More thoughts on marijuana (so to speak)

They’re simply not a lot of folks with experience taking or prescribing specific strains, formulations, and dosages. And the pharmaceutical industry is way behind.

PUTNEY — I have absolutely no doubt that certain strains of marijuana in certain dosages can successfully treat depression, anxiety, bipolar, and other mood disorders in certain people. As a guy who prides himself on having an open mind, I have no doubt. Nada. Zilch.

I measure success by the same standard that we expect from prescription antidepressants: that certain formulations in certain dosages help certain people. Ditto for over-the-counter remedies such as SAM-e, St. John's Wort, 5-HTP, B-vitamins, and amino acids.

I also have absolutely no doubt that all of these substances - legal, illegal, or controlled - also have the potential to lead to increased depression and anxiety as well as, in some cases, extraordinarily distressing side effects. Including suicide.

But, for some reason, marijuana is held to a higher (sorry!) standard than those other collections of well-meaning molecules.

All kinds of legislation, regulations, and anecdotal reports of side effects have hampered efforts of objective scientists to determine whether there are strains of cannabis that can meet that standard.

I am very sympathetic to legislators who don't want to legalize something they think might cause people harm. (Although the horse is already way out of the barn and across state lines on that one.)

I am equally sympathetic to medical professionals who are being asked to prescribe a drug that, in most cases, their patients know way more about than they do. I'm certainly sympathetic to anyone whose mental disorder can be attributed in some way to marijuana.

Still, Sidney Farber, one of the fathers of chemotherapy, famously said in response to similar challenges back in the 1950s: “The 325,000 patients with cancer who are going to die this year cannot wait.”

You could argue that 325,000 people with mental illness won't die this year, although twice that many will go to emergency rooms for treatment of “self-inflicted injuries.” Some 30,000 will “succeed” in committing suicide.

You could argue that treatment with marijuana might not have prevented any of these injuries or death.

Yet, the trials developed by Farber and other oncologists - which are accepted as important steps on the road to cures - frequently caused horrific suffering and often hastened death, while achieving shockingly low success rates.

* * *

I am one of the fortunate ones whose “mental disorder” is successfully treated with pharmaceuticals. However, if during my worst episode, someone had offered me a replicable dose of a marijuana extract or pill, I would not have hesitated to try. I'm sure the side effects wouldn't have been any worse than those I experienced with a dozen other drugs and supplements before finding ones that worked.

It's in that word “replicable” that, as the noted bipolar sociopath Captain Hook would have put it, “the canker gnaws.”

As anyone who has ever tried marijuana knows (you can all put your hands down now), every joint, pipe-full, tincture, and brownie is different. Too much can make you more anxious and depressed. Too little can have little if any effect.

The $200-to-$300-per-ounce designer pot of today is far different from the $15-per-ounce Mexican we smoked in the late '60s. Maintaining a “steady state” is virtually impossible with either, although I know some people who have successfully found ways to regulate their daily marijuana intake for decades (which is more than you can say for most antidepressants).

And, by the way, those long-term “abusers” of my acquaintance are productive members of society: construction workers, executives, lawyers, and I'm sure there are a few doctors in there, too.

If so, I haven't asked, and they certainly wouldn't tell.

* * *

The U.S. Food and Drug Administration's approval process is notoriously over-cautious and byzantine - often for good reason. Regardless what you think of it, however, its framework of three phases makes sense:

Phase I: Try it on a some people to see if they have intolerable side effects, if they drop dead, or if something happens to them somewhere in between. As long as some of those people make it through, they proceed to...

Phase II: Try it on a larger group of people to get more data on effectiveness, safety, and dosages. After that...

Phase III: Conduct a full-scale trial with thousands of people to see if it works better than a placebo.

We can save the FDA a lot of time. In terms of Phase I, the vast majority of people who've tried marijuana have not had unacceptable side effects or dropped dead. Phase III is also a slam-dunk. Thousands of people have found it pulls them from the depths of despair better than a placebo (i.e., not taking it). Okay, fine, the “data” is anecdotal, but not for want of volunteers.

The real challenge is Phase II, which addresses that replicable issue. There simply aren't a lot of folks with experience taking or prescribing specific strains, formulations, and dosages. And the pharmaceutical industry is way behind.

* * *

Just a few months ago, CNN Medical Correspondent Sanjay Gupta released his own brave apology for previously arguing against medical marijuana, saying: “We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that.”

So I have no doubt that some form(s) of marijuana-based treatments will eventually be available for many disorders - including mental ones.

For those who can't wait, there is some hope in the ever- increasing amount of unofficial research out there. Maybe it's time for an official medical marijuana database of those anecdotal results so people can at least have intelligent conversations with their doctors and friendly, neighborhood dispensers.

Because right now, there are a lot of people stumbling around in the darkness.

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