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Palliative care opinion

Medicinal marijuana: Puff, puff, take a pass?

No sooner had Uncle Sam thrown a triumphant Democratic fist in the air, than Massachusetts invited good 'ol Aunt Mary Jane for tea and... um, cookies. The referendum would make this the 18th state in the US to have legalized the use of cannabis for medicinal purposes, amidst debate surrounding its recreational abuse. This got me thinking about our own struggle with the weed and the feasibility of passing such a law in SA.
Back-track one year

As an intern rotating through Psychiatry, I remember a homely, middle-aged nurse who had reminded me of my mother, pulling me into a corner and asking me where she could get ganja? Playing along, I told her to follow the yellow brick road into the town square and ask for the Wizard of Grass, only to realize that she was sadly serious.

It turned out that her sister had been suffering with terminal cancer and had bone metastases, causing her to be in a state of perpetual pain. The palliative care physician suggested she try taking extracted cannabis oil in an attempt to relieve her pain.

Other than being effective in treating chronic pain syndromes and even upstaging placebos in treating elusive neuropathic pains, the questioned herb has been shown to decrease intraocular pressure in glaucoma, as well as stimulate appetite and decrease nausea in patients suffering with AIDS and those currently undergoing chemotherapy.

Pot calling the kettle black?

Exiting the corner that I had been backed into by our Florence Nightingale, I returned to a psych ward full of testimonials on the dangers of smoking marijuana recreationally. Other than the acute 'toxic' phase responses of panic, anxiety, and depression, patients present with acute psychosis, withdrawal symptoms, as well exacerbation of pre-existing mental illnesses. This has led to cannabis being stated by the good book of psychiatry, the DSM-IV, as a noted risk factor for mental illness.

The effects sadly go deeper than mental, with medical consequences of smoking cannabis being five times as detrimental as smoking a cigarette. Cannabis smokers are more likely to suffer from bronchitis, emphysema and lung cancer, as well as negative acute cardiac incidents. This is often on the backdrop of social turmoil experienced by the family of users due to recreational abuse as well as loss of productivity on behalf of the individual themselves.

Currently, the use of marijuana medicinally in the US is done via oral and inhalational routes by means of tinctures of pharmaceutical grade plants. This is regulated by the state with measures in place to prevent foul play.

In our backyard however, with a UN survey labeling South African cannabis use as twice the worldwide norm, it may be a different story altogether. Legalizing the medicinal use of cannabis, despite the ethical argument for its benefits, may trigger a slippery slope situation ending in recreational abuse in a society already struggling to contain other drug-related dilemmas.

With government's focus on issues that would seem more pressing, the proponents' hopes for a visit from Aunt Mary Jane anytime soon may just go up in smoke.
    
 

About Chamendran Naidoo

Chamendran Naidoo works as a General Practitioner in the SA Navy. His interests include fine surgery as well as approaching the patient as a whole in a Bio-Psycho-Social manner. He is passionate about the immersion of medicine into everyday life which he actively manages via social media fronts. Chamendran is also a co-presenter on SABC3's Dr Mol Show. Email Chamendran on and follow him on Twitter at @Chamendran.
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