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Official websites use. Share sensitive information only on official, secure websites. Casarett, a physician at the University of Pennsylvania, immerses himself in the culture, science, and smoke of medical marijuana in order to sort out the truth behind the buzz. Our reviewer, who has authored more than research papers and reviews on the regulation of synaptic inhibition and endocannabinoids, tell us what the author got right, but also overlooked on his journey to learn more about a complex and controversial subject. David Casarett was a palliative care doctor with an Archie-Bunkereseque level of skepticism regarding medical marijuana. It is an engaging, lively, thought-provoking tour seen from the street, not the laboratory; the walk-in clinic, not the ivory tower. The doctor wants to know not only the subject, but also how to explain it to his patients and readers in terms that they will understand; how to give them a voice in their own care and be informed medical consumers. In trying to accomplish this, he covers a lot of ground. Casarett discusses a range of maladies for which marijuana is said to be beneficial—including insomnia, nausea, cachexia, pain, and cancer—in vignettes that begin with an arresting anecdote or personal story of a patient including himself in one case. The uncertainty and caveats are unsurprising because many of the experimental studies available are small and not well controlled. The reader, who may be frustrated by the indefiniteness of his verdicts, is reminded that the scarcity of hard data results from the benighted federal drug policy that still classifies marijuana as a Schedule I drug dangerous and of no medical value , significantly worse than morphine, cocaine, or amphetamines, which are on the less restrictive Schedule II. Usually Casarett gives us enough scientific background to clarify his opinions without overdoing it. His accounts of why marijuana affects different people differently, and how the storage of THC the psychoactive chemical in cannabis in body fat can modulate its effects, are two good examples among many. But the book is as much sociology as medicine. Casarett often goes undercover to capture the experience of the individual patient peering in at the medical marijuana subculture. At one point he gets a tutorial in the psychoactive subtleties of marijuana varieties that is as nuanced as the wine recommendations of a sommelier at a tony New York restaurant Casarett takes it all in, but is a noncustomer. He does answer a commonly asked question: why smoke if you can get cannabinoids in FDA-approved pills, or edibles? In a nutshell: control. Because of the rapid transit time for THC to go from the lungs to the brain tens of seconds , an experienced user can titrate his intake to produce just the desired level of symptomatic relief. Taken by mouth, THC has to pass through the GI tract tens of minutes, with times dependent on what food was eaten and when, etc. Couple this lack of control with the disinclination of severely nauseated patients to swallow anything, and one appreciates the appeal of smoking. This anecdote, seemingly right out of the Reefer Madness handbook, is used to dramatize the withdrawal symptoms that might accompany cessation of marijuana use, although Casarett acknowledges that this case is atypical and hardly a controlled study. He is alarmed that nine percent of marijuana users meet the clinical definition of addiction as compared with 12 percent of alcohol users and 15 percent of heroin users , and takes it as a given that any addiction is bad. The discussion would have benefited from a more critical analysis. In opiates caused 25, deaths DrugAbuse. Finally, alcohol consumption was implicated in 10, deaths from car crashes in CDC website. Despite the presence of millions of recreational users in the US, there is no evidence that marijuana causes anything like that level of carnage. He cites the case of glaucoma, for which marijuana used to be recommended, but which is now controlled effectively by conventional medications. On the other hand, the discovery of the opioid receptor many years ago prompted confident predictions that opiate drugs would soon be available that would selectively relieve pain without causing euphoric or addictive side-effects. The current epidemic of prescription opiate-drug addiction and rebound heroin use in the US is enough to give one pause. Will Big Pharma have better luck in replacing marijuana? In fact, these variants will potentially interact with a large number of other molecular targets. We will need to know much more about the molecular targets of synthetic cannabinoids before assigning them a leading role in medical marijuana-type therapies. More significantly, Casarett skips over the myriad issues associated with the highly variable distribution of CB1 receptors across brain regions and functional classes of brain cells. Admittedly, this is a complicated subject, yet understanding it and figuring out how to target the cannabinoids correctly to carefully defined subregions will, I believe, ultimately be more relevant for developing marijuana-based therapies, than refining drug-receptor match-ups. Finally, Casarett barely scratches the surface of the exploding field of the endocannabinoid system, exploitation of which will surely be a major direction for the future of medical marijuana. Why worry about exogenous cannabinoids if we can harness the ones we already have on board? By and large, however, such lapses do not detract from my enthusiasm for the book. It accomplishes what it sets out to do, giving patients and care-givers a balanced, insightful view of medical marijuana in an entertaining, straight-talking way. I found it an enjoyable read and highly recommend it. Bradley E. Alger , Ph. He received his Ph. In the early s, Alger and Thomas Pitler characterized the first signaling process ultimately found to be mediated by endocannabinoids in the brain. Alger has authored over research papers and reviews, focusing in the past two decades on the regulation of synaptic inhibition and endocannabinoids. As a library, NLM provides access to scientific literature. Find articles by Bradley E Alger. Collection date Mar-Apr. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

International Cannabis Policy Study

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The ICPS Project consists of annual, population-based surveys conducted in 6 countries: Canada and the United States since , Australia, and New Zealand since , and Germany and the United Kingdom since with more than , respondents, including approximately , cannabis consumers. The overall objective of the ICPS project is to understand the impact of cannabis policies, including the overall impact of legalization, as well as specific regulatory measures, such as product standards, retail policies, cannabis marketing, and public education. The ICPS surveys provide a comprehensive assessment of cannabis use, includes detailed patterns of consumption, purchasing, adverse outcomes, as well as attitudes and beliefs towards cannabis. International Cannabis Policy Study. Recent papers from the ICPS study. Social norms for cannabis use following non-medical legalization in Canada. Winfield-Ward L, Hammond D. American Journal of Preventive Medicine ; S 23 Adverse outcomes of cannabis use in Canada, before and after legalization of non-medical cannabis: cross-sectional analysis of the international cannabis policy study. British Medical Journal Open ; 14 1 :e Legal status of recreational cannabis and self-reported substitution of cannabis for opioids or prescription pain medication in Canada and the United States. Substance Abuse ; 43 1 Perceptions of the health risks of cannabis: estimates from national surveys in Canada and the United States, Goodman S, Hammond D. Health Education Research ; 37 2 Prevalence and self-reported reasons of cannabis use for medical purposes in USA and Canada. Cannabis and mental health: prevalence of use and modes of cannabis administration by mental health status. Addictive Behaviors ; Mental health and medical cannabis use among youth and young adults in Canada. Substance Use and Misuse ; 55 4 : Perceived support for medical cannabis use among approved medical cannabis users in Canada. Harm Reduction Journal ; 3 : e—e

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