Letter: Sharfstein's caution and desire for more data on marijuana is warranted

I am surprised that the Towson Times (Feb. 15) would endorse the medical marijuana bill favored by state Del. Dan Morhaim (HB1158) and not endorse the medical marijuana bill (HB1024) favored by Dr. Joshua Sharfstein, secretary of the Maryland Department of Health and Mental Hygiene.

Sharfstein has an outstanding record in protecting public health from untoward side effects of drugs and other consumer products, and there is ample reason to believe his stance on medical marijuana is based on similar concerns.

As the Baltimore City health commissioner, Sharfstein pursued the mysterious cause of lead poisoning affecting Asian children in the city, determining that it resulted from imported children's eye makeup.

He fought against the marketing of over-the-counter cold medicines to infants and toddlers, medications for which the risk versus benefit for that age group was untenable. Because of his leadership on that issue, the American Academy of Pediatrics pressured the FDA to issue an advisory stating that "children younger than 2 years should not be given cold medications because of serious and life-threatening side effects."

Maryland should be proud to have him fighting for us.

What, you may think, could be Dr. Sharfstein's concerns about marijuana?

For starters, this is a drug that is commonly perceived as being safe but for which too few scientific studies have been conducted as to all the risks and benefits.

My understanding of what Dr. Sharfstein proposes is to provide a mechanism to acquire scientific data, by facilitating studies at our in-state academic institutions. Those studies would be conducted by professionals well-versed in the requirements of clinical trials, and the data would be collected and analyzed accordingly.

In Morhaim's proposed bill, the average physician who has never put together a clinical trial could be in charge of prescribing the drug and monitoring the outcome of its use. Morhaim's worry about academic institutions being able to legally acquire marijuana for scientific study seems specious, when the federal government is currently sponsoring NIH-funded clinical trials of this drug.

Some of the risks of marijuana have been well-studied, most notably its propensity to trigger symptoms of psychosis and, in some, the life-long psychotic disorder schizophrenia. (A documentary on the subject, "The Downside of High," is available on the Canadian Broadcasting Co. website and as a trailer on Youtube.

Google "paranoid" and "marijuana" and see how many posts there are on message boards on the subject. Cardiac side effects (episodes of a racing heart) are also noted. The oft-touted use for glaucoma is not endorsed by the Glaucoma Research Foundation, because maintaining a consistently low ocular pressure would require smoking six to eight times per day, and some data have indicated the high rebound pressure can be harmful if marijuana is not constantly smoked. Other available medications are much more effective.

In the area of its anti-nausea effects there is promise, but one study indicated that while the active ingredient of marijuana improves the taste of food for cancer patients, it did not increase the number of calories consumed.

Unfortunately, no adequately-sized study has investigated whether marijuana actually improves outcome in patients with cancer. And because of its anti-nausea effects, there is always the risk that a doctor in Maryland may decide that prescribing it for nausea during pregnancy would be a good idea. But if they were diligent, they would find a large study out of Hawaii which determined that mothers who smoked marijuana during their pregnancy were much more likely to deliver infants with congenital heart and gastrointestinal defects.

Fortunately, the 2012 version of Morhaim's bill contains protections against the possibility of such negligence in the form of requirements that prescribing physicians be trained on risks and benefits of this drug. Notably, neither his 2010 nor 2011 medical marijuana bills contained such a provision.

Thus, this extended process of lawmaking had a positive consequence.

Unfortunately, none of the three bills before the House contain a provision for educating the public as to the risk-benefit considerations with marijuana.

This is a concern regarding youth, who see marijuana as safe because of its "medicinal" properties. Marijuana use in teens has been on the increase for the past two years, according to studies put out by the Institute for Social Research at the University of Michigan.

The psychiatric consequences of this drug can be harsh on the developing brain, and education on this subject should be mandatory starting in middle school. I would like to see "The Downside of High" shown in health education and psychology classes.

Yet there has been a sea-change in the past few years concerning drug education. Where it once was common, even fashionable, to be outspoken about drug abuse, the end of the "war of drugs" also marked the end of aggressive drug-education efforts.

The Towson I know is capable of better than that.

Christine Miller, Ph.D


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