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AAHPM Summer Quarterly 2012 : Page 15

SUMMER 2012 In those discussions, physicians can tell their patients that a few well-designed RCTs have shown that medical mari-juana may offer relief for a variety of symptoms, many of which are common in the provision of palliative care. However, physicians should also acknowledge that the amount of evidence from RCTs is very limited and that even less medical research examining the health risks of long-term marijuana use for medical purposes exists. Finally, recognizing that the knowledge base about medical marijuana is limited, several key medical organizations have crafted position statements that call for more research about its safety and efficacy. For physicians practicing hospice and palliative medicine, however, there is currently no position statement on medical marijuana that conveys a consensus about its use in a palliative care context. Until then, the information contained in this article will hopefully help palliative care specialists to understand what they should know about medical marijuana to better serve their patients. Author’s note. In October 2011, federal prosecutors warned several Cali-fornia dispensaries to shut down or face criminal charges after the Inter-nal Revenue Service (IRS) determined that they illegally avoided paying federal taxes while operating their businesses. 41 This warning came about 2 months after the Department of Justice issued a statement “that mari-juana dispensaries and licensed growers in states with medical marijuana laws could face prosecution for violating federal drug and money-launder-ing laws.” 41 The IRS and Drug Enforcement Agency raided several of these marijuana dispensaries in early April 2012, leading some medical marijuana advocates to accuse the Obama administration of reversing its 2009 pol-icy. 42 The full impact of these actions on the decriminalization of medical marijuana in California and other states remains unclear at this time. 16. Associated Press. Justice Department memo rules on medical marijuana: prosecutors will not seek to arrest users who are in strict compliance with state laws, officials say. Los Angeles Times. October 19, 2009. http://articles.latimes. com/ 2009/oct/19/nation/na-medical-marijuana19. Accessed April 25, 2012. 17. Chang AE, Shiling DJ, Stillman RC, et al. Delta-9-tetrahydrocannabinol as an antiemetic in cancer patients receiving high-dose methotrexate: a prospective, randomized evaluation. Ann Intern Med. 1979;91(6):819-824. 18. Chang AE, Shiling DJ, Stillman RC, et al. Delta-9-tetrahydrocannabinol as an antiemetic in cancer patients receiving adriamycin and cytoxan chemotherapy. Cancer . 1981;47(7):1746-1751. 19. Levitt M, Faiman C, Hawks R, Wilson A. Randomized double-blind comparison of delta-9-tetrahydrocannabinol and marijuana as chemotherapy antiemetics. In: Proceedings from the Annual Meeting of the American Society of Clinical Oncology; May 6-8, 1984; Toronto, ON, Canada. 20. Abrams DI, Hilton JF, Leiser R, et al. Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial. Ann Intern Med. 2003;139(4):258-266. 21. Haney M, Rabkin J, Gunderson E. Dronabinol and marijuana in HIV+ marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology. 2005;181(1):170-178. 22. Haney M, Gunderson EW, Rabkin J, et al. Dronabinol and marijuana in HIV+ marijuana smokers: caloric intake, mood, and sleep. J Acquir Immune Defic Syndr . 2007;45(5):545-554. 23. Wilsey B, Marcotte T, Tsodkidov A, et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain. 2008;9(6):506-521. 24. Ellis RJ, Toperoff W, Vaida F, et al. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology. 2009;34(3):672-680. 25. Wallace M, Schulteis G, Atkinson JH, et al. Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology. 2007;107(5):785-796. 26. Greenberg HS, Werness SA, Pugh JE, Andrus RO, Anderson DJ, Domino EF. Short-term effects of smoking marijuana on balance in patients with multiple sclerosis and normal volunteers. Clin Pharmacol Ther. 1994;55:324-328. 27. Merrit JC, Crawford WJ, Alexander PC, Anduze AL, Gelbart SS. Effect of marijuana on intraocular pressure and blood pressure in glaucoma. Ophthalmology. 1980;87(3):222-228. 28. Wang T, Collet JP, Shapiro S, Ware MA. Adverse effects of medical cannabinoids: a systematic review. CMAJ. 2008;178(13):1669-1678. 29. Hashibe M, Straif K, Tashkin DP, Morgenstern H, Greenland S, Zhang ZF. Epidemiologic review of marijuana use and cancer risk. Alcohol. 2005;35(3):265-275. 30. Feng BJ, Khyatti M, Ben-Ayoub W, et al. Cannabis, tobacco and domestic fumes intake are associated with nasopharyngeal carcinoma in North Africa. Br J Cancer. 2009;101(7):1207-1212. 31. Daling JR, Doody DR, Sun X, et al. Association of marijuana use and the incidence of testicular germ cell tumors. Cancer. 2009;115(6):1215-1223. 32. Berthiller J, Lee YC, Boffetta P, et al. Marijuana smoking and the risk of head and neck cancer: pooled analysis in the INHANCE consortium. Cancer Epidemiol Biomarkers Prev . 2009;18(5):1544-1551. 33. Berthiller J, Straif K, Boniol M,et al. Cannabis smoking and risk of lung cancer in men: a pooled analysis of three studies in Maghreb. J Thorac Oncol. 2008;3(12):1398-1403. 34. Aldington S, Harwood M, Cox B,et al; Cannabis and Respiratory Disease Research Group. Cannabis use and risk of lung cancer: a case-control study. Eur Respir J. 2008;31(2):280-286. 35. Liang C, McClean MD, Marsit C, et al. A population-based case-control study of marijuana use and head and neck squamous cell carcinoma. Cancer Prev Res (Phila Pa) . 2009;2(8):759-768. 36. Peele S, Brodsky A. Gateway to nowhere: how alcohol became scapegoated for drug abuse. Addiction Res. 1998;5:419-426. 37. Tarter RE, Vanyukov M, Kirisci L, Reynolds M, Clark DB. Predictors of marijuana use in adolescents before and after licit drug use: examination of the Gateway hypothesis. Am J Psych. 2006;163(12):2134-2140. 38. Hilts PJ. Is nicotine addictive? It depends on whose criteria you use. New York Times. August 2, 1994. 39. Large M, Sharma S, Compton MT, Slade T, Nielssen O. Cannabis use and earlier onset of psychosis: a meta-analysis. Arch Gen Psychiatry. 2011;68(6):555-561. 40. Barthwell AG, Baxter LE, Cermack T, DuPont R, Levounis P (President’s Action Committee on Medical Marijuana of the American Society of Addiction Medicine). The role of the physician in “medical” marijuana [white paper]. September 2010. Documents/MedMarijuanaWhitePaper.pdf. Accessed April 25, 2012. 41. Leff L. Calif. pot dispensaries told by feds to shut down. Associated Press , Oct. 6, 2011. To45Yp4k6dA. Accessed May 21, 2012. 42. United Press International. Officials raid cannabis university. April 2, 2012. www. Accessed May 21, 2012. 15 References 1. Council on Scientific Affairs and Public Health Report 3. Use of Cannabis for Medicinal Purposes. Presented at: American Medical Association Interim Meeting; November 2009; Houston, TX. Kollas C, Boyer-Kollas B. Medical Marijuana: What Should Palliative Care Specialists Know? Presented at: 2011 Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association; February 17, 2011; Vancouver, BC, Canada. Uritsky TJ, McPherson ML, Pradel F. Assessment of hospice health professionals’ knowledge, views and experience with medical marijuana. J Palliative Med. 2011;14(12):1291-1296. Bostwick JM. Blurred boundaries: the therapeutics and politics of medical marijuana. Mayo Clinic Proc. 2012;87(2):172-186. O’Shaughnessy WB. On the preparation of the Indian hemp or gunjah (Cannabis indica): the effects on the animal system in health and their utility in the treatment of tetanus and other convulsive diseases. Trans Med Phys Soc Bombay. 1839;8:421-461. Aggarwal S, Carter G, Sullivan M, ZumBrunnen C, Morrill R, Mayer JD. Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions. J Opioid Manag. 2009;5(3):153-168. American College of Physicians. Supporting Research into the Therapeutic Role of Marijuana. Philadelphia, PA: American College of Physicians; 2008. Controlled Substances Act, 21 USC §802 (1970). California Secretary of State. Proposition 215: Text of Proposed Law. http:// Accessed April 25, 2012. Joy JE, Watson SJ Jr, Benson JA Jr, eds. Marijuana and Medicine: Assessing the Science Base . Division of Neuroscience and Behavioral Health, Institute of Medicine. Washington, DC: National Academy Press; 1999. Associated Press. New Jersey Gov. John Corzine signs medical marijuana bill into law. NY Daily News . January 18, 2010. Accessed April 25, 2012. Wikipedia contributors. California Proposition 215. Wikipedia, The Free Encyclopedia. July 22, 2004. US v Oakland Buyers’ Cooperative, 532 US 483 (2001). Conant v Walters, 309 F 3d 629 (9th Cir. 2002). Gonzales v Raich , 545 US 1 (2005). 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Chad D. Kollas, MD FACP FCLM FAAHPM, is medical director, Palliative and Supportive Care, at MD Anderson Cancer Center in Orlando, FL. Contact him at VOL. 13

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