Henry David Abraham, MD
Two thirds of the voters of Massachusetts have joined those in 17 other states to declare that marijuana is now a medicine. This is the not the usual way a medication gets approved for use. But marijuana is no usual medication. No modern medicine is smoked. Voters have danced democratically around the Federal government’s regulations, laws, and threats of punishment over the medical use of weed. Medical science took a back seat to all this, as if the laws of chemistry, physics and biology could be repealed by a show of hands.
To the majority the vote was all about compassion. On Valentine’s Day the Department of Public Health held a “listening session” on medical marijuana. Sufferers of many ailments for whom the weed is a godsend made moving testimonials. To others the vote appears to be the camel’s nose in the tent. If medicalized weed is here, can recreational weed be far behind? To many of my medical colleagues, the vote felt like we were being hijacked into offering a “medication” which has more proven risks than benefits. New evidence, for example, shows that weed is found more often in stroke victims than controls.
For parents the vote opened up a box of tough new potential questions from their kids. Is weed safer than we thought? If sick people can use it for medicine, why can’t other people use it for fun? And if they can use it, why can’t kids? These questions are likely to multiply as “treatment” centers blossom like poppies in the morn.
But hold on, Moms and Dads! Let’s stick to the evidence. Marijuana is still a risky drug to mess with, especially for kids. And the younger a kid starts, the worse it is. A recent study of more than 1,000 kids from New Zealand, for example, showed that if kids smoked heavily as teens, by age 38 their IQs were lower than those in kids who didn’t smoke. Now this is scary. Worse, mental declines persisted long after kids stopped the drug. This doesn’t prove that using weed caused the mental drop. Maybe weed users drank more alcohol, had more head injuries, or had more drug overdoses than controls. This kind of comparison usually has more than one explanation. But it’s consistent with many other brain and cognitive studies of the same question. Now let’s have a new vote. All you kids who want to be dumber please raise your hands. Not too many, eh? Good. This little vote is nothing I just made up, by the way. That’s what the data show.
Contrary to what you would fear, large scale surveys of high school students in the U.S. show that 80% “disapprove” of frequent marijuana use, and have done so for the last twenty years. By that measure, the average high school student gets higher marks than the average Massachusetts voter. But the kids don’t get straight A’s, since the same national survey found that the percentage of kids who saw smoking weed every day as a “great risk” fell steadily from 80 to 40% in the same twenty year period. Clearly, our kids are getting a bit too comfortable with weed in their lives. It’s important to note that the trend began before the first state approved of medical marijuana. But the medical marijuana movement is only likely to make the trend worse. In Danvers, for example, Jason Verhoosky, who works with kids messed up on drugs, reports weed use went up when we decriminalized it.
There is another concern. More weed in the community means more weed in the hands of our little darlings. John Carmichael Jr., the deputy police chief in Walpole, raised this point at the Public Health meeting. ‘‘It would be naive to think there is not going to be diversion,’’ he said. His fear is well founded. A recent study from the University of Colorado, where medical weed was legalized in 2000, found that the diversion of medical marijuana to the young can happen. Among 164 teens in treatment for drug abuse, 74% of them admitted using someone else’s medical marijuana.
Much of the discussion at the public meeting focused on who would be eligible for medical weed. Medical treatment is built on a hierarchy based on the types of evidence that support it. Does it work, and is it safe? A man who claims that marijuana reduces his chronic pain, for example, is worth listening to. He may be telling us something that medical scientists can work with to help lots of other people. But personal testimonials are seldom controlled experiments. I remember a nearly 100 year old man telling me the secret to his long life: “A glass of warm water every day.”
For stuff to become a proven medicine we need a higher level of validity than voting, personal or otherwise. We need studies that use powerful words in their titles like “controlled,” “placebo,” and “randomized.” While the body of evidence supporting medical marijuana is growing, it’s no credit to the Federal government for having stood in the way of legitimate research for decades in the name of the War on Drugs. Controlled studies are appearing for the use of weed in cancer chemotherapy, AIDS, and MS. Wider claims are being made for the treatment of pain and PTSD. Pain appears to be the commonest reason given for using medical marijuana.
In the end, will we smoking our way to health? I doubt it. But as Chou en Lai allegedly said when asked about the future of democracy given the success of the American revolution, “It’s too soon to tell.”