Medical marijuana, dope laws are continuing potboilers

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I was treating the gentleman’s prostate. I included his pelvic nodes in my radiation field. That carried almost no risk of nausea, but he heard I had access to marijuana and figured it was worth a try.

The next day he stuck his head into my office.

“Something wrong Mister?” — let’s say, “Jones” — I asked.

He dumped a fistful of cigarettes on my desk.

“I want you to send them back,” he said. “Don’t know what anyone sees in that stuff.”

He explained that weed did nothing to make him feel better than he already did. He left and I had a stack of smokes that smelled a bit like motor oil and I faced a conundrum.

The state supplied free marijuana for my patients, through a sham research study that must have bubbled up from an unusual session of the Legislature. The rules didn’t stipulate what I should do with unwanted joints. I kept them in a drawer for a week and decided to feed them to the fish.

Some of my patients had previous experiences with the street variety. They never brought any back and they graded it as fair quality. I drew the conclusion that a combination of exogenous brain chemistry, smoking THC, and intrinsic responses — placebo effect — were at work.

I will remind my readers that I’ve discussed placebos before. A quick recap might help. Functional brain studies suggest the activity of some drugs stimulate or suppress parts of the brain that are indistinguishable from the activity of placebos.

We are all aware that amputees may experience pain or other sensations in phantom limbs. When the anesthesiologist puts your brain to sleep, you feel nothing. If I tell you that pain is all in your head, don’t assume I’m equating that with psychosis. Our brains are part of our body and they connect us with our senses.

I called Dr. Cunningham at Providence St. Mary Regional Cancer Center in Walla Walla and asked for his thoughts. One way or another, patients can still access various forms of weed.

He notes there are many kinds of cannabinoids, not just THC. That makes analysis imprecise. We have better drugs for the patient who is receiving chemotherapy, but some patients benefit from marijuana, especially in getting relief from chronic effects, the inability to eat and what Midwesterners are likely to call an “ishy” sensation. Dr. Cunningham does discourage smoking because it commonly produces a nasty bronchitis.

If the federal government ever legalizes marijuana use, one of the benefits will be our ability to openly and honestly study the subject. There are negative aspects associated with legalization. I won’t take a stand on whether it is as inevitable as ending prohibition of alcohol. My column is titled “POV: Science” for a reason.

The marijuana debate in Washington state will get more confused as we deal with legal, social and ethical issues. By the end of the year, Olympia is supposed to have the rules written. Pot shops are unlikely to face interference from the federal government but doctors will probably maintain a cautious position.

The police will have their own problems. Among the challenges is dealing with the legal restriction against drawing blood. THC can’t be tested with a Breathalyzer and it isn’t the only active ingredient.

Let’s hypothesize that legalization will result in increased use. Traffic accidents may increase and the combined effects of marijuana and alcohol are worse than when one is used alone.

If we are serious about restricting use by children and we can tax the drug, usage could be curtailed. We can’t predict the outcome.

I hope use decreases and gang violence lessens, but basic science asks other questions. I’ll begin with the effects on brain function.

When I get past 800 words, many of my readers take a nap. I’ll continue on the same subject next time and try to avoid stopping this writing in mid-sentence.

Recall that the cells in our body have specialized receptor sites. Think of an incredibly complex lock-and-key arrangement. Human brain cells have a receptor called CB1. When THC locks into the receptor, it sets off a cascade of reactions involving chemicals that aren’t unique to this particular drug, the normal juices that make us feel better at some times, worse at others. The amounts released are higher than usual.

There are more receptors in some parts of the brain than others. Especially sensitive are the frontal lobes we need for higher level thinking; the amygdala, involved in emotional responses; and the hippocampus, critical to memory formation. These effects help explain why pot smokers tend to feel relaxed and hungry and why they forget what they were stressed about in the first place.

We’ll try to sort through the pluses and minuses next time, remaining alert to the fact that drug doses vary with the source and method of administration. Sensitivity varies among individuals, and a lot of what you read was written by people who made up their mind before they picked up a pen.

In some cases, they may be saying, “Yeah, man. I’ll write about that.”

Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at amazon.com and other online book retailers. He can be reached at mulkerin@charter.net.

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