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A Blunt Force to Crush Floridians’ Opposition to Marijuana

March 2, 2016 - 12:30pm

The well-funded movement to medicalize marijuana spreading across our nation calls out for caution and restraint. Activists claim that marijuana is a safe medicine but de facto, it is evolving into a gateway for marijuana legalization. The claim conflicts with current science, with intelligent public health policy, with rigorous standards of the drug approval process, and with best practices of medicine.

In 2014, Floridians wisely rejected legalization of marijuana as a medicine by their votes on a ballot initiative.  This sensible outcome was shaped by enough funds to educate the public on the realities of this critical issue and to counter misinformation circulating in Florida. But once again, the persistent marijuana industry is knocking on the gates of Florida, this time through legislative action in the Florida state House.
 
Florida Senator Rob Bradley, R-Orange Park, recently introduced an amendment to Florida Bill SB 460. In its original form, the bill limits the potency THC, of the main psychoactive, intoxicating, and addictive substance in marijuana, to 0.8%.  The spirit of the bill was to provide access to cannabidiol, a candidate anti-seizure medication that has been essentially bred out of most of the marijuana sold in dispensaries nation-wide. Cannabidiol is not intoxicating, is not addictive, does not interfere with learning and memory, and may even oppose the psychosis induced by THC in susceptible people.  In its original language, the bill allows for “low-THC cannabis”, the dried flowers of which contain 0.8 percent or less of tetrahydrocannabinol (THC), the main psychoactive and addictive component of marijuana and more than 10 percent of cannabidiol (CBD).
 
The Bradley amendment is a “Hail Mary pass” or a “cloaking device” or a “stealth bomber” –choose your metaphor. It is a furtive attempt to circumvent the decision of sage Florida voters who turned down the medical marijuana ballot initiative in 2014. The original bill wisely set THC levels at 0.8%, which are not generally intoxicating. Instead of referring to low-THC-cannabis, the amendment (line 35 onwards) now refers to low-THC cannabis and/or medical cannabis. By not defining medical cannabis, nor stating limits on THC doses, it opens the floodgates to “anything goes” – unspecified THC levels in marijuana that may range from 0.8 percent to 80 percent.  In its current amended form, SB 460 creates a marijuana industry, allowing high potency marijuana and marijuana edibles (cookies, sodas, candy), which are inherently hazardous and without any scientific evidence of medical safety or effectiveness.
 
To circumvent FDA experts and the process, the marijuana industry and their advocates devised ballot or legislative initiatives, flooded public media, engaged in extensive lobbying of legislative bodies, with scientifically barren emotional claims. Whole plant marijuana as a medicine is not approved by the Food and Drug Administration (FDA), as the evidence is insufficient to fulfill rigorous criteria for approval. To weigh the scientific evidence within the legitimate drug approval process, the FDA convenes an expert team of chemists, pharmacologists, physicians, other scientists, statisticians who study thousands of pages of scientific data, before a decision is made to approve a drug and provide surveillance after approval. This effective and rigorous scientific process is reflected in physician and patient packet inserts of prescription drugs – they include the precise chemical composition of a drug that a patient will introduce into their body, how often to use it, evidence-based safe doses, how frequently it should be taken, what types of studies were used to show the drug’s effectiveness for a specific condition, how long it takes to have an effect and stay in the body, how the body metabolizes the drug, drug interactions, who should/should not use the drug, a list of unwanted side effects and what proportion of people manifest them, adverse events, and precautions, and other information. This type of document does not exist in marijuana dispensaries.  If a false claim is made or an adverse effect sets in, who will protect the public? If a pharmaceutical company makes a false claim for an approved drug, the FDA sweeps in and fines them. It has extracted over $10 billion from drug companies in the past few years for unapproved claims. If adverse events rise to unacceptable levels, the FDA can restrict use of the drug, or label the drug with a severe “Black Box” warning, or withdraw the drug. These protections don’t exist for marijuana; there is no recourse for patients. 
 
Why is whole plant marijuana not approved? Concerns focus on abuse liability, safety and effectiveness.

Abuse liability. Marijuana has high abuse potential, no currently approved medical use and is considered unsafe. At least 4.2 million Americans have a cannabis (marijuana) use disorder, with about 30.5 percent of current marijuana users harboring this problem. Long-time heavy users can experience a robust withdrawal, reflecting adaptive changes in the brain and body caused by the drug. Shortly after use, marijuana intoxicates and impairs higher brain functions, learning, memory, planning, and decision-making. Driving skills are reduced and the risk for injuries increases. Functioning at school or at work is compromised, especially because marijuana takes so long to clear from the body, days to weeks, and much longer compared with an alcohol binge. Complex human performance can be impaired as long as 24 hours after smoking a moderate dose of marijuana and the user may be unaware of the drug's influence. For 7 to 20 days, abstinent marijuana users may have impaired attention, concentration and impulse control. The most robust, durable deficits are documented in heavy, steady marijuana users. Even after one month of withdrawal, daily, heavy marijuana smokers can manifest impaired higher brain functions. Yet the indications for marijuana are for chronic medical conditions, requiring daily or more frequent use.

Safety. There is a strong association between marijuana use and psychosis or schizophrenia, in at least four ways: (1) marijuana can produce transient schizophrenia-like symptoms in some healthy individuals; (2) in those harboring a psychotic disorder, marijuana may worsen the symptoms, trigger relapse, and negatively affect the course of the illness; (3)  susceptible individuals in the general population develop a psychotic illness with heavy marijuana use, which is associated with age of onset of use, strength of THC in marijuana,  frequency and duration of use; (4) marijuana use is associated with lowering the age of onset of schizophrenia. Among youth, marijuana use is associated with poor grades and with high school drop-out rates, with those dropping out of school engaging in high rates of frequent marijuana use. Early use of heavy marijuana is associated with lower income, lower college degree completion, greater need for economic assistance, and higher unemployment.  In sum, marijuana use is associated with an increased risk of degraded brain function, increased motor vehicle crashes, emergency department visits, psychiatric symptoms, reduced educational and employment achievement, reduced motivation, increased use of, and addiction to other drugs, and adverse health effects on the developing fetus.
 
Effectiveness. The FDA is not the only body that has questioned the effectiveness of marijuana. Non-government academic physicians and scientists have extensively scrutinized biomedical research (meta-analyses) on the use of whole plant marijuana for medical indications. Independently, they have concluded that there is scant, inadequate or no evidence that whole plant medicine is valuable as a first line treatment for a myriad of medical conditions claimed by the marijuana lobby.  For edibles, rigorous evidence is at zero or near-zero levels. Indeed, many specialty medical associations (Neurology, Psychiatry, Ophthalmology, Pediatrics) do not endorse marijuana as a medicine.
 
Clearly, this collective information impacts the amended Florida bill! First, the amendment places no limits on THC concentration, and does not address marijuana potency to be used for a single medical condition. No potency limits for chronic conditions are incompatible with growing evidence that the stronger the marijuana and the more frequently it is used, the more likely (1) for symptoms of psychosis to appear, (2) for reduced age of onset of schizophrenia, (3) for increased impairment of driving and brain function. Second, in chronic medical conditions, daily and more frequent use of marijuana is likely and this will increase the many risks outlined above.  Third, the amendment is vague on who can use, at what dose and for which specific diseases or symptoms. Yet, the more frequently marijuana is used and the longer the period of use, the more likely (1) for susceptible persons to become addicted to marijuana; (2) to become addicted to other drugs; (3) to sustain a reduction in I.Q.; (4) to be on welfare and unemployed; (5) to have psychotic episodes; and (6) to be less likely to complete high school or college.  
 
The Bradley amendment, whether intended or not, is likely to set Florida on a well-trodden path to legalization of marijuana. Its current objective is to normalize and legalize distribution of potent, intoxicating marijuana as a medicine, in the absence of solid medical evidence.  If it passes, the safeguards in the amended bill will not protect the public from an inevitable march towards unfettered access to, and de facto legalization of marijuana. The bill has little to do with compassionate use of marijuana for health, as open-ended THC doses have no scientific basis in medicine. But it will ensure that high potency marijuana becomes available to the public at large, inevitably spreading to youth, the real target of the marijuana industry. Early onset of marijuana use greatly increases the risk of becoming addicted to marijuana and to other drugs. Efforts to shield youth from marijuana have failed in states with “medical marijuana” laws as in these states, youth use marijuana more than in nonmedical marijuana states. 
 
This amendment ignores the FDA, ignores meta-analyses completed by independent biomedical researchers, ignores the policy statements of reputable medical associations, and ignores current marijuana science.  In 2014, Floridians wisely voted not to accept THC-laden marijuana as a “medical option”. Senator Bradley’s current amendment maneuvers the bill around the will of the people. Above all, this bill ignores the voters of Florida and the democratic process.  Floridians should protest this amendment, a blunt force to suppress their opposition to marijuana.
 
Bertha K. Madras is a professor at Harvard Medical School.
 

Comments

A belief that the U.S. government holds a patent for medical marijuana is an example of scientific imprecision that obfuscates the national debate on the uses of marijuana as medicine. Advocates for marijuana as medicine, including the media reporter Dr. Sanjay Gupta, refer to U.S Patent No. 6,630,507 as evidence of government hypocrisy on marijuana. The patent in question, “Cannabinoids as Antioxidants and Neuroprotectants” is assigned to the U.S. government (HHS) on behalf of three inventors serving at that time at the National Institutes of Health: Aidan J. Hampson, Julius Axelrod (a Nobel laureate) and Maurizio Grimaldi. The issued patent was published Oct 7 2003, with a priority date of 1998. A primer on patent claims. Claims are the heart of a patent. Patents protect inventions listed in the patent claims, which precisely define the limits and scope of what patent covers and protects. If a substance is not listed in the claims, the patent does not protect the substance. The patent holder has the right to exclude others from making, using or selling those things which are described by the claims. Patent Claims in U.S. Patent No. 6,630,507. The US government does not hold a patent for marijuana as a medicine. This U.S. patent makes a number of claims but marijuana and THC are not among them. The claims do not mention marijuana nor are most of the claims based on cannabinoids found in the marijuana plant. Marijuana cannot be used interchangeably with the term cannabinoid. It focuses not on unprocessed botanical marijuana but on individual cannabinoids, the majority designed by chemists. The inventors of this U.S. government patent did not patent medicinal uses of whole plant marijuana, nor its most prominent cannabinoid, THC, because they explicitly chose to avoid their undesirable, unacceptable psychoactive and psychotoxic effects, based on actions at cannabinoid receptors. Instead the patent claims unique novel cannabinoids designed and synthesized in laboratories but not found in nature, or cannabidiol made by the marijuana plant, or endocannabinoid derivatives made by the brain. Its focus is on non-psychoactive cannabinoids that act at different targets (receptors) than marijuana or THC. These cannabinoids are presumed to be neither psychoactive nor intoxicating, in contrast to marijuana and the cannabinoid THC. The claims are for specific neuroprotective and antioxidant actions, which are distinct from the majority of medical conditions currently embedded in state laws for using marijuana as a medicine. In contrast, most of the 750 chemicals, including some 104 different cannabinoids in the marijuana plant have not been interrogated individually. In summary, 1. Marijuana is not a claim of this invention. 2. The patent claims unique, single cannabinoids, not the mixture of 104 cannabinoids or 640 other chemicals found in the marijuana plant. 3. The patent specifically omits marijuana or THC because the inventions focus on single cannabinoids that are free of psychoactive or psychotoxic effects, and that are substantially non-toxic even at very high doses and without actions at cannabinoid receptors. Marijuana would not qualify as a claim, and is not claimed because it is psychoactive, psychotoxic at high doses, and acts primarily at cannabinoid receptors. THC, the most prominent cannabinoid in the marijuana plant is excluded and not claimed, for the same reason that marijuana is avoided. 4. Most of the newly designed compounds in the claims not produced by the marijuana plant. 5. The patent states that the “cannabinoid may be a cannabinoid other than THC” (the main cannabinoid in marijuana), and excludes “other potent cannabinoid receptor agonists”. As the cannabinoid receptor (CB1) is the mediator of psychoactive effects of marijuana and THC, and as THC is potent at this receptor, THC is also excluded. 6. The neuroprotective and antioxidant actions of listed cannabinoids in the claims are based on actions independent of cannabinoid receptors and without CB1 activity. De facto, marijuana and THC are excluded. Modern medicinal chemistry, biology and drug development focus on isolated or synthesized compounds for drug discovery and not on whole marijuana plant material. THC and CBD (cannabidiol) research has shown that these cannabinoids in the marijuana plant have opposite effects in the brain. 1. THC is intoxicating, psychoactive and addictive, can induce psychosis, anxiety, memory impairment and in some cases seizures. CBD is neither psychoactive nor addictive, does not impair memory, and may alleviate psychosis, anxiety and seizure activity, even antagonizing these THC-induced adverse effects. 2. THC principal targets are cannabinoid receptors, which the patent clearly states is not a desired biological target. CBD has very weak activity at cannabinoid receptors (affinity greater than 1,000 nM) and apparently acts on different brain receptors than THC. 3. From the perspective of medicinal properties, it is illogical to deliver two chemicals to the brain which produce opposite effects. 4. In peripheral organs, there are examples of CB2 receptors having beneficial functions in specific organs whereas CB1 receptors may be associated with disease processes. Yet THC targets both receptors with similar potency. Conclusion. Those who believe that the U.S. government holds a medical marijuana patent while simultaneously classifying marijuana in the most restrictive Schedule I category, use the term marijuana indiscriminately in referencing this patent. This allegation is mistaken because it disregards the primary claims of this patent. The contention that the U.S. government has patented medical marijuana is analogous to alleging that the inventors of the local anesthetic lidocaine, a cocaine derivative, patented the coca bush (Erythroxylum coca). A long time ago, with some examples dating to the 19th century, the structures of medicinal drugs were optimized from leads provided by plant products. Optimization resulted in pure, effective medications, dispensed at known doses. The same process is underway for the marijuana plant.

The point is that clearly cannabis has medicinal qualities and you have used a lot of time, energy and words to try to obfuscate that fact - why? No where in your diatribe do you address the hypocrisy or the apparent collusion to keep this plant at a schedule 1 classification which also prevents the FDA trials all of you prohibitionists scream for on a regular basis. Quite convenient if it is illegal to get the scientific evidence - dont you think? Yet you try and spin it to the fault of the people that want to have access to this "dangerous" drug. I would have thought that clear and ethical thinking would be part of a Harvard professor's MO, but it would appear that spin can happen in academia as easily as the mainstream media. It's a shame really. After journalists have lost their integrity, I guess it is now time for academia to sell out as well. The last safeguards against tyranny - journalists and educators are a dying breed. Sleep well madam professor you have argued for the tyranny of big pharma and a ignorant parent for a government. One last question - how many people has cannabis killed compared to all of the other "drugs" and substances on all the federal schedules combined? Your morality or lack there of does not and should not affect my freedom of choice in any policy, but especially this one.

The Florida legislature demonstrated this week that they are ready to lead on medical cannabis and that Florida does not need to rely on intellectual Carpetbaggers from Massachusetts. Just like nearly half of the states in this country, Florida has recognized that it is time to offer relief to the patients suffering here. Feel free to purse a Fool's Errand, but the tide has turned on the perception of cannabis as a medicine. Lead or get out of the way. For an optimistic and forward-looking view of medical cannabis refer to the conference coming up next month in Baltimore titled "Cannabis: A Botanical Medicine" See patientsoutoftime (dot) org for more information.

Junk science! The only research for decades has been junk science, because the only outcomes that were acceptable were negative ones. And any "Scientist" who doesn't acknowledge that is not worthy of the title. While it is not the cure all pro-cannabis folks want it to be, it is nowhere as bad as you make it out to be. Twisting results to fit a pre-determined outcome is not acceptable.

Consider using your position to advance science for the common good and work to remove the administrative and legal obstacles that prevent truly open research on cannabis. An article in the journal Nature "Israel: Research without prejudice" 525, S12–S13 (24 September 2015) offers a look at a more open scientific culture. Having a political apparatus that controls the scientific process impedes progress.

If you want to ignore the hundreds of peer reviewed research on Pub Med which contradicts Dr. Madras's position then watch the YouTube video of 10 year old Alexis Bortell at the south west cannabis conference in Texas. (This website won't allow me to post the link)

1. The Federal government holds the patent on medical cannabis (U.S. 6630507), but “the U.S. government has held back the medical community’s ability to conduct the type of research that the scientific community considers the experimental gold standard in guiding medical practice” (Brookings, October 2015) 2. In 2014, Floridians did not “wisely vote” against medical marijuana; 57.6% of Florida voters were in favor of Amendment 2. 3. An October 2015 Quinnipiac poll found that 87% of Floridians support medical marijuana. 4. Madras was a Bush appointee serving as Deputy Director for Demand Reduction for the White House Office of National Drug Control Policy (2006 – 2008) (LinkedIn) 5. “Clearly, this collective information impacts the amended Florida bill!” A supposedly research-based article uses an exclamation point for emphasis? Really? Doesn’t this turn the corner to opinion, or even advocacy?

A second report in three months by the World Health Organization (WHO) on marijuana (the term widely used in the United States in legal government documents, legislative and ballot initiatives), or cannabis (the term used internationally) was issued March 3, 2016: “The Health and Social Effects of Nonmedical Cannabis Use”. (http://www.who.int/substance_abuse/publications/cannabis_report/en/). It echoes and provides more extensive information than the one published December 2015 “Update of Cannabis and its Medical Use”. (http://www.who.int/medicines/access/controlled-substances/6_2_cannabis_update.pdf ). More than 35 experts globally contributed to this report including people from each of these countries (number of people in parentheses): Australia (2), Canada (3), Sweden (1), U.S. (5), India (2), Mexico (1), United Kingdom (2), European Union (2), France (2), United Nations (1), China (1), Chile (1), Kenya (1), Morocco (1), Brazil (1), and WHO (10). Executive summary (verbatim) of their research from the biomedical literature is provided below: 9.1 What do we know? In summary there is less knowledge about the health and social effects of nonmedical cannabis use than about the use of alcohol and tobacco. On the basis of the current review by experts, the following conclusions of the known and unknown effects can be made. 9.1.1 What do we know about the neurobiology of cannabis use? We know the following: • CB1 receptors (which respond to THC) are widely distributed in the brain, including areas that control attention, decision-making, motivation and memory. • These receptors modulate the effects of a variety of other neurotransmitter systems. • Short-term and long-term cannabis use down-regulates these receptors in ways that may explain the short-term and long-term effects of cannabis on working memory, planning and decision-making, response speed, accuracy and latency motivation, motor coordination, mood and cognition. 9.1.2 What do we know about the epidemiology of cannabis use and cannabis dependence? We know the following: • Cannabis is the most widely used illicit drug globally. In 2013, an estimated 181.8 million people aged 15-64 years used cannabis for nonmedical purposes globally (uncertainty estimates 128.5–232.1 million). • Cannabis use appears to be more common in developed countries than in developing countries, although we lack good data on prevalence of use in the latter. • Young people often use cannabis, with the mid-teens being the age of first use in many developed countries. • There has been an upward trend in the mean THC content of all confiscated cannabis preparations in the USA and some European countries. • Cannabis dependence exists and is a cluster of behavioural, cognitive and physiological phenomena that develop after repeated cannabis use. There are some indications that the prevalence of cannabis dependence increased worldwide between 2001 and 2010. • There is a major demand for addiction treatment systems for cannabis-use disorders in many high-income countries and in some low- and middle-income ones. 9.1.3 What do we know about the short-term effects of cannabis use? We know the following: • The most obvious short-term health effect of cannabis is intoxication marked by disturbances in the level of consciousness, cognition, perception, affect or behaviour, and other psychophysiological functions and responses. • A minority of first-time cannabis users become very anxious, have panic attacks, experience hallucinations and vomit. These symptoms may be sufficiently distressing to prompt affected users to seek medical care. • Acute use impairs driving and contributes to an increased risk of traffic injuries. • There is some evidence that cannabis use can trigger coronary events. Recent case reports and case series suggest that cannabis smoking may increase CVD risk in younger cannabis smokers who are otherwise at relatively low risk. 9.1.4 What do we know about the long-term effects of regular cannabis use? We know the following: • Regular cannabis users can develop dependence on the drug. The risk may be around 1 in 10 among those who ever use cannabis, 1 in 6 among adolescent users, and 1 in 3 among daily users. • Withdrawal syndrome is well documented in cannabis dependence. • Growing evidence reveals that regular, heavy cannabis use during adolescence is associated with more severe and persistent negative outcomes than use during adulthood. • In a number of prospective studies there is a consistent dose-response relationship between cannabis use in adolescence and the risk of developing psychotic symptoms or schizophrenia. • The association between cannabis use and psychosis or schizophrenia has been recognized for over two decades in at least four ways: 1. Cannabis produces a full range of transient schizophrenia-like positive, negative and cognitive symptoms in some healthy individuals. 2. In those harbouring a psychotic disorder, cannabis may exacerbate symptoms, trigger relapse and have negative consequences on the course of the illness (Manrique-Garcia et al., 2014). 3. With heavy cannabis use, susceptible individuals in the general population develop a psychotic illness which is associated with age of onset of use, strength of THC in the cannabis, frequency of use and duration of use. 4. Cannabis use is associated with lowering the age of onset of schizophrenia. It is likely that cannabis exposure is a "component cause" that interacts with other factors to precipitate schizophrenia or a psychotic disorder, but is neither necessary nor sufficient to do so alone. Symptoms of schizophrenia increase with cannabis use and strength. The magnitude of the symptoms is associated with the amount used and the frequency of use. Daily use in adolescence and young adulthood is associated with a variety of negative health and psychological outcomes. These include: - early school-leaving - cognitive impairment - increased risk of using other illicit drugs - increased risk of depressive symptoms - increased rates of suicidal ideation and behaviour. It remains to be determined which of these associations are causal. o Long-term cannabis smoking produces symptoms of chronic and acute bronchitis, as well as microscopic injury to bronchial lining cells, but it does not appear to produce COPD. o Long-term heavy cannabis smoking can potentially trigger myocardial infarctions and strokes in young cannabis users. o Smoking a mix of cannabis and tobacco may increase the risk of cancer and other respiratory diseases but it has been difficult to decide whether cannabis smokers have a higher risk, over and above that of tobacco smokers. o There is suggestive evidence that testicular cancer is linked to cannabis smoking and this potential link should be investigated further. Other comments: 1. Bertha Madras does not hold any NIDA grant currently. 2. The majority of traditional medicines involved whole plants (e.g. foxglove, cinchona bark, belladonna), metals (mercury), blood-letting (cutting holes in veins and allowing blood to leave body), or trepanation (skull holes). Modern medicine has progressed beyond proven and unproven claims of traditional medicine. 3. Dsyregulation of endocannabinoids in anorexia nervosa: there is no clinical evidence that the partial agonist THC, acting at CB1 or CB2 receptors will alleviate this condition and speculation on whether marijuana is indicated is premature. There is controversy as to whether an FAAH polymorphism or different alleles in the CB1 receptor gene are implicated in subtypes of eating disorders (along with other signaling systems). CB1 up-regulation may or may not be an adaptive response to endocannabinoid availability 4. THC and nabilone are approved by the FDA for certain medical conditions. Nabiximols are approved in Europe and Canada). Whole plant marijuana is currently not FDA-approved. CBD is under investigation as an anti-seizure medication, and for other medical conditions. CBD, extracted from the marijuana plant, has markedly different effects than THC. The American Academy of Neurology (AAN) reviewed studies that met AAN quality standards. Studies with the best design produce the highest quality evidence. The available studies examined evidence for the safety and effectiveness of medical marijuana for these conditions: symptoms of multiple sclerosis (MS), temporary, uncontrolled movements as a drug side effect in Parkinson disease (PD), motor (movement) symptoms in Huntington disease (HD), tics in Tourette syndrome, cervical dystonia (abnormal neck movements), seizures in epilepsy. Of the studies examined, only two looked at smoked marijuana. The studies did not provide enough evidence to show if smoked marijuana is safe or effective. AAN examined the therapeutic effects of what can be deemed as the current state of modern medicine: oral cannabis extract (OCE), a pill made of either pure CBD or a combination of CBD and THC shows: There is strong evidence that OCE pills made from pure CBD can help lessen patients’ reported spasticity symptoms short-term. There is weak evidence that OCE and THC might lessen patients’ reported symptoms of spasticity if continued for at least one year or might lead to improvement on tests for spasticity a doctor performs, if treatment continued for at least one year. For people with Parkinson’s disease, moderate evidence shows that OCE pills likely do not help relieve abnormal movements caused by levodopa. For Huntington’s disease, Tourette Syndrome, Cervical Dystonia, Epilepsy there is not enough evidence to show whether medical marijuana in pill or oral spray form reduces motor symptoms in HD, relieves tic severity in Tourette syndrome, lessens abnormal neck movements in cervical dystonia, reduces how often seizures occur in epilepsy. The AAN states the following Important Concerns About Cannabis “The long-term safety of cannabis is unknown. Most of the studies were short in duration. More research is needed on complications from long-term use. These include serious psychological problems such as depression, suicidal thoughts, and psychosis. About one in every 100 people (or 1 percent of the population) will be affected. More research also is needed on the risk of lung cancer from long-term use of smoked cannabis. There are safety concerns about the use of cannabis. All cannabis products have side effects, and some can be serious. Side effects include: Difficulty with attention or concentration; Dizziness or fainting symptoms; Drowsiness or tiredness; Dry mouth; Feelings of intoxication; Hallucinations (seeing or hearing things that are not there); Impaired judgment or coordination; Increased spasticity; Increased weakness; Loss of balance and falls; Nausea, vomiting, and constipation; Psychological problems such as depression or psychosis; Thinking (cognition) and memory problems”.

Unless and until the scientific method can be used to investigate cannabis, period, we cannot claim to have done the due diligence necessary for genuine scientific inquiry. You know full well that interested investigators' hands are tied by arbitrary and capricious restrictions that prevent doing basic science around cannabis. Stop the nonsense. You know full well that cannabis is treated as a special case and scientists are being prevented from using the scientific method. Your credentials and citations mean nothing if you don't emphasize - up front - that science around cannabis is incomplete and politically controlled. That is not how science works and you know it.

The good name of Harvard impels me to rebut this indeed, bluntly partisan and incompletely considered attempt to justify the continued prohibition of cannabis. Note: The term “marijuana” is slang; one would expect Dr. Madras to employ the proper terminology. Her failure to do so is indicative of other failures in scope and attention to detail comprising her argument for the continued, oppressive prohibition of a relatively harmless plant. Her argument, in layman terms is, weed is bad, and if there is anything good in it at all, trust a pharmaceutical company to sell it to you in pill form. In fact, pretty much all of Dr. Madras’ “abuse liability” condemnation flies in the face of what is actually known by medical science today about cannabis, and which can be proven by millennia of use via ceremony, tradition, recreation, etc. The few, unreferenced, claims of cannabis’ deleterious effects on cognition, psychosis, decision-making, etc. may indeed have some validity when measured against a broad spectrum of possible harm, and yet the danger remains vastly below the negative consequences of countless pharmaceuticals that are approved by Dr. Madras’ beloved F.D.A. Cannabis needs to be studied, not criminalized. Instead, Dr. Madras supports Big Pharma/FDA approved use of CBD and says, essentially, “Hey people, you’ve got Cannibiol! You don’t need that evil marijuana!” Because the FDA approved it, well it must be ok. I invite you to go to http://www.drugwatch.com and see the reality behind rigorous FDA testing. Of course, if you watch television, then you must see and notice the legal chatter involved in every new wonder drug, as a soothing voice swiftly disseminates a laundry list of possible (likely?) side effects—which typically involve horrible outcomes for the user. Indeed, along with the commercials for new wonder drugs, we have commercials for lawyers soliciting victims of the wonder drugs of yesterday. Did you use Paxil? Rogaine? Actos? Did you have x, y, and z happen to you? Well now it’s time to sue! Yet the FDA approved them once upon a time. How can this be? Dr. Madras crows about how the FDA has clawed back $10bn from drug manufacturers who claimed some effect their drugs did not, in fact, produce, although she doesn’t say what is done with that windfall, and why it got to that point in the first place. Of course, that $10bn is chump change compared to the hundreds of billions at stake in Big Pharma profits, profits which allow them to pay the damages brought years later by the injured parties. The Actos judgement alone was $2.7 billion, and probably most of you never heard of it. Dr. Madras is not concerned with your well being, but she is concerned with maintaining the status quo. As a GW Bush appointed Deputy Director for Demand Reduction for the WHO of National Drug Conrol Policy, she’s got a history of trying to keep any and all drugs out of the hands of “addicts” and a dim view of the possible positive effects of anything the administration deemed illicit. I believe she probably has the true courage of her convictions and is not merely a shill for Big Pharma, but she functions as one just the same in advancing the failed prohibition model.

Two quick points; A check of the author's credentials includes Federal grant funding from NIDA. Needless to say, this information would need to be included in any "scientific" publication which this is clearly not. The bias manifest in this article is obvious and the inaccuracies are many. One gross inaccuracy is in the scientific review of cannabis as medicine. A cannabis formulation (Sativex) has undergone scientific review by regulators in 26 countries and is approved to treat symptoms associated with MS . In the USA survey data indicate at least 100,000 MS patients are using cannabis as effective management of spasticity and pain associated with MS. Even the American Academy of Neurology supports medicinal cannabis for this use. Two groups in Europe (in Copenhagen and Brussels) have demonstrated the relationship between the endocannabinoid system and the genetic disorder, anorexia nervosa. The PET scan data is impressive and confirms the observations in anorexia patients who inherit the gene defect seen in Ashkenazi Jewish females. So if as the data indicates, there is a disorder directly associated with endocannabinoid "dysfunction", what better way to treat than to provide medicinal cannabis.

Well said. May I suggest you present your own "Opinion" piece to SSN and see if they will allow your piece to be posted here? ??

Thank you Dr. Petro! As we all know, there are plenty of Doctors with prestigious degrees who contradict Dr Madras's view, such as: John P Morgan, MD Lynn Zimmer PhD Lester Grinspoon MD (tenured professor of psychiatry at Harvard Med School who has been researching cannabis longer than anyone alive- since 1967) Carl Hart PhD (tenured professor of psychology and psychiatry at Columbia Univ med school) Donald Abrams MD (oncologist and renowned researcher of cannabis) Sanjay Gupta MD (neurosurgeon and chief medical correspondent at CNN) And the list goes on.

Thank you, Dr. Petro. Your work saves lives and your compassion for those suffering is famous. Look forward to hearing more about your work. We need more physicians like you.

I appreciate Dr. Madras comprehensive view and detailed facts regarding the Florida marijuana issue. Thank-you for your strong stand against “THC laden marijuana as a medical option”. I am so tired of those who over emphasize/misrepresent the emotional issue, “to suit their particular political agenda”. I appreciate Dr Madras logical, scientific approach. I am another Florida voter, tired of being ignored and that strongly protest this amendment to Florida SB 460.

I will rejoice the day when opinions like this join the ranks of the irrelevant like the flat Earth theory, trickle-down economics, misogyny and homophobia. You are trying to plug a dam that is already full of holes and about to burst. Give it up already. Your statements do not hold up when you reject the FDA as a source of truth.

More and more evidence from respected, educated scientists and doctors shows that marijuana is not a harmless substance. In particular the higher content THC in marijuana now being sold is particularly harmful. Whenever an article or piece of research is published adding to the evidence of harm the pro-pot lobby send in hundreds of responses denying the facts. The majority of these responses are clearly from users and usually contain personal attacks on the authors and rude, sometimes obscene, comments. No wonder they call it dope. People are entitled to their own opinions but they are not entitled to their own facts. Anyone who has lived with or worked with a heavy marijuana user will disabuse those who declare the substance to be non-addictive. I have counselled users of tobacco, alcohol, marijuana and heroin - every one of them found the most difficult substance to give up was marijuana. Those of us working in drug prevention are grateful to Dr. Madras and her colleagues for helping to get accurate information out to the general public - and in particular to our youth. Unfortunately Big Marijuana Business is fighting the legalisation battle with plenty of money and no regard for the health of the younger generation. Much of the media seems to be in thrall to those who want to see drugs legally available for all - but the results from more and more research will eventually prove that marijuana is harmful and should remain illegal. Extracts of the substance, pharmaceutically produced to high standards may well prove helpful for some medical conditions and could be prescribed by reputable doctors.

You are greatly misinformed. Caffeine is more dangerous than cannabis. The pain patch on my arm is infinitely more deadly than cannabis. Save some lives and vote yes on 2. States with functional medical cannabis have a 24.8% reduction in opiate overdoses. Medical cannabis could save my life.

Please contact me I would love to do a one on one interview. Everything you talk about is very backwards. Why not talk about heroin, alcohol, tobacco, pharma, soda, sugar, etc? You people are the devil and are preventing real sick people from utilizing the only medicine on Earth that will save them!! Please contact me at ceoinacity@yahoo.com so I can prove you wrong in person in a video interview.

There are no easy answers. The science may be beyond the reach of most people, but it's important to know what's going on in the science of cannabis now and what is being discussed by scientists. See pubmed dot gov for yourself. The citations Dr. Madras mentions will be found there, as well as many, many other citations that present a more complete view of the body of knowledge - and not just what she has chosen to include. This an emotional issue for some, particularly for those suffering from a serious medical condition. Cannabis can alleviate the suffering of patients that are being denied access to the medical benefits of this plant. Nobody denies the potential for abuse and harm - just as nobody should deny it's tremendous potential to alleviate suffering. There is some indication that THC may shrink or eliminate certain types of tumors. Dr. Madras does not represent academia well if she doesn't present a comprehensive view of the state of the art and only presents facts that conveniently suit a particular political agenda. We know the problem is more complex than that. Instead of trying to confound and confuse the issue, she would serve the common good more effectively by presenting the entire picture.

DEA FUNDING A WASTEFUL FAILURE Edit this pageWatch this page War on Drugs For other uses, see War on Drugs (disambiguation). As part of the War on Drugs, the US spends approximately $500 million per year on aid for Colombia, largely used to combat guerrilla groups such as FARC that are involved in the illegal drug trade.[1][2][3][4][5] The War on Drugs is an American term commonly applied to a campaign of prohibition of drugs, military aid, and military intervention, with the stated aim being to reduce the illegal drug trade.[6][7] This initiative includes a set of drug policies that are intended to discourage the production, distribution, and consumption of psychoactive drugs that the participating governments and the UN have made illegal. The term was popularized by the media shortly after a press conference given on 18 June 1971, by United States President Richard Nixon—the day after publication of a special message from President Nixon to the Congress on Drug Abuse Prevention and Control—during which he declared drug abuse "public enemy number one". That message to the Congress included text about devoting more federal resources to the "prevention of new addicts, and the rehabilitation of those who are addicted", but that part did not receive the same public attention as the term "war on drugs".[8][9][10] However, two years even prior to this, Nixon had formally declared a "war on drugs" that would be directed toward eradication, interdiction, and incarceration.[11] Today, the Drug Policy Alliance, which advocates for an end to the War on Drugs, estimates that the United States spends $51 billion annually on these initiatives.[12] On 13 May 2009, Gil Kerlikowske—the Director of the Office of National Drug Control Policy (ONDCP)—signaled that the Obama administration did not plan to significantly alter drug enforcement policy, but also that the administration would not use the term "War on Drugs", because Kerlikowske considers the term to be "counter-productive".[13] ONDCP's view is that "drug addiction is a disease that can be successfully prevented and treated... making drugs more available will make it harder to keep our communities healthy and safe".[14] One of the alternatives that Kerlikowske has showcased is the drug policy of Sweden, which seeks to balance public health concerns with opposition to drug legalization. The prevalence rates for cocaine use in Sweden are barely one-fifth of those in Spain, the biggest consumer of the drug.[15] In June 2011, a self-appointed Global Commission on Drug Policy released a critical report on the War on Drugs, declaring: "The global war on drugs has failed, with devastating consequences for individuals and societies around the world. Fifty years after the initiation of the UN Single Convention on Narcotic Drugs, and years after President Nixon launched the US government's war on drugs, fundamental reforms in national and global drug control policies are urgently needed."[16] The report was criticized by organizations that oppose a general legalization of drugs.[14] Contents

Not only that he choose to completely ignore the report he ordered that clearly showed marijuana as a potential cure for cancer just to further his anti drug agenda. But this doctor apparently didn't know about that she chooses to demonize marijuana just like we have since the late 30s... so stupid.

Great job Dr. Madras You have added clear scientific reasoning to this often too emotional debate. Let science decide this not votes based on emotion.

By inserting her opinions of the outcome of the ballet and 'speaking' for Florida's and what they think she is clearly being biased and trying to back up her arguments with incomplete facts. For instance in her assertion on marijuana 'causing' schizophrenia she failed to mention that it is only in patients that are pre disposed to schizophrenia that marijuana would exhibit an apparent correlation of causation. If marijuana actually caused schizophrenia wouldn't stand to reason that everyone that has smoked it would be schizophrenic? Biased factual reporting is still bias. Her article is clearly anti marijuana no mtater how you slice it. The fact she is a medical researcher trying to further an obviously draconian agenda just pisses me off.

The author of this commentary just completed an update on Cannabis and its Medical Use for the World Health Organization (WHO). Scientific references to each statement made in this commentary can be found in this report. Please follow this link to view them. http://www.who.int/medicines/access/controlled-substances/6_2_cannabis_update.pdf - See more at: http://sunshinestatenews.com/story/blunt-force-crush-floridians%E2%80%99-opposition-marijuana?page=1#sthash.SffpUMuc.dpuf

We can do this Florida! Yes on #2! Let the patient decide which medicine they want to use!

Dr. Madras presents much data and logic and scientifically proven facts in great detail, which connects many dots for those trying to navigate this messy environment. For those who think they have one ounce of her knowledge or could impune her reputation with their riduculous attacks and insults, you're not fooling anyone! Tactics like that are seen clearly and easily known for what they are!

No whole plant medicine. Um, what was it Dr. Sanjay Gupta said about Cannabis and the Entourage Effect? Oh yeah, that's right, I don't even need to answer that. How much did you pay for you Harvard Quack Degree???????

Even though you don't agree with her stance, a Harvard Degree is quite the accomplishment so give her the respect she deserves. You can voice your opinion but if you’re going to attack, attack on the facts, not the persons integrity. So what grade did you graduate from?

Wow a Harvard Degree! I wonder if she learned about this through the Harvard Medical Association, Our own Fed. Gov't. has a Patent on it! Cannabinoids as antioxidants and neuroprotectants US 6630507 B1 ABSTRACT Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease and HIV dementia. Nonpsychoactive cannabinoids, such as cannabidoil, are particularly advantageous to use because they avoid toxicity that is encountered with psychoactive cannabinoids at high doses useful in the method of the present invention. A particular disclosed class of cannabinoids useful as neuroprotective antioxidants is formula (I) wherein the R group is independently selected from the group consisting of H, CH3, and COCH3

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