The discomfort of cancer patients is unlike any. They don’t just
suffer from pain directly caused by cancer — they also have to contend
with the toxic effects of the very treatments helping them in their
battle. They feel nauseated and weak. They feel tired, on top of the
pain they already feel. Conventional drugs for their symptoms will not
always work. Unfortunately, stronger ones make them sleepy, aside from
exposing them to serious adverse effects.
Then comes along marijuana. Cancer patients who get stoned for
“leisure” realize that their symptoms go away – they feel a lot better
after smoking weed.
They experience a drug-induced high, their symptoms melting away
while they continue to smoke pot. Their anecdotes carry far and wide,
reaching the ears of health practitioners. Soon enough, a debate ensues
on whether or not medical marijuana use deserves to be legalized.
Taking the “high” road
Although marijuana can alleviate many symptoms experienced by cancer
patients, it is addictive — and that remains one of the most common (and
soundest) arguments against legalizing medical cannabis use.
A few countries, such as Canada and Israel, have legalized medicinal
hemp use. Some states in the US have passed laws to legalize marijuana
use for medical reasons as well. Even the Food and Drug Administration has approved the use of cannabinoids in relieving nausea and anorexia among cancer patients.
However, the US federal government still refers to marijuana as a
controlled substance, one that is absolutely outlawed, according the Matthew Seamon in his 2006 article published at The Annals of Pharmacotherapy.
The conflict between state and federal laws is as yet unresolved and
will remain so until the courts say that medical marijuana use is
constitutional. In the meantime, doctors and patients resort to playing
it by ear, something they shouldn’t have to do if the rules were clear.
As stakeholders struggle with the stalemate, Israel is tinkering with
a solution that they hope will end the debate once and for all.
Mary Jane gets a makeover
In a secret location in Israel, marijuana continues to grow in
seemingly endless fields. You see, unlike regular marijuana, the weed
grown in these Galilean hills cannot get you addicted.
This non-addictive variant of marijuana was developed by Zach Klein, the former advocacy and development director of Tikun Olam. The company’s name is Hebrew for “repairing the world" — a suitable name, considering their novel discovery.
The new strain of marijuana, named Avidekel,
contains less than two percent of tetrahydrocannabinol, the substance
responsible for getting hemp users stoned. Despite the greatly reduced
THC content, Avidekel marijuana still contains more than 15 percent
cannabidiol, theorized to reduce inflammation.
In contrast to THC, CBD does not attach to receptors in the brain —
that means it can exert its effects without getting a person “high."
Perhaps the new hemp strain can put the weed debate to rest. But the
original and addictive THC-rich weed can provide relief for other
symptoms, which means that marijuana supporters can still argue to have
regular marijuana legalized, not just the THC-free plant.
The “pot” is black, or so the kettle says
We are years away from reaching a compromise. Legalizing marijuana,
even if it’s for friends and family suffering from the disabling effects
of cancer, still comes with consequences.
Others argue that many controlled drugs in the market are also
addictive, such as anti-anxiety medication and sleeping pills, and that
marijuana has much fewer side effects compared to these. But the
back-and-forth continues as many of our doctors and lawmakers reach what
seems to be an impasse.
We try out best to look for solutions. Israel is doing its part in
establishing a compromise: marijuana, yes, but without the addictive
THC.
But we should check our opinions at the door. What we need is more data. We need facts. We need to determine whether or not smoking the plant is better than drinking a pill composed of chemicals extracted from it.
The public also needs to be educated on both the advantages and adverse effects of marijuana use.
Ulterior motives must be set aside if we want to achieve a therapeutic
milestone. For instance, people who use marijuana but know very little
about the science behind cannabinoids cannot simply support the
legalization of marijuana for their own selfish reasons. On the other
hand, people who wrinkle their nose at potheads should not automatically
condemn marijuana use in medicine.
The argument between the opposing camps exists for a reason. It is actually good that we don’t agree with each other.
Much has to be done before legislators figure out whether marijuana
should be legalized for medical use. Much has to be said before doctors
can ensure that marijuana is a plant that should be used by people who
allegedly need it.
But, as is the case in any worthy but difficult endeavor, we have to
start somewhere — even if that “somewhere” is in a heated debate with
brilliant people who, unfortunately, do not share the same point of
view.
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Smoking cannabis
does not worsen liver disease in people with HIV and hepatitis C virus (HCV)
co-infection, Canadian research published in the online edition of Clinical Infectious Diseases shows.
“We found no
evidence that cannabis smoking increases the risk of progression to significant
liver fibrosis or cirrhosis,” write the authors. Results also showed that
cannabis was widely used for pain relief by co-infected people.
Up to 30% of
people with HIV in resource-rich countries are co-infected with HCV. Liver
disease caused by HCV is a leading cause of serious illness and death in these
co-infected individuals.
Cannabis
(marijuana) is believed to be widely used by people with HIV. In a study conducted in
Ontario, Canada, 43% of participants reported use of cannabis in the previous year,
29% saying they had self-medicated with the drug.
Previous research
examining the effects of cannabis consumption on liver disease outcomes has produced
conflicting results. Three cross-sectional – or 'snapshot' – studies involving
people with chronic HCV infection found an association between cannabis use
and liver cirrhosis. In contrast, a small study involving 58 people with HIV
showed no association between cannabis use and significant changes in liver
enzyme levels over one year.
Given this
uncertainty, investigators in Canada designed a prospective study involving 690
HIV-positive people with chronic HCV co-infection and no significant fibrosis
at baseline enrolled in the Canadian Coinfection Cohort study. Every six months,
participants were asked if they had used cannabis. Users of the drug were asked how
often they smoked cannabis and the number of joints they consumed on the days
they smoked.
The investigators
then examined the association between cannabis use and progression to
significant fibrosis, cirrhosis and end-stage liver disease. Significant
fibrosis was defined as an AST platelet ratio index (APRI) score of 1.5 or above. An APRI score of 2.0 was
used to diagnose cirrhosis and the authors also looked at the relationship
between cannabis use and progression to a clinical cirrhosis diagnosis.
The investigators
were concerned that participants might start to consume cannabis – or
intensify their use of the drug – to alleviate symptoms related to
advancing
liver disease. By collecting concurrent data on exposure to cannabis and
disease outcomes it could appear that cannabis caused liver disease when
in
fact this was present before the participant changed their drug-use
behaviour. The
investigators therefore repeated their analyses looking at cannabis use
in the six
to twelve month period before liver disease assessments. They called
this
method of analysis “lagging”.
The participants were
followed for a median of 2.7 years and contributed a total of 1875 person-years
of follow-up. The majority of participants were male and the median age at baseline
was 44 years. Most of the participants had an undetectable HIV viral load and the
median CD4 cell count at the start of the study was 400 cells/mm3.
Injecting drug use was reported by 38% of participants and 15% had alcohol abuse
issues.
Over half (53%) of
participants reported use of cannabis at baseline with similar proportion of
individuals using the drug through follow-up. On entry to the study, approximately
40% of participants who used cannabis said they did so for symptom relief, and this
proportion increased to over 50% during follow-up. Turning to frequency of use,
the investigators found that 40% of cannabis smokers consumed the drug on a
daily basis.
During follow-up,
19% of participants developed significant fibrosis, 15% cirrhosis (diagnosed by
APRI score), 1% received a clinical diagnosis of cirrhosis and 2% progressed to
end-stage liver disease.
The incidence rate
of progression to APRI 1.5 or above was 39.2 per 1000 person-visits; incidence
of progression to APRI 2.0 or above was 29.2 per 1000 person-visits; incidence
of progression to a clinical cirrhosis diagnosis was 2.1 per 1000
person-visits; and incidence of progression to end-stage liver disease was 2.9
per 1000 person-visits. There were no differences in these incidence rates
between users and non-users of cannabis.
The
investigators’ initial analysis appeared to show that smoking cannabis
accelerated progression to a clinical diagnosis of cirrhosis (HR = 1.33; 95%
CI, 1.09-1.62 per ten joints/week). However, after lagging this association
ceased to be significant. Smoking cannabis was also initially associated with a
combined outcome of clinically diagnosed cirrhosis and end-stage liver disease
(HR = 1.13; 95% CI, 1.01-1.28). But once again this association ceased to be significant
when the researchers looked at cannabis consumption in the six to twelve months
before the clinical outcomes were diagnosed.
“Reported use for
symptom relief was very prevalent suggesting that the association of daily
cannabis use and more advanced fibrosis may, in fact, be related to an
increased use for symptoms management of the disease,” the authors suggest.
“Previous cross-sectional studies reporting an association between marijuana
smoking and liver fibrosis may be biased by reverse causation due to
self-medication with marijuana for relief of symptoms related to significant
liver fibrosis.”
They conclude, “We
could not demonstrate any important effect of marijuana on liver disease
outcomes.”
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