Willful ignorance is a pathetic condition I’ve written about before, but a new and unexpected manifestation came to my attention in the Saturday paper. In an extended interview with the Arkansas Democrat-Gazette, Dr. J. Carlos Roman voiced his thoughts on the Arkansas Medical Marijuana Act and the various twists and turns on its way to becoming a functioning service to people in need. Among those thoughts was this stellar quote: “What are we going to do as a state and culture to make sure medical marijuana doesn’t become the next opioid crisis?”
Oh please, Scotty, beam me up now.
It’s possible Dr. Roman made this statement in an attempt to be politically correct, considering that he’s under fire for possible conflict of interest in his role as one of five members of the commission that oversees the licensing of Arkansas’ first growing and dispensing facilities. As such, he gave the highest score to the Natural State Medicinals Cultivation group. Entities that didn’t score so high were understandably miffed that Natural State was one of only five chosen for a license, considering that Dr. Roman’s friend Dr. Scott Schlesinger is one of the Natural State’s owners. Consequently, several of those potential licensees not chosen have sued for bias.
Roman argues that he didn’t expect or receive any quid pro quo for his ranking of Natural State. He also pointed out that he has worked for years in his role as a pain management physician to fight the opioid crisis. He says his reason for accepting the voluntary role on the licensing board was in part to “ensure that the medical marijuana industry gets off the ground responsibly.”
He goes on to admit that he was initially opposed to the amendment that voters passed in 2016 legalizing medical use, not because he was totally opposed to marijuana’s medical use but because of public “ignorance” and so-called false information about its medical potential touted by many supporters of the new law. He concedes a few benefits of natural marijuana might be in its use in appetite stimulation and anti-anxiety and admits he will “reluctantly” certify patients to receive ID cards required in the program.
He’s such a great guy, isn’t he? And now, through no fault of his own, he’s being villainized by permit applicants who didn’t score as high as the group co-owned by his friend.
Sometimes you have to appreciate karma. Because this scandal about his potential conflict of interest is exactly the kind of spotlight that’s needed for people like Dr. Roman.
Why? Because who should be more qualified or informed about medical research than a physician? Yet here we have a physician who specializes in pain management worrying that marijuana could become the next opioid crisis. Talk about willful ignorance.
Farmer slicing opium flower pod to harvest the resin. Condensed resin forms raw opium.
Any physician, especially a specialist in pain treatment, should be fully aware of the history and effects of opiates. The opium poppy has been used medically as far back as 4000 BCE. For that matter, so has marijuana. But opium has served a greater role in pain relief.
Not content with what nature had to offer in the opium plant, chemists in the 19th century began tinkering. The first result was morphine, introduced in 1827 by Merck. But after the Civil War with thousands of injured soldiers becoming addicted, Bayer Pharmaceuticals gallantly invented heroin which hit the marketplace in 1894 as a “safe” alternative. Less than twenty years later as the addictive potential of heroin became more widely known, German chemists synthesized oxycodone.
This new “safe” alternative medication spawned generations of synthesized opiate clones, each touted as safer than its precursor: Oxycontin, Percocet, Vicodin, Percodan, Tylox, and Demerol, to name a few. Now we have the latest spawn, Fentanyl, at fifty times the strength of heroin.
Now, in order to capitalize on marijuana’s therapeutic gifts, the chemists are busy again. Already pharmaceutical grade THC, one of many active ingredients in marijuana, has been synthesized for legal sale as Marinol. You see where this is headed. Soon, coming to a town near you, we’ll have a potentially lethal form of marijuana.
But not yet. What Dr. Roman should know and apparently doesn’t is that marijuana is very different from opiates is two important ways. It’s not addictive. Opiates are. And marijuana is non-toxic, meaning no matter how much you manage to ingest, it won’t kill you.
And therein lies the absurdity of his statement.
Not to single him out. I’d wager that most physicians in Arkansas and elsewhere have made zero effort to learn more about the chemical properties of cannabis.
…In a large-scale survey published in 1994 [by] epidemiologist James Anthony, then at the National Institute on Drug Abuse, and his colleagues asked more than 8,000 people between the ages of 15 and 64 about their use of marijuana and other drugs. The researchers found that of those who had tried marijuana at least once, about 9 percent eventually fit a diagnosis of cannabis dependence. The corresponding figure for alcohol was 15 percent; for cocaine, 17 percent; for heroin, 23 percent; and for nicotine, 32 percent. So although marijuana may be addictive for some, 91 percent of those who try it do not get hooked. Further, marijuana is less addictive than many other legal and illegal drugs.
Please note that “dependence” and “addiction” are two very difference things, no matter how Anthony and others might interchange them.
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Psychological dependence develops through consistent and frequent exposure to a stimulus. Behaviors which can produce observable psychological withdrawal symptoms include physical exercise, shopping, sex and self-stimulation using pornography, and eating food with high sugar or fat content, among others.
Marijuana plant showing leaves, generally not containing much of the active ingredients, and flower buds, the primary medically-useful portion of the plant.
“Dependence” in itself is simply an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus such as the ‘high’ associated with marijuana. Some studies report that ending heavy marijuana use causes some users to experience wakefulness in subsequent nights and possibly headaches.
Compare that to opiate withdrawal. Within six to thirty hours of last use, symptoms include tearing up, muscle aches, agitation, trouble falling and staying asleep, excessive yawning, anxiety, nose running, sweats, racing heart, hypertension, and fever. Then within 72 hours, more severe symptoms ensue and last a week or more, in including nausea and vomiting, diarrhea, goosebumps, stomach cramps, depression, and intense drug cravings.
But more important than symptoms of withdrawal are the risks associated with use, most critical being the risk of overdose death. And this is where Dr. Norman’s ignorance takes center stage. People die from opiates at an increasing rate, about 181 people per day in 2017.
…Victims of a fatal [opiate] overdose usually die from respiratory depression—literally choking to death because they cannot get enough oxygen to feed the demands of the brain and other organ systems. This happens for several reasons… When the drug binds to the mu-opioid receptors it can have a sedating effect, which suppresses brain activity that controls breathing rate. It also hampers signals to the diaphragm, which otherwise moves to expand or contract the lungs. Opioids additionally depress the brain’s ability to monitor and respond to carbon dioxide when it builds up to dangerous levels in the blood.
Compare that to the effects of marijuana.
Because cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration, lethal overdoses from Cannabis and cannabinoids do not occur.”
Here’s a wake-up call to Dr. Roman and others in Arkansas playing this Mickey Mouse game over marijuana: in states where medical marijuana has been legalized, opiate-related deaths have decreased.
Over the past two decades, deaths from drug overdoses have become the leading cause of injury death in the United States. In 2011, 55% of drug overdose deaths were related to prescription medications; 75% of those deaths involved opiate painkillers. However, researchers found that opiate-related deaths decreased by approximately 33% in 13 states in the following six years after medical marijuana was legalized.
“The striking implication is that medical marijuana laws, when implemented, may represent a promising approach for stemming runaway rates of non-intentional opioid-analgesic-related deaths,” wrote opiate abuse researchers Dr. Mark S. Brown and Marie J. Hayes in a commentary published alongside the study.
We are nearly two years from the day Arkansas voters approved a measure to provide medical marijuana to citizens of the state. With these lawsuits filed against the commission for potential conflict of interest, the date when persons in need might obtain legal weed moves even further from reach.
Dr. Roman’s apparent failure to educate himself is only the last of so many failures regarding public health and marijuana. Prohibition propaganda remains deeply entrenched in those who don’t bother to become informed. Legislative foot dragging has never been more egregious than in the months of throwing everything but the kitchen sink in front of the voters’ choice on this measure. The tragedy is that while all these men and women responsible for the public welfare fiddle with the law’s implementation, people are suffering needlessly. And dying.
 March 31, 2018 issue, page 1
 See https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq#section/all; also https://www.leafscience.com/2017/10/17/overdose-marijuana/