Statistics show that prescription drugs are abused so readily in the United States that someone dies of an overdose from pills every 19 minutes.
In contrast, there is a drug that has never been known as the sole cause of an overdose death, and yet remains illegal in South Dakota and many other American states. That drug is marijuana, which is considered by the federal government as a Schedule I drug, meaning it has no medical value whatsoever.
But opinions on the medical value of marijuana are changing in America, and proponents of legalizing marijuana for medical use in South Dakota hope the state can join 23 other states and the District of Columbia where it is legal, and they’re pushing for a November 2016 statewide ballot measure to accomplish that.
For those who support marijuana as medicine, or those who now use it to fight pain or reduce seizures, there shouldn’t even be a debate over whether marijuana helps the sick.
Some clinical studies and numerous anecdotal reports indicate that marijuana can provide relief for patients dealing with a variety of serious illnesses. In addition to causing the high marijuana has long been known for, the studies and stories show marijuana can help reduce pain, alleviate nausea, block seizures, increase appetite, and help minimize the impacts of glaucoma.
At the very least, marijuana backers say, the drug should be studied more fully to uncover its full array of potential benefits and medicinal uses.
In the last decade, as American attitudes have shifted into more acceptance of marijuana, some doctors are becoming more comfortable with speaking out about the possible medical benefits of marijuana.
In 2009, the American Medical Association, an organization of more than 200,000 member doctors, pushed for the reclassification of marijuana in order to promote more research on the drug. The American Academy of Pediatrics made a similar plea in January.
Still, the federal government continues to hold fast to its characterization of marijuana as a Schedule I drug, alongside substances like heroin, LSD and ecstasy.
‘I know there’s value’
When Rapid City neurologist Dr. David Sabow thinks about the government’s classification of marijuana, he shakes his head in disbelief.
“I know there is value, I’ve seen it in my patients,” Sabow said.
Sabow, 74, is now retired from clinical neurology but is still a chief neurologist for Social Security’s Office of Disability Adjudication and Review. He also works as an expert witness in trials across the country. Lawyers, insurance companies, individuals and government entities often enlist his expertise on all things neurological to enlighten juries on the witness stand or make recommendations outside of court.
He lives just off the Rapid City Executive Golf Course with his wife, Andrea, and was the first neurologist in the state of South Dakota. Sabow has seen thousands of patients with a wide range of neurological disorders, from multiple sclerosis to Parkinson’s disease.
The doctor says it is easy for him to believe in the medical value of marijuana because patient after patient, year after year, has told him the drug brings them relief.
“When you see dozens of anecdotes you would be crazy not to recognize the beneficial effects of this product,” Dr. Sabow said in an April interview with the Rapid City Journal.
Sabow’s experiences with patients saying marijuana has helped is not uncommon for doctors who help patients who are dealing with pain. A 2014 survey of more than 1,500 doctors in the United States found that most of those in the medical professions believe marijuana can help their patients, and that it should be legal for medical use in their state.
Of those surveyed, 69 percent said it can help with certain treatments and conditions, and 67 percent believed it should be a medical option for patients.
Another article that same year, in the “Journal of the American Medical Association,” found that in states where medical marijuana had passed, deaths caused by painkiller overdose dropped by 25 percent.
Not without risks
Like any drug, prescription or otherwise, marijuana isn’t without side effects.
Because the most common current way of ingesting marijuana is by smoking, habitual users showed lower lung capacity and function. An American Lung Association Article found that marijuana smoke contains many of the same toxins as tobacco smoke. That research showed habitual marijuana users are more likely to get acute bronchitis and develop coughs and wheezing.
One thing researchers are working on is the study of how marijuana can effect the development of the brain. Habitual users of marijuana that start using at an early age can show long-term effects on cognition and problem-solving ability.
A 2014 Northwestern University Feinberg School of Medicine study found that young adults, aged 18-25, who smoked pot had abnormalities in the hippocampus section of the brain which is still developing. Those sections are important to the control of emotion and motivation.
“Evidence that the longer the participants were abusing marijuana, the greater the differences in hippocampus shape suggests marijuana may be the cause,” lead author Dr. Matthew Smith said about the study.
Also, the old adage that a person can’t become addicted to marijuana is dubious. Though rates of addiction are significantly less than with prescription drugs, alcohol, or tobacco, marijuana can be addictive in a psychological if not physical sense. According to a study by the National Institute of Drug abuse, about 10 percent of recreational marijuana users become dependent on it. That dependency can come with symptoms of withdrawal if users suddenly stop taking the drug.
Finally, marijuana has been known to cause acute panic attacks, depression or paranoia in users not familiar with the drug or unprepared for the incredible potency of modern marijuana.
Since Colorado legalized recreational marijuana, hospitals in the Denver area have seen a large increase in the number of marijuana-related cases at their emergency rooms, according to news reports. A vast majority of those ER visits are due to the ingestion of more than the recommended amount of marijuana-infused edibles. In a couple instances, marijuana overuse was considered a factor in a case where a young man dove to his death from a hotel window, and when a man shot his wife to death while she was on the phone with a 911 dispatcher.
Further, there is some belief that marijuana is a gateway drug that can lead users to harder drugs. However, that idea has largely been discredited scientifically. The peer-reviewed “Journal of School Health” found that if marijuana users go on to try harder drugs, it is likely because of social factors like a lack of money or severe psychological stress. The actual using of the marijuana doesn’t make the person seek out a new stronger high, the study suggested.
Pill form as effective?
Despite those risks, Sabow said he is “100 percent” in favor of legalizing medical marijuana because it brought relief to his neurology patients.
One of the problems for Sabow’s patients is a side effect of neurological disorders known as spasticity. The condition is characterized by tight or firm muscles that move unwillingly and without warning. The condition is found in patients with cerebral palsy, traumatic brain injury, stroke, multiple sclerosis, and spinal cord injuries.
For the spasticity, Sabow would prescribe what he was allowed to by law, Marinol. The drug is a man-made form of marijuana, but the problem is that most patients find the real thing works a lot better.
“Some of my patients got literally no benefit from Marinol,” Dr. Sabow said. In contrast, he said all of the patients that told him they were using marijuana, despite the fact it is illegal in South Dakota, got relief from it.
According to Sabow, the biggest difference between taking a dose of Marinol in pill form and smoking marijuana is how much and how quickly the active chemical in the drug is absorbed.
When a pill of Marinol get swallowed, it takes a long path to the blood stream. The pill first needs to reach the stomach where it is broken down. Then, it passes to the duodenum where a small amount is absorbed into the blood stream. From there it goes through the small intestine slowly getting adsorbed. The process can take an hour.
“When you are inhaling you are getting the most concentrated portion of the drug to the brain quickly,” Sabow says.
When someone inhales marijuana smoke, it goes to the pulmonary arterial structure extremely quickly. Those chemicals are transferred into the blood, go to the heart and then to the brain in a matter of only a few minutes.
Another potential difference between Marinol and marijuana is the synthetic drug’s lack of less-complex canidinoids. Marinol contains a type of THC, the chemical compound that create the marijuana high, but it doesn’t contain several other possibly beneficial chemical compounds. Recent studies have found that these other chemical compounds in marijuana have had beneficial effects on the nervous system, can be used to control seizures, and may have tumor-fighting properties.
If medical marijuana were legal, Sabow said many of his patients would be better off, even if the core condition they face isn’t being treated.
“It can totally change their quality of life,” he said. “Their lives are hard enough, so I have no problem with them feeling a little bit better.”
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