Dagga: Forget the Buzz it’s the facts that count!

Press Release 16 August 2012

News 24 recently featured an article on the decriminalization of dagga (cannabis) by an activist who goes by the name of Buzz. Doctors for Life International is intrigued by the position taken this activist as the whole article seems to be based more on Buzz’ impressions than real facts.

Buzz claims that decriminalizing dagga will:

not lead to a rise in it’s use
will make it possible to control it’s sales
make it less attractive
take it out of the hands of organized crime

To justify his argument he quotes the Dutch government’s liberal policies of quite some time ago on Cannabis and its use.

The opinion negates numerous studies amongst which is the massive, “General Lifestyle Survey of the Office of National Statistics of the British Government 2009”. This study demonstrated for the umpteenth time, a much higher use of legal drugs compared to that of illicit drugs.

The Dutch government started changing their liberal policy on dagga in 2010 by closing down coffee shops (about 43 in Amsterdam alone), forbidding foreigners to go to coffee shops, closing down coffee shops a certain distance from schools etc. The Dutch minister of Health and Justice justified the new trend when he admitted that they had been unable to root out the criminal element in the dagga trade when he stated: “…This law will put an end to the nuisance of criminality associated with “coffee shops” and “drugs trafficking”.

The argument that legalizing dagga will lead to a glut of people growing it for profit, which Buzz rejects, is exactly one of the reasons why the city of Los Angeles in California decided earlier this year to close down all (approximately 900 of them) pharmacies that sold dagga.

The whole idea that we should legalize harmful social practices that we have failed to get rid of while illegal is absurd, to say the least. Throughout the ages virtually no human vices have been completely prevented by making them illegal. But that does not mean we are considering legalizing theft or fraud, or the abuse of women, or even murder for that matter.

One of the most condemning facts against the legalization of dagga is the relationship between schizophrenia and dagga use, which has become dominant in medical literature over the past few years. There is no such association with tobacco smoke and psychosis associated with alcohol abuse only develops after long periods of alcohol addiction.

Dope smokers have been found to inhale deeper than cigarette smokers and hold smoke in the lungs for longer before they exhale. Ammonia levels were 20 times higher in marijuana smoke than in tobacco smoke. Hydrogen cyanide, nitric oxide and certain aromatic amines occurred at levels 3-5 times higher in marijuana smoke. Cannabis smoke contains seven times more tar and carbon monoxide than cigarette smoke.

One is forced to conclude that Buzz’ view represents one of those extreme views that is not based on scientific data, but is rather one of the view points of a small subgroup of society using thumb sucked statistics that suit them.

Doctors for Life International, represents more than 1400 medical doctors and specialists, three-quarters of whom practice in South Africa. Since 1991 DFL has been actively promoting sound science in the medical profession and health care that is safe and efficient for all South Africans. For more information visit: http://www.doctorsforlife.co.za

Dignity SA turning doctors into executioners?

Press Release 18 July 2012

In a recent press briefing, Prof Sean Davison of Dignity SA suggested that the law forbidding euthanasia in South Africa should be changed. One reason he gave was that some doctors told him they had “helped people to die …. at their request.”

Assisted suicide remains illegal in South Africa, and in all but 5 countries in the world. The World Medical Association says it is an unethical act. So Davison’s use of the illegal actions of a few doctors in South Africa as motivation for a change in the law is illogical. It would be like legalizing corruption because it happens in the civil service!

There are very good reasons why the vast majority of the world’s medical organisations oppose the legalization of assisted suicide, especially in developing countries. Chief amongst them is that it is a practice, which turns the doctor into occasional executioner, and radically changes the doctor-patient relationship. Assisted suicide is also a practice, which is almost impossible to police, especially in a country like ours, with poorly functioning police and justice systems. It is then too easily abused, as numbers of good scientific studies have shown.

We must be very careful not to trade off the security of vulnerable people in the hands of medical personnel across our land, in favour of the demands of a comparatively small number of people who demand legal freedom to control the timing of their deaths. Instead, we should be putting plenty of resources into training our medical fraternity so that they become really skilled at providing terminal care and pain control. Then none of us need fear the process of dying.

Is South Africa getting its own Dr. Death?

Press Release: 14 Mar 2012

Professor Davison, who helped launch Dignity SA, has returned to South Africa. Our media have hailed him as a good parent and a loving husband, who assisted his mother to die and who wants to legalize euthanasia/assisted suicide in SA.

But he seems to be following in the footsteps of Jack Kevorkian, the USA’s Doctor Death. He advocates assisted suicide for the terminally ill, but he fails to suggest adequate means to prevent South Africa from experiencing the widespread abuse of euthanasia legislation reported in every country where it is legal.

For example, the Swiss euthanasia organization “Exit”, reported this week that 1 out of 5 French and 1 out of 3 German seniors opting for assisted suicide were not terminally ill or in unbearable pain. They cited “weariness of life” and “bad health” as the main reasons for ending their lives. This seems to be a national expression of “suicide contagion” – of members of a group choosing suicide because their peers have done so.

The issue of assisted suicide is also a Pandora’s Box in other respects, where old people are concerned. It is just too easy for family members, who want access to the estate, to manipulate them into choosing suicide, especially if they feel they are a burden to their family. The effects of such dynamics in families can be very serious for their young people as well. Medical literature on suicide contagion points out that it is the young who are most vulnerable to subsequent suicides in any family in which one has happened.

Are we willing to open this Pandora’s Box, and see our loved ones dying in the future, because someone deemed a family member a burden to society?

The problem is that Professor Davison and the media do not address the fact that no country has been successful in preventing the coercion and the abuse of vulnerable people through assisted suicide. And we know that assisted suicide is not the only way out of pain and distress. There are good medical solutions to pain and suffering of every kind. We know that there is research showing that 95% of people with terminal illness who are requesting assisted suicide, will change their minds if given good terminal care by a competent hospice team. We also know that such competent care is being given even by home-based carers following short periods of training, so it need not be expensive.

We consider that our society should be putting all its energies into strengthening the Hospice movement rather than considering legislation for euthanasia/assisted suicide.

Doctors for Life International, represents more than 1800 medical doctors and specialists, three-quarters of whom practice in South Africa. Since 1991 DFL has been actively promoting health care that is safe and efficient for all South Africans.

Enquiries: Dr. Jon Larsen Tel: 032 481 5550

Letter to the Editor of the Natal Witness on the Legalisation of Cannabis

Press Release: 26 April 2012

The Editor,

It is with interest that Doctors for Life noticed your article on the legalization on cannabis (dagga). It would appear that this article quotes a web post by Dale T. McKinley. Even though I respect Mr McKinley for plucking up the courage to wade into this very controversial issue, I would like to caution him against using medical arguments. If he wants to use emotional arguments and blend them with being politically correct, that’s fine. Also, quoting one doctor does not make your premise medically sound. After all, one will actually be able to even get some doctors who smoke cannabis/dagga themselves, who will try and argue in favor of the so-called “health benefits” of dagga/cannabis. Making use of the odd multiple sclerosis (ms) patient smoking dope to make him/her feel better about their MS also does not ratify it scientifically either. I don’t know whether Mr. Mckinley realizes the implications of the legislation he is arguing for. Would he really want a team of doctors and anesthetists to perform open heart surgery or brain surgery on him while they are high on dope?

I am taking the liberty of commenting on the article as a medical professional, with the hope that my letter will receive the appropriate exposure in order to encourage an open debate on the matter.

In recent years, considerable progress has been made, including the discovery of specific cannabis receptors in the brain. Researchers have also identified THC-like substances produced by the body itself (endocannabinoids) which bind to these receptors. These findings tie in with certain of the effects and side-effects produced by cannabis, above all its effects on psychomotor and cognitive functions and its mood altering capabilities.

When cannabis is smoked, the THC level in the blood rises quickly, reaching its maximum within a few minutes. If the drug is taken by mouth and stomach (e.g. by eating cookies or chocolate containing cannabis), the maximum THC level is achieved after 30 to 60 minutes (depending on whether the taker is fasting or not). The maximum subjective effect more or less coincides with the blood level. The duration of intoxication is directly dependent on the size of the dose.

Cannabis contains more than 400 substances, the best known being the psychoactive tetrahedronannabinols (THC). With a slight generalization, cannabis can be said to produce two kinds of intoxicating effect. On the one hand, there are euphoric and calming effects (similar to those of other drugs with a sedative effect, such as alcohol and benzodiazepines) – the taker experiences calm, relaxation, a feeling of happiness and of distance from everyday life. On the other hand, there are more dramatic impacts on the taker’s emotions and cognitive functions – e.g. fragmentation of thought processes, major disruption of temporal perception, distortion of sensory impressions (sound, touch, light, etc.), reduced ability to maintain attention, considerable deterioration of short-term memory/imprinting ability and, in certain cases, a noticeable introversion and dissociation of the taker from other people. At high doses, there appear – in some people, perhaps not in all – hallucinations and delusions, during which the taker does not, however, lose contact with reality. The THC levels differ in different plants, the different areas the plants may come from and even the different places on one plant where the leaves may be harvested from

CANNABIS IS ADDICTIVE: Cannabis abuse can evolve into cannabis dependence, which is characterized by a compulsive need for the drug, daily or almost daily consumption and difficulties in stopping. The dependence is not only psychological but also physical; the latter aspect is manifested during detoxification as withdrawal symptoms such as moderate anxiety, irritability and sleeplessness. The proportion of cannabis abusers who become dependent has been found to vary considerably in different studies; on average, it is surprisingly high. Of those who smoke cannabis at least once, 10 per cent will develop dependence at some point in their lives. This is one of the reasons why, after the legal status of marijuana was downgraded in Britain in 2005 to a less dangerous Class C drug, in 2008 the legal status of marijuana was re-upgraded again to a more dangerous Class B drug. Cannabis-dependent people are more at risk of being affected by the harmful effects of cannabis smoking, and they are also more likely to move on to other illegal drugs.

CANNABIS AND MENTAL DISORDERS: (This has received an explosion of research across the world over the past 4 years). The following mental disorders are known or strongly associated with cannabis abuse in that the abuse may cause the mental disorder, precipitate a latent mental illness or severely exacerbate an existing illness/disorder: Delirium (acute confusional states), cannabis psychosis, other psychoses, schizophrenia, anxiety disorders, depersonalization syndrome, depression, suicide and impulsively violent behavior.

OTHER EFFECTS OF CANNABIS INCLUDE: suppression of the immune system which in HIV patients can lead to Kaposi Sarcoma, birth defects of babies born to mothers who smoke cannabis, emphysema, bullae of the lungs, tumors of the head and neck, heart disease, testicular cancer, bladder cancer and so on.

THE DANGERS TO NON-USERS: Cannabis use is strongly associated with juvenile crime. Cannabis plays a role in traffic accidents. Some of the most consistently identified problems with marijuana use are the effect on memory, concentration, coordination and reaction time. The effects on driving skills and coordination are extremely serious, and marijuana is regularly implicated in trauma. Since allowing cannabis dispensaries, California has experienced significant increases in cannabis-related trauma, and cannabis addiction cases far greater than the national average. In the USA in 2009, data from the the National Highway Traffic Safety Administration of the USA, showed that marijuana was the most prevalent drug found in drivers involved in fatal vehicle accidents – approximately 28 percent of fatally injured drivers tested positive for marijuana. Cannabis is actually taking over from alcohol as the most common drug involved in motor vehicle accidents in parts of the USA. The implications for accidents in the work place are obvious.

MEDICAL MARIJUANA OR CANNABIS AS MEDICINE: It is most important to understand that legislative actions giving access to marijuana seriously jeopardize consumer protection. Generally, processes for bringing medicine to the public have been established so that science, not emotion, prevails. Medicine needs to come through the medicine control boards of countries to assure safety and efficacy. More importantly, the recent legislative initiatives in some countries to legalize cannabis tend to create medicine by popular vote. Cannabis is not a safe drug, and is far from clearly effective. There is no advantage, and indeed there is a disadvantage, to smoking marijuana over available medications. Allowing such legislation to become law is riding a wave of emotion and mob psychology that has been carefully crafted, financed, and driven by the cannabis lobby. They have declared that the medical excuse of cannabis is the battlefield to gain the overall legalization of pot. The advocates’ strategy remains the same; play to emotion, overstate the benefits of marijuana, use the medical excuse to get the camel’s nose under the tent and then push for more legal access to pot.

Cannabis advocates allege benefits of marijuana use with little or no clear scientific basis. Neither cannabis nor pure THC has ever been compared to new anti-nausea medications which are extremely effective. Cannabis can actually enhance pain because of a very narrow therapeutic window. The progression of glaucoma is not slowed, and ophthalmologists do not consider it a reasonable treatment. Cannabinoids may reduce muscle spasm, but they damage gait in Multiple Sclerosis patients. While cannabinoids stimulate appetite, they appear to increase body fat rather than lean body mass. No credible evidence exists that marijuana is beneficial for depression, drug abuse, headaches, or menstrual cramps. Time and again we find that most frequent medical excuse users are young people manipulating the system by complaining of pain syndromes that are usually seen in much older patients

Supporting medical excuse cannabis either reflects serious ignorance of the medical literature, or a malignant misrepresentation of it. Medicine and policy makers must stop this circus of medicine by popular vote which is dangerous, and which plays into the pot of the legalization lobby.

Smoking any substance causes the smoker to inhale cancer causing substances. It is for that reason that no medicine is administered by smoking it. Dope smokers have been found to inhale deeper than cigarette smokers and to keep the smoke in the lungs longer before exhaling (ammonia levels were 20 times higher in the marijuana smoke than in the tobacco smoke, while hydrogen cyanide, nitric oxide and certain aromatic amines occurred at levels 3-5 times higher in marijuana smoke). Cannabis smoke contains seven times more tar and carbon monoxide than cigarette smoke. According to researchers from the French National Consumers’ Institute, smoking three cannabis joints will cause you to inhale the same amount of toxic chemicals as a whole pack of cigarettes.

SOME ENDORSEMENTS:

Antonio Maria Costa, Executive Director of the United Nations Office on Drugs and Crime, noted already in March 2007 “The debate over the drug is no longer about liberty; it’s about health.” He continued, “Evidence of the damage to mental health caused by cannabis use–from loss of concentration to paranoia, aggressiveness and outright psychosis–is mounting and cannot be ignored. Emergency-room admissions involving cannabis is rising, as is demand for rehabilitation treatment. …It is time to explode the myth of cannabis as a ‘soft’ drug.”

The American Glaucoma Society (AGS) has stated that “although marijuana can lower the intraocular pressure, the side effects and short duration of action, coupled with the lack of evidence that its use alters the course of glaucoma, preclude recommending this drug in any form for the treatment of glaucoma at the present time.”

Scientists at Sweden’s Karolinska Institute, a medical university, have advanced their understanding of how smoking marijuana during pregnancy may damage the fetal brain. Findings from their study, released in May 2007, explain how endogenous cannabinoids exert adverse effects on nerve cells, potentially imposing life-long cognitive and motor deficits in afflicted new born babies

The American Academy of Pediatrics (AAP) believes that “[a]ny change in the legal status of marijuana, even if limited to adults, could affect the prevalence of use among adolescents.” While it supports scientific research on the possible medical use of cannabinoids as opposed to smoked marijuana, it opposes the legalization of marijuana.9

Researchers from the University of Oulu in Finland interviewed over 6,000 youth ages 15 and 16 and found that “teenage cannabis users are more likely to suffer psychotic symptoms and have a greater risk of developing schizophrenia in later life.”

Robin Murray, a professor of psychiatry at London’s Institute of Psychiatry and consultant at the Maudsley Hospital in London, stated that the British Government’s “mistake was rather to give the impression that cannabis was harmless and that there was no link to psychosis.”

The National Multiple Sclerosis Society (NMSS) has stated that it could not recommend medical marijuana be made widely available for people with multiple sclerosis for symptom management, explaining: “This decision was not only based on existing legal barriers to its use but, even more importantly, because studies to date do not demonstrate a clear benefit compared to existing symptomatic therapies and because side effects, systemic effects, and long-term effects are not yet clear.”

The British Medical Association (BMA) voiced extreme concern that downgrading the criminal status of marijuana would “mislead” the public into believing that the drug is safe. The BMA maintains that marijuana “has been linked to greater risk of heart disease, lung cancer, bronchitis and emphysema.”11 The 2004 Deputy Chairman of the BMA’s Board of Science said that “[t]he public must be made aware of the harmful effects we know result from smoking this drug.”

The American Cancer Society (ACS) “does not advocate inhaling smoke, nor the legalization of marijuana,” although the organization does support carefully controlled clinical studies for alternative delivery methods, specifically a tetrahydrocannabinol (THC) skin patch.

And so the list goes on and on and on.

Even Holland appears to have now started the long road back after having legalized cannabis for some years. In the 1970’s individuals were allowed to buy 5g of marijuana at a time. Marijuana use among 18 to 20 year olds consequently increased from 15% to 44%. In 2004 Netherlands government implemented an action plan to discourage marijuana use. In 2008 Amsterdam started closing 43 coffee shops. Next, coffeeshops within a certain radius from schools were closed in December 2009. In Nov 2010 coffeeshops a certain distance from borders were closed to foreigners. In May 2011 Holland fully banned all tourists from visiting coffeeshops, the reason? Once legalized, the government was unable to separate the criminal element in the trade of cannabis from the legal trade. The coffeeshops had become a legal avenue for some drug syndicates to sell their goods. A letter from the Dutch Minister of Health at the time stated that “…This law will put an end to the nuisance of criminality associated with the coffeeshops and drugs trafficking.”

As mentioned in the beginning of the letter, most if not all of the statements made can be supported by multiple studies, by respected institutions, often representing the official stances of the national bodies of countries.

Dr A van Eeden
(Chief Executive Officer)

Harm Reduction: More than just side effects!

Press release: 18 January 2011

The recent stance from the managing editor of the South African Medical Journal in favor of the extremely controversial practice of decriminalizing drugs of abuse (Harm Reduction) is both surprising and disconcerting. It shows a mixture of “arm chair medicine”, selective quoting of studies and conventions, and some really flawed reasoning. One wonders when last he has sat in front of a drug addict who’s lost their family, through being consumed by an overriding passion for drugs, or lost their job due to multiple accidents in the workplace related to the abuse of cannabis, heroin or other drugs. Or when last has he treated a marijuana smoker who has developed schizophrenia as a result of his marijuana smoking, a complication which has become increasingly well established in medical publications over the last 4 years?

Medical Science is exploding with new research on virtually a weekly basis, that proves the harmful effects of marijuana use including:
· Causing psychosis in healthy people. [1]
· Harming the brains of teenagers. [2]
· Increasing the risk of testicular cancer. [3]
· Poor foetal growth. [4] · Suppression of the immune system. [5]

I suppose he has also not had to treat wash-out drug addicts from Switzerland like some of us have had to, where they have tried to regulate substance abuse through the medical provision of clean needles, syringes and drugs.

The archaic argument that we cannot root out drug abuse by keeping it a crime is also a strange way of thinking to Doctors for Life. Since time began we have not managed to root out one single crime, but we are far from considering decriminalizing murder, rape, theft and fraud, to name but a few. Really, to use the example of Jackie Selebi’s corruption as a argument to legalize drugs is an illogical and distorted way of reasoning.

Even though the article has quite a few references and appears very scientific, one is kind of left wondering what has happened to common sense. Dr van Niekerk keeps on quoting the fact that more harm is caused by legal drugs such as tobacco and alcohol (90% of all drug related deaths in the UK!) than illegal drugs, and somehow seems to miss the obvious point that having legalized them did not reduce the harm done by them. On the contrary, it appears to have increased the harm they cause. The implications of legalizing the use of drugs of abuse for the benefit of the economy of the country are vast. To mention just a few:

· Politoxemia, the simultaneous addiction to different drugs.
· The financial implication of increased accidents in the workplace.
· An increase in hours off work.
· Medical expenses for treating the complications of substance abuse.

It also includes the expense of establishing an infrastructure of medical personal to oversee the handing out of these drugs (and that in a country where our health system is already overloaded). DFL finds the reasoning justifying decriminalization immature.

Dr. van Niekerk also quotes the UN Single Convention on Narcotic Drugs of 1961, but does not mention the UNODC’s 52nd session of the Annual Commission on Narcotic Drugs March 2009, to which South Africa is a co-signatory. When some parties tried to slip in a Harm Reduction policy (such as Dr. van Niekerk is supporting), Sweden, Russia, Japan, USA, Colombia, Sri Lanka and Cuba refused to sign the document unless the reference to harm reduction was removed.

Experiences of a few countries that have moved in the direction of decriminalisation should also be taken note of:
The Alaska Supreme Court ruled in 1975 that the state could not interfere with an adult’s possession of marijuana for personal consumption in the home. Although the ruling was limited to persons 19 and over, a 1988 University of Alaska study, the state’s 12 to 17-year-olds used marijuana at more than twice the national average for their age group. Alaska’s residents voted in 1990 to re-criminalize the possession of marijuana, demonstrating their belief that increased use was too high a price to pay.

In Holland the Dutch government started closing down a third of their coffee shops because they found that many of the coffee shops had become a legal outlet for the illegal drug trade and after 15 years of legalised marijuana use, they were unable to separate the illegal and crime related activities from the legal trade. With the South African Police Force struggling to effectively police crime in the country, how do we think we ever are going to better the Dutch!

The U.K. first reclassified marijuana as a less harmful Class C drug, but in January 2009 moved it back to a more dangerous Class B drug.

Doctors For Life International is all in favour of doing more regarding the rehabilitation of drug addicts. But we do feel that having a prison sentence as an alternative to being sent for rehabilitation is a powerful incentive for many substance abusers to try and get help. To this end we would argue for more government funding to established rehabilitation units, and for NGO’s, who to a large extent have taken over the responsibility of the government in this regard.

Doctors for Life International, represents more than 1800 medical doctors and specialists, three-quarters of whom practice in South Africa. Since 1991 DFL has been actively promoting sound science in the medical profession and health care that is safe and efficient for all South Africans. For more information visit: http://www.doctorsforlife.co.za

References:
[1] Causing psychosis in healthy people: Dr Theresa Moore, Theresa HM Moore MSc, Dr Stanley Zammit PhD, Anne Lingford-Hughes PhD, Thomas RE Barnes DSc, Peter B Jones PhD, Margaret Burke MSc, Glyn Lewis PhD Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. University of Bristol, Institute of Psychiatry in Cardiff University, Wales. The Lancet, Volume 370, Issue 9584, Pages 319 – 328, 28 July 2007
[2] Harming the brains of teenagers: Manzar Ashtari, Ph.D: Children’s Hospital of Philadelphia Staci A. Gruber:Harvard Medical School http://news.harvard.edu/gazette/story/2010/11/marijuana-study/
[3] Increased risk of testicular cancer: Fred Hutchinson Cancer Research Center : Stephen Schwartz Association of Marijuana Use and the Incidence of Testicular Germ Cell Tumours http://www.fhcrc.org/about/ne/news/2009/02/09/marijuana.html Kristen Woodward, 206-667-5095 or kwoodwar@fhcrc.org
[4] Poor foetal growth: Hanan El Marroun, Henning Tiemeier, Eric A.P. Steegers, Vincent W.V. Jaddoe, Albert Hofman, Frank C. Verhulst, Wim van den Brink, Anja C. Huizink. Intrauterine Cannabis Exposure Affects Fetal Growth Trajectories: The Generation R Study Journal of the American Academy of Child & Adolescent Psychiatry December 2009 (Vol. 48, Issue 12, Pages 1173-1181)
[5] Suppression of the immune system: Venkatesh L. Hegde, Mitzi Nagarkatti and Prakash S. Nagarkatti. Cannabinoid receptor activation leads to massive mobilization of myeloid-derived suppressor cells with potent immunosuppressive properties. European Journal of Immunology, 2010; 40 (12): 3358-3371 DOI: 10.1002/eji.201040667

Embargo: Immediate release

Enquiries: Dr Thomas Gray

Date: 18 January 2011

Telephone: 032 4815550