Medical Marijuana

The issues are complex where the use of marijuana for treatment is concerned, and the decisions are being made on a state-by-state basis.

Dr. Darrin D’Agostino, chairman and associate professor in the Department of Internal Medicine at the University of North Texas Health Science Center.

At a party in the early 1980s, a friend fighting what turned out to be a losing battle against breast cancer called me aside. She asked where she could get marijuana to help with the side effects of chemotherapy.

That was my first brush with medical marijuana. California was the first state to approve its use in 1996, followed quickly by Alaska, Washington and Maine. As of September, medical marijuana is legal in 23 states and the District of Columbia. In politically conservative Texas, action is likely on the 12th of Never.

By any measure, it’s not an easy question. Ask Dennis Thombs, professor and chair of the Department of Behavioral and Community Health in the School of Public Health at the University of North Texas Health Science Center. His research focus is on drug and alcohol use and abuse. “We’re really concerned about the protocols and procedures that would be put in place and whether or not medical marijuana would just be a first step in increasing access to marijuana in the general population,” Thombs said. “That would, very likely, from a public health point of view, create a lot of harm.”

Dr. Darrin D’Agostino, chairman and associate professor in UNTHSC’s Department of Internal Medicine, also holds a master’s degree in public health and wrote his thesis on pain medicines, opiates in particular. “There’s this constant battle between protecting the safety of citizens and giving doctors the ability to practice medicine,” he said.

Diversion from intended use is an issue. “If the system is loose, every patient is going to be going into their physician saying, ‘Oh, I got these aches or that ache. Can you give me some marijuana?’ ” Thombs said. The active ingredient from marijuana — THC — is already incorporated in medicines such as Marinol, available in pill form and prescribed for HIV patients and others whose appetite is suppressed by their illness or its treatment, and “the safety of the medicine tends to be pretty good,” D’Agostino said. “Now the question is, ‘How is that drug going to be used differently when it’s in an inhaled form through smoking?’ ”

Like tobacco smoke, marijuana smoke contains cancer-causing chemicals and also deposits up to four times more tar into the lungs for equal amounts of product smoked.

But, says D’Agostino, medically there seems to be some positive benefit in treating chronic pain with marijuana beyond just blocking the sensation of pain. An example is rheumatoid arthritis. “We have wonderful medicines for rheumatoid,” he said. “The ones you get over the counter kill your kidneys. Ibuprofen and like that. If you use Tylenol for the arthritic pain, it turns into a liver issue. But if you are smoking marijuana for that pain, and you are getting benefit, you have very little downside.” Proponents of legalization argue that is a justification.

The Lung Association says marijuana use is particularly harmful to youth since the part of the brain that craves pleasure matures earlier than the area that controls the ability to understand risks and consequences.

“For me, the biggest concern is that invariably when you begin to increase access to a drug, regardless of what systems we put in place, young people find it more available,” Thombs said. “It’s not a good thing for teenagers to be using any kind of drugs from a brain-development point-of-view, from a social point-of-view, from an achievement-educational point-of-view.”