Fear of abuse taints medical marijuana


SOME physicians want freedom to prescribe marijuana for certain chronic disease sufferers but others oppose, because the latter fears there would be widespread abuse and misuse.

THE odour is pungent and asphyxiating. Users are often looked upon as deviant members of society. Until 1975 when the Gen. Murtala Ramat Muhammed administration reduced the jail sentence on the use or possession of Cannabis sativa (marijuana, or Indian hemp) from seven years to six months, the highly intoxicant weed's use was fought vigorously by law enforcement agents. Now, medical scientists globally are locked in a battle to legalize the use of marijuana to treat some diseases.

Some Nigerian physicians are buying into the global effort while others oppose it. A recent endorsement of medical marijuana by at least 14 states in the United States (U.S.) has resurrected the debate.

According to the U.S. State Department's 2007 International Narcotics Control Strategy Report, "sale and local consumption of marijuana is on the increase. The rise in marijuana use domestically in Nigeria is evinced by the increased quantities seized, the number and size of illicit plots discovered and destroyed, and numbers of arrests made."

The National Drug Law Enforcement Agency (NDLEA) is waging a war against the use of marijuana as part of the agency's effort to provide a drug-free society for all.

Chairman of the NDLEA, Ahmadu Giade, said the threat of narcotic drugs is palpable. "It is difficult to ignore this peril staring at us in the face. Cannabis control constitutes the biggest drug challenge in Nigeria and Africa. This is because it grows effortlessly in the country. This drug has the propensity to destroy our society but we equally have the capacity to subdue it," he said.

Despite these regulations, research and debate on the medical use of marijuana is on the rise. Some say that marijuana should be legalized for medical use because it has been known to suppress nausea induced by cancer chemotherapy, decrease muscle spasticity in patients with neurological disorders, stimulate appetite and eliminate menstrual pain. Spasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms (sustained muscle contractions or sudden movements).

The body of research surrounding the medicinal value of marijuana is extensive, much of it concerns is Tetra Hydro Cannabinol (THC), one of the cannabinoids in marijuana. Cannabinoids are a group of compounds present in cannabis and which occur naturally in the nervous and immune systems of animals. THC is what causes people to feel "high" and also what gives cannabis some of its medicinal properties, such as increased appetite.

In many states in the U.S. medical marijuana is recommended for many conditions and diseases, frequently those that are chronic. Among them are nausea, loss of appetite, chronic pain, anxiety, arthritis, cancer, Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), glaucoma, multiple sclerosis, insomnia, Attention Deficit Hyperactivity Disorder (ADHD), epilepsy, inflammation, migraines and Crohn's disease (an ongoing disorder that causes inflammation of the digestive tract, also referred to as the gastrointestinal tract).

Marijuana is also used to ease pain and improve quality of life for people who are terminally ill.

Opponents worry that legalizing medical marijuana might lead teens to believe that marijuana is safe for recreational use and increase availability of the drug. On the other hand, some supporters think changing the perception of marijuana from a party drug to a medication might make it less attractive to teens wanting to defy or rebel.

Legalized medical marijuana also presents law enforcement with challenges. How would federal, state and local governments control and regulate its production, distribution and sale? Who would define what is recreational versus medical use of the drug, and how would that be enforced?

Some of marijuana's reported side effects include: Problems with memory and learning; distorted perception; difficulty with thinking and problem solving; loss of coordination; increase in heart rate; dry mouth (cotton mouth or peanut-butter mouth); reddening of the eyes; and anxiety paranoia and panic attacks.

The debate over the addictive capacity of marijuana continues. Ongoing studies now show a number of possible symptoms associated with the cessation of marijuana use. The symptoms include irritability, nervousness, depression, anxiety and even anger. Other symptoms are restlessness, severe changes in appetite, violent outbursts, interrupted sleep or insomnia. In addition to these possible physical effects, psychological dependence usually develops because a person's mind craves the high that it gets when using the drug.

Beyond these effects that marijuana has, its smokers have been shown to be susceptible to the same health problems as tobacco smokers, such as bronchitis, emphysema, and bronchial asthma. Other effects include dry mouth, red eyes, impaired motor skills and impaired concentration. Long-term use of the drug can increase the risk of damaging the lungs and reproductive system. It has also been linked to heart attacks.

However, the use of medical marijuana has divided medical experts. An Adjunct Professor at Illinois University, Chicago, U.S. and renowned anatomist, Prof. Oladapo Ashiru said medical marijuana, to some, is a contradiction in terms of immorality but it represents an essential medicine that alleviates debilitating symptom. Without it, many people would not be able to treat their conditions.

As a medical scientist, he says the risk of abuse versus therapeutic benefits is the main issue behind the debate of legalizing marijuana. He said results obtained from studies that deem marijuana, as a "gateway drug," a drug that leads to the consumption of other illicit drugs, have so far proven inconclusive; and studies have shown that there are more benefits to smoking marijuana than there are risks.

"It is important to note that not all doctors support the medicinal use of marijuana and that doctors are only supposed to recommend it after determining that it can be medically helpful to the patient despite any side effects," Ashiru said.

He said some patients do not respond well to other medications and need medical marijuana to alleviate their symptoms. "Many pharmaceutical drugs create aversive side effects that these patients cannot endure. Since medical marijuana is illegal under federal law and pharmacies are prohibited from supplying it, doctors do not actually prescribe the drug. Instead, they 'recommend' it to patients that they feel could benefit from it," he said.

The anatomist said for some cancer and AIDS patients, drugs that are supposed to boost appetite simply do not work, Ashiru said.

He cautioned however on reliance on research results supporting medical marijuana use. "However, for those who use marijuana as a last resort to treat their pain, they should have the option of having access to it via legal channels.

"Whether physiological evidence supports use or not, those people who use marijuana to sooth illness obviously feel better by using it. If marijuana use is psychological, then so be it. The bottom line is that marijuana use for therapeutic purposes should feel effective to those who are using it.

"From the hundreds of studies done over the years, scientists and the general public have a general notion of what the short and long term effects are. If one is willing to take the risk and use marijuana to help them cope with their illness, then it is their choice to do so. There is an obvious necessity for more research to be done.

"Science is headed in the right direction by developing new drugs that mimic the effects of marijuana and by continuing its quest to learn more about it. Until drugs are developed that work as well as marijuana, there should be no doubt that this wonder drug should be allowed for medicinal use".

But a consultant obstetrician and gynaecologist and Chief Medical Director of Optimal Specialist Hospital, Surulere, Lagos, Dr. Ugochukwu Chukwunenye, disagrees. "It is a fluke designed to hoodwink unsuspecting members of the public. If we are to accept that terminology, then we should also be talking of medical mangoes, oranges, sugar cane, dogonyaro (neem tree), and so on, because these and so many other fruits and vegetables have their medicinal values and uses," he said.

He added: "Soon, we may start hearing of medical heroine, cocaine, promiscuity, etc. Already homosexuality is being explained as medical sexual orientation. Some young and unmarried patients have asked if their medical condition is due to their lack of sexual intercourse? So we may soon hear of medically indicated sex as an explanation for premarital sex. It is true that medicine or medical practice has attained a very high level of respect and acceptance in most communities and countries, using it to make some harmful practices appear acceptable, may soon bring medical practice itself into disrepute."

He however said marijuana has long been known to have some medicinal values but its strong aphrodisiac properties have made its use limited. He said the current trend since the 1990s of calling it medical marijuana and getting some states in the U.S. to legalize it is certainly aimed at increasing its acceptance and use.

Chukwunenye said the efforts are succeeding as the number of shops selling marijuana in the U.S. are on a rapid rise, but so is psychopathic and sociopathic behaviours in the States and neighboring Mexico.

"Recently, 16 school children were murdered in cold blood in Mexico, a country noted for the growing of marijuana weeds. In those states where marijuana use has been legalized, the medical conditions for which it can be used have been on the increase and some recently doubled the quantity an individual can be found with per day," he said.

According to him, Nigeria should not expend its limited resources in such ventures. "The effects it will have in our body polity are better imagined than experienced. Armed robbery, hired assassins, political thugs and communal violence would be taken to the next level while our already limited security forces and the police would be totally overwhelmed."

President, Pharmaceutical Society of Nigeria (PSN), Mr. Azubuike Okwor, added that although the debate over the use has been on for quite sometime, he believes the demerits far outweigh the benefits. "Marijuana use often leads to dependence and abuse. Marijuana is also a gateway drug as many addicts for heroin and cocaine all started with marijuana. Marijuana is known to cause very significant health problems and at this point in our battle should be how to control the extensive illicit use by youths."

To a consultant in public health and Chief Medical Director of Lagos University Teaching Hospital (LUTH), Idi-Araba, Prof. Akin Osibogun, it is "only dose that separates remedy from poison", as long as the use of the substance is well controlled.

An oncologist at Aurora BayCare Medical Center, U.S., Dr. Umang Gautam said: "I sincerely feel that marijuana does have some properties that can help cancer patients."

He said chemotherapy weakens cancer patients to the point that they often lose appetite. "This is a significant problem...nutrition is an extremely important part of cancer care," he said.

Gautam however believes if it were legalized, there needed to be strict guidelines to make sure the law was not abused.

Indeed, cannabis preparations have been used to relieve nausea and pain since ancient times. But over the last 15 years, research on the body's cannabinoid receptors has begun to decipher the chemistry and biology of the good effects.

More recently, clinical trials have shown that these benefits outweigh the concerns about addiction, heart and respiratory diseases, cancers, and psychoses - at least, with short-term use.

Many questions, however, remain to be answered, experts say. One of the biggest is whether smoked medical marijuana could be replaced by a pharmaceutical version.

Marinol, a synthetic cannabinoid pill, is approved by the U.S. Food and Drug Administration (FDA) for treating HIV/AIDS-related wasting and chemotherapy-related nausea. But many patients say choking down a slow-acting pill simply does not provide the convenient and immediate relief of inhaling pot.

A new drug though still on trial, Sativex, made by GW Pharmaceuticals, may renew the quest. A cannabinoid-based oral spray, Sativex has been approved in Canada for treating pain in multiple sclerosis and advanced cancer.

Chief of oncology at San Francisco General Hospital, U.S., Dr. Donald Abrams, who conducted the U.S., state and federally funded research concerning medical marijuana said: "I see cancer patients every day who suffer from loss of appetite, weight loss, pain, anxiety, depression, insomnia and nausea. With cannabis, I can recommend one medicine instead of writing prescriptions for six or seven."

The benefits of marijuana in tempering or reversing the effects of Alzheimer's disease have been challenged in a new study by researchers at the University of British Columbia (UBC) and Vancouver Coastal Health Research Institute (VCHRI), Canada.

The findings, published in the current issue of the journal, Current Alzheimer Research, could lower expectations about the benefits of medical marijuana in combating various cognitive diseases and help redirect future research to more promising therapeutics.

Studies have also shown that pot smoking during pregnancy may stunt fetal growth and induce other harmful effects.

For the new study, researchers in the Netherlands followed more than 7,000 pregnant women, three per cent of whom acknowledged smoking marijuana at least during early pregnancy. They found that babies born to marijuana users tended to weigh less and have smaller heads than other infants.

Medical marijuana use growing in medical circles but old fears persist

NDLEA chairman, Giade, says threat of narcotic hemp is palpable

PSN President, Okwor, advises against use

Anatomist, Prof. Ashiru, supports controlled use

LUTH CMD, Prof. Osibogun advocates correct use


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