Two-legged or four-legged, some guinea pigs have more fun than others.
Among the human variety, Dr. John Clendinning and Dr. David Casarett might be considered particularly fortunate. Back in 1843 Dr. Clendinning, a London physician and bad insomniac, reported on his personal experiences with various sleep-inducing substances. The clear winner was a tincture of marijuana, which brought him a good night’s sleep with none of what he termed opium’s “inconveniences.”
Now Dr. Casarett, a physician at the University of Pennsylvania, has assumed the Clendinning mantle, selflessly immersing himself in the culture, science and, yes, smoke of medical marijuana in order to unravel and report back on the truth behind the buzz.
Despite the book’s title, Dr. Casarett writes more as a doctor than as a stoner in “Stoned” — and let the record show he threw a particularly delectable brownie in an airport trash can rather than risk interstate transport problems. He delivers a readable, absorbing and informative account, laudably minimizing the yucks and emphasizing the science, or as least as much as the data allow. (Read an excerpt.)
Unfortunately, that’s not very much. All the many recent journalistic explorations of medical marijuana have slammed into the same brick wall: The definitive, rigorous studies that inform our use of other drugs simply do not exist for this one. Instead, the pundits must extrapolate from studies that are at best suggestive, and often augmented by a certain amount of wishful thinking.
You’d think it would be easy enough to collect a group of people suffering from any of the dozens of unhappy conditions marijuana is said to help, randomize them to active or placebo joints, then tally the results. But a long list of obstacles blocks this standard approach when it comes to marijuana.
The bottom line: The stuff is a pharmacological nightmare. The plant contains dozens of cannabinoid molecules, among which two (tetrahydrocannabinol, or THC, and cannabidiol, or CBD) are present in the highest amounts, and are thought to be responsible for most of its effects. But the amounts of both vary considerably among different plants, lending each strain its own signature pharmacology.
Cannabinoids can indeed be processed into various distillates, tinctures and oils, but the strength of these preparations varies, and individual reactions to them vary, and how relevant studies of standardized preparations are to the contents of the average baggie is anyone’s guess.
Logistical problems abound as well. Marijuana research has been difficult to fund and implement, with hurdles that include a Drug Enforcement Administration classification of marijuana as a substance with “no currently accepted medical use.” Researchers condemn the prejudice against their work: As one told Dr. Casarett in frustration, “Any drug that makes you feel good has a black mark against it. And that’s true no matter how effective a drug might be.”
With a dearth of research, the medicalization of marijuana has been driven largely by anecdote — stories of triumphs and failures in individual patients. And while anecdotes reliably make for pretty poor medicine, they make for good reading. Dr. Casarett’s boo
brims with human interest as he travels among patients, dealers, clinics and researchers, crossing continents and taking notes.
He meets Caleb, who relies on marijuana to treat the pain and nausea of incurable rectal cancer, but has increasing difficulty affording the drug. Alice just hopes the drug will help her sleep. Rachel, recovering from a spinal fracture and suffering from stabbing nerve pain, swears by her “vape pen,” the marijuana equivalent of an electronic cigarette.
In Israel, a certified “marijuana instructor” named Zach Klein has administered marijuana to dozens of demented nursing home patients with startling improvements in some, including one with Parkinson’s disease who signed his name for the first time in years.
In San Francisco, a noted oncologist emphatically debunks claims that marijuana cures cancer, but suspects that it may slow the progress of some cancers. In Los Angeles, a lung researcher fails to find lung damage in marijuana smokers and wonders if cannabinoids may protect against inflammation induced by smoke.
In the middle of all of this travel, Dr. Casarett’s own tricky back gives out, providing an excellent opportunity to test the product for himself.
His pain does get a little better after he smokes a joint, but he also begins to hear chattering voices coming from his empty living room, phantom air traffic controllers who had arrived to keep him company. Were he smoking for recreational purposes, the mild hallucination would be amusing. Were he heading off to a day’s hospital work, those voices would be a big problem.
Even more sobering is the morning Dr. Casarett spends in the passenger seat of a car, taking notes as the car’s driver, a stoned medical marijuana patient, tries and utterly fails to navigate an impromptu obstacle course set up in a local parking lot. “Marijuana and driving don’t mix,” Dr. Casarett concludes — not a novel sentiment, but another big problem for a recreational drug trying to make it in the pharmacopoeia.
In the end, like all the pundits before him, Dr. Casarett finds himself impressed by both marijuana’s medical possibilities and its risks, convinced by the stories he has heard that it is valuable treatment for some conditions, but calling for more research into a substance with a clear set of inconveniences of its own.
A version of this article appears in print on September 8, 2015, on page D3 of the New York edition with the headline: A Search for Truth in All the Smoke.
By Abigah Zuger, M.D. - The NY Times/Sept 7, 2015
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