420 Day: A physician's take on pot

There will be neither a presidential proclamation nor a pause for reflection in Congress – but just the same, people are literally dancing in the street today.

It’s April 20, aka National Weed Day.

We need to move slowly when we add another drug to those, like alcohol and tobacco, that are socially acceptable and legal. We need to establish a general set of rules, a framework that spells out its social implications, and we need to be ready to deal with a potential onslaught of ramifications.

Its origin is the stuff of folklore. Back in 1971, a group of high school kids in San Rafael, Calif., would meet daily at 4:20 p.m. and head out in search of a marijuana crop they’d heard about. They never found it, but over the next few decades the time of day, 4:20, became the day of the month, 4/20. Today, countless thousands of Americans, comfortable that their sheer numbers will prompt authorities to look the other way, will gather in public and light up a joint.

We need to move slowly when we add another drug to those, like alcohol and tobacco, that are socially acceptable and legal. We need to establish a general set of rules, a framework that spells out its social implications, and we need to be ready to deal with a potential onslaught of ramifications.

So this is the perfect day to look at where we stand on marijuana and what we need to do to keep things moving in the right direction as, for better or for worse, we change our laws regarding its use.

I have some experience with marijuana. I went to high school in southern Maryland in the late 1970s, and though I never actually smoked it myself, I’m not exaggerating when I say I came home every day smelling of the stuff.

Forty years later, I’m now an ophthalmologist who specializes in glaucoma treatment. Once again, I’m very familiar with marijuana, because a few of my patients have used it to manage their conditions.

And therein lies our dilemma. Marijuana hit a fork in the road years ago and headed off in two directions – medical and recreational. But the argument for legalization or relaxing the laws is different for each. Medical marijuana and recreational marijuana are very different conversations, and we need to approach them separately.

For starters, to establish a clear separation between the two, we need to stop calling them by the same name. Medical marijuana isn’t “weed” or “pot” or “grass” or any of the myriad other names given to the recreational drug. Let’s start calling it what it is –cannabis, the name of its plant genus.

Now let’s look closely at cannabis. Here’s a substance that is still listed by the federal Drug Enforcement Administration as a Schedule I drug, defined as a substance “with no currently accepted medical use and a high potential for abuse … with potentially severe psychological or physical dependence.”

That puts it on a par with heroin, ecstasy and LSD. But various trials have shown cannabis can be effective in treating multiple sclerosis, Parkinson’s disease, schizophrenia, epilepsy, intestinal disorders, glaucoma and pain.

That’s an impressive list, and it calls for a lot more research. We need to know: How many randomized clinical trials have been performed? Where did the drug work … and where did it not? What were its benefits and detriments? What was the drug’s potency in each trial? What were the concentrations of its many components in each trial? And – very importantly – can the results be replicated?

That really shouldn’t be too hard, but it is – because it’s very hard to get the government to grant approval to examine the potential medical benefits of a Schedule I drug.

So the first thing we need to do is change the designation of medical marijuana – cannabis – to Schedule II, putting it in a class with cocaine, amphetamines and prescription pain relievers, all of which are defined as dangerous drugs, but ones that have medical uses. Doing that would enable more researchers to conduct controlled clinical trials to determine which compounds in cannabis work for which conditions.

But that’s cannabis, not weed. We need to tread much more carefully with casual use. We can’t just legalize the drug and let all hell break loose. Though many municipalities have effectively decriminalized possession of small amounts of marijuana, and two states – Washington and Colorado – along with Washington D.C. have legalized possession and recreational use, we are “progressing” way too quickly.

For one thing, this is April 20, 2015. The potency of marijuana – determined by measuring levels of its main psychoactive ingredient, delta-9-tetrahydrocannabinol (THC) – has skyrocketed in the last 40 years. According to the University of Mississippi's Potency Monitoring Project (UMPMC), the average THC content of marijuana in 1978 was 1.37 percent. In 2008, it was 8.49 percent. Yes, many CEOs and even presidents have smoked marijuana. But, clearly, this is not your father’s weed.

We need to move slowly when we add another drug to those, like alcohol and tobacco, that are socially acceptable and legal. We need to establish a general set of rules, a framework that spells out its social implications, and we need to be ready to deal with a potential onslaught of ramifications.

For example, we currently have no way to measure the level of weed in a person who has engaged in social misbehavior. There is no “breath test” comparable to the one we administer to a driver or a violent person who is suspected of being intoxicated.

The citizens of Washington and Colorado made a mistake when they voted to legalize pot. They should have established parameters to keep it out of the hands of people who will use it recklessly. I wish they’d shown an inclination to treat it like some other, less dangerous drugs that have the potential for abuse.

Take, for example, pseudoephedrine hydrochloride, a nasal decongestant found in many cold and allergy medications. It used to be over-the-counter, but limitations were applied when people increasingly learned that it could be used to manufacture methamphetamine. Now it’s moved behind the counter. It’s not a prescription drug, but there are limits to how much people can buy in a month. Is it asking too much to do the same with weed? Shouldn’t it have consistent national guidelines? Shouldn’t it at least be on a par with a decongestant?

On National Weed Day, let’s say yes to cannabis. Let’s make it much more available to researchers so we can determine ways it can be used to treat illnesses. Nobody should be denied a potentially beneficial medication because it’s listed as a Schedule I drug.

But let’s also pull back the reins on runaway legalization of weed. We just don’t know enough yet.