nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Sunday, April 25, 2010

Medical Marijuana Prescribing Standards. Balancing Risk

Isn't medical marijuana, when smoked, a health hazard?

How come we never hear about that?

At the same time the Administration announced it would no longer prosecute medical marijuana users that were in compliance with their respective state law,  the FDA was given greater authority to control and restrict the manufacture, marketing, distribution, sale, and importation of tobacco products. 

So we're loosening legal requirements for marijuana smoking while tightening the law regarding tobacco smoking.  For the record, I'm not a user, but that doesn't mean I have strong objections to medical marijuana use in itself.  What bothers me is the inconsistency. 

Cause-specific mortality tables show that tobacco use is ranked second as cause of death in this country.

There are a boat-load (pun intended) of well-controlled studies on marijuana that show increased risk of disease with marijuana use--besides lung cancer.  Here are a couple of recent findings:

1.  Daily marijuana use has been implicated in increasing the rate of liver fibrosis in patients with hepatitis C.

2.  Controlling for age, sex, race, education, alcohol consumption, pack-years of cigarette smoking, and passive smoking, the risk of squamous cell carcinoma of the head and neck was increased with marijuana use.

For Onion Peelers (the boring statistics)
Risk of head and neck cancer was increased  [odds ratio (OR) comparing ever with never users, 2.6; 95% confidence interval (CI), 1.1– 6.6]. Dose-response relationships were observed for frequency of marijuana use/day (P for trend < 0.05) and years of marijuana use (P for trend < 0.05). These associations were stronger for subjects who were 55 years of age and younger (OR, 3.1; 95% CI, 1.0 –9.7).  These are large confidence intervals, but statistically a minor caveat.

The volume of research showing other adverse risks is legion, going back at least 50 years.  It's clear that marijuana has deleterious effects on the immune system, cancer development, respiratory illnesses, and brain function.  Not counting behavior, dude.

It would be irresponsible not to recognize that even for medical purposes, there are both benefits and risks.  These must be weighed in order to make a decision regarding public policy and law with regard to its use.  Blanket policies in the states allowing its use for specific diseases doesn't explore the entire realm of medical benefit, but ignoring the adverse impact when smoked isn't the right approach either.


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