For medical marijuana patients, dosing is DIY

BY SUZANNE JACOBS
Daily Staff Reporter
Published September 7, 2010

In 2008 Michigan voters legalized the medical use of marijuana, but unlike most other medicines, marijuana does not come with a standard dosing procedure.

The responsibility of dosing the medicine falls to the patient because the effects of marijuana vary depending on the individual, the condition being treated and the type of marijuana used. Until scientists do more research on the individual compounds in marijuana, their effects on medical conditions will remain unpredictable.

Dennis Hayes, one of the founders of the Ann Arbor Medical Marijuana Patient Collective (A2M2PC) and a lawyer who specializes in medical marijuana legislation, said that even veteran marijuana users don’t have a way to calculate important effects such as timing, intensity and duration.

Mike McLeod, another founder of A2M2PC, , said experts may be able to devise an optimal dosing approach for marijuana in the future, but it won’t be possible without federally-supported research on the individual compounds in marijuana. Until then, he said, patients will have to navigate the dosing landscape themselves.

“Even the most experienced doctors say you’ll have to experiment a little,” he said.

McLeod has worked with a doctor in California who has a lot of experience with medical marijuana. They have made efforts to compile data on what works best for different patients, but McLeod said the situation is “just a real political hot potato,” adding that more research is needed, but it won’t come until there’s a change in federal drug policy.

Dr. Daniel Clauw, director of the University’s Chronic Pain and Fatigue Research Center, helped write the University Hospital’s medical marijuana guide — a comprehensive summary of how marijuana reportedly affects patients with the qualifying medical conditions specified in Michigan’s medical marijuana law. He said because marijuana hasn’t undergone the same level of testing that “classic drugs” have, marijuana is “more like a nutritional supplement.”

Clauw, who has given written certifications to some of his patients, said without more knowledge of the intricacies of how the drug works, physicians don’t know what dose to recommend to their patients. He also said the strength and purity of the medicine varies depending on where it comes from.

Mike Meno, the director of communications for the Marijuana Policy Project — the organization responsible for drafting Michigan’s medical marijuana law — said substantial research has been done on marijuana, but none of it has been done through the Federal Drug Administration because marijuana is a schedule I drug under the Controlled Substances Act and is therefore held to a “ridiculous standard.”

The Drug Enforcement Agency has put marijuana, along with GHB, heroin and LSD, in the schedule I drug classification — the most restrictive out of the five drug classifications listed under the CSA. The category consists of drugs that have a high potential for abuse and no accepted medical use in the United States. In 2001 the DEA denied a petition to make marijuana a less restricted classification, citing its lack of medical use as the primary reason.

Meno disagrees with DEA’s decision and said several studies confirm marijuana’s safety and medicinal properties.

“It’s a blatant lie for the federal government to say (marijuana) has no medical efficacy,” Meno said. “There are patients who are benefiting from it right now.”

According to Dr. Rebecca Van Dyke, a professor in the Department of Internal Medicine at the University and a specialist in gastroenterology and hepatology, the lack of federally supported research on marijuana is not only because of its schedule I status, but also because it is a herbal medicine.

“The problem that we have with marijuana and some herbal materials is they have not undergone the same level of controlled testing, and so we often can’t give as good information about how well will this work, what are its side effects, what might be reason to choose this material over other material,” she said. “I’m a scientist and a physician, and I think that use of any biologically active agent, whether it’s called a drug or a medicinal plant or an herb, should be tested and if possible compared against other treatments for the same problem so that both physicians and patients can make an informed choice about what’s the best treatment.”

Van Dyke — who said she warns her patients against using marijuana because current research suggests it may increase liver scarring in patients with Hepatitis C or liver disease — added that she thinks the United States should change the way it conducts drug testing so agents like marijuana can be thoroughly studied.

Until more research is done on marijuana, many new patients who don’t yet know how to dose themselves look to local collectives for guidance.

Jim Cifor, owner of the Ann Arbor Health Collective, said many of the more than 1,500 patients in the collective ask for advice on what to buy. On the first visit, he said many end up sampling a variety of products.

According to Cifor, certain strains of marijuana are best for specific conditions. For example, Cifor has found that the strain called Lavender works best for patients with multiple sclerosis. Arthritis patients like himself, he said, benefit from the collective’s glycerin tincture — a liquid extraction of the active cannabinoids found in marijuana. To use the tincture, patients put five drops under their tongue and then wait 20 minutes to see how it affects them.

In addition to marijuana seeds and tinctures, the Health Collective offers massage oils, lip balms, topical sprays, ointments and baked goods, like their chocolate-dipped coffee and cinnamon flavored “canna cake” with cannabis cream filling. Because of federal drug laws and to avoid legal troubles, Cifor declined to say how much his products cost.