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August 8, 2013

"Why I changed my mind on weed"

The title of this post is the headline of this lengthy new commentary by Dr. Sanjay Gupta, CNN's Chief Medical Correspondent. Here is how it gets started:

Over the last year, I have been working on a new documentary called "Weed." The title "Weed" may sound cavalier, but the content is not. I traveled around the world to interview medical leaders, experts, growers and patients. I spoke candidly to them, asking tough questions. What I found was stunning.

Long before I began this project, I had steadily reviewed the scientific literature on medical marijuana from the United States and thought it was fairly unimpressive. Reading these papers five years ago, it was hard to make a case for medicinal marijuana. I even wrote about this in a TIME magazine article, back in 2009, titled "Why I would Vote No on Pot."

Well, I am here to apologize. I apologize because I didn't look hard enough, until now. I didn't look far enough. I didn't review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.

Instead, I lumped them with the high-visibility malingerers, just looking to get high. I mistakenly believed the Drug Enforcement Agency listed marijuana as a schedule 1 substance because of sound scientific proof. Surely, they must have quality reasoning as to why marijuana is in the category of the most dangerous drugs that have "no accepted medicinal use and a high potential for abuse."

They didn't have the science to support that claim, and I now know that when it comes to marijuana neither of those things are true. It doesn't have a high potential for abuse, and there are very legitimate medical applications. In fact, sometimes marijuana is the only thing that works. Take the case of Charlotte Figi, who I met in Colorado. She started having seizures soon after birth. By age 3, she was having 300 a week, despite being on seven different medications. Medical marijuana has calmed her brain, limiting her seizures to 2 or 3 per month.

I have seen more patients like Charlotte first hand, spent time with them and come to the realization that it is irresponsible not to provide the best care we can as a medical community, care that could involve marijuana.

August 8, 2013 at 01:13 PM | Permalink

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Comments

"I mistakenly believed the Drug Enforcement Agency listed marijuana as a schedule 1 substance because of sound scientific proof."

Ah, the great misperception of most people on their recent leaders. "We're from the government. We don't need no stinking reason."

Why? Because we can - and don't go thinking about it.

Posted by: albeed | Aug 8, 2013 1:40:39 PM

Now maybe we can enlist Dr. Gupta and others to have marijuana removed from Schedule I classification.

Posted by: Michael R. Levine | Aug 8, 2013 2:05:13 PM

The problem where is that if marijuana falls then so do so many other drugs. For example, ecstasy was used by psychiatrists to treat martial problems before it was banned. The truth is most drugs are banned for political reasons, not medical ones let alone scientific reasons. What has changed is not the medical understanding of marijuana but the political forces in favor of its legalization. What Gupta is really saying is "Sorry guys, I was on the wrong side of history. Got to cover my ass, ya know." It's embarrassing.

Posted by: Daniel | Aug 8, 2013 3:14:04 PM

The active ingredient in marijuana, THC, is already legally available by prescription. Dr. Gupta may have his views of the desirability of freelancing it, but the Mayo Clinic seems to think differently, http://www.cbsnews.com/8301-204_162-57589671/mayo-clinic-teens-with-chronic-pain-should-not-use-medical-marijuana/

Posted by: Bill Otis | Aug 8, 2013 3:20:16 PM

Dr. Gupta said nothing about providing teens with medical marijuana. The Mayo Clinic study concerned ONLY (REPEAT "ONLY") pain with respect to ONLY adolescents.

Try again.

Posted by: John | Aug 8, 2013 3:51:00 PM

John --

"Dr. Gupta said nothing about providing teens with medical marijuana."

Why not? Because he found the same dangers as the Mayo Clinic?

Is the Mayo Clinic a part of the Vast Right Wing Conspiracy?

Posted by: Bill Otis | Aug 8, 2013 4:01:52 PM

CNN's bravery is overwhelming.

Posted by: Guy | Aug 8, 2013 4:27:21 PM

Sigh...

OK. I am not one to jump on the drug legality/illegality thingee with any sort of opinion, but in this case I'd like to highlight the argument as diverse as the particular issues involved with regard to medicinal vs. recreational.

As far as alcohol and tobacco, along with various over-the-counter drugs, they are all currently legal for adults (over 21), and some drugs are available to young adults (18-20) as well as some drugs (such as aspirin or cough syrup) and caffeinated coffee and soda that is available to minors.

PRESCRIBED drugs are ONLY legal in being dispensed as authorized by a doctor's prescription. Any other use of such drugs is illegal.

Finally, there are drugs that are NOT legal, even through doctor's prescription, except under certain circumstances.

Having framed the parameters, we see we have two clear issues that should not have anything to do with each other: medical prescription vs. recreational use.

Now, I'm not a doctor nor have any non-laymen knowledge of the medical effect of drugs on the body no matter how they are ingested. But "legalization of marijuana" actually can be interpreted in two different ways: production geared toward medical prescriptions, or production geared toward recreational use. The arguments toward legalization seem to be inferring that medical usage is the paramount reason for legalization, when it is obvious that the vast majority of usage of marijuana is done for recreational purposes.

So the first thing we have to do is to define the arguments. Given that we have an approval process through the FDA which approves production and usage of drugs based upon (ostensibly) strict, rigorously developed protocols, one can reasonably approve marijuana IF it is developed under the same protocols as other drugs. These protocols also include the method of ingestion; certainly there would be very few circumstances that smoking may be allowed. To that end, I would have no problem with such legalization and, in fact, if the benefits of prescribed marijuana are as promised, it would be a damn shame to see such development curtailed.

Nonetheless, this is a COMPLETELY SEPARATE argument from recreational use, which by definition does not prescribe limits on such usage, and in fact lead to greater abuse. However, there is a valid liberty argument that can be construed, but that argument can NOT ETHICALLY be made in the same context of medical legalization.

I really hate people taking arguments citing extremes as normal when there are justifiable arguments to be made in context to the real agenda.


Posted by: Eric Knight | Aug 8, 2013 4:48:34 PM

The tipping point is getting closer and closer to legalization of marijuana.

Posted by: Anon | Aug 8, 2013 4:50:50 PM

There is no documented case of someone over dosing from marijuana. So the consumption of peanut butter has caused more deaths than the consumption of marijuana?

Posted by: Anon | Aug 8, 2013 4:56:24 PM

dr. gupta was pretty explicit re: issues concerning marijuana use and developing brains and would not recommend marijuana use until a person's brain has fully developed in their twenties.

Posted by: anonymous | Aug 8, 2013 5:07:08 PM

The distinction between mj on the one hand, and alcohol and tobacco on the other, is arbitrary. Each is addictive (though mj is the least addictive of all), each is harmful (though mj, unlike the others, can also be helpful), and each is used by plenty of rational, normally-functioning people who are willing to accept the risks of addiction and harm because of the pleasure they derive from using the substance. There is no reasonable basis for treating them differently. The only explanation is that mj is associated with disfavored counterculture.

Posted by: HGD | Aug 8, 2013 5:13:07 PM

Anon --

"The tipping point is getting closer and closer to legalization of marijuana."

"The tipping point is getting closer and closer to abolition of capital punishment." -- Generic Liberal, circa 1970

Posted by: Bill Otis | Aug 8, 2013 5:40:43 PM

To me it seems like he is saying he was an idiot and has changed his mind, which has more to do with the politics of medical marijuana than the medical side.

Posted by: Adam | Aug 8, 2013 5:41:17 PM

Bill, greetings. You suggest that the day is still far off when the use of marijuana will become legal. If we assume for the sake of argument that the legalization of medical marijuana is just a subterfuge for recreational use (which you and many others maintain), then that day is already here for at least 20 states.

Posted by: Michael R. Levine | Aug 8, 2013 6:16:59 PM

Hi Michael --

I have one point of agreement and one of disagreement. I disagree that "medical" marijuana is legal in 20 states. I think the more precise way to say it is that the state law of 20 states permits medical marijuana, but in all 20, federal law remains supreme, and federal law prohibits marijuana of any kind.

I agree -- indeed I more than agree -- that the day of more-or-less accepted, or at least tolerated, pot smoking has arrived. Indeed, it arrived years ago. As I have often said on this site, pot is de facto legal. All you have to do is smoke it at home and the practical reality is that no one's going to bother you. This has been true at least since I was in law school.

As to whether pot will ever find the degree of acceptance that will result in a change in federal law -- heck, how should I know? There are no facts about the future (as the "Death-penalty-is-dead" celebrations of circa 1970 show). My intuition is that there is not sufficient support in the country to change federal law on this subject, partly because so few people (out of 315,000,000) ever go to jail for it, partly because smoking pot (or anything) is lousy for your health in an increasingly health-conscious nation, and partly because politicians of both parties are invested in issues higher on the agenda (e.g., expansion of gay rights on the Left, and national solvency on the Right).

If I ever get to LA, let me take you to lunch. I want you to give me an autographed copy of the opinion where Reinhardt said you were the most wonderful thing since sliced bread.

Posted by: Bill Otis | Aug 8, 2013 6:59:25 PM

Bill, you write "I ever get to LA, let me take you to lunch. I want you to give me an autographed copy of the opinion where Reinhardt said you were the most wonderful thing since sliced bread." I'll do it for sure. I've already engraved the citation on my tombstone: U.S. v. France, 886 F.2d 223 (9th Cir. 1989). But if we're going to meet, L.A. won't do, because I live in Portland, Oregon--we have much cleaner air.

Posted by: Michael R. Levine | Aug 8, 2013 7:28:57 PM

Talking about "changing my mind" with a sentencing aspect:

http://herculesandtheumpire.com/2013/08/08/shon-hopwood-and-kopfs-terrible-sentencing-instincts/

Posted by: Joe | Aug 8, 2013 7:52:04 PM

Did little Charlotte get Marinol, with exactly 2.5 mg of cannabis, grown and made by the federal government. This is a pill, taken orally. It travels in the intestines, liver, etc, before entering blood and brain. Its slowness makes hard to intoxicate. But wait an hour and the THC blood level is very respectable.

People who must smoke are people who want to get high, not just get medical marijuana.

Posted by: Supremacy Claus | Aug 9, 2013 2:40:22 AM

SC -

Charlotte reportedly gets a few drops of oil on her food each day. The oil is extracted from a strain of cannabis that's been crossbred to be low in THC but high in the compound cannabidol (CBD). CBD apparently has medicinal properties but no psychoactivity.

Details about Charlotte's story and the cannabis being used are reported here: http://www.cnn.com/2013/08/07/health/charlotte-child-medical-marijuana/index.html?iref=allsearch

Posted by: arfarf | Aug 9, 2013 7:30:52 AM

Inhaling is a useful way for some to intake certain medicinal drugs and smoking here allows some degree of dosing pursuant to ones needs. Some people, e.g., can't hold down food. If it was legal, it is likely that a less psychoactive breed of marijuana could be developed. As to getting "high," various types of medicines can have that result, getting "high" and the effects of certain medicines a matter of degree at best. Opiates used for pain is but an example.

Posted by: Joe | Aug 9, 2013 10:33:40 AM

I believe any doctor may get an individual IND from the FDA to provide unapproved medication. One simply writes a letter outlining the medical justifications, and one gets permission to import or manufacture the unapproved substance. The whole procedure takes minutes to achieve. Little Charlotte should get her marijuana oil, then.

She should not be exploited for political purposes. Legalization should be debated on its merits.

Posted by: Supremacy Claus | Aug 10, 2013 1:32:49 AM

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