Re­port finds pot ef­fec­tive medicine, with draw­backs

San Francisco Chronicle Late Edition - - FROM THE COVER -

cal re­view of the botan­i­cal drug, which an es­ti­mated 8 per­cent of Amer­i­can adults used in the past month.

Chief among the find­ings, re­searchers crit­i­cized the U.S. govern­ment’s con­tin­ued list­ing of mar­i­juana as a “Sched­ule 1” drug, mean­ing it has no es­tab­lished med­i­cal use and a high po­ten­tial for abuse. Pot ranks above pre­scrip­tion opi­oids, such as Vi­codin and OxyCon­tin, that were linked to more than 180,000 deaths from 1999 to 2015.

Cannabis’ Sched­ule 1 des­ig­na­tion “im­pedes the ad­vance­ment of ... re­search,” the study found. “It is of­ten dif­fi­cult for re­searchers to gain ac­cess to the quan­tity, qual­ity, and type of cannabis prod­uct nec­es­sary to ad­dress spe­cific re­search ques­tions on the health ef­fects of cannabis use.”

Echo­ing the re­sponse to the re­port by med­i­cal mar­i­juana ad­vo­cates in the Bay Area and around the coun­try, Berke­ley­based physi­cian and cannabis spe­cial­ist Dr. Frank Lu­cido said, “Our govern­ment should de-sched­ule mar­i­juana.”

The Na­tional Acad­e­mies com­mis­sioned the re­view of re­search in re­ac­tion to the swift ex­pan­sion of med­i­cal and adult-use pot laws in Amer­ica. Twenty-eight states and Wash­ing­ton, D.C., have le­gal­ized med­i­cal pot, and eight states and Wash­ing­ton, D.C., have le­gal­ized recre­ational use.

“The grow­ing ac­cep­tance, ac­ces­si­bil­ity, and use of cannabis raise im­por­tant public health con­cerns and there is a clear need to es­tab­lish what is known and what needs to be known about the health ef­fects of cannabis use,” the re­port stated.

The re­view in­volved 16 ex­perts, in­clud­ing UCSF on­col­o­gist Dr. Don­ald Abrams, and was paid for by fed­eral, state, phil­an­thropic and non­govern­men­tal or­ga­ni­za­tions. The com­mit­tee con­sid­ered more than 10,700 pub­lished stud­ies and ar­rived at nearly 100 re­search conclusions, among them that mar­i­juana can help cer­tain pa­tients who use it.

Parts of the re­port un­der­mine crit­ics of le­gal­iza­tion. It found cannabis can in some cases treat chronic pain, the nau­sea and vom­it­ing as­so­ci­ated with can­cer treat­ment, mus­cle spasms as­so­ci­ated with mul­ti­ple sclero­sis, and sleep dis­tur­bances. Un­like with le­gal to­bacco or al­co­hol, stud­ies show cannabis does not cause lung, head or neck can­cer, the re­port found.

How­ever, the re­port also di­min­ishes some claims of pot ad­vo­cates, find­ing, for in­stance, that there is not suf­fi­cient ev­i­dence that cannabis or its com­pounds can treat can­cer, epilepsy or schizophre­nia.

The study found “lim­ited ev­i­dence” of a link be­tween heavy cannabis smok­ing and a highly cur­able type of tes­tic­u­lar can­cer. There is also “lim­ited ev­i­dence” of a link be­tween pot smok­ing and heart at­tack or stroke.

Some op­po­nents of broader ac­cess to mar­i­juana cel­e­brated the re­port, in­clud­ing Kevin Sa­bet, di­rec­tor of the an­ti­le­gal­iza­tion group Project Smart Ap­proaches to Mar­i­juana.

“This is a damn­ing re­port for le­gal­iza­tion ad­vo­cates, to be per­fectly hon­est,” Sa­bet wrote in an email. “This re­port is a wake-up call to all Amer­i­cans who have been sold the false prom­ise that mar­i­juana use is not harm­ful across mul­ti­ple health out­comes.”

Cannabis is a mixed bag, in many re­spects. Ma­ter­nal cannabis smok­ing could be linked to lower birth weight, the re­view found, but there is lit­tle ev­i­dence it causes preg­nancy com­pli­ca­tions or later neg­a­tive out­comes in off­spring.

The sci­en­tists found some ev­i­dence of a link be­tween pot use and cer­tain men­tal health con­di­tions like schizophre­nia, but the link might be ex­plained by other vari­ables. Speak­ing of the re­port in gen­eral, re­view com­mit­tee chair Marie McCormick said, “There are a lot of ques­tions, par­tic­u­larly around de­ter­min­ing causal­ity.”

The re­port but­tresses calls for age re­stric­tions on cannabis use, such as those in place in Cal­i­for­nia, as sci­en­tists are fairly cer­tain that teens who smoke weed in­crease their risk of de­vel­op­ing “prob­lem cannabis use” — de­fined as use that neg­a­tively af­fects school, work or re­la­tion­ships or is dif­fi­cult to stop.

Pot also might be a gate­way drug to to­bacco, al­co­hol or other drug use, the re­port said, but there is lim­ited ev­i­dence and it’s not clear whether mar­i­juana use is the cause or merely cor­re­lated.

The re­port is likely to in­crease pres­sure on law­mak­ers to resched­ule mar­i­juana. Ari­zona physi­cian Dr. Sue Sis­ley, who has tried for years to gain fed­eral ap­proval to study cannabis as a treat­ment for post­trau­matic stress dis­or­der in hu­mans, said it was “un­sur­pris­ing” the Na­tional Acad­e­mies did not find ev­i­dence cannabis can treat can­cer or epilepsy.

“The fed­eral govern­ment has sys­tem­at­i­cally im­peded ef­fi­cacy stud­ies,” she said.

Lu­cido said the re­view was clearly lim­ited by fed­eral re­search bar­ri­ers. “For epilepsy, it’s a slam dunk,” he said of pre­scrib­ing cannabis. “That def­i­nitely helps. I’ve seen over 100 kids with seizure or autism, and a lot of them are do­ing much bet­ter with cannabis than mul­ti­ple harm­ful med­i­ca­tions in the past. It doesn’t work for ev­ery­body, but it’s been mirac­u­lous for some of the kids.”

While more in­ten­sive re­search must be done, the re­port re­futes crit­ics’ claim that there’s no cur­rent ba­sis to le­gal­ize weed, said Paul Ar­men­tano, deputy di­rec­tor of the Na­tional Or­ga­ni­za­tion for the Re­form of Mar­i­juana Laws.

“The fo­cus ought to be on the data we do have and do know,” Ar­men­tano said. “We’re hope­ful that the pub­li­ca­tion of this re­port may en­cour­age law­mak­ers to act dif­fer­ent in the fu­ture.” David Downs is the San Fran­cisco Chronicle’s cannabis editor. Sub­scribe to the Chronicle’s en­hanced cannabis cov­er­age by email­ing ddowns@sfchron­i­cle.com Twit­ter: @davidr­downs

Michael Ma­cor / The Chronicle

Dr. Frank Lu­cido, a cannabis spe­cial­ist, meets with pa­tient Carla New­bre in his Berke­ley of­fice.

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