Using Marijuana to Treat Pain? A Pill May Outlast a Puff

Study shows a pill containing THC lasts longer and may be safer than smoking pot

By Brenda Goodman

HealthDay Reporter

MONDAY, April 22 (HealthDay News) -- A pill may work as well as a puff when it comes to using marijuana to treat pain, according to a small but carefully controlled new study. Pain relief from pills may last longer, however, and may not leave people feeling as high as they do after they smoke the drug.

Medical marijuana is now legal in 18 states and the District of Columbia, according to the nonprofit group ProCon.org. Surveys show pain is one of the main reasons doctors prescribe it. But studies testing marijuana as a pain reliever have had mixed results. Some have shown that it works as well as mild opioid (narcotic) pain relievers like codeine, while others have indicated that the drug might actually make pain worse.

To learn more, researchers at the Substance Use Research Center of the New York State Psychiatric Institute pitted two strengths of smoked marijuana against two strengths of the drug dronabinol, which contains tetrahydrocannabinol, or THC, the same active ingredient as in marijuana plants.

Dronabinol has been FDA-approved since 1985 to treat the nausea and loss of appetite that commonly afflict patients with cancer and AIDS. Less is known about its effects on pain.

For the government-sponsored study, researchers recruited 30 healthy, pain-free men and women who were already regular marijuana smokers.

During five experimental sessions, participants took a capsule and then 45 minutes later smoked a marijuana cigarette. The capsules contained either an inactive placebo, or 10 milligrams or 20 milligrams of dronabinol. The cigarettes were specially made by the U.S. National Institute on Drug Abuse, which funded the study. Cigarettes were standardized to contain marijuana with no THC, a low dose of the drug or a higher dose.

People in the study never knew whether they were smoking or swallowing the drug or how strong the dose was. Researchers made sure they never got a double hit of the drug during the same session.

The testing days were spaced at least two days apart, and participants were asked to refrain from smoking the night before their lab visits.

Several times during the sessions, researchers had each person place their hands in a water bath kept just above freezing temperatures. They measured how long it took study participants to feel pain and then how long they were able to tolerate the pain before they yanked their hand out of the water. Participants also answered questions about how intensely they felt the pain during the experiments and how high they felt.

When researchers tallied their data, they found that both the smoked drug and the pill were about equally effective at controlling pain.

After smoking the strongest cigarettes or taking the highest strength of the pill, it took people an average of about 12 to 13 seconds longer to report feeling pain from the cold water compared to when they took the placebos. Both forms of the drug also significantly increased pain tolerance, the amount of time a person was able to stand the pain before they pulled their hand out of the cold water.

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Most Docs OK With Medical Marijuana: Survey

Majority would give a prescription to an advanced cancer patient in pain

By Serena Gordon

HealthDay Reporter

WEDNESDAY, May 29 (HealthDay News) -- Three-quarters of doctors who responded to a survey about medical marijuana said they would approve the use of the drug to help ease pain in an older woman with advanced breast cancer.

In a February issue of the New England Journal of Medicine, doctors were presented with a case vignette, as well as arguments both for and against the use of medical marijuana. Doctors were then asked to decide whether or not they would approve such a prescription for this patient.

The results now appear in the May 30 edition of the journal.

Seventy-six percent of the 1,446 doctors who responded said they would give the woman a prescription for medical marijuana. Many cited the possibility of alleviating the woman's symptoms as a reason for approving the prescription.

"The point of the vignette was to illustrate the kinds of patients that show up on our doorstep who need help. This issue is not one you can ignore, and some states have already taken matters into their own hands," said Dr. J. Michael Bostwick, a professor of psychiatry at the Mayo Clinic in Rochester, Minn.

Bostwick wrote the "pro" side for the survey, but said he could've written the "con" side as well, because there are valid arguments on both sides of the issue.

"There are no 100 percents in medicine. There's a lot of anecdotal evidence that this is something we should study more. Forgive the pun, but there's probably some fire where there's smoke, and we should investigate the medicinal use of marijuana or its components," Bostwick said.

Marijuana comes from the hemp plant Cannabis sativa. It's a dry, shredded mix of the plant's leaves, flowers, stems and seeds. It can be smoked as a cigarette or in a pipe, or it can be added to certain foods, such as brownies.

The case presented to the doctors was Marilyn, a 68-year-old woman with breast cancer that had spread to her lungs, chest cavity and spine. She was undergoing chemotherapy, and said she had no energy, little appetite and a great deal of pain. She had tried various medications to relieve her pain, including the narcotic medication oxycodone. She lives in a state where the use of medical marijuana is legal, and asks her physician for a prescription.

Dr. Bradley Flansbaum, a hospitalist at Lenox Hill Hospital, in New York City, said he sided with the majority for this particular case.

"I think there's some context that needs to be considered," Flansbaum said. "This was a woman with stage 4 cancer who wasn't responding to [anti-nausea medications]. I'm not saying let's legalize marijuana, but this is a woman at the end of her life, so what's the downside, given that there might be a benefit. In a different situation, medical marijuana might not be so well embraced."

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Kids Poisoned by Medical Marijuana, Study Finds

Children helping themselves to drug-laced cookies, brownies

By Steven Reinberg

HealthDay Reporter

MONDAY, May 27 (HealthDay News) -- Legalizing marijuana may have unintended consequences. Since medical marijuana was legalized in Colorado, more than a dozen young children have been unintentionally poisoned with the drug, researchers report.

About half the cases resulted from kids eating marijuana-laced cookies, brownies, sodas or candy. In many cases, the marijuana came from their grandparents' stash, the investigators said.

"We are seeing increases in exposure to marijuana in young pediatric patients, and they have more severe symptoms than we typically associate with marijuana," said lead researcher Dr. George Sam Wang, a medical toxicology fellow at the Rocky Mountain Poison and Drug Center in Denver.

But doctors aren't familiar with marijuana poisoning in children, so unless the parents are forthcoming it can take time and tests to diagnose the problem, Wang said. Symptoms of marijuana poisoning in children include sleepiness and balance problems while walking.

"We hadn't seen these exposures before the big boom of the medical marijuana industry," Wang said.

The active chemical in marijuana, tetrahydrocannabinol, is in higher than normal concentrations in medical marijuana, and often is sold in baked goods, soft drinks and candies, the researchers said in the study, which was published online May 27 in the journal JAMA Pediatrics.

"We are seeing more symptoms because some of these products have very high amounts of marijuana in them," Wang said. "You get such a high dose on such a small child, the symptoms are more severe."

As with many similar poisonings, treatment is limited to supportive care and waiting until the marijuana clears the system, he said.

Children recover quickly in most cases, Wang said. "They don't need more than a day or two of hospitalization," he said. "There were no deaths or lasting side effects."

This report stems from one Denver hospital, and Wang said he doesn't know how extensive the problem is elsewhere. Colorado adults are allowed to possess up to 1 ounce of marijuana or six marijuana plants, according to the study. And Denver issued more than 300 sales tax licenses for marijuana dispensaries in 2010.

For the study, Wang's team compared the number of children treated in the emergency room for marijuana poisoning before and after the law was enacted in October 2009.

In all, almost 1,400 children under 12 were evaluated for accidental poisonings in this one hospital -- 790 before Sept. 30, 2009, and 588 after that.

After decriminalization, 14 children -- mostly boys and some as young as 8 months -- were found to have ingested marijuana. Eight had consumed medical marijuana, and seven ate marijuana in foods. Two were admitted to the intensive care unit.

Before Sept. 30, 2009, none of those possible poisonings was attributed to marijuana, the researchers found.

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Medical Marijuana: Voodoo or Legitimate Therapeutic Choice?

By Barbara Bronson Gray

HealthDay Reporter

WEDNESDAY, Feb. 20 (HealthDay News) -- Imagine a 68-year-old woman with advanced breast cancer, looking for a better way to ease her chronic pain, low appetite, fatigue and nausea. Should she or shouldn't she be prescribed marijuana?

That's the question physicians debate in the "Clinical Decisions" section of the New England Journal of Medicine released online Feb. 20.

According to the hypothetical case study in the journal, a woman named Marilyn has metastatic breast cancer that has spread to her lungs and spine. She's taking chemotherapy and two anti-nausea drugs that just aren't working. Despite taking 1,000 milligrams (mg) of acetaminophen, such as Tylenol, every eight hours, she's in pain. At night, she sometimes takes 5 to 10 mg of oxycodone, a narcotic pain reliever similar to morphine, to help relieve the pain so she can sleep.

Marilyn lives in a state where marijuana is legal for personal medicinal use, and her family stands ready to grow it for her.

Why not let Marilyn try it?

One reason not to, in the view of one of the "con" argument's authors, Dr. Robert DuPont, is that it probably wouldn't help her. "Although marijuana probably involves little risk in this context, it is also unlikely to provide much benefit," said DuPont, a clinical professor of psychiatry at Georgetown Medical School in Washington, D.C., and the first director of the National Institute on Drug Abuse under Presidents Nixon, Ford and Carter.

Marijuana is a dry, shredded mix of flowers, stems, seeds and leaves of the hemp plant Cannabis sativa. People usually smoke it as a cigarette or in a pipe. It's the most commonly abused illegal drug in the United States, according to the U.S. National Library of Medicine.

In an interview, DuPont said that because smoked marijuana has not been reviewed and approved by the U.S. Food and Drug Administration for safety, effectiveness and purity, it would be inappropriate for a physician to prescribe it. "It would divert the attention away from an effective medical treatment and get her into something that's at best voodoo," he said.

The cannabis (marijuana) plant contains hundreds of pharmacologically active compounds that could interact with the medications Marilyn's now taking, DuPont said. It's impossible to know the chemical make-up or potency of a given dose, he noted, adding, "Medical marijuana has no dose. There is nothing else in medicine like that."

DuPont said it's also uncertain how Marilyn might react to the experience of smoking marijuana. He said the drug could affect her ability to think effectively. And just the act of smoking, coupled with the impact of the cancer on her lungs, could reduce her ability to get oxygen to her brain, he added.

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Recreational Marijuana: Are There Health Effects?

Dec. 11, 2012 -- On Monday, Colorado Gov. John Hickenlooper signed an order legalizing recreational marijuana use for adults.

Last week, Washington was the first state to OK adult recreational use of the drug. Several other states are considering similar laws.

While much research has focused on the value of medical marijuana to help chronic pain and other problems, what about the health effects of purely recreational marijuana?

WebMD turned to two experts, recently published studies, and the National Institute on Drug Abuse to draw up a scorecard of possible major health effects.

"Putting smoke in your lungs is not good for the lungs," says Roland Lamarine, HSD, professor of public health at California State University, Chico. He reviewed published studies on the health effects of marijuana earlier this year for the Journal of Drug Education.

Smoking marijuana produces a nearly threefold increase of inhaled tar compared with tobacco, according to some studies. Other research suggests that marijuana smokers, compared to cigarette smokers, inhale more deeply and hold their breath longer.

"There are still questions that aren't answered about lung damage," Lamarine says. For cigarette smokers who also smoke marijuana, there may be an additive effect, he says.

Combining the two appears to be a trend, he says. "Some of the [college] kids tell me they buy cigars and put in some marijuana, so there is both marijuana and tobacco," Lamarine says.

Marijuana smoke contains cancer-causing substances, according to the National Institute on Drug Abuse. Some research shows that marijuana smoke has up to 70% more cancer-causing substances than tobacco smoke, it says.

"Nobody is advocating that routinely inhaling carcinogenic smoke is healthy," says Paul Armentano, the deputy director of NORML (National Organization for the Reform of Marijuana Laws).

However, he says, many marijuana users these days have turned to alternate delivery methods, such as oral, tinctures, and vapor forms. In research, he says, the vaporized forms have fewer adverse chemicals than the inhaled form.

Those who keep marijuana use light do not appear to lose lung function, according to a 2012 study in the Journal of the American Medical Association.

Researchers compared tobacco and marijuana users. Tobacco use was associated with lower lung function, and the function got worse as smoking levels increased.

For the study, low levels of lifetime exposure to marijuana, defined as one joint a day for seven years, did not show evidence of adverse effects on lung function. The study does not confirm these findings with heavy users.

Long-term, heavy use of marijuana can lead to impaired thinking skills and memory problems, Lamarine says, citing published studies.

The impairments can be especially hazardous when trying to do everyday activities such as driving.

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Teen Marijuana Use Remains at All-Time High

By Rita Rubin
WebMD Health News

Dec. 19, 2012 -- A new survey shows marijuana use by teens remains high, and officials say it will probably increase as a result of Washington and Colorado decriminalizing the drug last month.

“Based on what we know ... we are predicting that it’s going to go up,” says Nora Volkow, MD, director of the National Institute on Drug Abuse. “Just the fact that there are some states that have made it legal ... will send a message” to teens throughout the country.

Already, the proportion of teens who consider marijuana to be harmful is the lowest it’s been in decades, according to the 2012 “Monitoring the Future” survey of eighth, 10th, and 12th graders. The annual survey of teen drug use is conducted by researchers at the University of Michigan.

The survey's silver lining is that it shows the use of illicit drugs, alcohol, and cigarettes is declining.

Still, about 70% of eighth graders said they thought regular use of marijuana was harmful, while about 42% said they considered occasional use harmful. Those rates are the lowest since the survey began asking eighth graders that question in 1991.

Among 12th graders, the proportion who said regular use was harmful was about 44%, occasional use, about 21%. Those are the lowest rates since 1979 and 1983, respectively.

The survey shows that 6.5% of high school seniors said they smoke marijuana daily, which is about the same as last year but up from 5.1% five years ago.

Use of synthetic marijuana, known as K-2 or Spice, was stable in 2012, with slightly more than 11% of high school seniors reporting they had used it in the past year, the survey shows.

Teens who think marijuana is safe to use are mistaken, Volkow says. “I think that the data are quite clear that smoking marijuana during adolescence is harmful to your brain.”

A National Institutes of Health-funded study, published in August in the Proceedings of the National Academy of Sciences, found a significant drop in IQ -- an average of eight points -- between the ages of 13 and 38 in people who had been heavy marijuana users since their teens. Even those who quit using the drug showed impaired mental abilities if they had started smoking marijuana in their teens.

“Findings are suggestive of a neurotoxic effect of cannabis on the adolescent brain and highlight the importance of prevention and policy efforts targeting adolescents,” the researchers concluded.

Washington and Colorado voters approved measures legalizing possession of up to an ounce of marijuana by people 21 and older. Washington’s law went into effect Dec. 6, while Colorado’s is set to become effective Jan. 5. Medical use of marijuana is legal in 18 states and the District of Columbia.

Although marijuana is illegal under federal law, President Obama told ABC’s Barbara Walters in a Dec. 11 interview that going after recreational users in states where marijuana is legal should not be a “top priority” of federal law enforcement officials.

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Fake Marijuana Use Is a Serious Problem for Teens

ByDenise Mann
WebMD Health News Reviewed byLouise Chang, MD

Dec. 4, 2012 -- Close to 11,500 people were treated in emergency rooms in 2010 for nausea, vomiting, dizziness, and other symptoms related to the use of synthetic or fake marijuana products such as "K2" or "Spice."

Three-quarters of these people were aged 12 to 29, and 78% in this group were male. Most did not receive follow-up care after they were sent home from the ER.

The new data were released by the Substance Abuse and Mental Health Services Administration (SAMSHA), as part of their Drug Abuse Warning Network. There were 2.3 million ER visits involving drug misuse or abuse in 2010, and of these, 11,406 involved fake marijuana products.

What Is Synthetic Marijuana?

Synthetic marijuana is marketed to have marijuana-like effects in the brain.

"Spice,” “K2,”  “Mr. Smiley,” “Red X Dawn,” and “Blaze” are just some of the street names for synthetic marijuana drugs.

Until July 2012, they were available online and in convenience stores. Then the Drug Enforcement Administration (DEA) stepped in and banned five chemicals found in Spice and K2. This does still leave some wiggle room for creative manufacturers.

“I believe people are still able to get these products in different ways,” says Rear Admiral Peter Delany, PhD. He is the director of the Center for Behavioral Health Statistics and Quality at SAMSHA in Rockville, Md. “You can ban chemicals, but if manufacturers modify the chemical format, they are no longer on the banned list.”  

The group plans to have some data available next year as to what has happened since the DEA’s ban.

Until then, parents need to understand what fake marijuana products are and the lingo that kids use to discuss these substances.

“This is a drug and it can have repercussions, especially if it is mixed with other things,” Delany says.  

According to the new report, in almost 60% of emergency room visits involving synthetic marijuana in people ages 12-29, no other substances were involved.

Symptoms of fake marijuana use may include:

Agitation Anxiety Nausea Vomiting Paranoia Seizures Hallucinations Increased heart rate and blood pressure Tremors

“Kids are coming in intoxicated with nausea and dizziness more frequently than in the past, and synthetic marijuana is something that we consider when we see these symptoms,” says Robert Glatter, MD, an emergency medicine doctor at Lenox Hill Hospital in New York City. “They present in ways that you would think they were using mind- or mood-altering substances.”

These products can’t be detected on drug screens, which is why some kids are drawn to them and why it is challenging to capture solid information on their use and abuse, he says.

Paul Hokemeyer, PhD, says fake marijuana use is a real crisis. He is a therapist at Caron Treatment Center's New York City Office.  “Adolescent boys are always looking for new ways to get high.” Here,  “they get high off of toxic chemicals, and this may have long-term risks,” he says. “We don’t know what they are putting into their body.”

View Article Sources

SOURCES:

Rear Admiral Peter Delany, PhD, director, Center for Behavioral Health Statistics and Quality (CBHSQ), SAMSHA, Rockville, Md.

Robert Glatter, MD, emergency medicine dcotor, Lenox Hill Hospital, New York City.

Paul Hokemeyer, PhD, therapist, Caron Treatment Center, New York City.

SAMSHA: "The Dawn Report."

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