Doctors For Life International (DFL) is concerned about the way news reporting on the Medical Innovations Bill keeps presenting the issue of 'medical marijuana' to the public. These reports pose the danger of confusing critical issues in the debate to legalise cannabis for medicinal use.
Actually there is no such thing as 'medical marijuana'; that is, there is not a particular type of marijuana/dagga used for medicinal purposes, let alone for specific medicinal purposes. Conflating marijuana with isolated cannabinoids misunderstands the scientific literature and confuses physicians, policy makers and patients. The medical marijuana movement was created to blur the regulatory and legal boundaries. In most states in the USA with medical marijuana laws, the vast majority (>90%) of those holding registry cards are young males with vague 'pain' or sleep problems. Their profile is not representative of a patient in need of compassionate medicine such as at end stage cancer or Aids, as was initially sold to the public.
Whereas DFL is not against the use of using herbs in their whole state for medicinal purposes, the case with dagga or Cannabis Sativa is different. We know for a fact that amongst the +/- 700 molecules in the cannabis plant there are some very harmful substances which cause serious, permanent brain damage on their own, or in combination with other substances in the plant. The effects of smoking or ingesting the whole cannabis plant have certain harmful effects on the body as a whole, such as the lungs, reproductive system and brain development in unborn babies etc.
Negative effects on the executive functions of the brain can be divided into those experienced during the phase of acute intoxication; those associated with the 21 days following ingestion and those that are considered long term.
The negative effects on executive functions that can last up to 21 days after smoking include: poor decision making, poor concept formation and planning deficits.
What is of especially grave concern are the long term / permanent impairment in executive functions of the brain. Adolescent long term use is associated with significant reduction in IQ measured at 38 years, reduced motivation and increased prevalence of psychoses and schizophrenia later in life.
A recent article by the National Institute of Drug Addiction in the USA voiced concern that the spread of marijuana through the medical or legalisation route, is troublesome in view of the growing evidence of adverse effects of cannabis including: addiction, poor school performance, memory impairment, compromised lifetime achievement, gateway drug effects, plus risks of cancer and motor vehicle accidents. No other prescription drug has this peculiar combination of risk factors.
There is strong scientific support for concluding that adequate assurances regarding whether whole plant dagga can be safely used under medical supervision, are lacking. The psychoactive effects of cannabis present a significant ethical obstacle to designing double-blinded clinical trials on the plant as a whole. In addition, the only indications for the medical use of dagga offered by its proponents, have been for chronic conditions which imply long term use, which does the most harm. Added to this is the fact that the THC (delta-9th- tetrahydrocannabinol) levels vary from <1% to >30%. It varies from strain to strain; from plant to plant; is affected by the water supply; the time of the year when harvested; the soil quality; the light quality; microbial environment; mineral content of the soil; fertilizer and pesticides used - and even by how long the plant has lain after harvest before it was processed. In the case of being smoked, it is also influenced by the concentration of Cannabidiol (CBD) and dosages depend on the depth of inhalation and the length of time the smoke is retained in the lungs before exhaling.
Physician recommendations for medicinal use of smoked cannabis (obtained in a dispensary) are not grounded on systematic, evidence-based research - which is the hallmark of our health system
THC is the most active constituent of cannabis that has been produced synthetically and is available as Dronabinol or Nabilone or Cesamet (a synthetic cannabinoid to THC).
Sativex which contains THC and CBD in a 1:1 equal amount combination is currently approved in the UK, plus several European countries and - Canada and is in the fast track false III studies to be registered with the FDA in the USA.
A Cannabidiol (CBD) based drug called Epidiolex has recently been developed for childhood epilepsy.
In a clinical trial comparing the effects of smoked dagga with Dronabinol (THC alone) under controlled conditions, marijuana and Dronabinol both decreased pain, but Dronabinol produced longer lasting decreases in pain sensitivity - and lower ratings of abuse-related subjective side effects
Consequently, Doctors For Life International is of the opinion, with other experts, that if there is any future in dagga as medicine, it lies in its isolated components: the cannabinoids and their synthetic derivatives.
View the online version: http://www.doctorsforlife.co.za/pg/conflating-marijuana-plants-with-isolated-cannabinoids/
Doctors for Life International represents more than 1500 medical doctors and specialists, three-quarters of whom practice in South Africa. Since 1991 DFL has been actively promoting sound science in the medical profession and health care that is safe and efficient for all South Africans. For more information visit: http://www.doctorsforlife.co.za