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The Marijuana Debate: How strong is the case for legalizing marijuana for recreational or medical reasons?

Publishing Date : 19 July, 2018

Author :

Dr Edward T. Maganu

I am delving into this subject because I realize our Nation has to interrogate it and make its mind on the future use of Marijuana (Cannabis, Dagga, Motokwane, Ganja or whatever one wants to call it) in the country.


The debate is hectic, but I think it is highly impaired by lack of knowledge on the subject or actually patchy knowledge which makes people argue from an emotional rather than an informed rational angle. For example people need to understand the so-called medical marijuana, what it actually is as opposed to the plant, and what can actually be licensed. I have taken reference mainly from a reputable organization, the National Institute on Drug Abuse (NIDA) at the National Institutes of Health, USA.


Consequently in the article I refers a lot to the U.S. Food and Drug Administration (FDA), which is the main regulatory body for drugs in the USA and one of the most influential internationally. The article concludes with my opinion on the route Botswana should take on the subject.


Some Facts on the Drug: What is marijuana?

Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant. The plant contains the mind-altering chemical THC (Tetrahydrocannabinol) and other similar compounds. Extracts can also be made from the cannabis plant.
According to sources, Marijuana is the most commonly used illicit drug in the United States. Its use is widespread among young people. This is likely the case in Botswana. Legalization of marijuana for medical use or adult recreational use is a major subject of debate in a growing number of countries.


How do people use marijuana?

People smoke marijuana in hand-rolled cigarettes (joints) or in pipes or water pipes (bongs). They also smoke it in blunts—emptied cigars that have been partly or completely refilled with marijuana. To avoid inhaling smoke, some people are using vaporizers. These devices pull the active ingredients (including THC) from the marijuana and collect their vapor in a storage unit. A person then inhales the vapor, not the smoke. Some vaporizers use a liquid marijuana extract. People can mix marijuana in food (edibles), such as brownies, cookies, or candy, or brew it as a tea. A newly popular method of use is smoking or eating different forms of THC-rich resins


How does marijuana affect the brain?

Marijuana has both short-and long-term effects on the brain.

Short-Term Effects

When a person smokes marijuana, THC quickly passes from the lungs into the bloodstream. The blood carries the chemical to the brain and other organs throughout the body. The body absorbs THC more slowly when the person eats or drinks it. In that case, they generally feel the effects after 30 minutes to 1 hour. THC acts on specific brain cell receptors that ordinarily react to natural THC-like chemicals. These natural chemicals play a role in normal brain development and function.
 

Marijuana over-activates parts of the brain that contain the highest number of these receptors. This causes the "high" that people feel. Other effects include:  i)altered senses (for example, seeing brighter colors), ii) altered sense of time, iii) changes in mood, iv) impaired body movement,              v) difficulty with thinking and problem-solving, vi) impaired memory, vii) hallucinations (when taken in high doses), viii) delusions (when taken in high doses) and ix) psychosis (when taken in high doses).

Long-Term Effects

Marijuana also affects brain development. When people begin using marijuana as teenagers, the drug may impair thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. Researchers are still studying how long marijuana's effects last and whether some changes may be permanent.


What are the other health effects of marijuana?

Marijuana use may have a wide range of effects, both physical and mental.

Physical Effects

Breathing problems. Marijuana smoke irritates the lungs, and people who smoke marijuana frequently can have the same breathing problems as those who smoke tobacco. These problems include daily cough and phlegm, more frequent lung illness, and a higher risk of lung infections.


Increased heart rate. Marijuana raises heart rate for up to 3 hours after smoking. This effect may increase the chance of heart attack. Older people and those with heart problems may be at higher risk. Problems with child development during and after pregnancy.  Marijuana use during pregnancy is linked to lower birth weight and increased risk of both brain and behavioral problems in babies. If a pregnant woman uses marijuana, the drug may affect certain developing parts of the fetus's brain.


Intense Nausea and Vomiting. Regular, long-term marijuana use can lead to some people developing Cannabinoid Hyperemesis Syndrome. This causes users to experience regular cycles of severe nausea, vomiting, and dehydration, sometimes requiring emergency medical attention.

Mental Effects

Long-term marijuana use has been linked to mental illness in some people, such as i) temporary hallucinations, ii) temporary paranoia and iii) worsening symptoms in patients with schizophrenia—a severe mental disorder with symptoms such as hallucinations, paranoia, and disorganized thinking. Marijuana use has also been linked to other mental health problems, such as depression, anxiety, and suicidal thoughts among teens. However, study findings have been mixed.


How Does Marijuana Affect a Person's Life?

Compared to those who don't use marijuana, those who frequently use large amounts report the following:  i) lower life satisfaction, ii) poorer mental health, ii) poorer physical health and iii) more relationship problems. People also report less academic and career success. For example, marijuana use is linked to a higher likelihood of dropping out of school. It's also linked to more job absences, accidents, and injuries.

Is marijuana addictive?

Marijuana use can lead to the development of a substance use disorder, a medical illness in which the person is unable to stop using even though it's causing health and social problems in their life. Severe substance use disorders are also known as addiction. Research suggests that between 9 and 30 percent of those who use marijuana may develop some degree of marijuana use disorder. People who begin using marijuana before age 18 are four to seven times more likely than adults to develop marijuana use disorder. Many people who use marijuana long term and are trying to quit report mild withdrawal symptoms that make quitting difficult. These include: i) grouchiness, ii) sleeplessness, iii) decreased appetite,  iv) anxiety, and v)cravings.

What treatments are available for marijuana use disorder?

No medications are currently available to treat marijuana use disorder, but behavioral support has been shown to be effective. Examples include therapy and motivational incentives (providing rewards to patients who remain drug-free). Continuing research may lead to new medications that help ease withdrawal symptoms, block the effects of marijuana, and prevent relapse.

What is medical marijuana?

The term medical marijuana refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions. The U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine. However, scientific study of the chemicals in marijuana, called cannabinoids, has led to two FDA-approved medications that contain cannabinoid chemicals in pill form.


Continued research may lead to more medications. Because the marijuana plant contains chemicals that may help treat a range of illnesses and symptoms, many people argue that it should be legal for medical purposes. In fact, a growing number of states have legalized marijuana for medical use.


Why isn’t the marijuana plant an FDA-approved medicine?

The FDA requires carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication. So far, researchers haven't conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it's meant to treat.

How might cannabinoids be useful as medicine?


Currently, the two main cannabinoids from the marijuana plant that are of medical interest are THC (Tetrahydrocannabinol) and CBD (Cannabidiol).  THC can increase appetite and reduce nausea. THC may also decrease pain, inflammation (swelling and redness), and muscle control problems.


Unlike THC, CBD is a cannabinoid that doesn't make people "high." These drugs aren't popular for recreational use because they aren't intoxicating. It may be useful in reducing pain and inflammation, controlling epileptic seizures, and possibly even treating mental illness and addictions. The FDA approved a CBD-based liquid medication called “Epidiolex” for the treatment of two forms of severe childhood epilepsy.


Many researchers, including those funded by the National Institutes of Health (NIH), are continuing to explore the possible uses of THC, CBD, and other cannabinoids for medical treatment. For instance, recent animal studies have shown that marijuana extracts may help kill certain cancer cells and reduce the size of others. Evidence from one cell culture study with rodents suggests that purified extracts from whole-plant marijuana can slow the growth of cancer cells from one of the most serious types of brain tumors. Research in mice showed that treatment with purified extracts of THC and CBD, when used with radiation, increased the cancer-killing effects of the radiation.


Scientists are also conducting preclinical and clinical trials with marijuana and its extracts to treat symptoms of illness and other conditions, such as:  i) diseases that affect the immune system, including HIV/AIDS, and multiple sclerosis (MS), which causes gradual loss of muscle control,              ii) inflammation, iii) pain,  iv) seizures, v) substance use disorders, and vi) mental disorders.


What medications contain cannabinoids?

Two FDA-approved drugs, dronabinol and nabilone, contain THC. They treat nausea caused by chemotherapy and increase appetite in patients with extreme weight loss caused by AIDS. Continued research might lead to more medications. The United Kingdom, Canada, and several European countries have approved nabiximols (Sativex), a mouth spray containing THC and CBD. It treats muscle control problems caused by MS, but it isn't FDA-approved.

Conclusion

It is obvious that dagga (marijuana) is a topical issue not only in Botswana but internationally. Countries have approached it in different ways, with a few countries permitting it legally for recreational use, and a few more allowing what they call medical marijuana. With the harm that this substance causes, I would oppose seriously anybody campaigning for allowing recreational use of dagga in Botswana. The potential for negative consequences on our population, especially youth, is great.


Comparing it with alcohol does not really hold water- the two substances have very different historical trajectories. It appears that historically, most societies that advanced beyond the hunter-gatherer stage developed the ability to produce alcohol for consumption, either from their agricultural produce or from fruits. So alcoholic drinks became very important social lubricants in community gatherings and even in religious rituals. This is borne out by old literature, including the Judeo-Christian Bible (Old and New Testament).


However, there is always an injunction against drunkenness or alcohol abuse. Marijuana has no such history. It has obviously been used by some societies for a long time, but it never achieved the social acceptance of alcohol. Is it because of its negative social and health effects?

As for “Medical Marijuana”, my interpretation is that this is a misnomer. This is because this phrase is meant to refer to extracts from the plant, and not the plant itself. In the same way as there are still a few modern medical drugs that are manufactured from plants, medicines can and are now being produced from the marijuana plant.


Like other medicines, whether extracted from plants or not, such drugs have to undergo the vigorous clinical trials to determine safety, effectiveness and efficacy that modern scientific medicine demands for any drug that enters the pharmaceutical market.  This has happened to other medicines derived from plants such as opiates (Opiates are the natural alkaloids found in the resin of the opium poppy)and digitalis products from the foxglove.


I would therefore support the registration and licensing of medicines originating from the marijuana plant if they have undergone the normal rigorous tests, but not the recognition of the marijuana plant as a medicine. This is the condition that Botswana should follow, and the phrase “Medical Marijuana” should not be used as it is misleading.  This portion of the article has borrowed largely from an article from NIDA (NIH’s National Institute on Drug Abuse (June 2018): Marijuana
 

 This portion of the article has borrowed largely from another article from NIDA (NIH’s National Institute on Drug Abuse (June 2018): Marijuana as Medicine

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