by AMANDA WINTERS,

MARK COUHIG

AND MATTHEW NASH

Sequim Gazette

For Dr. Ronald Bergman, a specialist in pain management, medical cannabis is a matter of the good, the bad and the ugly.

The good, he says, is that it has been shown to inhibit pain — and it’s less dangerous than more potent painkillers. The bad is that high school students abuse marijuana, which can have a lifelong impact on their cognitive abilities.

Use of marijuana by young people can “stop the maturing of the brain,” he said.

The concerns regarding youthful abuse are made worse by studies that show that legalizing a drug makes it more likely that it will be considered safe, particularly among the young. That leads to more frequent abuse and at earlier ages.

The ugly is that the use of marijuana is in very rare cases addictive — though the odds are “less than for caffeine,” Bergman said.

Bergman agreed the use of marijuana often precedes the abuse of other drugs and substances but he stopped short of saying it’s a “gateway drug,” noting “that hasn’t been shown to be the case. The use of tobacco or alcohol in youth is a higher predictor of eventually using hard drugs,” Bergman said.

After weighing the pros and cons, Bergman said he believes legalizing medical cannabis is worth the risk. “I am a very strong and positive advocate of the responsible use of medical marijuana in the treatment of chronic pain,” he said.

Bergman also provided a number of caveats, including perhaps the most important one: Smoked marijuana is not a medicine, a conclusion agreed upon by the Food and Drug Administration and National Institute on Drug Abuse.

Instead, Bergman said, medical practitioners need something new: “a smokeless delivery system which results in rapid onset, high blood levels and minimal side effects and which is affordable.” That may involve a vaporizer, extended release tablets or dermal patches.

A vital part of creating that system will be establishing “standardized therapeutic dosing values.” To date, Bergman said, the research is insufficient to determine the appropriate dosage for the specific condition that is being treated. Given the extensive list of conditions for which marijuana may be helpful, that’s important.

Swift Sanchez, a Detective Sergeant with the Suquamish Police Force, arrived at the crux by a different means, but supported Bergman’s contention that discerning dosages must be a research priority.

Sanchez, who also is a state-certified field sobriety test instructor, says the state is seeing fewer cases of drunken drivers and more drugged drivers. A lot of those are abusing marijuana, she said. She added marijuana impairment is more dangerous than alcohol because “you can’t measure it. There are so many different types” of marijuana, she said. As opposed to 86-proof bourbon, the relative strength of a given sample of marijuana is difficult to measure.

Sanchez said, “A blood test will tell you how many nanograms are in a driver’s system,” but she also said the tests currently used in Washington have a minimum threshold. If the blood dosage is below a certain level — a level which may or may not cause impairment — the test will show the driver is marijuana-free. She said it costs the state too much to provide more accurate testing.

A cautionary tale

A practicing Sequim physician who requested anonymity agreed there are both pros and cons regarding the use of medical marijuana.

He recently had a patient — a woman diagnosed with a mental disorder — request medical marijuana, but he refused, believing it was dangerous for someone with her condition.

The patient later received medical marijuana from an organization in the Seattle area.

The Sequim doctor said he called the dispensary requesting she not receive this form of treatment but they issued it anyway.

“Although marijuana is relatively safe for most, it can be dangerous to some individuals as the psychotropic effects of (it) are very variable and include euphoria or dysphoria, disruption of short-term memory, cognitive impairments, sense of time distortion, reduced coordination and sleepiness,” the Sequim physician said.

“Acute exposure to cannabis increases psychosis-like symptoms, even among healthy volunteers without preexisting Axis I psychotic disorders.”

Effects early on

The Sequim doctor confirmed Bergman’s comments on the use of marijuana by young people, pointing to a study that provided objective evidence that it can result in long-term harm.

In a March 1, 2010, story online at the Archive of General Psychiatry, researchers found through a study of 228 sibling pairs that using marijuana at a young age increases the risk for hallucinations or delusions later in life.

The longer the young adults “reported since first marijuana use” (the younger they began), the more likely they were to report isolated psychosis symptoms.

“On the other hand, a legal drug such as alcohol can be equally dangerous to patients with mental conditions such as bipolar disorder,” the Sequim physician said.

“Alcohol can actually cause severe impairment (including death) in anyone who consumes too much as manifested by drunk drivers and bar fights. I don’t believe there has been a documented case of overdose due to marijuana and in general marijuana is less likely to cause significant impairment.”

Bergman agreed, saying, “Our worst drug is alcohol. Period.”

Discerning the impact

The difficulty of studying the impact of medical marijuana on patients is exacerbated by a lack of data.

While the Washington State Department of Health provides limited information on medical marijuana, it doesn’t keep any records of patients who have been authorized to use medical marijuana or on the doctors who authorized the use. Donn Moyer, the agency’s media relations manager, said the only time the department gets involved is if someone complains to them about a doctor, in which case the department investigates the complaint.

Moyer said the state has no pro or con stance on the use of medical marijuana.

Tom Locke, Clallam County public health officer, said the use of medical marijuana is kept in the realm of medical care, not public health, and government agencies do not play any legally prescribed role in medical marijuana education or recommendation.

“The initiative which established the right of licensed health care providers to recommend medical marijuana for a set of qualifying conditions kept the decision-making and education process in the confines of the provider-patient relationship and outside the domain of government,” he said.