IDEAS-CANADA.CA 16 Dec 2017

In London, Cannabis declared no better that codeine at controlling pain and because of its undesirable side effects "It has no place in mainstream medicine". (British Medical Journal)

TRUE and FALSE, also INCOMPLETE

In 2001, the British Medical Journal did publish two reviews of existing scientific studies on cannabinoids, one on pain management, the other on nausea control. These reviews did not include data on herbal cannabis, also called marijuana; instead, the studies reviewed examined only oral THC and two synthetic cannabinoids.

The reviews found that "Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use," and "In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness. Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use." The quote given in the IDEAS Found.'s assertion, regarding mainstream medicine, does not appear in either article, nor in the editorial on medical cannabis appearing in the same issue, nor in the letters which appeared in BMJ in response, nor in the authors' response to those letters.

(sources: Campbell, Fiona A., Martin R. Tramer, et al., "Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review," British Medical Journal 2001; 323:13, July 7, 2001; Tramer, Martin R., Dawn Carroll, et al., "Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review," British Medical Journal 2001;323:16, July 7, 2001.)

In a related editorial in the BMJ, Eija Kalso, associate professor at Helsinki University Hospital, wrote: "Future research may provide us with better cannabinoid compounds with potential new therapeutic applications. However, the current information is that the adverse effects of cannabinoids outweigh their effectiveness. About a year ago in the BMJ Strang et al asked for a more informed debate about the therapeutic use of cannabinoids, and this week's two systematic reviews contribute to this debate. On current evidence cannabinoids can be recommended only for use in controlled clinical trials in carefully selected conditions for which there is no effective treatment. The launch of the first large multicentre trial on cannabis in the control of pain and tremors in multiple sclerosis is the first step on this way." (Source: Eija Kalso, "Cannabinoids for pain and nausea," British Medical Journal 2001; 323:2-3, July 7, 2001.)

Other medical experts are more supportive of cannabis's therapeutic potential. According to the Canadian Medical Association Journal: "Health Canada's decision to legitimize the medicinal use of marijuana is a step in the right direction. But a bolder stride is needed. The possession of small quantities for personal use should be decriminalized. The minimal negative health effects of moderate use would be attested to by the estimated 1.5 million Canadians who smoke marijuana for recreational purposes. The real harm is the legal and social fallout. About half of all drug arrests in Canada are for simple possession of small amounts of marijuana: about 31,299 convictions in 1995 alone."
(Source: "Marijuana: federal smoke clears, a little," Canadian Medical Association Journal, May 15, 2001, Vol. 164, No. 10, p. 1397)

In an editorial in the New England Journal of Medicine in 1997, Dr. Jerome Kassirer wrote: "Federal authorities should rescind their prohibition of the medicinal use of marijuana for seriously ill patients and allow physicians to decide which patients to treat. The government should change marijuana's status from that of a Schedule 1 drug (considered to be potentially addictive and with no current medical use) to that of a Schedule 2 drug (potentially addictive but with some accepted medical use) and regulate it accordingly. To ensure its proper distribution and use, the government could declare itself the only agency sanctioned to provide the marijuana. I believe that such a change in policy would have no adverse effects. The argument that it would be a signal to the young that 'marijuana is OK' is, I believe, specious."
(source: Kassirer, Jerome P., MD, "Federal Foolishness and Marijuana," New England Journal of Medicine, Vol. 336, No. 5, Jan. 30, 1997, from the web at http://www.mapinc.org/drugnews/v97/n000/a014.html)

In the US government's Institute of Medicine report on medical marijuana in 1999, the authors conclude that "The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation."
(Source: Joy, Janet E., Stanley J. Watson Jr., and John A. Benson Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine, National Academy of Sciences (Washington, DC: National Academy Press, 1999).

In Wisconsin, marijuana overdose visits in emergency rooms equal to heroin or morphine, twice as common as Valium. (Wisconsin Department of Justice)

IRRELEVANT and STATISTICALLY NORMAL

Notably there are no numbers given, only comparisons. The rates are similar to national averages. It should be noted that alcohol-in-combination is a larger problem than any of the illicit drugs.

First, an explanation of terminology: the federal entity which collects data on drug mentions in emergency department and medical examiner reports, the Drug Abuse Warning Network or DAWN, explains the difference between emergency room visits and emergency room drug mentions thus:
"Drug Episodes vs. Drug Mentions Drug-Related Episode: A drug or ED episode is an ED visit that was induced by or related to the use of an illegal drug(s) or the nonmedical use of a legal drug for patients age 6 years and older. Drug Mention: A drug mention refers to a substance that was mentioned during a drug-related ED episode. Because up to 4 drugs can be reported for each drug abuse episode, there are more mentions than episodes cited in this report." (p. 1)
Source: "Year-End 2000 Emergency Department Data from the Drug Abuse Warning Network," Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, July 2001.

Nationally, the number of marijuana/hashish mentions is nearly equal to that of heroin/morphine. DAWN reports that:

"In 2000, there were 601,776 drug-related ED episodes in the coterminous U.S. with 1,100,539 drug mentions (on average, 1.8 drugs per episode). There was no statistically significant change between 1999 and 2000 in the number of ED episodes (from 554,932 to 601,776) or ED drug mentions (from 1,015,206 to 1,100,539) (Table 2 and Figure 1).

"In 2000, drug abuse-related ED visits occurred at the rate of 243 ED episodes per 100,000 population in the coterminous U.S. (Table 30). "Cocaine continued to be the most frequently mentioned illicit drug, comprising 29 percent of episodes (174,896 mentions) in 2000. Cocaine was followed in frequency by heroin/morphine (16%, 97,287 mentions), marijuana/hashish (16%, 96,446 mentions), amphetamine (3%, 16,189 mentions), and methamphetamine/speed (2%, 13,513 mentions) (Table 2 and Figure 2).

"During 2000, the highest rates of ED drug mentions occurred for: alcohol-incombination (83 mentions per 100,000 population), cocaine (71), heroin/morphine (39), and marijuana/hashish (39) (Table 30).

"Alcohol-in-combination was mentioned in 34 percent (204,524) of ED drug episodes in 2000 and remains the most common substance reported by DAWN EDs (Table 2). Note that alcohol is only reported to DAWN when present in combination with another reportable drug. "Mentions of the narcotic analgesics oxycodone and hydrocodone are relatively infrequent (mentioned in 2% and 3% of episodes, respectively), but revealed significant increases. From 1999 to 2000, mentions of drugs containing oxycodone increased 68 percent (from 6,429 to 10,825), and mentions of drugs containing hydrocodone increased 31 percent (from 14,639 to 19,221). Mentions of oxycodone were 108 percent higher in 2000 than in 1998, and mentions of hydrocodone were 53 percent higher than in 1998." (p. 11)

Additionally:
"Mentions of the antidepressants trazodone (9,798, 2% of episodes), amitriptyline (6,446, 1%), fluoxetine (7,938, 1%), doxepin (1,552, 0.3%), and imipramine (564, 0.1% of episodes) showed no statistically significant changes between 1999 and 2000 (Table 2).

"Mentions of the benzodiazepines alprazolam (22,105, 4% of episodes), clonazepam (18,005, 3%), diazepam (12,090, 2%), lorazepam (10,671, 2%), and triazolam (362, 0.1%) remained stable from 1999 to 2000 (Table 2). Since 1993, mentions of clonazepam have increased 77 percent, and mentions of triazolam have decreased 71 percent." (p. 26)

According to DAWN, nationally in 2000 there were a total of 264,240 emergency room department drug episodes arising from overdose (table 18, p. 77), in which there were 518,654 drug mentions (table 20, p. 79). There were 18,734 marijuana/hashish 'mentions' in emergency room visits attributed to overdose in 2000 (table 26, p. 85), cocaine accounted for 27,794 such mentions (table 22, p. 81), and heroin another 16,999 (table 24, p. 83).

It is important to note again that mention of a drug in an emergency department visits does not mean that the drug was the *cause* of the visit. The DAWN report for 2000 says:
"Marijuana/hashish mentions related to all motives were stable from 1999 to 2000 (Table 26). ED contacts due to chronic effects increased 25 percent (from 6,891 to 8,621), and contacts due to patients seeking detoxification increased 18 percent (from 11,908 to 14,110). However, 2 important caveats must be kept in mind. First, the drug use motive and reason for ED contact were frequently unknown or reported as "other" (24% and 23% of mentions, respectively). Second, drug use motive and reason for ED contact pertain to the episode, not a particular drug. Since marijuana/hashish is frequently reported in combination with other drugs, the reason for the ED contact may be more relevant to the other drug(s) involved in the episode." (p. 21)

Top Story:   The Prohibitionist Counterattack in Canada -- DEA Is Their Middle Name. May Conference In Vancouver Requires Serious Response.
Posted by Richard Cowan on 2001-12-13 17:36:53

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