In January, 2014, Colorado became the first state in the United States to legalize marijuana for recreational purposes, marking the beginning of what will likely become the end of marijuana prohibition. Marijuana was legal in the United States until 1937, when Congress passed the Marijuana Tax Act, effectively making the drug illegal. The American Medical Association (AMA) opposed the legislation at the time of its passage. Additionally, from 1850-1942, marijuana was listed in the US Pharmacopoeia, the official list of recognized medical drugs . Cannabis was marketed as extract or tincture by several pharmaceutical companies and used for ailments such as anxiety and lack of appetite.
Despite the medical establishment’s views on the benefits of marijuana, the passage of the Comprehensive Drug Abuse Prevention and Control Act of 1970 classified marijuana as a Schedule I drug, defined as a category of drugs not considered legitimate for medical use. Other Schedule I drugs include heroin, phencyclidine(PCP), and lysergic acid diethylamide (LSD).
A significant paradox and disconnect continues to exist between the federal government’s outdated policies versus changing state laws, the general public’s perception and acceptance of marijuana, and even the President himself. In discussing his own marijuana use with New Yorker editor David Remnick, President Obama commented, "As has been well documented, I smoked pot as a kid, and I view it as a bad habit and a vice, not very different from the cigarettes that I smoked as a young person up through a big chunk of my adult life. I don’t think it is more dangerous than alcohol." He elaborated that marijuana was actually less dangerous than alcohol "in terms of its impact on the individual consumer."
Currently, 21 states have legalized marijuana for medicinal purposes, with many others actively considering the issue. Additionally, a recent survey by NBC News/The Wall Street Journal shows that the majority of Americans support legalizing marijuana. Recent federal policy changes have attempted to redress the inconsistencies between federal and state law. In 2009, the Justice Department issued a federal medical marijuana policy memo to the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), and US Attorneys instructing prosecutors not to target medicinal marijuana patients and their providers for federal prosecution in states where medicinal marijuana has been legalized. In the summer of 2010, the Department of Veteran Affairs issued a department directive to "formally allow patients treated at its hospitals and clinics to use medical marijuana in states where it is legal, a policy clarification that veterans have sought for years."
In the Netherlands, where the distribution of marijuana has been legalized, the effect of decriminalization has had little effect on the consumption rate of cannabis. In 2004, Reinarman et al looked at the consumption of marijuana rates between San Francisco and Amsterdam to see what effect decriminalization had on these different populations. The results showed that the consumption habits between the two populations were negligible. Little evidence has shown that the decriminalization of cannabis has changed the consumption habits of the populations involved.
While there is a rich history of anecdotal accounts of the benefits of marijuana and a long tradition of marijuana being used for a variety of ailments, the scientific literature in support of medicinal uses of marijuana is less substantial. Considered one of the first scientifically valid papers in support of marijuana’s medicinal benefit, in 2007, Dr. Donald Abrams and colleagues published the results of a randomized placebo-controlled trial examining the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model. The authors concluded that smoked cannabis effectively relieved chronic neuropathic pain in HIV-associated sensory neuropathy and was well tolerated by patients. The pain relief was comparable to chronic neuropathic pain treated with oral drugs.
According to Harvard Medical School’s April, 2010 edition of the Harvard Mental Health Letter : Consensus exists that marijuana may be helpful in treating certain carefully defined medical conditions. In its comprehensive 1999 review, for example, the Institute of Medicine (IOM) concluded that marijuana may be modestly effective for pain relief (particularly nerve pain), appetite stimulation for people with AIDS wasting syndrome, and control of chemotherapy-related nausea and vomiting.
These widely held beliefs in the medical community supporting the medicinal benefit of marijuana are starting to gain support in the form of rigorous empirical evidence demonstrating its clinical benefit and limited potential for harm. In 2012, the AMA published a landmark study that followed more than 5,000 patients longitudinally over 20 years. The results of the study were somewhat surprising. Although many had assumed that regular exposure to marijuana smoke would result in pulmonary function damage, similar to the deleterious effects seen with regular tobacco smoke exposure, the study convincingly demonstrated that regular exposure to marijuana smoke did not adversely affect lung function. Even more surprising, regular marijuana smokers demonstrated increased total lung function capacity.
The authors report, “Marijuana may have beneficial effects on pain control, appetite, mood, and management of other chronic symptoms. Our findings suggest that occasional use of marijuana for these or other purposes may not be associated with adverse consequences on pulmonary function.”
The AMA is urging the federal government to change the classification of marijuana from a Schedule I drug to enable further clinical research on marijuana. Additionally, Harvard Mental Health Letter’s authors point out that while marijuana works to relieve pain, suppress nausea, reduce anxiety, improve mood, and act as a sedative, the evidence that marijuana may be an effective treatment for psychiatric indications is inconclusive.
In a recently published systematic review published as a “Report of the Guideline Development Subcommittee of the American Academy of Neurology”, the authors performed a systematic review of medical marijuana from 1948 to November 2013 to identify the role of medical marijuana in the treatment of multiple sclerosis (MS), epilepsy and, movement disorders. The authors concluded that medical marijuana was found to be effective for treating MS-related pain or painful spasms.
While marijuana may have medicinal benefits, its use in excess by some individuals can lead to marked impairment in social and occupational functioning. Published in 2013, the fifth edition of TheDiagnostic and Statistical Manual of Mental Disorders (DSM-5) included significant changes to substance-related and addictive disorders. DSM-5 combined the previously separate categories of substance abuse and dependence into a single disorder of substance use, specific to the substance (eg, Alcohol Use Disorder, Cannabis Use Disorder)
DSM-5 recognizes the following 5 cannabis-associated disorders :
Please review the article in it’s entirety online thru link above. There are many people vying for the "Cannabis use disorder" syndrome for the purpose of promoting physician care and pharmaceutical drugs. In my opinion this is because they need something new to pick up the slack in their business because Cannabis legalization is continuing to grow across the Nation.
Be aware of what your Physician is trying to do to you with this Diagnosis code which will be permanently instilled into your medical records, along with your prescription drug use thru the monitoring programs now in existence.
We are being wrapped up nice and tight with a new bow tie….CANNABIS ABUSE.
These additional articles previously posted on site are also related to this issue: (smk)