Cannabis Is A “Potential Exit Drug To Problematic Substance Use”

According to survey data published in the journal Addiction Research and Theory, three quarters of medical cannabis consumers report using it as a substitute for prescription drugs, alcohol, or some other illicit substance.

The subjective impact of marijuana on the use of licit and illicit substances via self-report in a cohort of 404 medical cannabis patients recruited from four dispensaries in British Columbia, Canada was assessed by an international team of investigators from Canada and the United States.

Subjects frequently substituted cannabis for other substances, including conventional pharmaceuticals, researchers reported and added, “Over 41 percent state that they use cannabis as a substitute for alcohol (n=158), 36.1 percent use cannabis as a substitute for illicit substances (n=137), and 67.8 percent use cannabis as a substitute for prescription drugs (n=259). The three main reasons cited for cannabis-related substitution are ‘less withdrawal’ (67.7 percent), ‘fewer side-effects’ (60.4 percent), and ‘better symptom management’ suggesting that many patients may have already identified cannabis as an effective and potentially safer adjunct or alternative to their prescription drug regimen.”

The authors concluded: “While some studies have found that a small percentage of the general population that uses cannabis may develop a dependence on this substance, a growing body of research on cannabis-related substitution suggests that for many patients cannabis is not only an effective medicine, but also a potential exit drug to problematic substance use. Given the credible biological, social and psychological mechanisms behind these results, and the associated potential to decrease personal suffering and the personal and social costs associated with addiction, further research appears to be justified on both economic and ethical grounds. Clinical trials with those who have had poor outcomes with conventional psychological or pharmacological addiction therapies could be a good starting point to further our under- standing of cannabis-based substitution effect.”

The study, “Cannabis as a substitute for alcohol and other drugs: A dispensary-based survey of substitution effect in Canadian medical cannabis patients,” appeared online in Addiction Research and Theory.

Multiple Medical Marijuana Reform Measures Introduced By Congress

A bi-partisan coalition of United States House lawmakers has introduced multiple measures in Congress for reforming federal marijuana laws.

The House Bill 1983, The Medical Marijuana Patient Protection Act ensures that medical cannabis patients, caregivers, or third-party providers in states that have approved its use will no longer have to fear arrest or prosecution from federal law enforcement agencies. It states, “No provision of the Controlled Substances Act shall prohibit or otherwise restrict in a State in which marijuana may be prescribed or recommended by a physician for medical use under applicable State law.”

Says the bill’s primary sponsor, Rep Barney Frank (D-MA): “The time has come for the federal government to stop preempting states’ medical marijuana laws. For the federal government to come in and supersede state law is a real mistake for those in pain for whom nothing else seems to work. This bill would block the federal prosecution of those patients who reside in those states that allow medical marijuana.”

State-authorized medical marijuana businesses have full access to banking services by amending the federal Bank Secrecy Act, as per the House Bill 1984, The Small Business Banking Improvement Act of 2011. The measure is sponsored by Rep. Jared Polis (D-CO), who states: “When a small business, such as a medical marijuana dispensary, can’t access basic banking services they either have to become cash-only — and become targets of crime — or they’ll end up out-of-business. In states that have legalized medical marijuana, and for businesses that have been state-approved, it is simply wrong for the federal government to intrude and threaten banks that are involved in legal transactions.”

The Internal Revenue Code of 1986 has been amended to allow a deduction for expenses in connection with the trade or business of selling medical cannabis pursuant to state law under the House Bill 1985, The Small Business Tax Equity Act of 2011. The bill’s lead sponsor, Rep. Pete Stark (D-CA) said, “Our tax code undercuts legal medical marijuana dispensaries by preventing them from taking all the deductions allowed for other small businesses. While unfair to these small business owners, the tax code also punishes the patients who rely on them for safe and reliable access to medical marijuana prescribed by a doctor. The Small Business Tax Equity Act would correct these shortcomings.”

Medical Marijuana And Human Immunodeficiency Virus

The human immunodeficiency virus (HIV) is a retrovirus that invades cells in the immune system of human beings, making it highly susceptible to infectious diseases. Over 500,000 Americans have died from HIV/AIDS and over one million US citizens are living with the disease, according to the World Health Organization.

Survey data suggests that cannabis is used by as many as one in three patients from North America with HIV/AIDS for treating symptoms of the disease as well as the side-effects of various antiretroviral medications. It was reported by a recent study that more than 60 percent of HIV/AIDS patients self-identify as “medical cannabis users.”

Patients suffering with HIV/AIDS most frequently report using cannabis for countering symptoms of anxiety, nausea, and appetite loss. At least one study has reported that patients who use cannabis therapeutically are 3.3 times more likely to adhere to their antiretroviral therapy regimens than non-cannabis users.

Use of cannabis does not adversely impact CD4 and CD8 T cell counts and could even improve immune function, according to clinical data.

Investigators at Columbia University published clinical trial data in 2007 and reported that HIV/AIDS patients who inhaled cannabis four times daily experienced “substantial … increases in food intake … with little evidence of discomfort and no impairment of cognitive performance.” They concluded, “Smoked marijuana … has a clear medical benefit in HIV-positive [subjects].”

In the same year, it was reported by investigators at San Francisco General Hospital and the University of California’s Pain Clinical Research Center in the journal Neurology that HIV-associated neuropathy is significantly reduced with inhaling cannabis compared to placebo. It was reported by researchers that inhaling cannabis three times daily reduced patients’ pain by 34 percent. They concluded, “Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated neuropathy [in a manner] similar to oral drugs used for chronic neuropathic pain.”

Researchers at the University of California at San Diego reported similar finding while writing in the journal Neuropsychopharmacology in 2008. They concluded: “Smoked cannabis … significantly reduced neuropathic pain intensity in HIV-associated … polyneuropathy compared to placebo, when added to stable concomitant analgesics. … Mood disturbance, physical disability and quality of life all improved significantly during study treatment. … Our findings suggest that cannabinoid therapy may be an effective option for pain relief in patients with medically intractable pain due to HIV.”
Many experts, as a result, now believe that “marijuana represents another treatment option in [the] health management” of patients with HIV/AIDS.

[1] Woolridge et al. 2005. Cannabis use in HIV for pain and other medical symptoms. Journal of Pain Symptom Management 29: 358-367.
[2] Prentiss et al. 2004. Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting [PDF]. Journal of Acquired Immune Deficiency Syndromes 35: 38-45.
[3] Braitstein et al. 2001. Mary-Jane and her patients: sociodemographic and clinical characteristics of HIV-positive individuals using medical marijuana and antiretroviral agents. AIDS 12: 532-533.
[4] Ware et al. 2003. Cannabis use by persons living with HIV/AIDS: patterns and prevalence of use. Journal of Cannabis Therapeutics 3: 3-15.
[5] Belle-Isle and Hathaway. 2007. Barriers to access to medical cannabis for Canadians living with HIV/AIDS. AIDS Care 19: 500-506.
[6] de Jong et al. 2005. Marijuana use and its association with adherence to antiretroviral therapy among HIV-infected persons with moderate to severe nausea. Journal of Acquired Immune Deficiency Syndromes 38: 43-46.
[7] Chao et al. 2008. Recreational drug use and T lymphocyte subpopulations in HIV-uninfected and HIV-infected men. Drug and Alcohol Dependence 94:165-171.
[8] Rachiel Schrier. 2010. Effects of medicinal cannabis on CD4 immunity in AIDS. In: University of San Diego Health Sciences, Center for Medicinal Cannabis Research. Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding. op. cit.
[9] Abrams et al.2003. Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial. Annals of Internal Medicine 139: 258-266.
[10] Fogarty et al. 2007. Marijuana as therapy for people living with HIV/AIDS: social and health aspects 19: 295-301.
[11] Haney et al. 2007. Dronabinol and marijuana in HIV-positive marijuana smokers: caloric intake, mood and sleep. Journal of Acquired Immune Deficiency Syndromes 45: 545-554.
[12] Abrams et al. 2007. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial.
[13] Ellis et al. 2008. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. op. cit.
[14] Fogarty et al. 2007. op. cit.

Legalizing Marijuana Efforts Gaining Momentum

Despite fierce opposition from the federal government, efforts for legalizing marijuana for recreational use gaining momentum in Colorado and Washington state. Recently, officials in Washington remarked that an initiative for legalizing pot has enough signatures to get qualified for the ballot in November. Officials in Colorado are about to make a similar determination about an initiative in the state.

Pot supporters are ready to possibly spend millions of dollars ahead of the ballot in November, when they are hoping for a strong voter turnout, especially among youth, for the U.S. presidential election will aid their cause.

“Whether it’s make or break depends on what public opinion does after 2012, but in terms of voter turnout this is the best year to do it,” said Alison Holcomb, director of New Approach Washington, the initiative’s sponsor.

Marijuana use for medical purposes is presently being allowed in 16 states, including Washington and Colorado, along with the national capital. However, cannabis still remains an illegal narcotic under U.S. law and opinion of public is sharply divided on the merits of full marijuana legalization.

The U.S. Department of Justice has cracked down on medical cannabis operations in California after voters from the state turned back a ballot initiative to legalize marijuana for recreational use in 2010.

“Our highest priority are the folks that violate both state and federal law,” said Rusty Payne, spokesman for the Drug Enforcement Administration. “There are places that have made a lot of money who claim to be nonprofit, and they have faced both local and federal scrutiny.”

Supporters of the Washington state initiative in an undeterred manner said it represents the “grown-up” approach to legalization.

“Voters aren’t being asked to imagine as much as they are in other states, they have seen that marijuana can be regulated and it doesn’t result in significant problems,” said Mason Tvert, co-director of the Colorado-based Campaign to Regulate Marijuana Like Alcohol.

Public disclosure records show that Washington effort organizers have been able to collect over $1.1 million in campaign funds, with $250,000 of that coming from Progressive Insurance chairman Peter Lewis.
“If young voters turn out in droves like they did in 2008 or even start to approach those numbers … then I think this will pass, but they very well may not,” said Loren Collingwood, senior researcher for the nonpartisan Washington Poll run by the University of Washington.

“There’s a set of factors that suggest both the Washington and Colorado initiates have a better chance of winning than any of the initiatives that have happened before,” said Ethan Nadelmann, executive director of the Drug Policy Alliance.

“But that said, even with a majority of likely voters in both states saying they favor legal marijuana, we know in the final stretch there’s always a small percentage that get nervous or scared off or fearful of change,” he said.

Legalization “is not good for states and citizens who live in those states, and it’s certainly not good for the outlook of children who live in those states,” said Calivina Fay, head of the Florida-based Drug Free America Foundation.

“Right now in Seattle, we’re feeling that it’s a bit unfair that we are being tolerant of medical cannabis users, when other localities are not, because we tend to become suppliers for the whole state rather than our own citizens,” said Washington City Attorney Peter Holmes.

Marijuana Substituted For Prescription Drugs By Patients

According to an anonymous survey, people qualifying for prescriptions of medical marijuana frequently report substituting the substance for their other prescription medications.

Sixty-six of 350 clients at the Berkeley (Calif.) Patients Group, a medical marijuana dispensary, remarked they use marijuana as a substitute for prescription drugs as they think it provided better symptom control with fewer side effects than did prescription drugs. Those with pain symptoms said marijuana has less addiction potential than opioids and others said it helped in reducing the dose of other medications.

Almost 50 percent of those surveyed said they use cannabis two or three times per day. More than 75 percent of respondents said they made use of cannabis for psychiatric disorders, including bipolar disorder, posttraumatic stress disorder, depression, anxiety, and persistent insomnia. Dr. Reiman reported at the American Psychiatric Association’s Institute on Psychiatric Services that patients believe marijuana didn’t leave them feeling like “zombies.”

Dr. Reiman said about 75% had health insurance that covered prescriptions and “they are still opting to utilize medical cannabis, which is not covered by insurance.”
“Instead of having a pain medication, an antianxiety medication, and a sleep medication, they are able to just use cannabis, and that controls all of those symptoms,” said Amanda Reiman, Ph.D., the director of research and social services at the Berkeley center.