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Benefits of licensed pot are up in the air

Published: Friday, Nov. 1, 2013 9:40 a.m. CDT

CHICAGO (MCT) — Even though 20 states have passed laws legalizing medical marijuana, swayed in part by thousands of personal testimonies, current research hasn't nailed down exactly if, and how, marijuana alleviates all the specific diseases the drug is being legalized to treat, experts say.

A number of proponents believe marijuana could benefit people with everything from glaucoma to cancer, and it's been legalized in Illinois to aid patients with some 40 medical conditions. But opponents of its medicinal use believe the risks of smoking medical marijuana outweigh the benefits, while others question whether patients really improve or only feel like they improve.

Marijuana's best-known compound is THC, but the plant actually has 105 unique cannabis compounds with potential for medicinal use, proponents say. THC has already been approved by the Food and Drug Administration in synthetic form to help patients with nausea and decreased appetite.

Some scientists believe the plant's other compounds — called cannabinoids — could have equal promise. Although research has increased in recent years as more states legalize medical marijuana, solid evidence of how individual cannabinoids could help people with specific diseases has been significantly lacking, a review of medical literature and interviews with experts shows.

Researching the potential effects of marijuana's various components on conditions such as multiple sclerosis, fibromyalgia or lupus could have serious implications for doctors who want to prescribe medical marijuana to patients.

If the specific benefits could be proved, experts say, doctors ultimately would be able to assign particular strains _ with varying chemical mixes _ to people, depending on their condition. Further research also may help determine optimal doses and whether marijuana works better than other medicines, experts say.

While most medicines derived from nature are tested before they reach the masses, the process to evaluate marijuana has been confounded by its longtime status as an illegal drug, which it retains in the eyes of the federal government. A complicated federal approval process and limited availability of research-grade marijuana add to the difficulty.

The only study specifically cited in Illinois' law, signed by Gov. Pat Quinn in August and set to go into effect next year, is a 1999 Institute of Medicine report. But Dr. John Benson, a lead editor of the report, said legislators stretched the conclusion of the book-length study when it said modern medical research "has confirmed the beneficial uses of cannabis."

While the report did say there was promise that marijuana could have medical benefits, it also suggests researchers need to continue to dig deeper into the issue. It also says marijuana should not be smoked, he said.

"Smoking marijuana is not recommended," the report states. "The long-term harm caused by smoking marijuana makes it a poor delivery system."

The 14-year-old article has become a primary source for both critics and supporters of medical marijuana _ the Drug Enforcement Administration and advocacy groups have cited it to prove opposite points.

"I don't think whatever the legislature is saying (in the law) is in effect untrue," Benson, now retired, said from his California home, "but it needs to be qualified."

Illinois legislators knew they had an uphill battle getting the medical marijuana bill passed last summer, Rep. Lou Lang said. Lang worked at swaying his colleagues for five years and said he compromised on the list of about 40 conditions _ some of which are closely related _ that will qualify people for medical marijuana once it becomes available sometime next year.

Illinois legislators, he said, did "a substantial amount of reading," but they did not evaluate each condition on the list with any scientific methodology.

"I can't point to specific studies that we used," Lang said. "Much of it was done by patients telling us what worked and what didn't. ... It became crystal clear some of these things that ought to be in the bill." The legislators relied mostly on personal testimonies and compared notes with states that have also passed medical marijuana laws.

"When thousands of people come to me and say they're using this drug illegally because it's the only thing that works," Lang said, "that's good enough for me."

Mike Graham, of Manteno, was one person who shared his story with legislators. A little more than a decade ago, he was using 14 different pharmaceuticals. Living with an extremely painful degenerative spine disease, he has been through multiple surgeries in efforts to remedy it. But doctors feared one more could paralyze him, so he took medications for pain instead.

"I didn't even know my name," Graham said. "It was horrid."

When he was in his late 30s, doctors sent him home with a hospice care nurse. After reviewing his medications, she told him he would die early if he continued taking all of them. To his surprise, she recommended pot, he said.

"I almost fell out of bed laughing," Graham, 51, said. "I come from a law enforcement family."

Increasingly desperate, in 2002, he decided to give it a try. He was able to cut back on all his previous medications except a morphine pump under his skin. Now, he takes three or four puffs of marijuana in the morning and at night. Once down to 135 pounds, the more than 6-foot-tall Graham now says he's back up to 250 after regaining his appetite.

"What it comes down to here (is) I wouldn't be here if I hadn't made that decision," Graham said.

While stories like Graham's are plentiful, doctors and researchers say the nonmedical elements of the plant could have sometimes serious adverse effects.

Dr. Eric Voth, a Topeka, Kan., internist and pain specialist and chairman of the Institute on Global Drug Policy, said relying on anecdotal evidence is dangerous because other factors could influence why patients start to feel better.

"It's very hard to differentiate whether somebody feels better because they're stoned or because they're getting a true therapeutic benefit from the drug," Voth said.

Smoking marijuana could increase the risk of cancer because of inhalation of tar and other carcinogens in the plant, Voth said. While proponents of its use point to the 105 unique compounds, as detailed in a soon-to-be published report by leading cannabinoid researcher Dr. Mahmoud ElSohly and his colleagues, that may be useful for medicine, there are hundreds more compounds in marijuana that some scientists believe not only have no use but may be harmful.

"You've still got (hundreds of other) substances in there," Voth said. "It just (shouldn't) be smoked. That is a crazy precedent."

(c)2013 Chicago Tribune Distributed by MCT Information Services

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