Sanjay Gupta: What the Next Surgeon General Doesn't Know About Pot

If Dr. Sanjay Gupta is picked for the post of surgeon general, he would become the nation's leading medical advocate. His experience in the media would be beneficial in bringing the Surgeon General's office back to the prominence it held when C. Everett Koop was successfully battling tobacco smoking.

But is Gupta ready to deliver the Obama administration's promised end to the politicization of science and medicine? More specifically, will Gupta toe the federal line that cannabis is lacking in any medical value, or will he recognize what 13 states and the past 12 years of research prove -- that cannabis is a beneficial medicine for some people and an intoxicant far less harmful than alcohol for others?

In 2002, Gupta was more than willing to echo the outrageous claims that smoking pot would lead to psychosis, depression and schizophrenia:

But the three studies you are talking about talk specifically about schizophrenia and depression, and the fact that marijuana use earlier in life actually may lead to an increased -- 30 percent increase -- in schizophrenia later in life.

Depression, also a very big diagnosis -- roughly 18.8 million in this country have it. Again, they looked this time at 1,600 high school students and followed them over about seven years. This is in Australia, not in the United States. But they actually found that all of these boys and girls, particularly girls, were more vulnerable to the symptoms of depression later on in life, again if they were frequent or even daily marijuana users.

I hope that the next surgeon general has been following the research on cannabis and mental health since 2002. This year, Dr. Mikkel Arendt of Aarhus University in Risskov, Denmark, said that people treated for a so-called cannabis-induced psychosis "…would have developed schizophrenia whether or not they used cannabis."

I hope that Gupta has kept up with the journal Schizophrenia Research and the research published there last year by the London's Institute of Psychiatry, which found no statistically significant "differences in symptomatology between schizophrenic patients who were or were not cannabis users," found no "evidence that cannabis users with schizophrenia were more likely to have a family member with the disorder" and that these findings "argue against a distinct schizophrenic-like psychosis caused by cannabis," authors concluded.

Regarding depression, in 2006, researchers at Johns Hopkins University's Bloomberg School of Public Health in Baltimore found "that the associations observed between marijuana use and subsequent depression status may be attributable not to continued marijuana use, per se, but to third (common) factors associated with both the decision to use marijuana and to depression."  In fact, the year prior, researchers at USC had found among cannabis smokers, "those who used once per week or less had less depressed mood, more positive affect and fewer somatic (physical) complaints than non-users," and that "[d]aily users [also] reported less depressed mood and more positive affect than non-users."

Or we could just ask the incoming surgeon general to apply some common sense.  If smoking cannabis is a strong predictor of future depression or schizophrenia, then shouldn't there be a spike in the reporting of those conditions around 1978, when 37 percent of high school seniors reported past-month cannabis use, and a decline in depression and schizophrenia around 1992, when the modern low of 12 percent was reported? Instead, what we find is that about 1 percent of the population develops schizophrenia, and that figure stays relatively steady even as cannabis use rises and falls.

In 2006, Gupta was penning the article "Why I Would Vote No on Pot" for Time magazine as Colorado and Nevada had non-medical-cannabis-regulation ballot measures pending. It doesn't seem like he's been following the past two decades of research:

I'm constantly amazed that after all these years -- and all the wars on drugs and all the public-service announcements -- nearly 15 million Americans still use marijuana at least once a month.

Frequent marijuana use can seriously affect your short-term memory. It can impair your cognitive ability (why do you think people call it dope?) and lead to long-lasting depression or anxiety. While many people smoke marijuana to relax, it can have the opposite effect on frequent users. And smoking anything, whether it's tobacco or marijuana, can seriously damage your lung tissue.

But I'm here to tell you, as a doctor, that despite all the talk about the medical benefits of marijuana, smoking the stuff is not going to do your health any good. And if you get high before climbing behind the wheel of a car, you will be putting yourself and those around you in danger.

First, I'm wondering what Gupta is amazed about -- that 15 million Americans trust their own experiences with cannabis over government anti-drug propaganda and hyperbole? The anti-drug PSAs he mentions have been proven to not reduce teen cannabis use and may actually increase it. The Annenberg Public Policy Center at the University of Pennsylvania was commissioned by the National Institute on Drug Abuse to study the effect of government anti-cannabis ad campaigns over four years and found, "Youth who were more exposed to Campaign messages are no more likely to hold favorable beliefs or intentions about marijuana than are youth less exposed to those messages, both during the Marijuana Initiative period and over the entire course of the Campaign."

Gupta claims that smoking cannabis will impair your cognitive ability, and again, I fear he's parroting politics rather than following the research. Just this November, the journal Neuropsychopharmacology published data from Columbia University that reported "the finding that accuracy [on cognitive testing] was unaffected by smoked marijuana indicates that heavy, daily marijuana smokers will not fulfill the DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, 4th edition] criterion for marijuana intoxication that requires impairment of complex cognitive functioning,"  This is on the heels of a Harvard study published in the Archives of General Psychiatry that determined that long-term marijuana smokers who abstain from the drug for one week or more perform identically on cognition tests as non-users, and a previous study on marijuana and cognition by researchers at Johns Hopkins that found "no significant differences in cognitive decline between heavy users, light users and non-users of cannabis" over a 15-year period in a cohort of 1,318 subjects.

Gupta also makes the mistake of comparing tobacco smoke to cannabis smoke. While it is true that long-term cannabis smoking can lead to wheezing, cough and bronchitis, investigators writing last year in the journal Thorax did not find a positive association between smoking cannabis and the development of emphysema (overinflation of the air sacs in the lungs). Of course, all the pulmonary harms of smoking cannabis can be alleviated through eating it or through cannabis vaporization.  Investigators at San Francisco General Hospital reported last year in the journal Clinical Pharmacology & Therapeutics that the "vaporization of marijuana does not result in exposure to combustion gases." A previous clinical trial, published in 2006 in the Journal of Pharmaceutical Sciences, reported that vaporization is a "safe and effective" cannabinoid delivery system that "avoid[s] the respiratory disadvantages of smoking."

In 1997, Dr. Donald Tashkin's research at the UCLA Medical Center found that, "Neither the continuing nor the intermittent marijuana smokers exhibited any significantly different rates of decline in [lung function]" as compared with those individuals who never smoked marijuana. "No differences were noted between even quite heavy marijuana smoking and nonsmoking of marijuana." These findings starkly contrasted those experienced by tobacco-only smokers who suffered a significant rate of decline in lung function.

By 2006, the Washington Post reported on Tashkin's latest research on cannabis use and cancer. Tashkin said, "We hypothesized that there would be a positive association between marijuana use and lung cancer, and that the association would be more positive with heavier use. What we found instead was no association at all, and even a suggestion of some protective effect."

As for driving, nobody here at NORML suggests that people smoke cannabis and then drive a car. But someone's potential irresponsible use of cannabis is not an argument for the danger of cannabis itself. In fact, researchers at Britain's Transport Research Laboratory found in September that text messaging and alcohol are far more dangerous on the road than cannabis. "The reaction times of people texting as they drove fell by 35 percent, while those who had consumed the legal limit of alcohol, or taken cannabis, fell by 21 percent and 12 percent respectively."

To be fair, in his 2006 Time article, Gupta does seem to begrudgingly admit some of cannabis' vast medicinal uses:

Several recent studies, including a new one from the Scripps Research Institute, show that THC, the chemical in marijuana responsible for the high, can help slow the progress of Alzheimer's disease. (In fact, it seems to block the formation of disease-causing plaques better than several mainstream drugs.) Other studies have shown THC to be a very effective anti-nausea treatment for people -- cancer patients undergoing chemotherapy, for example -- for whom conventional medications aren't working. And medical cannabis has shown promise relieving pain in patients with multiple sclerosis and reducing intraocular pressure in glaucoma patients.

But back in 2002, even when he gives in on the most recognized medical uses of cannabis, he still recites the government line that there are other drugs that can be used instead of cannabis:

There are some benefits to marijuana use. It can make cancer chemotherapy patients hungrier -- also in HIV and AIDS patients. … And marijuana can offer some of those things, especially when it comes to reducing nausea and vomiting, not advocating that necessarily myself. I think there are other ways to do that besides marijuana.

This is the mind-set I call "marijuana as medicine of last resort." It's the concept that any time a medical benefit to cannabis is absolutely undeniable, then it can be somewhat accepted, but only if no other medicine will suffice. This "medicine of last resort" idea is the notion that if both OxyContin and cannabis will relieve pain, you should take OxyContin because it is legal, despite the fact that OxyContin is addictive and has severe side effects. It's the notion that if you're vomiting from severe nausea, you should first try to swallow a synthetic THC pill called Marinol that won't work for 45 minutes rather than smoking an illegal doobie that works immediately.  Even when cannabis is the superior medicine for a symptom or condition, the drug-war mentality that there are "good" drugs and "bad" drugs kicks in, and the doctors will recommend a less-effective "good" drug over the more-effective "bad" one.

In a weekly radio address to the nation, President-elect Barack Obama offered his view of science and public policy:

Because the truth is that promoting science isn't just about providing resources -- it's about protecting free and open inquiry. It's about ensuring that facts and evidence are never twisted or obscured by politics or ideology. It's about listening to what our scientists have to say, even when it's inconvenient -- especially when it's inconvenient. Because the highest purpose of science is the search for knowledge, truth and a greater understanding of the world around us. That will be my goal as president of the United States -- and I could not have a better team to guide me in this work.

If your team is going to ensure the science behind medical cannabis isn't twisted by ideology, we'd invite you and Gupta to meet with us here at NORML so we can show you all the inconvenient truths about cannabis that have been discovered over the past 12 years. Thirteen states and millions of medical users are depending on you to support the truth, not the politics, Dr. Gupta. Will you have the courage of another surgeon general, Dr. Joycelyn Elders, who testified in support of medical marijuana in Rhode Island, saying:

The evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS -- or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day.  It is simply wrong for the sick and suffering to be casualties in the war on drugs. Let's get rid of the myths and institute sound public-health policy.

Sound public health policy free from drug war mythology? President-elect Obama, Dr. Gupta, that is the kind of change we can believe in.