Call it marijuana....don't call it medicine

[lobelsteve]

Jack: Some good people to follow on twitter: @andrewkolodny @dawso007 @DrKevinHill @DavidJuurlink

Leaving off Lynn Webster ?

---

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[drusso]

http://www.wsj.com/articles/a-brave-new-weed-1478043007

A Brave New Weed
The costs so far from marijuana legalization are higher than advertised.

0:00 / 0:00
Updated Nov. 2, 2016 1:29 p.m. ET
753 COMMENTS

Marijuana is now legal in 25 states for medicinal purposes and in four for recreational use. Voters in another five have a chance on Nov. 8 to legalize the retail consumption of pot, but the evidence rolling in from these real-time experiments should give voters pause to consider the consequences.

In 2012 Colorado and Washington voters legalized recreational pot, followed by Alaska and Oregon two years later. Initiatives this year in California, Arizona, Nevada, Maine and Massachusetts would allow businesses to sell and market pot to adults age 21 and older.

Adults could possess up to one ounce (more in Maine) and grow six marijuana plants. Public consumption would remain prohibited, as would driving under the influence. Marijuana would be taxed at rates from 3.75% in Massachusetts to 15% in the western states, which would license and regulate retailers.


Marijuana is a Schedule I drug under the federal Controlled Substances Act of 1970, which prohibits states from regulating possession, use, distribution and sale of narcotics. However, the Justice Department in 2013 announced it wouldn’t enforce the law in states that legalize pot. Justice also promised to monitor and document the outcomes, which it hasn’t done. But someone should, because evidence from Colorado and Washington compiled by the nonprofit Smart Approaches to Marijuana suggests that legalization isn’t achieving what supporters promised.

One problem is that legalization and celebrity glamorization have removed any social stigma from pot and it is now ubiquitous. Minors can get pot as easily a six pack. Since 2011 marijuana consumption among youth rose by 9.5% in Colorado and 3.2% in Washington even as it dropped 2.2% nationwide. The Denver Post reports that a “disproportionate share” of marijuana businesses are in low-income and minority communities. Many resemble candy stores with lollipops, gummy bears and brownies loaded with marijuana’s active ingredient known as THC.

The science of how THC affects young minds is still evolving. However, studies have shown that pot use during adolescence can shave off several IQ points and increase the risk for schizophrenic breaks. One in six kids who try the drug will become addicted, a higher rate than for alcohol. Pot today is six times more potent than 30 years ago, so it’s easier to get hooked and high.

Employers have also reported having a harder time finding workers who pass drug tests. Positive workplace drug tests for marijuana have increased 178% nationwide since 2012. The construction company GE Johnson says it is recruiting construction workers from other states because it can’t find enough in Colorado to pass a drug test.

Honest legalizers admitted that these social costs might increase but said they’d be offset by fewer arrests and lower law enforcement costs. Yet arrests of black and Hispanic youth in Colorado for pot-related offenses have soared 58% and 29%, respectively, while falling 8% for whites.


The share of pot-related traffic deaths has roughly doubled in Washington and increased by a third in Colorado since legalization, and in the Centennial State pot is now involved in more than one of five traffic fatalities. Calls to poison control for overdoses have jumped 108% in Colorado and 68% in Washington since 2012.

Colorado Attorney General Cynthia Coffman has said that “criminals are still selling on the black market,” in part because state taxes make legal marijuana pricier than on the street. Drug cartels have moved to grow marijuana in the states or have switched to trafficking in more profitable drugs like heroin.

One irony is that a Big Pot industry is developing even as tobacco smokers are increasingly ostracized. The Arcview Group projects that the pot market could triple over four years to $22 billion. Pot retailers aren’t supposed to market specifically to kids, though they can still advertise on the radio or TV during, say, a college football game. Tobacco companies have been prohibited from advertising on TV since 1971.

The legalization movement is backed by the likes of George Soros and Napster co-founder Sean Parker, and this year they are vastly outspending opponents. No wonder U.S. support for legalizing marijuana has increased to 57% from 32% a decade ago, according to the Pew Research Center.

We realize it’s déclassé to resist this cultural imperative, and maybe voters think the right to get high when you want is worth the social and health costs of millions of more stoners. Then again, since four states have volunteered to be guinea pigs, maybe other states should wait and see if these negative trends continue.

Correction: An earlier version of this editorial incorrectly said the 178% increase in positive workplace drug tests for marijuana since 2012 occurred in Colorado.

 

[Mad Jack]

http://www.wsj.com/articles/a-brave-new-weed-1478043007

A Brave New Weed
The costs so far from marijuana legalization are higher than advertised.

0:00 / 0:00
Updated Nov. 2, 2016 1:29 p.m. ET
753 COMMENTS

Marijuana is now legal in 25 states for medicinal purposes and in four for recreational use. Voters in another five have a chance on Nov. 8 to legalize the retail consumption of pot, but the evidence rolling in from these real-time experiments should give voters pause to consider the consequences.

In 2012 Colorado and Washington voters legalized recreational pot, followed by Alaska and Oregon two years later. Initiatives this year in California, Arizona, Nevada, Maine and Massachusetts would allow businesses to sell and market pot to adults age 21 and older.

Adults could possess up to one ounce (more in Maine) and grow six marijuana plants. Public consumption would remain prohibited, as would driving under the influence. Marijuana would be taxed at rates from 3.75% in Massachusetts to 15% in the western states, which would license and regulate retailers.


Marijuana is a Schedule I drug under the federal Controlled Substances Act of 1970, which prohibits states from regulating possession, use, distribution and sale of narcotics. However, the Justice Department in 2013 announced it wouldn’t enforce the law in states that legalize pot. Justice also promised to monitor and document the outcomes, which it hasn’t done. But someone should, because evidence from Colorado and Washington compiled by the nonprofit Smart Approaches to Marijuana suggests that legalization isn’t achieving what supporters promised.

One problem is that legalization and celebrity glamorization have removed any social stigma from pot and it is now ubiquitous. Minors can get pot as easily a six pack. Since 2011 marijuana consumption among youth rose by 9.5% in Colorado and 3.2% in Washington even as it dropped 2.2% nationwide. The Denver Post reports that a “disproportionate share” of marijuana businesses are in low-income and minority communities. Many resemble candy stores with lollipops, gummy bears and brownies loaded with marijuana’s active ingredient known as THC.

The science of how THC affects young minds is still evolving. However, studies have shown that pot use during adolescence can shave off several IQ points and increase the risk for schizophrenic breaks. One in six kids who try the drug will become addicted, a higher rate than for alcohol. Pot today is six times more potent than 30 years ago, so it’s easier to get hooked and high.

Employers have also reported having a harder time finding workers who pass drug tests. Positive workplace drug tests for marijuana have increased 178% nationwide since 2012. The construction company GE Johnson says it is recruiting construction workers from other states because it can’t find enough in Colorado to pass a drug test.

Honest legalizers admitted that these social costs might increase but said they’d be offset by fewer arrests and lower law enforcement costs. Yet arrests of black and Hispanic youth in Colorado for pot-related offenses have soared 58% and 29%, respectively, while falling 8% for whites.


The share of pot-related traffic deaths has roughly doubled in Washington and increased by a third in Colorado since legalization, and in the Centennial State pot is now involved in more than one of five traffic fatalities. Calls to poison control for overdoses have jumped 108% in Colorado and 68% in Washington since 2012.

Colorado Attorney General Cynthia Coffman has said that “criminals are still selling on the black market,” in part because state taxes make legal marijuana pricier than on the street. Drug cartels have moved to grow marijuana in the states or have switched to trafficking in more profitable drugs like heroin.

One irony is that a Big Pot industry is developing even as tobacco smokers are increasingly ostracized. The Arcview Group projects that the pot market could triple over four years to $22 billion. Pot retailers aren’t supposed to market specifically to kids, though they can still advertise on the radio or TV during, say, a college football game. Tobacco companies have been prohibited from advertising on TV since 1971.

The legalization movement is backed by the likes of George Soros and Napster co-founder Sean Parker, and this year they are vastly outspending opponents. No wonder U.S. support for legalizing marijuana has increased to 57% from 32% a decade ago, according to the Pew Research Center.

We realize it’s déclassé to resist this cultural imperative, and maybe voters think the right to get high when you want is worth the social and health costs of millions of more stoners. Then again, since four states have volunteered to be guinea pigs, maybe other states should wait and see if these negative trends continue.

Correction: An earlier version of this editorial incorrectly said the 178% increase in positive workplace drug tests for marijuana since 2012 occurred in Colorado.

The trouble is, there isn't a whole hell of a lot of proof any of these people were using marijuana at the time of whatever incident occurred- they are usually using urine tests, which pick up matijuana use days, weeks, or even months later in some users. More people are testing positive for THC, sure, but more people are using it, and will test positive for it the VAST majority of time that they aren't smoking.

Imagine if after you drink alcohol, you tested positive for a week, despite only being impaired for a few hours of that week. Most people I know have a coyole drinks on the weekend, they'd never test negative. That's pretty much what happens with marijuana in regard to testing, it's kind of ridiculous.

 

[lobelsteve]

The trouble is, there isn't a whole hell of a lot of proof any of these people were using marijuana at the time of whatever incident occurred- they are usually using urine tests, which pick up matijuana use days, weeks, or even months later in some users. More people are testing positive for THC, sure, but more people are using it, and will test positive for it the VAST majority of time that they aren't smoking.

Imagine if after you drink alcohol, you tested positive for a week, despite only being impaired for a few hours of that week. Most people I know have a coyole drinks on the weekend, they'd never test negative. That's pretty much what happens with marijuana in regard to testing, it's kind of ridiculous.

Do you offer a better explanation of the impairment that caused the accident?

If bac is .00 and thc is high.....
Or was it a seizure cuz they didnt smoke enough weed?

 

[Mad Jack]

Do you offer a better explanation of the impairment that caused the accident?

If bac is .00 and thc is high.....
Or was it a seizure cuz they didnt smoke enough weed?

The majority of fatal traffic accidents happen under the influence of nothing. It's less than a quarter of all traffic fatalities. To say that every person who tested positive for marijuana was high at the time of the accident would fly in the face of both the statistics and the science of how poor marijuana tests are at determining impairment at the time of testing.

 

[PainDrain]

Leaving off Lynn Webster ?

Is this sarcasm?

 

[lobelsteve]

Is this sarcasm?

 

[Ducttape]

The majority of fatal traffic accidents happen under the influence of nothing. It's less than a quarter of all traffic fatalities. To say that every person who tested positive for marijuana was high at the time of the accident would fly in the face of both the statistics and the science of how poor marijuana tests are at determining impairment at the time of testing.

so its okay to have an accident that is due to marijuana, because the majority are due the influence of nothing?

also your argument is predicated on determining that cannabinoids do not have some sort of effect, based on the individual's judgement of his/her capacity. a person who has cannabinoids in his/her urine has cannabinoids in his/her system. is there EBM that the presence of cannabinoids in a persons urine is 100% correlated with no systemic effects whatsoever?

 

[Mad Jack]

so its okay to have an accident that is due to marijuana, because the majority are due the influence of nothing?

also your argument is predicated on determining that cannabinoids do not have some sort of effect, based on the individual's judgement of his/her capacity. a person who has cannabinoids in his/her urine has cannabinoids in his/her system. is there EBM that the presence of cannabinoids in a persons urine is 100% correlated with no systemic effects whatsoever?

9-carboxy-THC has no known psychoactive properties, and virtually all THC is converted to 9-C-THC within hours of exposure, but 9-C-THC persists for a minimum of a week in most individuals. Marijuana tests screen for 9-C-THC, not THC. As to someone using a vehicle, do you drink alcohol? Do you also drink and drive? I do the former but have never done the latter; one can use substances responsibly.

 

[lobelsteve]

9-carboxy-THC has no known psychoactive properties, and virtually all THC is converted to 9-C-THC within hours of exposure, but 9-C-THC persists for a minimum of a week in most individuals. Marijuana tests screen for 9-C-THC, not THC. As to someone using a vehicle, do you drink alcohol? Do you also drink and drive? I do the former but have never done the latter; one can use substances responsibly.

And if the officer notes impairment at scene and THC + BAC neg, then it must be an unrelated medical event.

 

[Mad Jack]

And if the officer notes impairment at scene and THC + BAC neg, then it must be an unrelated medical event.

Please note where any sign of impairment existed in the THC positive cases. It's standard to take blood work in any fatal crash, not just ones where the drivers appear impaired.

 

[lobelsteve]

Please note where any sign of impairment existed in the THC positive cases. It's standard to take blood work in any fatal crash, not just ones where the drivers appear impaired.

You are beyond reason.

 

[Mad Jack]

You are beyond reason.

I mean, I'm kinda feeling the same in regard to you. A person that smokes once a week will show up as 9-C-THC positive 100% of the time, despite only being high only a couple of hours in the week. Given that regular marijuana users make up 15% of Colorado's population, and 18% of fatal crashes tested positive for THC, that means that there is only a 3% overrepresentation of marijuana users (and a mere 20% higher than expected, hardly enough to split correlation from causation given that younger drivers tend to be in more accidents regardless of drug use, but younger individuals also happen to use drugs more often), and virtually no chance that all of that sample were high at the exact time they were either killed or involved in an accident that killed another driver. Some of them certainly were, sure, but all of them? Not a chance in hell.

 

[lobelsteve]

But you make the argument is it smoking marijuana is protected against impairment and motor vehicle crashes. Your argument is disingenuous and pure nonsense. marijuana is a psychoactive drug and can cause impairment. There is an increase in fatalities due to marijuana once it was legalized in Colorado and that literature was published earlier in this thread choosing to ignore it means you're ......

 

[Ducttape]

and information suggesting otherwise:

https://www.ncbi.nlm.nih.gov/pubmed/14642878?access_num=14642878&link_type=MED&dopt=Abstract

Accid Anal Prev. 2004 Mar;36(2):239-48.
The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes.
Drummer OH1, Gerostamoulos J, Batziris H, Chu M, Caplehorn J, Robertson MD, Swann P.
Author information
Abstract
A multi-center case-control study was conducted on 3398 fatally-injured drivers to assess the effect of alcohol and drug use on the likelihood of them being culpable. Crashes investigated were from three Australian states (Victoria, New South Wales and Western Australia). The control group of drug- and alcohol-free drivers comprised 50.1% of the study population. A previously validated method of responsibility analysis was used to classify drivers as either culpable or non-culpable. Cases in which the driver "contributed" to the crash (n=188) were excluded. Logistic regression was used to examine the association of key attributes such as age, gender, type of crash and drug use on the likelihood of culpability. Drivers positive to psychotropic drugs were significantly more likely to be culpable than drug-free drivers. Drivers with Delta(9)-tetrahydrocannabinol (THC) in their blood had a significantly higher likelihood of being culpable than drug-free drivers (odds ratio (OR) 2.7, 95% CI 1.02-7.0). For drivers with blood THC concentrations of 5 ng/ml or higher the odds ratio was greater and more statistically significant (OR 6.6, 95% CI 1.5-28.0). The estimated odds ratio is greater than that for drivers with a blood alcohol concentration (BAC) of 0.10-0.15% (OR 3.7, 95% CI 1.5-9.1). A significantly stronger positive association with culpability was seen with drivers positive to THC and with BAC > or =0.05% compared with BAC > or =0.05 alone (OR 2.9, 95% CI 1.1-7.7). Strong associations were also seen for stimulants, particularly in truck drivers. There were non-significant, weakly positive associations of opiates and benzodiazepines with culpability. Drivers positive to any psychoactive drug were significantly more likely to be culpable (OR 1.8, 95% CI 1.3-2.4). Gender differences were not significant, but differences were apparent with age. Drivers showing the highest culpability rates were in the under 25 and over 65 age groups.

https://www.ncbi.nlm.nih.gov/pubmed/26240297

Clin Chem. 2015 Oct;61(10):1256-64. doi: 10.1373/clinchem.2015.240846. Epub 2015 Aug 3.
Cannabinoid concentrations detected in fatal road traffic collision victims compared with a population of other postmortem cases.
Andrews R1, Murphy KG2, Nahar L3, Paterson S3.
Author information
Abstract
BACKGROUND:
Acute cannabis consumption nearly doubles the risk of motor vehicle collision resulting in injury or death. Limited data have been published regarding the concentrations of cannabinoids associated with fatal road traffic collisions (RTCs), and these have not previously been compared to a population of other postmortem cases.

METHODS:
We conducted analysis for cannabinoids [Δ(9)-tetrahydrocannabinol (THC), 11-hydroxy-THC, 11-nor-THC-9-carboxylic acid, cannabidiol, and cannabinol], drugs, and alcohol on consecutive fatal RTC cases (100) and non-RTC cases (114) from coroners' jurisdictions in London and southeast England and compared the data.

RESULTS:
The incidence of cannabinoids detected in non-RTC and RTC cases was similar (25% vs 21%, P = 0.44), but THC was detected more frequently (90% vs 59%, P = 0.01) and at significantly higher concentrations in the cannabinoid-positive RTC cases than the non-RTC cases (P = 0.01). The distribution of non-RTC and RTC cases over 4 categories of THC concentration was significantly different (P = 0.004). There was no significant difference in the concentrations of other cannabinoids detected between the 2 groups. Cannabinoids were detected in more fatal RTC cases (21) than alcohol >80 mg/dL (17). Detection of other drugs was low compared to cannabis and alcohol.

CONCLUSIONS:
These first data on the concentrations of cannabinoids in the postmortem blood of fatal RTC victims compared with a population of other routine coroners' cases highlight the importance of specifically measuring THC concentrations in the blood to aid interpretation of postmortem cases where cannabis may be implicated.

 

[Stim4me]

http://www.wsj.com/articles/a-brave-new-weed-1478043007

A Brave New Weed
The costs so far from marijuana legalization are higher than advertised.

0:00 / 0:00
Updated Nov. 2, 2016 1:29 p.m. ET
753 COMMENTS

Marijuana is now legal in 25 states for medicinal purposes and in four for recreational use. Voters in another five have a chance on Nov. 8 to legalize the retail consumption of pot, but the evidence rolling in from these real-time experiments should give voters pause to consider the consequences.

In 2012 Colorado and Washington voters legalized recreational pot, followed by Alaska and Oregon two years later. Initiatives this year in California, Arizona, Nevada, Maine and Massachusetts would allow businesses to sell and market pot to adults age 21 and older.

Adults could possess up to one ounce (more in Maine) and grow six marijuana plants. Public consumption would remain prohibited, as would driving under the influence. Marijuana would be taxed at rates from 3.75% in Massachusetts to 15% in the western states, which would license and regulate retailers.


Marijuana is a Schedule I drug under the federal Controlled Substances Act of 1970, which prohibits states from regulating possession, use, distribution and sale of narcotics. However, the Justice Department in 2013 announced it wouldn’t enforce the law in states that legalize pot. Justice also promised to monitor and document the outcomes, which it hasn’t done. But someone should, because evidence from Colorado and Washington compiled by the nonprofit Smart Approaches to Marijuana suggests that legalization isn’t achieving what supporters promised.

One problem is that legalization and celebrity glamorization have removed any social stigma from pot and it is now ubiquitous. Minors can get pot as easily a six pack. Since 2011 marijuana consumption among youth rose by 9.5% in Colorado and 3.2% in Washington even as it dropped 2.2% nationwide. The Denver Post reports that a “disproportionate share” of marijuana businesses are in low-income and minority communities. Many resemble candy stores with lollipops, gummy bears and brownies loaded with marijuana’s active ingredient known as THC.

The science of how THC affects young minds is still evolving. However, studies have shown that pot use during adolescence can shave off several IQ points and increase the risk for schizophrenic breaks. One in six kids who try the drug will become addicted, a higher rate than for alcohol. Pot today is six times more potent than 30 years ago, so it’s easier to get hooked and high.

Employers have also reported having a harder time finding workers who pass drug tests. Positive workplace drug tests for marijuana have increased 178% nationwide since 2012. The construction company GE Johnson says it is recruiting construction workers from other states because it can’t find enough in Colorado to pass a drug test.

Honest legalizers admitted that these social costs might increase but said they’d be offset by fewer arrests and lower law enforcement costs. Yet arrests of black and Hispanic youth in Colorado for pot-related offenses have soared 58% and 29%, respectively, while falling 8% for whites.


The share of pot-related traffic deaths has roughly doubled in Washington and increased by a third in Colorado since legalization, and in the Centennial State pot is now involved in more than one of five traffic fatalities. Calls to poison control for overdoses have jumped 108% in Colorado and 68% in Washington since 2012.

Colorado Attorney General Cynthia Coffman has said that “criminals are still selling on the black market,” in part because state taxes make legal marijuana pricier than on the street. Drug cartels have moved to grow marijuana in the states or have switched to trafficking in more profitable drugs like heroin.

One irony is that a Big Pot industry is developing even as tobacco smokers are increasingly ostracized. The Arcview Group projects that the pot market could triple over four years to $22 billion. Pot retailers aren’t supposed to market specifically to kids, though they can still advertise on the radio or TV during, say, a college football game. Tobacco companies have been prohibited from advertising on TV since 1971.

The legalization movement is backed by the likes of George Soros and Napster co-founder Sean Parker, and this year they are vastly outspending opponents. No wonder U.S. support for legalizing marijuana has increased to 57% from 32% a decade ago, according to the Pew Research Center.

We realize it’s déclassé to resist this cultural imperative, and maybe voters think the right to get high when you want is worth the social and health costs of millions of more stoners. Then again, since four states have volunteered to be guinea pigs, maybe other states should wait and see if these negative trends continue.

Correction: An earlier version of this editorial incorrectly said the 178% increase in positive workplace drug tests for marijuana since 2012 occurred in Colorado.

Great summary. Wish all docs were forced to read this and the NEJM MJ reviews. Sounds like a lot of physicians were asleep during their mandatory public health requirements during Med school....

 

[Mad Jack]

But you make the argument is it smoking marijuana is protected against impairment and motor vehicle crashes. Your argument is disingenuous and pure nonsense. marijuana is a psychoactive drug and can cause impairment. There is an increase in fatalities due to marijuana once it was legalized in Colorado and that literature was published earlier in this thread choosing to ignore it means you're ......

I don't get how you ever got that impression- I said that most people that test positive for 9-C-THC have no THC in their blood at the time of the rest, therefore it is unknown how many people involved in these crashes were high at the time of the crash. It makes at least as much sense as the arguments other posters were throwing around earlier that the massive number of people with opioids in their system at the time of death were like, totally not dying of the opioids. Except the big difference is that tests for opioids test for active metabolites, not inactive, so we've got direct proof that all of these people dying of respiratory failure definitely had opioids on board and active.

 

[Mad Jack]

Great summary. Wish all docs were forced to read this and the NEJM MJ reviews. Sounds like a lot of physicians were asleep during their mandatory public health requirements during Med school....

Like the same ones in this thread that see no link between opioid prescriptions and the opioid epidemic, despite the NEJM publishing research that is infinitely more damning? Read Trends in Opioid Analgesic Abuse and Mortality in the United States, it was in the January 2015 issue.

 

[Mad Jack]

and information suggesting otherwise:

https://www.ncbi.nlm.nih.gov/pubmed/14642878?access_num=14642878&link_type=MED&dopt=Abstract


https://www.ncbi.nlm.nih.gov/pubmed/26240297

Solid data. I'll buy it, actually.

 

[Stim4me]

Like the same ones in this thread that see no link between opioid prescriptions and the opioid epidemic, despite the NEJM publishing research that is infinitely more damning? Read Trends in Opioid Analgesic Abuse and Mortality in the United States, it was in the January 2015 issue.

If you actually evaluate trends we have seen over time; the masses die from heroin (80s), then prescription opioids, then illicit opioids, then methadone, then fentanyl, now heroin again, more recently heroin laced with fentanyl, and it goes in circles. Adding MJ or etoh for that matter to the mix doesn't help, the public health crisis. We have an addiction problem period, ignoring that and making a case for rampant medical MJ criteria or pushing for pure recreational MJ without actually addressing the underlying addiction epidemic is reckless. We have no long term safety data, and the data coming out form departments of transportation are scary....

 

[Mad Jack]

If you actually evaluate trends we have seen over time; the masses die from heroin (80s), then prescription opioids, then illicit opioids, then methadone, then fentanyl, now heroin again, more recently heroin laced with fentanyl, and it goes in circles. Adding MJ or etoh for that matter to the mix doesn't help, the public health crisis. We have an addiction problem period, ignoring that and making a case for rampant medical MJ criteria or pushing for pure recreational MJ without actually addressing the underlying addiction epidemic is reckless. We have no long term safety data, and the data coming out form departments of transportation are scary....

I just don't think it should be the government's job to make sure people are consuming substances responsibly. It isn't their place to make sure we live in a perfectly safe bubble. People should have freedom, with the personal responsibility that that necessitates. That's why we've got guns, alcohol, cigarettes, hell, even cars- could take all of those things away, and life would be much safer, thousands of lives would be saved. But that's the cost of freedom, unfortunately. I think marijuana is no more dangerous than many things that are already legal, and has more benefits than alcohol or tobacco, which provide minimal to none, and yet here they are with few clamoring to ban them.

 

[Stim4me]

I just don't think it should be the government's job to make sure people are consuming substances responsibly. It isn't their place to make sure we live in a perfectly safe bubble. People should have freedom, with the personal responsibility that that necessitates. That's why we've got guns, alcohol, cigarettes, hell, even cars- could take all of those things away, and life would be much safer, thousands of lives would be saved. But that's the cost of freedom, unfortunately. I think marijuana is no more dangerous than many things that are already legal, and has more benefits than alcohol or tobacco, which provide minimal to none, and yet here they are with few clamoring to ban them.

Your point of libertarianism and autonomy is very valid. I just think being a physician we need to be the conservative and data/literature based thinkers of society and public policy.

 

[Mad Jack]

Your point of libertarianism and autonomy is very valid. I just think being a physician we need to be the conservative and data/literature based thinkers of society and public policy.

Data shouldn't get in the way of rights. I suppose that gets right down to the point of the thread- we should just be calling it marijuana and not medicine. If it has some side effects that are beneficial to some people, that's fine. But it has its risks and benefits, and should have associated penalties that impact those who cannot use it responsibly. It's less a belief that the data matters, and more a belief that certain rights and their concomitant responsibilities are inherent that leads me to the legalization argument.

 

[Stim4me]

Data shouldn't get in the way of rights. I suppose that gets right down to the point of the thread- we should just be calling it marijuana and not medicine. If it has some side effects that are beneficial to some people, that's fine. But it has its risks and benefits, and should have associated penalties that impact those who cannot use it responsibly. It's less a belief that the data matters, and more a belief that certain rights and their concomitant responsibilities are inherent that leads me to the legalization argument.

Autonomy verses paternalism... federalism vs socialism... regulation vs free market... safety vs slippery slope... Plato vs artistotle

 

[lobelsteve]

Your right to smoke pot has to be balanced with consequences of driving under the influence. no different than driving on alcohol or heroin.

 

[Ducttape]

we have a responsibility to encourage patients be as safe as possible.

im not sure the Hippocratic oath is entirely compatible with libertarianism and self-autonomy with respect to patient care and safety.

 

[SeniorWrangler]

According to the New York Times, legalization measures on the ballot in five states including California on Tuesday. If it passes in most or all of them, this argument will be moot.

 

[drusso]

http://www.theatlantic.com/health/a...pots-potential-to-replace-painkillers/507200/

"Lindley’s plan is to enroll 50 patients with chronic back and neck pain. While “these patients are large consumers of opioids,” she says, opioid painkillers aren’t very effective for many of them, especially over the long term. The idea to investigate cannabis came from a survey conducted several years ago with patients at the University of Colorado Hospital’s Spine Center. At the time—and this was before Colorado legalized recreational marijuana, in 2012—nearly a fifth of the patients reported self-treating with pot. Of those, more than three-quarters said it provided as much or more relief as their opioid pain drugs. It felt like a lead worth following up on with a carefully controlled clinical study."

 

[lonelobo]

Since California passed legal MJ, the Feds will follow in the next 5-7 years

 

[Norma Stilner]

Just treat it like alcohol, legal but regulated, taxed significantly, not allowed until age 21. I expect California to make recreational MJ legal in six weeks.

However MJ does alter the sensorium as does alcohol and so I won't write COT for patients taking MJ, (or alcohol). Only one mind altering substance at a time.

Exactly! I am thinking same things. If Govt. not allowed alcohol and drug until the age of 21, the teenager should be safe.

 

[EtherBunny]

The cognitive dissonance of this country's political discourse absolutely drives me nuts. The debate over recreational and medical marijuana is a prime example (gun control is another, but that's an entirely different topic).

To the opponents of legalizing recreational marijuana usage: Alcohol and tobacco are legal in the United States. And yet, as physicians we all know that alcohol and tobacco--two highly addictive substances--can be incredibly harmful to people. Cancer, permanent brain damage, neuropathy, liver cirrhosis, fatalities from drunken driving, etc. The list of harmful effects from these LEGAL substances that are used recreationally is seemingly endless. It just seems very hypocritical to me to keep tobacco and alcohol legal in the United States, both of which kill or severely harm so many Americans every year, but keep marijuana illegal.

The same thing goes for medicinal use of marijuana. How can opioids be considered legal and professionally acceptable for the treatment of pain, and yet cannabinoids are illegal and a professional taboo? Every year countless Americans become addicted to opioids and every year thousands of Americans are killed by opioid overdoses. We know that long term systemic opioid therapy has a host of pathological effects on the body, such that there is a mounting body of evidence that the long term adverse effects of systemic opioids outweigh any potential benefits. Moreover, the "evidence" supporting the use of systemic opioids in the treatment of chronic non-malignant pain is poor. How can one support the use of long term systemic opioid therapy in patients and simultaneously express a vehement opposition to cannabinoids?

Cognitive dissonance... It's rampant in our nation's political discourse on controversial topics. Logic gets thrown out the window.

If it were up to me, I would legalize both the recreational and medicinal usage of marijuana, so that we can begin to study it extensively. It needs to be subjected to rigorous scientific inquiry. As long as it's classified as a schedule I drug, that scientific exploration will never occur in earnest.

 

[MaximusD]

Majority of those examples effect individuals. MJ, alcoholism and guns effect others... Regulate things that effect public health and society. I can careless if you like surfing or down hill skiing or motorbikes with no helmets , as long as you have money to pay for you ICU costs . If you don't have the money your assests should be free game.

Nope those high cost hospital stays are diversified across the payer base. We all pay for high risk behavior whether it be marijuana, sky diving, or sleeping with your sister

 

[Ducttape]

The cognitive dissonance of this country's political discourse absolutely drives me nuts. The debate over recreational and medical marijuana is a prime example (gun control is another, but that's an entirely different topic).

To the opponents of legalizing recreational marijuana usage: Alcohol and tobacco are legal in the United States. And yet, as physicians we all know that alcohol and tobacco--two highly addictive substances--can be incredibly harmful to people. Cancer, permanent brain damage, neuropathy, liver cirrhosis, fatalities from drunken driving, etc. The list of harmful effects from these LEGAL substances that are used recreationally is seemingly endless. It just seems very hypocritical to me to keep tobacco and alcohol legal in the United States, both of which kill or severely harm so many Americans every year, but keep marijuana illegal.

The same thing goes for medicinal use of marijuana. How can opioids be considered legal and professionally acceptable for the treatment of pain, and yet cannabinoids are illegal and a professional taboo? Every year countless Americans become addicted to opioids and every year thousands of Americans are killed by opioid overdoses. We know that long term systemic opioid therapy has a host of pathological effects on the body, such that there is a mounting body of evidence that the long term adverse effects of systemic opioids outweigh any potential benefits. Moreover, the "evidence" supporting the use of systemic opioids in the treatment of chronic non-malignant pain is poor. How can one support the use of long term systemic opioid therapy in patients and simultaneously express a vehement opposition to cannabinoids?

Cognitive dissonance... It's rampant in our nation's political discourse on controversial topics. Logic gets thrown out the window.

If it were up to me, I would legalize both the recreational and medicinal usage of marijuana, so that we can begin to study it extensively. It needs to be subjected to rigorous scientific inquiry. As long as it's classified as a schedule I drug, that scientific exploration will never occur in earnest.

your post also points to a point of confusion regarding marijuana.

marijuana itself should not be considered ever be considered legal, because each different strain - probably each different hit - has different concentrations of active substances. just like how opium is considered schedule 1, but morphine and codeine are not.

so far, 2 of the various chemicals in marijuana should be studied for clinical efficacy. that is being done, with marinol, and sativex. more should be done by big pharma regarding cannibidiol (hemp oil) and other active components of marijuana.

 

[drusso]

Does this make it medicine now?

New U.S. Patent Allowance Granted to AXIM® Biotechnologies, Inc. for Cannabinoid Ophthalmic Solutions for Glaucoma and Conjunctivitis Treatment

 

[lobelsteve]

Baby boy is first marijuana overdose death, doctors claim
Baby boy is first marijuana overdose death, doctors claim

 

[clubdeac]

So I saw one of my patients today on the inpatient psych floor who was admitted for severe depression and suicidal ideation. I have been giving him quarterly GON blocks and cervical TPIs for chronic myofascial pain and post concussive headaches related to a gunshot wound to the neck and head several years prior. He always reports a couple months relief from the blocks. I was reading the intake H&P and was interested to read that he smokes marijuana daily however the pain was still the primary reason for his depression and SI. Apparently weed isn't as effective as everyone's claiming! Needless to say I'm going to try botox in between his quarterly GON blocks as we're obviously not obtaining as much relief as I had thought. Poor guy

 

[Ducttape]

Attorney General Sessions to end Obama-era policy that let legal pot flourish

Attorney General Sessions to end Obama-era policy that let legal pot flourish


Sessions will roll back Obama-era policy on legal marijuana
Attorney general to rescind policy allowing legal pot in states without federal intervention.

Attorney General Jeff Sessions plans to roll back an Obama-era policy that had allowed legal marijuana to thrive without federal intervention, Fox News confirmed Thursday.

The Obama administration back in 2013 announced via a memo from then-Deputy Attorney General James Cole that it would not obstruct states that legalized marijuana, on the condition the drug was not allowed to move to states where it was illegal and it was kept away from children and gangs.

Sessions is expected to announce that he will rescind that memo and instead leave it to U.S. attorneys in states where the drug is legal to decide to what extent they will enforce federal laws.

The Associated Press reported that the move will likely add to confusion among users and suppliers about whether they can grow, buy and sell marijuana in states -- as federal law bans it.

The government regards marijuana as a controlled dangerous substances, grouped together with drugs such as heroin. Sessions has blamed its increased use for spikes in violence in the U.S.

Attorney General Jeff Sessions will roll back Obama-era policies that allowed legal marijuana to thrive in states. (AP)

Sessions’ announcement will come just days after California joined states such as Colorado in permitting pot for recreational purposes. The drug will be legal for adults 21 and older, and residents will be allowed to grow up to six plants and possess up to an ounce of marijuana.


Twenty-nine states have adopted medical marijuana laws, while seven other states have legalized the drug for recreational purposes.

Fox News’ Jake Gibson and The Associated Press contributed to this report.