Philip Seymour Hoffman’s death points to broader opioid drug epidemic

Drugs are prepared for injection by a user addicted to heroin in St. Johnsbury, Vt. Vermont Gov. Peter Shumlin devoted his State of the State speech to the scourge of heroin. (Spencer Platt/Getty Images)
The death last Sunday of Oscar-winning actor Philip Seymour Hoffman at age 46 focused media attention on the nationwide surge in heroin use and overdoses. But the very real heroin epidemic is framed by an even more dramatic increase since the beginning of the century in overdoses from pharmaceutical drugs known as opioids.
These are, in effect, tandem epidemics — an addiction crisis driven by the powerful effects on the human brain of drugs derived from morphine.
Prescription opioids are killing Americans at more than five times the rate that heroin is, according to the most recent numbers from the Centers for Disease Control and Prevention. These drugs are sold under such familiar brand names as OxyContin, Vicodin and Percocet and can be found in medicine cabinets in every precinct of American society. They’re also sold illicitly on the street or crushed and laced into heroin.
There have been numerous efforts by law enforcement agencies to crack down on “pill mills” that dispense massive amounts of the pharmaceuticals, as well as regulations aimed at preventing users from “doctor shopping” to find someone who will write a prescription.
Those efforts have had the unintended effect, officials say, of driving some people to heroin in recent years as their pill supply dries up.
(Patterson Clark / The Washington Post/Source: CDC)
The latest government survey of drug abuse shows a drop since 2010 in first-time users of illegally obtained OxyContin. But heroin use is up. It’s akin to pushing on a beanbag chair. Health officials in Maryland, for example, reported that in the first seven months of 2012, a 15 percent drop in pharmaceutical opioid overdoses was accompanied by a 41 percent increase in heroin overdoses.
Market forces play a role in this drug substitution, as do the brutal realities of addiction and the need for a fix. Street heroin is much cheaper than a pharmaceutical — typically $10 a packet for heroin, compared with perhaps $80 on the street for an 80 milligram OxyContin, public health officials say.
The stigma and lethality of street heroin — long viewed much more negatively than drugs such as cocaine, according to government surveys — are no deterrent to someone facing the agony of withdrawal from an opioid.
“In the storm of narcotic withdrawal, any opiate port will do,” said Jim Hall, an epidemiologist at Nova Southeastern University in Florida who studies addiction.
Prescription painkillers may also grease a slippery slope toward a relapse for former heroin addicts. Hoffman appears to be a case in point. He was found with a needle in his arm and dozens of heroin packets in his Manhattan apartment. The autopsy and initial toxicology tests were inconclusive, and so the precise cause of Hoffman’s death — whether he overdosed on heroin alone, for example, or in combination with one or more other drugs — is pending further investigation.
But the actor revealed last year that, after being clean for two decades, he suffered a relapse into heroin use after first taking prescription pills.
“The main driver of overdoses right now in our country is from opioid medications, more than from heroin,” said Nora Volkow, director of the National Institute on Drug Abuse.
In 2010, according to the CDC, 3,036 people died in the United States from heroin overdoses, up from 1,960 in 1999.
But 22,134 people died in 2010 from unintentional pharmaceutical drug overdoses, nearly triple the 7,523 deaths reported in 1999, according to the CDC. About three out of four of those overdoses — 16,652 — were from opioids. Most of the rest of the overdoses came from such drugs as Xanax, Valium and Ativan, which are used for anxiety or sleeplessness and are categorized scientifically as benzodiazepines.
Most people who abuse pills don’t have legal prescriptions for them. They get them from family and friends, and sometimes from drug dealers. Young people may view them as safer than street drugs such as heroin because they are manufactured as medicine and originate with doctors.
“We have tried to shatter the myth that these are safe,” Volkow said.
Young people are often the victims of chemical combinations they don’t understand, said Karen Hacker, director of Pennsylvania’s Allegheny County Health Department, which includes the city of Pittsburgh. They combine pills with alcohol and other drugs. They may feel that snorting or smoking certain drugs is safer than injecting them. And they may not realize that slow-release opioid painkillers have long-lasting effects.
“We had people going to sleep kind of drunk and literally not waking up in the morning,” Hacker said.
Her county had a rash of 16 deaths between Jan. 17 and Jan. 30 from heroin laced with the opioid painkiller fentanyl, which is many times stronger than heroin. The chief medical examiner, Karl Williams, said that in the 1980s and 1990s, Allegheny County would typically have about 100 overdoses annually. But in the late ’90s, he said, the numbers began steadily rising, and now there are about 250 overdoses each year.
Even that huge rate of overdoses didn’t prepare the coroner for what he saw on Friday, Jan. 17, when three bodies were brought in with signs of heroin overdoses. The next day, Saturday, he saw four more cases, and then Sunday brought three more — 10 deaths in three days. Laboratory tests showed that all had taken a lethal 50-50 mixture of heroin and fentanyl.
The overdoses from the fentanyl-laced heroin apparently have stopped, Williams and Hacker said — presumably because word got to users that they were in grave peril from heroin sold in plastic envelopes stamped “Theraflu” and “Bud Ice.”
“One of the challenges, of course, with this is that there are people who hear that there is some particularly strong heroin, and they would like some of it,” Hacker said. But, she added, “most users don’t want to die. They’re not looking to overdose. They’re not looking to commit suicide. They’re looking to get high.”
Gil Kerlikowske, a former Seattle police chief who is director of the White House Office of National Drug Control Policy, said he is concerned that many young people simply don’t grasp how addictive heroin can be.
“We see it in suburbs, among high school kids, and again it goes back to high school kids not being aware how dangerous it is. They think if they snort it or smoke it, they won’t become addicted — and within weeks they’ve become an injecting drug user,” Kerlikowske said.
“This is really among the most debilitating of drug addictions that we historically know of,” said Hall, the Florida epidemiologist. “The heroin or opioid becomes the whole focus of the person’s life. Everything is centered on how are they going to take care of their need to have the opiate in their brain in the next 24 hours and what are they going to do to get that.”
The White House is pushing more cities to follow the model of Quincy, Mass., where officers on patrol carry an anti-overdose medication called naloxone, which is sold under brand names such as Narcan. Lt. Patrick Glynn, commander of the Quincy police narcotics unit, said the program began after the city and neighboring jurisdictions had 99 overdose deaths in just 18 months in 2008 and 2009.
“We realized we could not arrest our way out of this epidemic. Young people, middle-aged people were dropping on the street, overdosing on heroin,” Glynn said.
In a recent three-year period, Glynn said, police administered 227 doses of nasal-spray Narcan and were able to reverse 216 of the overdoses.
Related: 8 questions about heroin and the death of Philip Seymour Hoffman


Find information about the popularity of traditional painkillers, anti-anxiety medications and anti-nausea drugs in states that adopted medical marijuana laws.

Studies indicate that medical marijuana is effective in treating chronic pain; PTSD; anxiety; AIDS; and spasms. Overall, most of the same studies report that there has been a decrease in a variety of drugs, especially pain-killers, in states that have adopted medical marijuana laws. Among the older population, medical marijuana is reportedly improving their quality of life, making them less dependent widely prescribed opioid painkillers and other drugs. Documents mentioning Washington are relevant.

Find scholarly articles that support this question's claims.

New rules on narcotic painkillers cause grief for veterans and VA

Craig Schroeder, who was injured in 2006 while serving with the Marines in Iraq, suffers from traumatic brain injury and pain, for which he has been on a steady regimen of opioids. (Ted Richardson/For The Washington Post)
New federal rules that make it harder to get narcotic painkillers are taking an unexpected toll on thousands of veterans who depend on these prescription drugs to treat a wide variety of ailments, such as missing limbs and post-traumatic stress.
The restrictions, adopted last summer by the Drug Enforcement Administration to curb a national epidemic of opioid abuse, are for the first time, in effect, forcing veterans to return to the doctor every month to renew their medication, although many were already struggling to get appointments at overburdened VA health facilities. And even if patients can get appointments, the new rules pose an additional hardship for many who live a good distance from the health centers.
Although the tighter regulation applies to everyone on opioid painkillers, it’s hitting veterans especially hard because so many are being treated for horrific injuries sustained during the long wars in Iraq and Afghanistan and have become dependent on the Department of Veterans Affairs’ beleaguered health-care system for medical care.
The rules come at a time of turmoil for VA. The agency’s widespread problem with patient backlogs burst into view last year with revelations that employees had covered up how long veterans had to wait for care, even for such pressing matters as cancer and suicide prevention.
[How the VA developed its culture of cover-ups]
In dramatically curtailing access to the highly addictive painkillers, the government is trying to roll back what the Centers for Disease Control and Prevention has termed “the worst drug addiction epidemic in the country’s history, killing more people than heroin and crack cocaine.” The rules apply to “hydrocodone combination products,” such as Vicodin.
More than half a million veterans are now on prescription opioids, according to VA.
Pain experts at VA say that in hindsight they have been overmedicating veterans, and doctors at the Pentagon and VA now say that the use of the painkillers contributes to family strife, homelessness and even suicide among veterans. A study by the American Public Health Association in 2011 also showed that the overdose rate among VA patients is nearly double the national average.
But some veterans say they have come to depend on these painkillers to function and now, unable to get a timely renewal of the prescription, are suffering withdrawal symptoms that feel like a panic attack and the flu at the same time.
Craig Schroeder was injured in a makeshift-bomb explosion while serving as a Marine corporal in the “Triangle of Death,” a region south of Baghdad. He suffers from traumatic brain injury, which has affected his hearing, memory and movement, and from pain related to a broken foot and ankle and a herniated disc in his back. He has been on a steady regimen of opioids.
But after the DEA regulations were put in place, he was unable to get an appointment to see his doctor for nearly five months, he said. He stayed in bed at his home in North Carolina much of that time.
“It was a nightmare. I was just in unbearable, terrible pain,” he said. “I couldn’t even go to the ER because those doctors won’t write those scripts.”
His wife, Stephanie Schroeder, said getting him a VA appointment turned into a part-time job and her “main mission in life.” While part of the problem was a shortage of doctors, she said she also noticed that VA had become hostile toward patients who asked for painkillers.
“Suddenly, the VA treats people on pain meds like the new lepers,” she said. “It feels like they told us for years to take these drugs, didn’t offer us any other ideas, and now we’re suddenly demonized, second-class citizens.”
Officials at Disabled American Veterans, a veterans service organization, said VA needs to be more compassionate and help veterans through the changes.
“We’re hearing from veterans with lifelong disabilities, who never had a problem with addiction issues. They have been on these drugs for decades, and then all of a sudden it was boom, a total change in attitudes,” said Joy Ilem, the group’s deputy national legislative director.
Gavin West, a clinical operations chief at VA, said there has been a systematic effort since autumn to contact veterans to explain the new rules, broader concerns about opioid use and alternative options for treatment. At the same time, he said, the agency is working to ensure that veterans get the access to medical care that’s required.
“The DEA did a good thing here for opioid safety,” he said. But he added, “How do you balance the sensitivity of patients and the new rules when all of a sudden a veteran, who’s been treated with this medication for 15 years or 20 years, has everything change?”
To help patients adjust to the changes, Rollin Gallagher, VA’s national director for pain management, said staff members are meeting personally with veterans. “There is the real anxiety of being in pain and losing control of that pain. We are aware of the fact that we need to pay attention to this,” he said.
The agency recently set up a Choice Card program for veterans, which would allow those facing long wait lists or who live more than 40 miles away from a VA hospital to use private clinic visits. Veterans say the initiative is complicated and confusing. VA officials acknowledged this month that veterans have been using this program at a lower rate than anticipated.
[Veterans say new choice cards are causing more problems]
DEA officials declined to comment on the specific challenges that the new rules pose for veterans. Barbara L. Carreno, a DEA spokeswoman, said in a statement that everyone, including “practitioners employed by the U.S. Veterans Administration,” have to follow the new regulations. The officials said the rules are a response to multiple medical studies that have showed that the opioid overdose rate is higher in the United States than anywhere else.
DEA officials offer some flexibility, allowing doctors to write prescriptions for up to 90 days by post-dating them. But many VA doctors will not do that because of concerns over fraud or fatal overdoses; doctors are telling patients they need to come back every month, medical staff say.
Half of all returning troops suffer chronic pain, according to a study in the June issue of the Journal of the American Medical Association. So a new generation of pain doctors is pushing for alternative ways to help veterans cope with chronic pain. Some alternatives are acupuncture, bright light therapy and medical marijuana. As part of a $21.7 million initiative with the National Institutes of Health, VA is looking for therapies that could substitute for opioids.
“Our hospitals are doing some really exciting things to combat chronic pain and take care of our veterans. There are VA hospitals that are using alpha-stimulation devices to treat pain and depression,” VA Secretary Robert McDonald said. “That’s only going to continue and keep getting better. And we are getting there.”
[Federal research seeks alternatives to addictive opioids for veterans in pain]
In the meantime, however, veterans say they continue to bear the burden of the new restrictions on narcotic painkillers.
A retired staff Army sergeant who served in Iraq, who spoke on the condition of anonymity for medical privacy reasons, said he can’t drive because of shrapnel in his femur and pelvis. He takes the bus nearly two hours for “a one-minute consult” to get his medications. He has been taking them for more than nine years and has never had an addiction problem, he said.
Mike Davis, a retired Army corporal, said he shattered his left arm from the elbow to the fingertips when he fell off of a Pershing missile during maneuvers in Germany in 1979. Over the years, he has had six surgeries.
After the last one, in 2003, he was prescribed opioids and said he has been on them since. Davis, who now works as a social worker in Illinois, said he feels lucky to have found a combination of painkillers that works for him.
“It’s just insulting to the veteran to assume they are abusing these drugs,” said his wife, Linda Davis, who works as his personal patient advocate. “I’m fully aware that people doctor-shop, some docs overprescribe. But I think they need to realize that there’s a real difference between addiction and dependence.”
But Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, called the new DEA rules “the single most important change that could happen. The best way to treat any disease, whether it’s Ebola or opioid addiction, is to stop creating more people with the disease.”
At the same time, he said, VA needs to do far more to help veterans through the rocky transition.
“Unfortunately, veterans are the victims here,” Kolodny said. “The VA created this mess by aggressively jumping onto pills as the solution. But it’s not something you can just abruptly stop.”
The Washington Post has created a Facebook community for veterans to share their experiences. If you’ve served, please join here: www.facebook.com/groups/478888458878205.


25 states now call marijuana “medicine.” Why doesn’t the DEA?

Charles Schatz of Bel Air, Maryland holds a sign demanding the use of marijuana for medical cases as he joins dozens of protestors for the legalization of marijuana in front of the White House, April 2, 2016, in Washington, DC. Mike Theiler/AFP Ohio's measure is more restrictive than medical marijuana bills in many other states. It does not allow patients to smoke marijuana -- they must ingest it orally via edible products, or use a vaporizer. It doesn't allow patients to grow their own marijuana, and only a handful of conditions, including epilepsy, chronic pain and cancer, qualify for a medical marijuana recommendation. This year has been a symbolically significant year for medical marijuana policy: with the passage of legislation in Pennsylvania and Ohio nearly 175 million Americans -- over half of the population -- now have access to medical marijuana. These changes are putting pressure on the federal government to update a decades-old marijuana policy that most experts agree is out of step with current scientific understanding of the drug and its risks and benefits. As of Feb. 26, 2015 marijuana was made legal in D.C.—sort of. Here are the ins and outs of the complex pot law.

Charles Schatz of Bel Air, Maryland holds a sign demanding the use of marijuana for medical cases as he joins dozens of protestors for the legalization of marijuana in front of the White House, April 2, 2016, in Washington, DC. Mike Theiler/AFP
John Kasich signed Ohio's medical marijuana bill into law yesterday, making it the 25th state (26 counting Washington, D.C.) to allow some form of medical marijuana use.
Ohio's measure is more restrictive than medical marijuana bills in many other states. It does not allow patients to smoke marijuana -- they must ingest it orally via edible products, or use a vaporizer. It doesn't allow patients to grow their own marijuana, and only a handful of conditions, including epilepsy, chronic pain and cancer, qualify for a medical marijuana recommendation.
Medical marijuana advocates had launched a campaign to put a broader medical marijuana bill before voters this fall. But the bill approved by legislature and signed by Gov. Kasich was in many tended to stave off more permissive ballot measures. And it appears to have been successful: the group pushing for the ballot initiative recently suspended that campaign, calling the legislature's bill "imperfect" but saying the bill's passage represented "a joyous day for the thousands of Ohioans who will finally be able to safely access much-needed medicine.
This year has been a symbolically significant year for medical marijuana policy: with the passage of legislation in Pennsylvania and Ohio nearly 175 million Americans -- over half of the population -- now have access to medical marijuana.

These changes are putting pressure on the federal government to update a decades-old marijuana policy that most experts agree is out of step with current scientific understanding of the drug and its risks and benefits.
The Drug Enforcement Administration has, since the 1970s, classified marijuana under the most highly restrictive category of regulation: Schedule 1, meaning it has "no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse." Marijuana shares this designation with heroin.
But drug science has come a long way since the 1970s. Researchers now know that marijuana is actually one of the least-addictive mind-altering drugs. Even chronic uses poses few serious risks to physical health.
Most importantly, at least for federal classification purposes, marijuana has been shown to have great promise when it comes to medical use. It's been shown to be an effective treatment for chronic pain. Given that people with this condition are routinely prescribed powerful painkillers that cause tens of thousands of overdose deaths each year, broader use of medical marijuana in these cases would quite literally save lives.
But neither the research, nor more widespread public acceptance, have so far prompted drug authorities to relax federal restrictions on marijuana. The biggest marijuana-related change at the DEA in the past year was an acknowledgement by the administration's chief that heroin is in fact more dangerous than marijuana. The DEA Administrator still believes that medical marijuana is "a joke."
The DEA is currently in the final stages of reviewing a petition to re-schedule marijuana and has told lawmakers it will have a final decision by July. Advocates of medical marijuana reforms say the petition represents a chance to bring the agency more in line with public opinion, scientific consensus, and the lived experience of millions of medical marijuana patients.
As of Feb. 26, 2015 marijuana was made legal in D.C.—sort of. Here are the ins and outs of the complex pot law.


Marijuana research hampered by access from government and politics, scientists say

With funding from the National Institute on Drug Abuse, the Marijuana Project at the University of Mississippi cultivates and supplies research-grade cannabis material for scientific and medical research. (Robert Jordan/Associated Press)
Millions of ordinary Americans are now able to walk into a marijuana dispensary and purchase bags of pot on the spot for a variety of medical ailments. But if you’re a researcher like Sue Sisley, a psychiatrist who studies post-traumatic stress disorder, getting access to the drug isn’t nearly so easy.
That’s because the federal government has a virtual monopoly on growing and cultivating marijuana for scientific research, and getting access to the drug requires three separate levels of approval.
Sisley’s fight to get samples for her study
While 20 states and the District have made medical marijuana legal — in Colorado and Washington state the drug is also legal for recreational use — it remains among the most tightly controlled substances under federal law. For scientists, that means extra steps to obtain, transport and secure the drug — delays they say can slow down their research by months or even years.
The barriers exist despite the fact that the number of people using marijuana legally for medical reasons is estimated at more than 1 million.
At a news conference for the National Cannabis Industry Assoc., Rep. Jared Polis (D-Colo.) was asked how many members of Congress he thinks smokes pot.
Stalled for decades because of the stigma associated with the drug, lack of funding and legal issues, research into marijuana’s potential for treating diseases is drawing renewed interest. Recent studies and anecdotal stories have provided hope that marijuana, or some components of the plant, may have diverse applications, such as treating cancer, HIV and Alzheimer’s disease.
But scientists say they are frustrated that the federal government has not made any efforts to speed the process of research. Over the years, the Drug Enforcement Administration has turned down several petitions to reclassify cannabis, reiterating its position that marijuana has no accepted medical use and remains a dangerous drug. The DEA has said that there is a lack of safety data and that the drug has a high potential for abuse.
Sisley’s study got the green light from the Food and Drug Administration in 2011, and for most studies, that would have been enough. But because the study is about marijuana, Sisley faced two additional hurdles.
First, she had to apply to the Department of Health and Human Services to purchase research-grade samples from the one farm in the United States — housed at the University of Mississippi and managed by the National Institute on Drug Abuse — that is allowed to grow marijuana under federal law. HHS initially denied her application but then approved a revised version March 14 — more than four months after it was submitted.
Now, Sisley must get permission from the DEA to possess and transport the drug.
Spokeswoman Dawn Dearden said that the agency is supportive of medical research on marijuana but needs to follow regulations under the Controlled Substances Act. “DEA has not denied DEA registration to a HHS-approved marijuana study in the last 20-plus years,” she said.
Sisley, who began her work with PTSD while at the Department of Veterans Affairs and now works at the University of Arizona College of Medicine, says she considers the HHS news a “triumph” for marijuana research. But she says the study has “a potentially long road with the DEA who is famous for delays.”
Born with a rare chromosomal disorder, 6-year-old Lydia Schaeffer suffers from life-threatening seizures that doctors haven’t been able to control despite countless medications. In marijuana, Lydia’s family members think they might have found a treatment that works. Now, they are trying to help legalize the drug.
“There is a desperate need for this research, but it’s impossible to study this drug properly in an atmosphere of prohibition,” she said.
Orrin Devinsky, director of the epilepsy center at New York University’s Langone Medical Center, said many would-be marijuana researchers are driven to abandon projects after they discover how time-consuming and expensive it can be to obtain the drug.
“There is no rationale for this except for the federal government’s outdated 1930s view about marijuana,” said Devinsky, who is studying the use of an extract of the plant for the control of seizures.
A resurgence in research
The cannabis plant was once a staple in American pharmacies, but since the turn of the 20th century, some states began to see it as a poison and introduced restrictions. Research on its medicinal uses came to a virtual standstill.
There are now 156 active researchers who are approved by the DEA to study marijuana — a number that has remained steady in recent years — but scientists say most are government-funded and focus on the ill effects of smoking marijuana rather than on potential medicines.
That’s poised to radically change. As an increasing number of states have legalized the use of medical marijuana, a bustling industry of start-up drug companies and medical groups focused on finding marijuana-based treatments has emerged. GW Pharmaceuticals, a British company, is studying two different extracts of marijuana that have shown promise for patients with Type 2 diabetes and epilepsy. ISA Scientific, based in Utah, is researching medications for pain and diabetes made from the cannabinoids found in marijuana that could be swallowed in capsule form.
Some of these new-generation researchers are exploring ways to try to speed up their work by bypassing the federal process for obtaining the drug. In Colorado, for instance, academic researchers have asked state officials whether they would allow them to study extracts grown within the state. In Georgia, scientists are seeking legislative action to allow the state’s five medical research universities to cultivate marijuana. A bill allowing them to do so recently won the backing of a House committee.
Much of the debate surrounding marijuana research is focused on its classification by the DEA as a Schedule I drug, the most restrictive of five categories. Schedule I drugs are considered to have a high potential for abuse and no accepted medical use. Other drugs in that group include LSD, heroin and ecstasy.
The American Medical Association said in November that it does not support state medical marijuana efforts and still considers the drug dangerous. But it also called on the government to encourage more clinical research — by reconsidering its classification as a Schedule I drug. A lower-level classification would allow researchers to obtain marijuana more easily.
The fact that the Obama administration in recent months has moved to loosen restrictions on marijuana in other regards has raised hopes that it will take similar action that will help scientists. The Justice Department said last year that it would not challenge state laws legalizing marijuana, and in February, the Treasury announced new guidelines meant to make it easier for cannabis businesses to open bank accounts in states where the drug is legal.
Kevin Sabet, a former White House senior adviser for drug policy who has been dubbed the No. 1 legalization enemy by Rolling Stone magazine, said he supports efforts to break down barriers for researchers. But he proposed that this could be done more efficiently without rescheduling the drug — which remains highly controversial and would have implications for the criminal justice system.
Sabet signed a letter
‘The whole process is wrong’
In the brave new world of medical marijuana, family doctors, psychiatrists and other community practitioners are the gatekeepers and must determine whether a patient truly needs the drug. But in many cases, doctors are prescribing the drug for their patients against the recommendations of medical societies and with only limited research to back up what they are doing.
“The whole process is wrong,” said Andrew Weil, the American doctor and author who conducted the first double-blind clinical trials of marijuana in 1968.
“There is a great deal of evidence both clinical and anecdotal of its therapeutic effects, but the research has been set way back by government polices,” Weil added.
“We are at the point where we are really just learning about this, and for doctors that means a lot of experimentation,” said Bonni Goldstein, a pediatrician who is medical director of the Ghost Group, which manages WeedMaps.com, a searchable directory of doctors and dispensaries.
In many states, for instance, marijuana is approved for pain and prescribed for those with arthritis. But a study published in the journal of the American College of Rheumatology this month found that the effectiveness and safety of marijuana to treat conditions such as arthritis are not supported by medical evidence.
Another condition for which medical marijuana is widely prescribed is PTSD. Yet the American Psychiatric Association discourages doctors from using it to treat psychiatric disorders. In a statement in November, the APA said, “There is no current scientific evidence that marijuana is in any way beneficial for the treatment of any psychiatric disorder.”
Sisley said she has been working with marijuana for several years to treat soldiers returning from Afghanistan and Iraq who have flashbacks, insomnia and anxiety, but she has had questions about dosages that haven’t been answered. Is one gram a day optimal? Or two? Is it better to smoke the marijuana or use a vaporizer, which heats ground marijuana leaves to produce a gas?
Sisley — who is working on the PTSD study with Rick Doblin, executive director of the Multidisciplinary Association for Psychedelic Studies — says she thinks the next big political fight over marijuana may come from studies such as hers. If research shows that marijuana is an effective medical treatment, it could force the federal government’s hand on reclassifying it.
More from The Washington Post:
‘Mommy lobby’ emerges as a powerful advocate for medical marijuana
The Lazarus Weed: The strange rise again of legalized pot
Medical marijuana clinic takes on IRS
Pot: It’s just good business
In-depth: Marijuana’s acceptance comes after many failures


The Senate marijuana reform bill would bring federal policy in line with medical research

A bipartisan trio of Senators plan to unveil a medical marijuana reform bill today that would remove many of the federal barriers to states that want to implement medical marijuana regimes. The bill, sponsored by Senators Rand Paul, Cory Booker and Kirsten Gillibrand, is being hailed as "historic" by drug policy reform organizations.
Over at GovBeat, Niraj Chokshi has a detailed rundown of the bill's provisions. They include:
- Downgrading marijuana from Schedule 1 to Schedule 2 of the Controlled Substances Act;
- Ease some restrictions on transporting marijuana between states, which would expand access to medical marijuana to some patients in states that currently don't allow it;
- Make it easier for banks to do business with the marijuana industry;
- Direct the National Institute on Drug Abuse to broaden access to marijuana for research;
- And allow doctors with the Dept. of Veteran's Affairs to recommend marijuana in the states that allow it.
A key point is that this bill wouldn't legalize medical marijuana per se. Rather, it amends many of the outdated federal policies that have prevented states from embarking on their own medical marijuana programs. As such, it represents a fundamentally modest package of reforms that would bring federal policy more closely in line with the recommendations of major medical organizations.
The American Medical Association, for instance, has recommended that "marijuana’s status as a federal schedule I controlled substance be reviewed with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines." The American Cancer Society "believes that the classification of marijuana as a Schedule I controlled substance by the U.S. Drug Enforcement Administration imposes numerous conditions on researchers and deters scientific study of cannabinoids." It calls for federal officials to "examine options consistent with federal law for enabling more scientific study on marijuana." And the American Academy of Pediatrics has explicitly called for moving marijuana from Schedule 1 to Schedule 2.
The organizations' recommendations on medical marijuana are especially significant given that all three steadfastly oppose the full legalization of cannabis. From the medical community's standpoint, rescheduling the plant represents a reasonable middle-ground approach that would enable more research into marijuana's effects without opening the floodgates to legalization and potential widespread use. Several surveys of doctors have found broad support among them for medical marijuana.
The Senate bill would also help federal policy catch up with public sentiment. Large majorities of Americans have supported the use of medical marijuana for decades now. The most recent numbers show public support for medical marijuana approaching an astonishing 90 percent -- when's the last time 90 percent of the public agreed on anything? There are robust majorities in favor of medical marijuana even in the deepest of red states like Utah, where two thirds of voters supported a recent medical marijuana measure that ultimately failed to pass the state Senate by a single vote.
Most importantly, the Senate bill would bring federal and state policies into closer alignment on the question of medical marijuana. Currently 23 states plus the District of Columbia have medical marijuana programs in place. 146 million Americans -- 46 percent of the population -- now live in a state with some form of legalized marijuana. For these people, the gap between lived experience and federal law grows wider by the day.
The danger for federal authorities is that outdated laws that stand in opposition to science, medical research and public opinion will make scofflaws of us all. We are now closing in on two decades of real-world experience with medical marijuana at the state level, starting when California voters approved medical marijuana in 1996. And yet, despite opponents' dire warnings, California hasn't fallen into the ocean, the world hasn't ended, and the patchouli-scented apocalypse has failed to materialize. It's good news that Congress is finally starting to take notice.


What getting medical marijuana is like today vs. what getting medical liquor was like during Prohibition

Left: Orange County sheriff’s deputies dump illegal alcohol (via Orange County Archives). Right: Members of the Colorado National Guard with illegal marijuana (Lewis Geyer/Times-Call via AP)
During Prohibition, people were able to legally consume alcohol if they received a prescription from a doctor, similar to how residents of some states are able to legally consume marijuana. Here’s how that worked.
In what states was medical liquor legal?
In all 48 states (Alaska and Hawaii were not granted statehood until 1959, 26 years after Prohibition was repealed). Medical liquor was regulated by the U.S. Treasury department and not the states, like medical marijuana is. Pharmacies’ ease of obtaining permits to fill prescriptions varied by geography, author Daniel Okrent wrote in “Last Call: The Rise and Fall of Prohibition,” according to Smithsonian. Pharmacies in big cities, on the coasts and along the Canadian border had an easier time.
In what states is medical marijuana legal?
Today, 23 states and the District of Columbia have passed laws allowing at least some form of medical marijuana, including Colorado and Washington, which have also legalized recreational use. The amount of marijuana someone can posses varies by state. In Alaska, Montana and Nevada, individuals are limited to one ounce, while in Oregon, one can possess up to 24 ounces.
What qualified someone for medical liquor?
Prescriptions for medical liquor were available to patients with anemia, tuberculosis, pneumonia, high blood pressure and other disorders, according to the History Channel. The American Medical Association actually adopted a resolution in June 1917, less than three years before Prohibition began, stating alcohol’s use as a “therapeutic agent” had no scientific value and “should be further discouraged.” However , alcohol had long been used for medical purposes, including during the Civil War to treat soldiers’ pain when they ran out of other painkillers.
What qualifies someone for medical marijuana?
In California, which in 1996 became the first state to legalize medical marijuana, its Department of Public Health allows marijuana to be used by those with a “serious medical condition,” including AIDS, anorexia, arthritis, cachexia, cancer, chronic pain, glaucoma, migraines, persistent muscle spasms, seizures, severe nausea or any other chronic medical symptom that limits their life activities or would cause serious harm to their physical or mental safety if untreated.
How did someone apply for medical liquor?
Prohibition prescription front (Licensed under Public domain via Wikimedia Commons)
Patients had to receive a prescription from a doctor that noted the kind of alcohol they were to receive, and a dosage, according to Okrent. It usually cost $3 for a prescription and $3 or $4 to have it filled at a pharmacy, Okrent wrote, or about $40 in today’s dollars. Quality varied, ranging from cheap alcohol to well-known brands like Jack Daniel’s, which included a phrasing “Unexcelled for Medicinal Purposes” on its label.
How does someone apply for medicinal marijuana?
California’s medical marijuana application form (via California Department of Public Health)
Applying varies by state. In California, a resident must receive a doctor’s recommendation and provide that along with proof of identity and proof of residency in their county. The state charges a fee of $33 to $66.  The highest fee in the country is the $200 charged by Minnesota, New Jersey and Oregon, while in Maine and New Mexico, there is no fee.
How much medical liquor could someone possess?
The maximum legal prescription was for one pint of alcohol every 10 days, according to Okrent.
How much medical marijuana can someone possess?
It varies greatly by state. In Alaska, Montana and Nevada, it’s legal to possess one ounce of usable marijuana, in addition to plants, while in Oregon and Washington, it’s legal to posess 24 ounces of usable marijuana in addition to plants.


NFL players fight pain with medical marijuana: ‘Managing it with pills was slowly killing me’

Cannabis that is rich in cannabidiol (CBD) is being grown west of Colorado Springs, which proponents say could help NFL players manage pain without the risks presented by opioids. (Brennan Linsley/Associated Press)
BOULDER, Colo. —
“Every day, I wake up in pain, from my ankles to my neck,” said Ebenezer Ekuban, 40, who played defensive end for nine NFL seasons. “It’s part of the territory. I know what I signed up for.”
Retirement is a daily exercise in managing pain, which is what brought the men to the unmarked CW Hemp offices on a recent Friday for a tour and a firsthand lesson on the potential benefits of the marijuana plant. As the country’s discussion on the drug broadens, state laws change and public perception shifts, there’s a movement in football circles to change the way marijuana is viewed and regulated within the NFL, which still includes cannabis on its list of banned substances.
For decades, football players have treated pain with postgame beers, over-the-counter anti-inflammatories and powerful prescription painkillers. The sport’s overreliance on drugs for pain management is the subject of a federal lawsuit and has sparked an investigation by the Drug Enforcement Administration. Retired NFL players use opioids at four times the rate of the general population, according to one study, and marijuana advocates say there’s a safer, healthier alternative available.
No professional sport has so many outspoken proponents of marijuana’s medicinal qualities, but then again no sport is as closely associated with pain and injury .
“This pain is never going away. My body is damaged,” said Eugene Monroe, 30, who was released by the Baltimore Ravens last year three weeks after becoming the first active player to publicly call on the league to permit medical marijuana. “I have to manage it somehow. Managing it with pills was slowly killing me. Now I’m able to function and be extremely efficient by figuring out how to use different formulations of cannabis.”
Since his release from the Baltimore Ravens, Eugene Monroe has emerged as the leading advocate among former players for change in the NFL’s restrictions on use of medical marijuana. (Bill O'Leary/The Washington Post)
There’s still no shortage of opposition to marijuana, and many on both sides of the debate agree that further research is needed. While many states have rolled back laws in recent years, early signs from the Trump administration suggest that the Justice Department isn’t ready to soften its stance. Attorney General Jeff Sessions said last month that marijuana is “only slightly less awful” than heroin.
NFL Commissioner Roger Goodell said last week that he opposes players using the drug recreationally but is willing to listen to the league’s medical advisers on the potential value of medicinal marijuana. “To date, they haven’t said this is a change we think you should make that’s in the best interests of the health and safety of our players,” he said. “If they do, we’re certainly going to consider that.”
Most of the former Broncos on the tour in Boulder had been skeptics not long ago. But the more they learned, the more they’d come to think that some form of marijuana could be the alternative they’d been looking for, the answer for their sore backs, balky knees, pounding headaches and sleepless nights.
“Hey, everybody. Thank you so much for being here,” said Del Jolly, CW Hemp’s business development manager. “We’re excited to tell you about who we are, how much care is put into this product, and how it’s incredibly legit, incredibly safe and incredibly high-quality, something we need to get the NFL to start understanding.”
The former players put on protective glasses and prepared to tour the facility. “You all got a grow house in here?” asked one player. Another inquired about a free sample before the tour began, and another asked, “Will we be able to drive home when we’re finished?”
The room laughed. “It depends on what you had before this,” Jolly explained.
‘Let me give this a shot’
CW Hemp specializes in cannabis that is rich in cannabidiol (CBD) that the ex-players were told acts acts much differently than marijuana as most people know it. The company’s roots are in helping cancer patients undergoing radiation and chemotherapy, and it began making headlines when children with epilepsy saw a dramatic drop in the number of seizures they experienced after taking CBD.
The plant used to be called “hippie’s disappointment,” Vijay Bachus, the company’s site director, told the former players, “because it wouldn’t get you high.”
“It had high levels of CBD but low levels of THC. Nobody would be smoking it for recreational purposes,” he said, likening the THC levels to the amount of alcohol found in an O’Doul’s.
THC — tetrahydrocannabinol — is the cannabinoid that produces the high that most associate with marijuana. CBD has some similar properties but not the psychoactivity and mood-altering effects.
While researchers have found that THC might have some benefits — particularly with pain, anxiety or nausea — the science behind CBD is not as robust. But recent studies have found evidence that it can be effective treating everything from epilepsy and cancer to heart disease, diabetes, anxiety and schizophrenia. It can also act as an anti-inflammatory and a neuroprotectant, raising hopes it may be valuable in treating and preventing head injuries.
Vanessa Cantu pours out hemp oil at the CW Hemp facilities in Boulder, Colo., in 2016. (Paul Aiken/Associated Press)
The group entered a room where two dozen 40-pound barrels were filled with ground-up cannabis plant.
“I can smell it now,” said Steve Foley, 63, who played defensive back for the Broncos from 1976 to 1986.
The scent is faint; more like a college dorm room after a vigorous cleaning. The quality control room is the first step of the process.
“Where does the oil come from?” asked one former player.
“Have some patience,” Le-Lo Lang said with a laugh.
A laboratory processing cannabis is about the last place Lang would ever have imagined himself. As a professional athlete — a defensive back for the Broncos from 1990 to 1993 — he never took drugs. He didn’t taste alcohol until a sip of champagne on his wedding day, and still today he rarely drinks. “It was never something that interested me, not even a little bit,” he said.
Lang, 50, has been away from the sport for nearly 25 years. Today he has headaches, difficulty sleeping, back pain, knee pain, shoulder pain “and everything else,” he said.
But for him, there was a stigma attached to marijuana and the people who use it. He lives in Colorado, which was a pioneer in relaxing state marijuana laws, but his feelings still took years to overcome.
The country has moved in a similar direction. In a recent poll, 72 percent of Americans said regular alcohol use posed more of a health risk than regular marijuana use. The same survey found that nearly one in five marijuana users rely on the drug to help manage pain.
That prospect is what helped Lang and his fellow ex-athletes open their minds. “I just felt like with all the pain and issues that I’m having, let me give this a shot,” he said.
The exact effects of CBD are mostly anecdotal. It’s not classified as medicinal marijuana and is currently regulated as a hemp product. Manufacturers, like CW Hemp, are careful not to make too many medical claims. But increasingly, researchers are finding a correlation between marijuana use and a decreased dependence on opioids. The National Institute on Drug Abuse cites a pair of government-funded studies in saying “that medical marijuana products may have a role in reducing the use of opioids needed to control pain.” The federal institute cautioned that more research is needed.
After a few weeks of using CBD, Lang noticed he was sleeping much better. He still had headaches, but they weren’t as bad. Some of his other pains were still present, though.
Bachus led the group into a lab. The cannabis had soaked in alcohol, and an employee was squeezing liquid out of a mesh bag into a pan. “Just like squeezing the juice out of a tomato,” one of the players observed.
The lab has hosted football players in the past, including Kyle Turley, a former offensive lineman who says his football career led to a painkiller addiction, and Jake Plummer, a former quarterback who has become a vocal proponent of CBD.
Retired players Justin Sandy and Ebenezer Ekuban during their tour of the CW Hemp facilities. Said Ekuban: “I think in due time, the NFL is gonna realize that CBD is not a performance-enhancing drug.” (RM/Photo by Malek Asfeer/CW Hemp)
Ekuban played with Plummer for four seasons with the Broncos and had first heard about the potential benefits of cannabis from his former teammate. Ekuban retired in 2009 after nine seasons, and it wasn’t until five or six months had passed that he realized the aches weren’t going away.
“I thought I’d feel better getting away from all those hits,” he said, “but I was worse off.”
As a player, Ekuban had surgery on his lower back, knee, shoulder and Achilles’ tendon. Painkillers and anti-inflammatories were a regular part of his regimen, the drugs carrying him from one game into the next. “A couple blood tests showed elevated liver enzymes,” he said. “I knew they were from all those painkillers.”
The more he studied cannabis, the more he felt comfortable with it. He’s started using CBD in the mornings and at night. “It hasn’t taken everything away,” he said, “but I believe it’s helping significantly.”
Research has found that CBD increases a molecule called anandamide, which reduces pain and increases the production of neurons in the hippocampus region of the brain, which can impact mood and anxiety. Compared with a placebo, the National Academies of Science, Medicine and Engineering found “strong evidence” that marijuana is effective at dealing with chronic pain. Twenty-nine states plus the District of Columbia have legalized medical marijuana; 22 of the NFL’s 32 teams play their home games in those jurisdictions.
“I think in due time, the NFL is going to realize that CBD is not a performance-enhancing drug,” Ekuban said. “If anything, it helps with anxiety, helps with concentration, it helps with pain.”
Former Broncos quarterback Jake Plummer takes a dose of cannabinoid oil before playing handball in 2016. (AAron Ontiveroz/Denver Post)
‘Make a smart decision’
The NFL does not release the results of drug tests, so there’s no way to know the number of active players who use marijuana or the reasons they might use it. Players who have never violated the league’s drug policy are tested for recreational drugs only once a year — at some point between April and August.
“There is no doubt that players are using cannabis extensively, almost as a substitution therapy for other treatments that the NFL is offering that they perceive as more toxic or highly addictive,” said Sue Sisley, an Arizona-based physician who serves on the board of advisers for the Korey Stringer Institute, which has partnered with the NFL on health and safety issues. “For instance, these players obviously receive mega-dosages of opioids easily from their trainers and team docs. But when they want to seek out what they believe is a safer, less toxic alternative like cannabis, they’re fined and sanctioned.”
The NFL has indicated an interest in studying the issue but seems resistant to major changes. Goodell told ESPN Radio last week that marijuana is addictive and unhealthy and that he is not currently in favor of allowing players to use it recreationally.
“Listen, you’re ingesting smoke, so that’s not usually a very positive thing that people would say,” the league commissioner said. “It does have [an] addictive nature. There are a lot of compounds in marijuana that may not be healthy for the players long term. All of those things have to be considered. And it’s not as simple as someone just wants to feel better after a game.”
Former NFL players Ricky Williams, Lance Johnstone, Nate Jackson and Eben Britton at a conference on medical marijuana at the Harvard Medical School last month. (Steven Senne/Associated Press)
The NFL Players Association has formed a pain management committee to study the issue, and many expect marijuana to become a bigger discussion point in the near future. The union could urge the league to differentiate between recreational and medicinal use or push to lessen the penalties for a failed test. “We still think there can be a more therapeutic approach in the way we deal with marijuana in particular, and we’d like the league’s help with that, and we know owners feel that way, too,” said George Atallah, a union spokesman.
The current collective bargaining agreement is set to expire in 2020, and both sides have indicated they might be willing to address the issue — either the testing, the legality or the penalties levied.
“I would hope that the NFL stands by what it says it stands for — player health and safety, first and foremost,” said Monroe, who since his retirement has emerged as football’s most prominent marijuana proponent. “If that statement is true, there’s enough info out there right now for the NFL to make a smart decision.”
‘A young industry’
Stopping at CW Hemp’s research and development lab, Bachus explained to the former players that the company must be poised for regulatory changes. Marijuana is still classified as a Schedule 1 drug, which means the federal government sees a potential for abuse and no medical value. It also means researchers have a difficult time cutting through red tape to study the drug.
The Food and Drug Administration is considering how it classifies CBD, and if the extract gets approval as a medication, not only could doctors start prescribing it, the DEA could classify CBD differently than marijuana .
One of the players in the group, Justin Sandy, was more familiar with cannabis than his cohorts. Sandy, 35, was in the NFL for parts of four seasons — a career that lasted just long enough to break bones in both feet, require four knee surgeries and trigger daily pain in his back, knees and feet. He got into organic agriculture early in his retirement and recently began growing five acres of cannabis in nearby Boulder County.
“This is such a young industry,” he said. “I think the majority of the country still lumps hemp and marijuana together. It’s like a tomato plant with different varieties, that’s how I like to think about this.”
The research is continuing. CW Hemp’s charitable partner, Realm of Caring, is working with researchers out of Johns Hopkins and the University of Pennsylvania on studies specific to football players. Several of the former Broncos players would sign up.
The tour was wrapping up, and the former players began removing their protective glasses.
“Any final questions?” Bachus asked.
“You all going to let us try some?” one of the former players deadpanned.


Study: Medical marijuana changes how employees use sick time

Cannabis plants grow at Vireo Health's medical marijuana cultivation facility in Johnstown, N.Y., on Aug. 19. (Drew Angerer/Getty Images)
"Fact #1: Legalizing marijuana is bad for the workplace."
That's the stark warning from the Institute for a Drug-Free Workplace, a nonprofit that works to combat drug use among American employees.
"The impact of employee marijuana use is seen in the workplace in lower productivity, increased workplace accidents and injuries, increased absenteeism, and lower morale," the institute writes. "This can and does seriously impact the bottom line."
Does it really, though?
New research published in the journal Health Economics suggests that the argument is overstated. Darin F. Ullman, an economist who recently received his PhD from the University of Wisconsin at Milwaukee, wanted to know what effect, if any, the enactment of medical marijuana laws has had on employee absentee rates.
A fair amount of research has been done on the aggregate impact of illicit marijuana use on workplace productivity. Generally speaking, the most recent research — gathered and summarized in this 2014 paper — indicates that most marijuana use has little effect on workplace productivity, although chronic or heavy pot use can be a problem.
On net, the evidence is mixed. "It is simply uncertain as to whether there are negative labor market consequences of drug use in general, and cannabis use in particular," the 2014 paper concludes.
But there hasn't been a lot of research into the impact of licit marijuana use — particularly medical marijuana use — on the workplace. So Ullman decided to look into what happened to employee sick-day use in states that legalized medical marijuana, according to the Bureau of Labor Statistics' Current Population Survey (CPS).
On the one hand, you might expect broader access to marijuana to result in more workers calling in sick, because they're too stoned to work or because they just don't feel like showing up on a given day. On the other hand, if medical pot is successfully treating conditions that would otherwise render somebody unable to work, you might expect sick days to decrease.
So Ullman examined before-and-after sick-day data from 24 states that had medical marijuana laws at the time of his study. On average, he found that "respondents were 8% less likely to report being absent from work due to health issues after medical marijuana laws" were passed. The CPS numbers also suggest that states with fewer restrictions on the use of medical marijuana, such as on the number of conditions it could be recommended for, had more of a decrease in sick-day use than states with stricter regulations.

Now, if you read much about this type of research, you're probably expecting a Big Important Caveat to appear here, and you're right: Ullman's study can say that sick-day use decreased after the passage of medical marijuana laws. But it can't say medical marijuana caused that decrease. There are any number of factors that could have accounted for a drop in absenteeism in the states Ullman studied — better access to health care, better workplace wellness programs, improved employee health overall, etc. The decline in absenteeism could be driven more by any of those factors than by whatever happened to the state's marijuana laws.
However, Ullman notes that the effect of the laws was stronger for middle-aged workers and for males, the groups most likely to hold medical marijuana cards. That, combined with the stronger effect of the laws in the more lax states, does suggest that the laws themselves could be a driver of the reduced absenteeism seen in the data.
Ullman notes that there are any number of plausible reasons this could be the case. If self-treating with medical marijuana lets "individuals experience relief from disabling symptoms, absence from work could decline." Beyond that, other studies have shown that alcohol consumption declines after the passage of medical marijuana laws. Heavy drinking is a big driver of absenteeism, so if medical marijuana cuts back on boozing, it would have the net effect of reducing absenteeism, as well.
"The results of this paper therefore suggest that [medical marijuana laws] would decrease costs for employers as it has reduced self-reported absence from work due to illness/medical issues," Ullman concludes.
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Pregnant women are increasingly using marijuana for morning sickness, study finds. That’s not good.

A cannabis plant. (Matt McClain/The Washington Post)
More U.S. women are using marijuana during pregnancy than in previous years to treat nausea and morning sickness, a new study suggests.
The findings present potentially serious medical concerns because of earlier studies indicating that infants who were exposed to marijuana were more likely to be anemic, have lower birth weight and be placed in neonatal intensive care than infants of mothers who did not use marijuana.
According to the study published Monday in the Journal of the American Medical Association, nearly 4 percent of pregnant women between the ages of 18 and 44 reported in 2014 they had used marijuana in the past month, compared with 2.4 percent in 2002.
“Some sources on the Internet are touting marijuana as a solution for the nausea that commonly accompanies pregnancy,” said Nora D. Volkow, director of the National Institute on Drug Abuse, writing in an editorial published online with the study. However, she said, “doctors must be aware of the risks involved and err on the side of caution by not recommending the drug for pregnant patients.”
Some data suggest pregnant women are turning to marijuana specifically during the first trimester of pregnancy, the period that presents the greatest risks of drug exposure to the fetus, Volkow wrote.
Although the influence of marijuana on human brain development is not entirely clear, studies have shown links between prenatal marijuana exposure and impaired functions such as impulse control, visual memory and attention during school years. An ongoing study also found an association between prenatal marijuana exposure and restricted fetal growth during pregnancy, as well as increased frontal cortical thickness among school-age children.
The American College of Obstetricians and Gynecologists recommends that pregnant or breast-feeding women — and women considering pregnancy — should be screened for and discouraged from using marijuana and other substances.
The study published Monday analyzed data from women ages 18 through 44 from the annual National Survey on Drug Use and Health from 2002 through 2014. Researchers assessed data from 200,510 women of reproductive age, including 10,587 pregnant women.
Among pregnant women, the prevalence of the use of marijuana in the past month increased 62 percent from 2002 through 2014. The use was most prevalent among women ages 18 to 25, indicating that younger women are at greater risk. Recent use among women who were not pregnant also increased, from about 6 percent in 2002 to 9 percent in 2014, researchers reported.
Marijuana is the most widely used illegal drug during pregnancy, Volkow wrote, and a study from Hawaii suggested that pregnant women with severe nausea are more likely to use marijuana than other pregnant women.
Despite medical recommendations, some online forums and articles laud the pain-relieving benefits of marijuana use during pregnancy, particularly to treat hyperemesis gravidarum, a severe type of morning sickness consisting of persistent nausea and vomiting that can lead to dehydration, weight loss and electrolyte imbalances.
To date, 29 states and Washington, D.C., have passed laws legalizing medical marijuana. Nausea is a medically approved reason to take marijuana in all of the states where medical use is legal. Although no states specifically list pregnancy-related conditions as an indication for the drug, none of them prohibit or include warnings about the possible harms of marijuana, Volkow wrote.
The numbers of pregnant women using marijuana — less than 4 percent, according to the study — are not high. Nevertheless, the authors of the study wrote, “the increases over time and potential adverse consequences of prenatal marijuana exposure suggest further monitoring and research are warranted.”
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A powerful new form of medical marijuana, without the high

Medical marijuana plant propagated at  a growing operation in Washington, DC.  (Linda Davidson/The Washington Post)
Jackson Leyden had always been a healthy kid; he practiced taekwondo, and he played lacrosse and baseball. But in 2011, a few months after his eighth birthday, he began having seizures several times a day. Many were brief, a half-minute of staring into space, but he also had severe episodes in which he would collapse, sometimes injuring himself. Over the next two years, he was hospitalized about 50 times, and he missed much of fourth and fifth grade.
His parents took him to more than 20 doctors around the country, and he tried more than a dozen medications. Nothing worked. Two years ago, the Leydens were at the end of their rope. They decided to see whether marijuana might help. (Medical use of the drug is legal in the District, where they live, and the Leydens found a doctor willing to work with them.) In 2014, Jackson got his first dose of cannabis.
“Within a few days, he was having hardly any seizures,” says his mother, Lisa. “I was shocked.” Over the next few months, he stopped taking other medications.
Not only did the medicine help, it did so without making him high. The strain of marijuana that Jackson takes is unusual: It contains high levels of cannabidiol, or CBD, one of the two main molecules in marijuana; the other is tetrahydrocannabinol, or THC. While THC is famously mind-altering, CBD is not.
Over decades, researchers have found that THC may help treat pain, nausea, loss of appetite and other problems, while CBD was thought to be biologically inactive in humans. But in the past 10 years, scientists have concluded that CBD may be quite useful. Dozens of studies have found evidence that the compound can treat epilepsy as well as a range of other illnesses, including anxiety, schizophrenia, heart disease and cancer.
Now 13, Jackson — whose diagnosis is undetermined — continues to use marijuana every day. (Like many patients, he ingests it in droplet form, which allows for more precise dosing and avoids lung problems.) He still has seizures, but they are less severe and they occur once every week or two, down from around 200 a month before he started using cannabis. He is back in school full time and is well enough to go on hikes and bike rides with his family.
Thousands of people around the country are using high-CBD marijuana.
“This is a really powerful compound,” says Mikhail Kogan, the medical director of the George Washington University Center for Integrative Medicine. “I’ve seen it work for a lot of my patients.” He prescribes high-CBD strains of cannabis regularly for such illnesses as epilepsy, post-traumatic stress disorder, anxiety, autoimmune disorders, autism and insomnia.
‘A game-changer’
In the cannabis plant, CBD and THC generally have an inverse relationship: The more THC there is, the less CBD, and vice versa. In recent years, growers have bred some plants to contain high levels of CBD. Some say the two compounds work synergistically and that for many ailments, combining CBD and THC is best.
What makes CBD especially appealing is that it doesn’t get the user high. Most recreational marijuana users want this effect, of course, but many patients would rather avoid it. This has allowed CBD to sidestep many of the political, legal and medical concerns that have hindered the spread of medical marijuana.
“CBD has been a game-changer for medical marijuana,” says Martin Lee, the director of Project CBD, a Northern California nonprofit that promotes use of the compound. “Its safety and lack of psychoactivity undermines any argument that it should be illegal. It’s really shifted the national discussion on this issue.”
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As more scientists recognize the compound’s potential, there has been an “explosion of research,” according to Pal Pacher, a pharmacologist and cardiologist at the National Institutes of Health in Bethesda. He has been studying the chemical for more than a decade; his work has shown that CBD may have benefits in both heart disease and diabetes.
One key area of CBD research is epilepsy. Several scientists are focusing on its potential to reduce seizures, especially among those for whom other treatments have failed. “We’ve found significant positive effects with CBD,” says New York University neurologist Orrin Devinsky, who studies the compound for severe childhood epilepsy.
In a study whose findings have not yet been published, he and a colleague, Daniel Friedman, found that patients receiving CBD in addition to their usual medicines had 39 percent fewer convulsive seizures than patients who remained on their normal drug regimen. Given that the study included only the most treatment-resistant patients, this is an “excellent response,” Devinsky says.
Much more research is needed, he says, to establish whether CBD works, and if so for what conditions, but he understands that severely ill patients, or their parents, may not want to wait for this data: “If other drugs don’t work, it’s certainly reasonable to try this.”
The compound has also shown promise in treating anxiety, depression and schizophrenia. Much of this work has been in rats and mice, but several studies have found benefits for humans. For instance, German researchers showed in 2012 that giving CBD to schizophrenic patients reduced psychotic symptoms such as hallucinations and disordered thinking.
CBD seems to have anti-cancer properties, too. At the California Pacific Medical Center Research Institute in San Francisco, researchers Sean McAllister and Pierre Desprez have found that CBD can block cancer cells from metastasizing.
It’s not clear how CBD works. This is partly because it stimulates multiple biochemical pathways, which may account for its wide range of effects. The compound is a powerful anti-inflammatory and antioxidant, and it increases levels of the neurotransmitter serotonin as well as another molecule, anandamide, which reduces pain and anxiety.
Francisco Guimaraes, a pharmacologist at the University of Sao Paolo in Brazil, has found that it increases growth of new neurons in the brain, especially in the hippocampus, a region that plays a key role in depression and anxiety.
“[CBD] is a Disneyland for a pharmacologist,” he says. “There are so many possible mechanisms, so many possible ways it can be useful.”
But studying CBD is not easy: Scientists complain that laws and regulations put excessive constraints on their work. Although it doesn’t make users high, CBD (both the molecule and CBD-rich cannabis) is classified by the federal government as a Schedule 1 drug, which means they have high potential for abuse and no accepted medical use.
The list includes marijuana (undifferentiated by strain) and heroin. (While the federal government oversees marijuana research, marijuana use is regulated, in part, by state laws.) As a result, scientists who study the compound must follow a host of restrictive rules. Last year, responding to a request from several governors to change marijuana’s designation, the Drug Enforcement Administration announced that all cannabis would remain a Schedule 1 drug.
Still on Schedule 1
“It’s ludicrous and arbitrary,” according to Devinsky, who says getting government approval for his epilepsy trial required dozens of hours of extra work. Like most scientists who study the compound, he uses almost pure CBD. Although not at all psychoactive, it must be kept in a heavy safe with an alarm system.
Even as the research proceeds, thousands of people are using CBD as medicine. A British pharmaceutical company, GW Pharma, has developed two CBD drugs: Sativex, which contains a 1-to-1 ratio of CBD and THC, and Epidiolex, which is pure CBD. The former is prescribed for the painful muscle spasms that occur in multiple sclerosis, while the latter is aimed at childhood seizures. Sativex is not available in the United States, but it is approved in 29 other countries, including Canada, England and Israel.
Epidiolex has not been cleared for sale anywhere in the world; GW Pharma says it expects to begin the approval process with the Food and Drug Administration next year.
And thousands of Americans are using strains of cannabis with a strong CBD content. Advocates and medical marijuana dispensaries agree that as awareness about CBD grows, so does demand.
Stephanie Kahn, who with her husband, Jeffrey, runs the Takoma Wellness Center, a medical marijuana dispensary in Northwest Washington, says that about half of her 1,200 patients use CBD-rich products. Her dispensary offers several strains of high-CBD cannabis as well as CBD oil, with different ratios of CBD and THC, each of which she recommends for particular conditions. “We get questions about it every day,” she says. “A lot of our patients get relief with this, and a lot of times this works better than pharmaceutical drugs.”
No insurance
The cost of treatment varies: Depending on the dispensary and the dosage, it can range from around $100 a month to more than $1,000. Despite the cost, which is not covered by insurance, CBD medicines are drawing great interest for children with severe, intractable epilepsy. California and Colorado, which were among the first states to legalize medical marijuana, have become hot spots for such patients. Before other states legalized medicinal CBD use, some families moved to these states so they could have access to the compound.
One of the most experienced practitioners in this field is Los Angeles physician Bonni Goldstein, who has used the compound to treat dozens of children with intractable epilepsy. She says about half of these patients have seen a significant drop in the number of seizures. “Used in the right way, with the right patient, CBD is extremely powerful,” she says.
Yet even those who believe in this power recognize that CBD medicine remains largely unexplored: Treatments are not systematized, many products are not standardized or tested, and patients (or their parents) are generally left to figure out dosing on their own. While some suppliers and dispensaries test the CBD and THC levels of their products, many do not. “We really need more research, and more evidence,” Kogan says. “This has to be done scientifically.”
For Lisa Leyden, Jackson’s mother, these issues don’t negate the compound’s enormous potential. “I realize this isn’t perfect,” she says. “We absolutely need to know more. But in the meantime, many people need help. They’re in bad shape, and this seems to work.”


Risky alone, deadly together: Overdoses on combined prescriptions plague white women

UNNATURAL CAUSES SICK AND DYING IN SMALL-TOWN AMERICA |
In Bakersfield, Calif., middle-aged white women are struggling with addictions. Some are dying. Meet three women tied together by pain.
BAKERSFIELD, Calif. —
In all, Franklin, 60, takes more than a dozen different prescription drugs, washing them down with tap water and puffing on a Marlboro while she waits for them to kick in.
“They take the edge off, but that’s about it,” Franklin says. So she keeps a bottle of vodka handy for added relief, increasing her risk of joining the legions of American women dying from prescription-drug overdoses.
While death rates are falling for blacks and Hispanics in middle age, whites are dying prematurely in growing numbers, particularly white women. One reason: a big increase in overdoses, primarily from opioids, but also from anti-anxiety drugs, which are often prescribed in tandem.
Between 1999 and 2014, the number of middle-aged white women dying annually from opiate overdoses shot up 400 percent, according to a Washington Post analysis of data from the Centers for Disease Control and Prevention. Anti-anxiety drugs known as benzodiazepines contributed to a growing share of the 54,000 deaths over that period, reaching a third in the past several years, The Post found — though spotty reporting in death records means it is likely that the combination is even more widespread.
Both drugs depress the central nervous system, temporarily easing pain and anxiety while suppressing respiration, heart rate and the gag reflex. Alcohol has the same effect, and combining any of these can be fatal.
“They act like a dimmer switch on the central nervous system,” said Rear Adm. Susan Blumenthal, former U.S. assistant surgeon general and an expert on women’s health issues. “When taken in combination, a person’s breathing and heart will slow down, and can ultimately stop. People can go to sleep and never wake up.”
White women are more likely than women of other races to be prescribed opiates, and far more likely to be prescribed both opiates and anti-anxiety drugs, according to an analysis of middle-aged participants in the latest National Health and Nutrition Examination Survey. White women prescribed opiates are five times as likely as white men to be given that drug combination — helping to explain why white women may be at special risk.
Federal health officials have recognized the danger. This spring, in a guideline that urged doctors to reduce the use of opioids for chronic pain, the CDC warned against prescribing them together with benzodiazepines, except for patients battling fatal diseases such as cancer. At the very least, the CDC urged doctors to warn patients of the risks, especially when the drugs are mixed with alcohol.
Karen Franklin shows some of the pills she takes during an eight-hour period. She suffers from a back injury and lives with chronic pain. She said that despite taking morphine and other prescription medications, her pain level is usually a 10. (Bonnie Jo Mount/The Washington Post)
On Thursday, the U.S. Food and Drug Administration began requiring warning labels on opioids and benzodiazepines — nearly 400 products in total — with information about the potentially fatal consequences of taking these medications at the same time.
“It is nothing short of a public health crisis when you see a substantial increase of avoidable overdose and death related to two widely used drug classes being taken together,” FDA Commissioner Robert Califf said in a statement. “We implore health care professionals to heed these new warnings and more carefully and thoroughly evaluate, on a patient-by-patient basis, whether the benefits of using opioids and benzodiazepines — or CNS depressants more generally — together outweigh these serious risks.”
Federal officials have no power to mandate a change in doctors’ prescribing habits. Even if they did, a mandate would do little for patients such as Franklin who get their prescriptions from multiple physicians.
“An opioid might be prescribed by a pain specialist while a general practitioner or a psychologist may prescribe the benzodiazepine. They may not know about one another,” said Deborah Dowell, lead author of the CDC’s new opioid guidelines.
Franklin’s struggle began 17 years ago with a single prescription for Vicodin. At the time, she had her own home and managed a grocery store. But the side effects of long-term opioid use soon set in. Mounting anxiety. Sleeplessness. Depression. With each new problem, doctors sent her home with more pills.
Now she lives with her 88-year-old father and spends her days shuffling between the TV, a refrigerator stocked with chocolate Ensure and the bathroom, which relatives call her sanctuary. Armed with a Bible and a carton of Marlboros, she prays for God’s protection, cracking the bathroom window to let the cigarette smoke drift into the back yard.
Lately, Franklin has been blacking out. Her sister found her facedown in a plate of food, and she started using a walker after losing consciousness on her way to the mailbox.
“What is happening right now is a slow suicide,” said her friend Ellen Eggert, a supervisor for the Kern County Mental Health Department. But Franklin is resisting Eggert’s appeals to seek help with her addictions.
“I know it’s not good for me,” Franklin said. “But I would rather say my prayers and take my medication.”

Suicides have doubled
Bakersfield lies in the heart of Kern County, a vast sprawl of lush cropland in California’s Central Valley. Here, accidental overdoses among white women have tripled since 1999, according to federal health data, and suicides have doubled.
The death toll has alarmed health-care workers like Eggert and given rise to a loose network of therapists, nurses, pastors and drug counselors struggling to understand a generation of women overwhelmed by modern life and undone by modern medicine.
Some, like Franklin, begin their descent after an injury. Others seek relief from conditions related to menopause. Middle-aged women also are more likely than men to suffer from a variety of painful conditions, including lupus, migraines and rheumatoid arthritis.
Whatever the complaint, doctors and drug companies have since the late 1990s responded with highly addictive painkillers, many of them central nervous system depressants previously reserved for the terminally ill. The more expansive use of opioids has fed an epidemic of dependency, leading to new prescriptions for anti-anxiety drugs and a rash of fatal overdoses.
(Bonnie Jo Mount/The Washington Post)
(Bonnie Jo Mount/The Washington Post)
These drugs appear to be a factor even among suicides, another major contributor to rising female mortality. According to Kern County coroner records obtained by The Post, 85 white women ages 35 to 60 killed themselves here over the past seven years. About half overdosed on prescription drugs, The Post found, and about half of those — 21 women — had some combination of opioids, benzodiazepines and alcohol in their bloodstreams.
Many of the women who chose other means of suicide, such as gunshot or hanging, also died in a haze of prescription drugs, The Post found. In nearly half of the 28 cases in which a toxicology test was performed, the women had consumed opioids, benzodiazepines or other central nervous system depressants.
When a woman dies in Kern County, it falls to Coroner Manager Dawn Ratliff to determine what happened. Her investigators explore medicine cabinets, flip through journals, scrutinize text messages and interview friends. Repeatedly, a pattern emerges, Ratliff said: A personal crisis leads to prescriptions to soothe the pain. And then they lose control.
Beverly Layman shares her fears with pastor Craig Amos, who was making a hospice visit to her home in Bakersfield. Layman died the following week from cirrhosis of the liver. She had been a longtime user of painkillers, anti-anxiety medications, alcohol and illicit drugs. (Bonnie Jo Mount/The Washington Post)
“They are worn down. And they can’t rise above it,” said Ratliff, who puts the blame in part on the rise of social media, which can create unrealistic expectations about how life should go.
“Before, if you lived in a rural area, all you knew was your community. You just knew what people in your community looked like, what their lives were like. You didn’t expect to look like a movie star — or live like one,” she said.
Ratliff, 60, works closely with Eggert, 58, who created an outreach team for surviving family members of suicides that has been lauded as a national model. Eggert said she, too, has noticed the weariness and the desire for a quick fix to life’s problems.
“Women have had to be strong for so long. Opioids are a good way out. Benzos are a good way out,” Eggert said. Women “start depending on them to get through. Then, after a while, it’s not getting them through anymore. It’s running their life.”
The autopsy reports are filled with stories of dependency:
Bonnie Jean Marshall, 54, overdosed in 2012 after drinking alcohol and taking three prescription drugs, including the opioid Vicodin and the benzodiazepine Xanax. She lived in Wofford Heights, a village in the southern Sierra Nevada, and suffered from hypertension, pain and anxiety. She left a suicide note: “Sick for months—can’t get well so sorry nana.”
Holi Michele Mitchell, 43, shot herself in 2014 after taking Vicodin and two benzodiazepines — Klonopin and Xanax. She lived in Bodfish, a small town in the Kern River Valley, and struggled with depression after her son died in a car accident. His picture and a broken charm bracelet were found by her body.
Cheryl Moore, 56, left a journal that described two suicide attempts in the weeks before she overdosed on painkillers and alcohol in February 2015. Moore, who lived in Bakersfield, had begun taking opiates 18 months earlier after breaking her ankle. Then her husband, Duane, died of liver cancer, leaving a stockpile of stronger painkillers.
Moore’s brother, Eugene Frey, said he understands why women might turn to suicide, even when, like his sister, they have the means to seek treatment.
“There is an expectation for them to keep it together. People think: ‘Hey, you are white. You are privileged. So why do you have so many problems? Maybe you are the problem,’ ” Frey said. “There isn’t a lot of space for them to be vulnerable.”
Ellen Eggert, center, leads a suicide prevention training session in Bakersfield. (Bonnie Jo Mount/The Washington Post)
Cultural shift
Eggert is part of a network of female health professionals working to understand the increase in white female mortality in Kern County. She said that she believes it is rooted in the cultural shift of the 1960s. As taboos were stripped away, women began drinking, smoking and medicating themselves more like men. As they aged, they began to suffer the effects: Since 1999, the death rate from alcohol abuse has more than doubled among white women ages 45 to 54, according to CDC data, though the rate for white men remains twice as high.
“It’s become normalized,” Eggert said. “Why does alcohol kill more people than all the other drugs combined? Because it’s acceptable, available, and there’s not a thing wrong with it. Why do women fail to see the danger of taking so many pills? Because it’s legitimate. It comes from a doctor.”
Joan Knowlden, a psychologist in Kern County, said she saw a sharp rise in middle-aged female patients in the early 2000s. Many had turned to alcohol, anti-anxiety drugs and painkillers to “mellow them out.”
Some had delayed childbearing, Knowlden said, and were trying to raise children just as they reached their peak professionally. Many were also entering menopause, which typically causes a drop in serotonin, a chemical that naturally soothes the brain.
“With perimenopause and menopause, you already have anxiety, sleep loss, loss of bladder control and loss of sex drive,” Knowlden said. “It can just become too much.”
Sometimes, Knowlden sends her clients to Sherri Bergamo, a nurse practitioner known as “the Hormone Queen of Bakersfield.” Bergamo noted that the rise of opioid painkillers coincided with a shift in treatment for menopausal women: Doctors stopped prescribing hormone-replacement therapy after studies found it increased the risk of stroke, blood clots and breast cancer.
Forced to “white knuckle” their way through menopause, Bergamo said, many women sought other forms of relief for mood swings and depression. She offers them custom-mixed hormones, which she argues are safer.
“There are some risks, but they are calculated, and they are carefully monitored,” said Bergamo, 74, who has undergone hormone therapy for 26 years. “I believe it saves lives.”
Medicine is coming back around to Bergamo’s point of view. This year, a panel of experts assembled by the North American Menopause Society concluded that hormone replacement is largely safe, especially for women under 60. In October, the society plans to recommend a return to hormone therapy for most healthy women, according to executive director JoAnn Pinkerton, division director of the Midlife Health Center at the University of Virginia Health System.
One thing menopausal women should probably avoid is long-term opioid use, which can further lower hormone levels, said Stanford University professor Beth Darnall, who specializes in pain psychology research.
“When women go through menopause, there are big changes with pain, anxiety and depression. There is a hard body of research on this,” Darnall said. “Opioids, taken long term, reduce the level of hormones in the body. This can lead to a greater sensitivity to pain. And it can feed into this dose-escalation cycle.”
Karen Franklin, right, sleeps during the afternoon in Bakersfield. She lives with her father, Richard Barker, 88. (Bonnie Jo Mount/The Washington Post)
The turning point
The turning point in Franklin’s life came in the late 1990s, when she said her tailbone was fractured during an episode of domestic violence. The pain led her to Vicodin, starting with the lowest dose: tablets containing five milligrams of the opioid hydrocodone.
“It might as well have been baby aspirin,” she says now. “All it did was make me a little sleepy.”
At the time, Franklin was managing a grocery store, a physically demanding job that had her lifting Halloween pumpkins, boxes of Easter candy and endless cases of soda. Within a few months, she persuaded her doctor to double the dose. Then she begged for stronger opiates, cycling through prescriptions for codeine, oxycodone and OxyContin.
Periodically, her doctors cut her off. “They would say, ‘You kind of like this too much,’ ’’ Franklin recalled. So she would call 911 and take a trip to the emergency room, where doctors typically offered a shot of Demerol, another powerful opioid.
In the early 2000s, Franklin’s mother died, her second marriage began to unravel, and she decided to quit working. Doctors added antidepressants, sleeping pills and anti-anxiety medications to her list of prescriptions.
Her world began to narrow. She saw fewer people. Franklin said she became “a hermit.”
Her friend Eggert suggested a psychologist, group therapy, long walks, church, yoga. Franklin rejected each idea. She came to believe she needed surgery. So in 2004, a surgeon implanted metal rods at the base of her spine.
The surgery failed to provide relief, and Franklin filed for disability.
“I was told it would be 80 percent better,” she said, “but instead it was 80 percent worse.”
Franklin keeps an X-ray of her back clipped to her refrigerator. If anyone questions her pain, she points to the X-ray: “They see those plates and they know it’s bad.”
In recent months, her chronic drug use has generated a host of new health problems, including pancreatitis and irritable bowel syndrome. Those conditions led to more doctor visits, which produced more prescriptions, and more pills to shake out of more bottles in her pink-tiled bathroom.
Her bottle of vodka, once stowed under the bathroom sink, now stays out on the floor, within easy reach.
Dale Carter and Brian Benson deliver a recently deceased 44-year-old white female to the Kern County coroner in Bakersfield. Prescription narcotics were among the medications found in the woman’s apartment. (Bonnie Jo Mount/The Washington Post)
Keating reported from Washington.


N.Y. governor takes careful step on medical marijuana

NEW YORK — While nearly two dozen states have approved marijuana for medical purposes and Colorado and Washington have legalized its use for pleasure, Cuomo (D) is tapping a 1980 state law to allow as many as 20 hospitals to dispense the drug to people with certain severe illnesses as an experimental research project. “I’m absolutely thrilled that he’s actually verbalized the words ‘medical marijuana,’ but he’s just got to go further,” said Susan Rusinko, a 52-year-old central New York resident who said a hit of pot is a “wonder drug” that relaxes immobilizing leg spasms from her multiple sclerosis. It’s unclear whether she would even qualify for Cuomo’s initiative or whether there would be a participating hospital near her. While advocates are frustrated, Cuomo’s limited embrace of medical marijuana may be a politically astute and scientifically sensitive move on an issue on which popular enthusiasm has outpaced a weak body of medical research, experts say. Some doctors avidly back using cannabis to treat problems ranging from chemotherapy-related nausea to chronic pain, but other medical experts say there are good reasons for caution. While the marijuana plant holds tantalizing possibilities, they say, it’s still a question mark as medicines go. Cuomo’s initiative is styled as a test of whether pot can be effectively used as medicine without being abused. Under his plan, people with cancer, glaucoma and possibly some other “life-threatening or sense-threatening” conditions could seek to get marijuana through studies based at hospitals yet to be named, with “stringent research protocols and eligibility requirements.” Cuomo’s initiative bypasses a state legislature that has weighed but failed to pass more ambitious medical marijuana laws. He’s relying instead on his administrative powers to carry out a 1980 law allowing medical-marijuana research. Critics think medical marijuana is an entree to more recreational use of a drug that was widely outlawed in the United States in the 1930s. “I think it sends the wrong signal to our young people,” said Michael Long, chairman of the New York Conservative Party. Supporters say the marijuana plant is effective against various ailments, including backaches, anxiety and seizures. If the medical science is unsettled, allowing pharmaceutical pot is popular with New Yorkers. A Quinnipiac University poll in June found 70 percent of state voters support it. And for Cuomo, the issue represents an opportunity to plant a flag on the left — but not too far — as

NEW YORK —
While nearly two dozen states have approved marijuana for medical purposes and Colorado and Washington have legalized its use for pleasure, Cuomo (D) is tapping a 1980 state law to allow as many as 20 hospitals to dispense the drug to people with certain severe illnesses as an experimental research project.
“I’m absolutely thrilled that he’s actually verbalized the words ‘medical marijuana,’ but he’s just got to go further,” said Susan Rusinko, a 52-year-old central New York resident who said a hit of pot is a “wonder drug” that relaxes immobilizing leg spasms from her multiple sclerosis. It’s unclear whether she would even qualify for Cuomo’s initiative or whether there would be a participating hospital near her.
While advocates are frustrated, Cuomo’s limited embrace of medical marijuana may be a politically astute and scientifically sensitive move on an issue on which popular enthusiasm has outpaced a weak body of medical research, experts say.
Some doctors avidly back using cannabis to treat problems ranging from chemotherapy-related nausea to chronic pain, but other medical experts say there are good reasons for caution. While the marijuana plant holds tantalizing possibilities, they say, it’s still a question mark as medicines go.
Cuomo’s initiative is styled as a test of whether pot can be effectively used as medicine without being abused.
“This does not start with a premise: ‘Oh, this is a slam dunk. . . . We can do it without any ancillary problems,’ ” he told reporters Monday. “It’s the exact opposite.”
Under his plan, people with cancer, glaucoma and possibly some other “life-threatening or sense-threatening” conditions could seek to get marijuana through studies based at hospitals yet to be named, with “stringent research protocols and eligibility requirements.”
Cuomo’s initiative bypasses a state legislature that has weighed but failed to pass more ambitious medical marijuana laws. He’s relying instead on his administrative powers to carry out a 1980 law allowing medical-marijuana research.
Critics think medical marijuana is an entree to more recreational use of a drug that was widely outlawed in the United States in the 1930s. “I think it sends the wrong signal to our young people,” said Michael Long, chairman of the New York Conservative Party.
Supporters say the marijuana plant is effective against various ailments, including backaches, anxiety and seizures.
If the medical science is unsettled, allowing pharmaceutical pot is popular with New Yorkers. A Quinnipiac University poll in June found 70 percent of state voters support it.
And for Cuomo, the issue represents an opportunity to plant a flag on the left — but not too far — as he faces reelection this year amid talk of his potential 2016 presidential prospects. Cuomo enjoys favorability ratings around 55 and 60 percent in recent polls, but some of the state’s Democratic limelight has been shining lately on newly installed, staunchly liberal New York Mayor Bill de Blasio.
— Associated Press