Internists Tell Feds to Lighten Up on Marijuana

Medical Marijuana at the U.S. Federal level.

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Internists Tell Feds to Lighten Up on Marijuana

Postby palmspringsbum » Fri Feb 22, 2008 2:34 pm

The Wall Street Journal wrote:February 15, 2008, 1:24 pm

Internists Tell Feds to Lighten Up on Marijuana

The Wall Street Journal
Posted by Shirley S. Wang

<span class=postbigbold>Ease off on marijuana, a national doctor group is telling the feds. </span>

<img src=http://www.palmspringsbum.com/bin/icon_pdf.gif alt="Click on the icon to read the position paper" align=right>The American College of Physicians, 124,000 members strong, has issued a 13-page position paper asking the federal government to drop marijuana from its classification as a substance considered to have no medicinal value and a high chance of abuse, reports the Baltimore Sun. (Read this Health Blog post for one doctor’s high opinion of medical marijuana.)

“They’ve said essentially that the federal government has it all wrong,” Bruce Mirken, spokesman for the Marijuana Policy Project, tells the Health Blog. The ACP, which represents internists, is the largest physician group to date to ask for such a classification change, he says.

The Sun reports that the ACP’s declaration could pressure legislators and regulators to consider pushing for the schedule change. The federal government thus far has resisted fully exploring the medical benefits of marijuana, but a dozen states have legalized medical use. The ACP paper makes a broad case for easing restrictions on marijuana research and says that doctors and patients in these states shouldn’t be penalized under federal law. (Click on PDF image to read the position paper.)

But at least some in the government disagree vehemently with the idea of legalizing medical marijuana. “What this would do is drag us back to 14th-century medicine,” Berta Madras, the deputy director for demand reduction at the White House Office of National Drug Control Policy tells the Sun. “It’s so arcane.”

Last edited by palmspringsbum on Fri Feb 22, 2008 7:24 pm, edited 3 times in total.
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Doctors: Ease penalties for medical use, research.

Postby palmspringsbum » Fri Feb 22, 2008 4:07 pm

The Philadelphia Inquirer wrote:Posted on Sat, Feb. 16, 2008

Doctors: Ease penalties for medical use, research.

<span class=postbigbold>Phila. group prescribes new look at pot for U.S.</span>

By John Sullivan
The Philadelphia Inquirer
Inquirer Staff Writer

In a move it hopes will spur research into medical uses of marijuana, the nation's second-largest physicians' group is calling on the government to ease criminal penalties for doctors who study and recommend the plant, and patients who smoke it.

The American College of Physicians says several nonmedical factors - a fierce battle over legalization of the drug, a complicated approval process, and limited availability of research-grade marijuana - has hobbled scientists from looking into its full benefits.

"A clear discord exists between the scientific community and federal legal and regulatory agencies over the medicinal value of marijuana, which impedes the expansion of research," the Philadelphia-based organization states in a 13-page policy paper.

A White House official dismissed the report yesterday as a "political act" that contained no new science, and noted that other doctors' organizations think differently.

Researchers generally agree that there is some medicinal benefit to the drug. The policy paper reviews evidence that its psychoactive ingredient - tetrahydrocannabinol, or THC - is useful for the treatment of glaucoma, multiple sclerosis, nausea and pain.

But the report also argues that marijuana in its raw form may be helpful in ways that THC alone is not. It explains, for example, how patients who experience nausea and vomiting during chemotherapy may prefer smoked marijuana's milder effects over those obtained from its active ingredient in approved pills.

The paper was three years in coming, and the organization knew it would be controversial, said its president, David C. Dale, a Seattle internist and professor at the University of Washington.

"In terms of advocating for the public good and the good of medicine, this was the right thing to do," he said.

"We recognize that this is a drug that may be able to help and harm," he said, noting that medicines often work at that interface. "But the prejudices of the past shouldn't limit research into the good it can do."

Of concern to many physicians is the patchwork of state laws on the issue, and federal agencies' power to prosecute them regardless, making physicians reluctant to pursue research.

"If it's permissible by state law, patients and physicians should not be guilty of a crime for marijuana and its uses," Dale said.

To encourage study, the college wants the federal government to downgrade the drug from its status as a schedule 1 controlled substance - the same as heroin, crystal meth, LSD, and other drugs with no clear medicinal value.

A dozen states - Pennsylvania and New Jersey are not among them - have approved the use of medical marijuana or offered some protection to patients. The Food and Drug Administration has also approved two medicines containing THC.

Medical-marijuana advocates hailed the paper as a breakthrough.

"This is 124,000 doctors that have just told the federal government they are wrong," said Bruce Mirken, spokesman for the Marijuana Policy Project, a Washington group that lobbies for medical use of marijuana.

"The question about whether this is useful has been studied, and it's time to move on and figure out how to use it."

The White House Office of National Drug Control Policy said it changed nothing.

"This is not medical science," said chief scientist David Murray. "This is a policy paper. A political act calling for political response."

"It says, 'We want more research,' and we generally support more research as well."

Murray noted that other medical organizations - the 240,000-member American Medical Association, the National Cancer Institute, the American Cancer Society, and the National Multiple Sclerosis Society - do not support the smoked form of marijuana as medicine.

He acknowledged that compounds in marijuana, mainly cannabinoids, have some value with certain illnesses, such as when treating neurological disorders or used as an analgesic.

Research into those applications should be pursued, but drugs given to patients must be only isolated, purified compounds proven in clinical trials and approved by the FDA, Murray said. "Whatever it looks like, it will not be the raw, crude weed delivering a stew of chemicals that are demonstrably harmful and toxic."

The American College of Physicians is hoping the paper will encourage the government to help science thoroughly investigate a plant that, after 40 years of study, researchers still know less about than they would like.

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Second Largest Doctors Group Supports Medical Marijuana

Postby palmspringsbum » Fri Feb 22, 2008 4:19 pm

The Marijuana Policy Project wrote:
Second Largest Doctors Group Supports Medical Marijuana


The Marijuana Policy Project
February 15, 2008

(Washington D.C.) The American College of Physicians, the largest medical specialty organization and the second largest physician group in the United States, today issued a strong statement urging a fundamental rethinking of U.S. government policy on medical marijuana, stating, “ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted by state laws.”

ACP’s position paper specifically criticized the federal classification of marijuana as a Schedule I drug, deemed by the government as not having accepted medical uses or safety for use under medical supervision. “ACP urges review of marijuana’s status as a Schedule I controlled substance and reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana’s safety and efficacy in some clinical conditions,” the statement declared.

Founded in 1915, ACP publishes Annals of Internal Medicine, the most widely cited medical specialty journal in the world.

“This is a historic statement by one of the world’s most respected physician groups, and shows the growing scientific consensus that marijuana is a safe, effective medicine for some patients, including many battling life-threatening illnesses like cancer and AIDS,” said former U.S. Surgeon General Dr. Joycelyn Elders. “Large medical associations move cautiously, and for the American College of Physicians to note ‘a clear discord’ between scientific opinion and government policy on medical marijuana is a stinging rebuke to our government. It’s time for politicians and bureaucrats to get out of the way of good medicine and solid research.”

“This statement by the American College of Physicians recognizes what clinicians and researchers have been seeing for years, that for some patients medical marijuana works when conventional drugs fail,” said Dr. Michael Saag, director of the Center for AIDS Research at the University of Alabama Birmingham. “One of the challenges in HIV/AIDS treatment is helping patients to adhere to drug regimens that may cause nausea and other noxious side effects. The relief of these side effects that marijuana provides can help patients stay on life-extending therapies.”

“This statement by America’s second largest doctors’ group demolishes the myth that the medical community doesn’t support medical marijuana,” said Rob Kampia, executive director of the Marijuana Policy Project in Washington, D.C. “The ACP’s statement smashes a number of other myths, including the claims that adequate substitutes are available or that marijuana is unsafe for medical use. 124,000 doctors have just said what our government refuses to hear, that it makes no medical or moral sense to arrest the sick and suffering for using medical marijuana.”

The full ACP statement on medical marijuana, titled, “Supporting Research into the Therapeutic Role of Marijuana,” is available at www.acponline.org/acp_news/medmarinews.htm

Currently, 12 states — Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington — permit seriously ill patients to use medical marijuana without fear of arrest. Signatures have been filed for a medical marijuana ballot initiative for the November ballot in Michigan, and medical marijuana legislation is either under consideration or expected to be introduced shortly in numerous states, including Minnesota and Illinois.

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Top Doctors Association Says "YES" to Medical Mari

Postby palmspringsbum » Wed Feb 27, 2008 5:38 pm

The Drug War Chronicle wrote:<span class=postbold>Drug War Chronicle - world’s leading drug policy newsletter</span>

Top Doctors Association Says "YES" to Medical Marijuana in Historic Endorsement

from Drug War Chronicle, Issue #524, 2/21/08

In a position paper, a leading American medical association has endorsed the medicinal use of marijuana, called for more studies of its medical uses, and urged the US government to get out of the way. The position paper from the American College of Physicians was released last Friday after being approved by the group's governing body.

The American College of Physicians (ACP) is the nation's second largest doctors' organization, behind only the American Medical Association. It is made up of some 124,000 internal medicine specialists dealing primarily with adults.

The college pointed to strong evidence that marijuana has proven useful in treating AIDS wasting syndrome, glaucoma, and the nausea and vomiting associated with cancer chemotherapy treatments. The college also noted that there is anecdotal evidence for many other medical uses of marijuana, but that research had been stymied by "a complicated federal approval process, limited availability of research grade marijuana, and the debate over legalization." The science of medical marijuana should not be "hindered or obscured" by the controversy over legalizing the plant for personal, non-medical use, the group said.

"This is a historic statement by one of the world's most respected physician groups, and shows the growing scientific consensus that marijuana is a safe, effective medicine for some patients, including many battling life-threatening illnesses like cancer and AIDS," said former US Surgeon General Dr. Joycelyn Elders in a press release from the Marijuana Policy Project. "Large medical associations move cautiously, and for the American College of Physicians to note 'a clear discord' between scientific opinion and government policy on medical marijuana is a stinging rebuke to our government. It's time for politicians and bureaucrats to get out of the way of good medicine and solid research."

"This statement by the American College of Physicians recognizes what clinicians and researchers have been seeing for years, that for some patients medical marijuana works when conventional drugs fail," said Dr. Michael Saag, director of the Center for AIDS Research at the University of Alabama-Birmingham. "One of the challenges in HIV/AIDS treatment is helping patients to adhere to drug regimens that may cause nausea and other noxious side effects. The relief of these side effects that marijuana provides can help patients stay on life-extending therapies."

"This statement by America's second largest doctors' group demolishes the myth that the medical community doesn't support medical marijuana," said Marijuana Policy Project executive director Rob Kampia. "The ACP's statement smashes a number of other myths, including the claims that adequate substitutes are available or that marijuana is unsafe for medical use. 124,000 doctors have just said what our government refuses to hear, that it makes no medical or moral sense to arrest the sick and suffering for using medical marijuana."

While the ACP position paper consists of 13 closely reasoned pages, the group summarizes its medical marijuana positions thusly:<blockquote>Position 1: ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of medical marijuana and the publication of such findings.

Position 1a: ACP supports increased research for conditions where the efficacy of marijuana has been established to determine optimal dosage and route of delivery.

Position 1b: Medical marijuana research should not only focus on determining drug efficacy and safety but also on determining efficacy in comparison with other available treatments.

Position 2: ACP encourages the use of non-smoked forms of THC that have proven therapeutic value.

Position 3: ACP supports the current process for obtaining federal research-grade cannabis.

Position 4: ACP urges review of marijuana's status as a schedule I controlled substance and its reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana's safety and efficacy in some clinical conditions.

Position 5: ACP strongly supports exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who prescribe or dispense medical marijuana in accordance with state law.</blockquote>Similarly, ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted under state laws.

"The richness of modern medicine is to carefully evaluate new treatments. Marijuana has been in a special category because of, I suppose, its abuses and other concerns," Dr. David Dale, the group's president and a University of Washington professor of medicine, told Reuters in a phone interview.

An uncharacteristically terse David Murray, chief scientist for the White House Office of National Drug Control Policy, could only appeal to science in an interview with Reuters. "The science should be kept open. There should be more research. We should continue to investigate," he said.

Dale Gieringer, executive director of California NORML had a few nits to pick with the ACP's statement, but approved overall. "This is an important step," he said. "But when they say they support the existing federal supply system, it suggests they are unaware of all the systematic blockage of independent research caused by the NIDA monopoly and DEA interference."

Similarly, said Gieringer, while government licensing and regulation of medical marijuana makes sense, that doesn't mean we have to maintain the existing NIDA monopoly. "It just doesn't make sense to do that," he said.

Where Gieringer was pleasantly surprised was with the ACP's call to end the criminal persecution of medical marijuana patients, providers, and doctors. "They came out really forcefully against criminalization," he noted. "That's very impressive. No one else has been willing to address that. All of these apologists for the government run around saying you can't have unregulated medical marijuana, but that doesn't mean you need to throw patients and doctors in jail."

The medical community's embrace of medical marijuana has been timid and hesitant, with a number of important organizations, including the American Medical Association, lagging behind. This policy statement by the nation's second largest medical association should give that process an important boost.

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American College of Physicians Takes Pro-Cannabis Stand

Postby palmspringsbum » Wed Feb 27, 2008 10:00 pm

I have never read a Fred Gardner article I didn't like.

CounterPunch wrote:<span class=postbold>Weekend Edition</span>
February 23 / 4, 2008

<span class=postbigbold>Pot Shots</span>

American College of Physicians Takes Pro-Cannabis Stand (Mostly)

CounterPunch
By FRED GARDNER


One-and-a-half cheers for the American College of Physicians, which has issued a statement "Supporting Research into the Therapeutic Role of Marijuana." The ACP is the nation's largest medical specialty group -124,000 internists- and is widely respected. "There are no more prestigious letters to have after your name," says Philip A. Denney, MD (president of the Society of Cannabis Clinicians), "than FACP -standing for Fellow of the American College of Physicians."

The statement commits the ACP to five positions:
<blockquote>
1. ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of medical marijuana and the publication of such findings.

1a. ACP supports increased research for conditions where the efficacy of marijuana has been established to determine optimal dosage and route of delivery.

1b: Medical marijuana research should not only focus on determining drug efficacy and safety but also on determining efficacy in comparison with other available treatments.

2. ACP encourages the use of nonsmoked forms of THC that have proven therapeutic value.

3. ACP supports the current process for obtaining federal research-grade cannabis.

4. ACP urges review of marijuana's status as a schedule 1 controlled substance and its reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana's safety and efficacy in some clinical conditions.

5. ACP strongly supports exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who prescribe or dispense medical marijuana in accordance with state law. Similarly, ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted under state laws.
</blockquote>
From the perspective of pro-cannabis doctors and patients in California, Position 5 is the best and bravest aspect of the ACP statement. The support for physicians who "prescribe and dispense medical marijuana under state law" could have been written with Marian Fry, MD, in mind. Fry and her husband, attorney Dale Schafer, were convicted under federal law for cultivation for sale (to her patients) and are soon to be sentenced.

Position 4 is long overdue. Marijuana was categorized as a Schedule 1 drug -as if it had no medical use and a high potential for abuse- by the federal Controlled Substance Act of 1970. In 1999 dependence on marijuana was deemed "relatively rare and... less severe than dependence on other drugs" by the Institute of Medicine in a report commissioned by the Drug Czar's office. The medical utility of marijuana has been confirmed in numerous ways and settings, including the IOM report and a recent study published in a prestigious peer-reviewed journal ("Cannabis in painful HIV-asssociated sensory neuropathy," by Abrams et al, Neurology, Feb 13, 2007).

Position 2 singles out the Volcano vaporizer as an efficient delivery system (right on, right on).

Position 3 seems to undermine the rest of the position paper. Why open wide the valves on the research pipeline while leaving the main closed and allowing only the slightest trickle? At present the would-be researcher must get an Investigational New Drug Application approved by the FDA and a Schedule I license from the DEA to receive marijuana grown by a NIDA-funded contractor at the University of Mississippi and processed into cigarettes at the Research Triangle Institute in North Carolina. The DEA can choke off research, the FDA can choke off research, NIDA can choke off research. Over the years they have taken turns doing so, working a four-cornered stall (the NIH and the Drug Czar's office get involved as needed) as if diagrammed by the Tarheels' legendary basketball coach, Dean Smith himself.

Botanist Lyle Craker of UMass Amherst applied in 2001 for a DEA license to grow marijuana for privately funded research. There was an extensive hearing in 2005. In February, 2007, an Administrative Law Judge recommended that Craker's application be approved. The DEA Administrator keeps sitting on it, of course, and is not bloody likely to give Craker a license. This is the system the ACP endorses sanctimoniously: "Obtaining research-grade cannabis is critical to conducting well-designed clinical trials on the safety and efficacy of marijuana and its cannabinoids. In addition, because of the drug's widespread general use and high potential for abuse, it is imperative that the federal process is followed for obtaining research-grade marijuana and conducting clinical trials."

Note that the trials being contemplated in the argument for Position 3 -and Position 1b- involve "safety and efficacy." Why the former? The safety of cannabis has been established by countless NIDA studies seeking to establish its harmfulness (not to mention the data collected by California doctors as published in O'Shaughnessy's Winter/Spring 2007).

"More research is needed" is a lie when applied to safety, and spending money on more safety studies is a way of delaying the much-needed efficacy studies. It's almost as if a Prohibitionist within the ACP committee that drafted the position paper asserted him or herself at key points. The ACP statement includes the following re adverse effects: "Chronic use of smoked marijuana is associated with increased risk of cancer, lung damage, bacterial pneumonia, and poor pregnancy outcomes." A footnote cites the IOM Report (no pages specified) to back these assertions. But chronic use of marijuana does NOT cause cancer of the lung, upper airways, or esophagus, according to the definitive study reported to the American Thoracic Society in June 2006 by Donald Tashkin and colleagues from the UCLA School of Medicine. Although tars in cannabis damage bronchial tissue, the damaged cells, for some unknown reason, don't become malignant. Evidently something in cannabis is exerting an anti-cancer effect! This is an area that truly warrants more research.

The ACP's assertion of "poor pregnancy outcomes" is based on the IOM Report, which is based on a NIDA-funded project -the Ottawa Prenatal Prospective Study- led by a man named Peter Fried, who determined that the children of mothers who had smoked marijuana during pregnancy showed impaired "executive function." Fried measured "executive function" by having the kids press a clicker whenever they heard a musical tone. The tone consisted of two quick beeps, one emphatic, one a sort of echo. The kids whose moms had smoked pot tended to make two quick clicks in response. The other kids tended to make one click, which Fried -well aware of what his NIDA funders wanted- defined as superior executive function!! (He might have defined it more logically as a sign of laziness, bad hearing, or even a form of cheating.) When the kids whose moms had smoked pot were found to have higher IQs and more friends in school, Fried attributed it to what he called "the earth-mother effect." He claimed that the same women who had harmed their babies in the womb by smoking pot, gave them ample attention and good nutrition when they emerged, so they turned out quite well on the whole.

Peter Fried's far-from-rigorous finding of "impaired executive function" underlies the ACP's assertion of "poor pregnancy outcomes" and the medical establishment's line that pregnant women should not smoke marijuana. Once the results of a study get published in "the literature" they can be cited as if they were proven fact -as if the process of peer-review guaranteed the publication of Incontrovertible Truth. This reverent attitude towards "the literature" belongs in the realm of religion, not science.

<span class=postbigbold>Quotable Quotes</span>

Eric Bailey got some quotes worth quoting for a Feb. 14 Los Angeles Times article about the ACP statement.

"We felt the time had come to speak up about this," said ACP president David Dale. The implication being: 'We've known the truth about this for years, but were afraid to make a peep." California voters passed Prop 215 in 1996 with the ACP on the sidelines. The Institute of Medicine Report was published in 1999. What took the ACP so long to say that the government ought to act on it?

Bailey quotes Bruce Mirken of the Marijuana Policy Project describing the ACP statement as "an earthquake that's going to rattle the whole medical-marijuana debate." Isn't it amazing how many tipping-point victories we've won over the years? Reform bureaucrats need "wins" to impress their backers and keep the money coming in. By unreservedly praising a flawed document like the ACP statement, Bruce Mirken et al confer undeserved credibility on it. And these things sometimes come back to bite the movement in the butt. The DEA could very well cite the ACP's Position 3 as grounds for denying Prof. Craker a license in the period ahead.

Bailey elicited this verbal gem from Bertha Madras, deputy director for demand reduction at the Drug Czar's office (the White House Office of National Drug Control Policy): "'What this would do is drag us back to 14th-century medicine,' said Madras. 'It's so arcane.'"

Since "arcane" means "hidden," we infer that the Czarette meant to say, "it's so archaic." People who misuse fancy words are pretentious. Since pretense is what the Drug Czar's office is all about, we can also infer that Ms. Madras is perfectly suited to her job at Demand Reduction HQ.

Fred Gardner edits O'Shaughnessy's, the journal of Cannabis in Clinical Practice. Reach him at fred@plebesite.com

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