readers to offer their ideas, and we will report back on their responses, pro and con.

We recognize that this Congress is as unlikely to take action on marijuana as it has been on other big issues. But it is long past time to repeal this version of Prohibition.