CNN’s Dr. Sanjay Gupta has gotten some education

Remember back in 2002 when CNN’s Dr. Sanjay Gupta was going off about how cannabis use leads to depression, schizophrenia, and psychosis?

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.

Or back in 2006 when he was writing the article “Why I Would Vote No on Pot“?

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…. 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.

Now in 2009 it seems like the good doctor has finally paid attention to the over 17,000 studies showing marijuana’s medical efficacy.  Here’s a transcript from his appearance last night on the Anderson Cooper 360° show (emphasis mine):

ANDERSON COOPER: Sanjay, let’s get at it. Are there benefits to medical marijuana? Is there a case for its use, because the patients we talk to swear by it?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, the answer is yes. I mean, there are some medical benefits to marijuana, and this is more than just anecdotal evidence now, Anderson. There are some studies to sort of back that up.

We know that there are receptors in the brain, cannabinoid receptors. And they control things like your pain levels, your hunger levels, things related to your mood. And therein lies some of the possible benefits, medically, of marijuana.

For example, someone who’s having terrible malnourishment or terrible nausea as a result of chemotherapy or being infected with HIV/AIDS, using marijuana could stimulate appetite.

Neuropathic pain, Anderson, something I deal with quite a bit as a neurosurgeon. It’s that lancinating nerve pain that’s often caused by trauma or some sort of injury or surgery. Sometimes it can be very refractive to pain medications. Marijuana can help there, as well.

Multiple sclerosis, something else that I treat: that’s something that can cause significant tremors, for example. Marijuana can help.

But the caveat, Anderson, is that sometimes other medications which we know more about may be better alternatives. So it can help, but there might be other things that are even better.

We know a whole lot about some of those other medications, all right.  Like most of them have severe side effects, some are addictive, and many are toxic at high doses.

COOPER: Is there medical evidence that it can be dangerous? What do doctors say?

GUPTA: Well, most of the studies on this really look at some of the shorter term effects of marijuana. It is hard to make the statement right now about the longer term dangers of marijuana.

I guess Dr. Tashkin’s 30 years of studying of marijuana smokers doesn’t count as “long term”.  How about the evidence of the human race using marijuana medicinally for over 5,000 years, does that count for anything?

The medical community as a whole, for example the American Medical Association is against the smoking of marijuana. That is a stance that they take as an organized medical association.

But there are several areas in the brain, again, that marijuana affects. The hippocampus, Anderson, is an area that’s responsible for memory. So short-memory problems is something that is often cited.

While you are under the influence of marijuana.  Studies have shown there is no long term effect to cognitive abilities even for frequent and heavy marijuana users.

Also the developing brain; is marijuana — does it have somehow a greater impact on the developing brain? There are studies on this, although as I looked at them today, even not conclusive. It’s a real concern.

It probably does impact the developing brain, which is why marijuana use is something for adults only.

There’s also, you know, this idea that you talk about THC, the active ingredient that Joe Johns was talking about in a lot of the other pieces this week. But there are 300 other compounds or so, as well. And what exactly do they do?

Well, we know that one of the cannabinoids, cannabidiol, inhibits breast cancer cell growth, inhibits glioma (a type of brain cancer) growth, inhibits prostate cancer, and slows the progression of Alzheimer’s disease.  We know that cannabidiol, as well as cannabigerol, cannabichromene, and cannabinol, are effective anti-bacterials against drug-resistant MRSA and tuberculosis.  We also know that these few cannabinoids of the 60 that exist have analgesic, antispasmodic, anxiolytic, antipsychotic, antinausea, anti-convulsant, anti-rheumatoid arthritic, anticonvulsant, anti-inflammatory, antidepressant, anti-tumoral, and antioxidant properties, and can help mitigate or protect against glutamate neurotoxicity, multiple sclerosis (MS), Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease) and Huntington’s Disease.

And finally, this issue that you raised, Anderson, about addiction. Is it addictive? You’re going to find conflicting studies, not an exact number. But anywhere between 5 and 9 percent of people who smoke marijuana regularly could become addicted.

Take a look there, as compared to other substances: tobacco, 31 percent; heroin, 23; cocaine 17. You can see the numbers there, and you have cannabis at the bottom, 9 percent.

So there is that risk, as well, Anderson.

COOPER: Because, I mean, a lot of people like Melissa Etheridge. I said the addictive question. She basically just laughed and said, “Absolutely not. There’s no way it’s physically addictive.”

Other people say, well, maybe psychologically it has some addictive. Does one make a difference between possible psychological addiction and physical addiction?

GUPTA: That’s a great question. And when you talk about addiction, typically, from a medical standpoint, you are talking about some sort of physical addiction. So the body changes in some way. It could be a mood-related thing, but associated with that mood you may have — you know, some sort of physical manifestations of the withdrawal. So there are criteria for withdrawal.

They really should have pointed out that the figures mentioned have to do with clinical dependence and not addiction.  According to the DSM-IV, in order to be considered dependent, you must exhibit three or more of these criteria within a twelve-month period with regard to your substance use:

• Tolerance (marked increase in amount; marked decrease in effect)
• Characteristic withdrawal symptoms; substance taken to relieve withdrawal
• Substance taken in larger amount and for longer period than intended
• Persistent desire or repeated unsuccessful attempt to quit
• Much time/activity to obtain, use, recover [I've always found this one unfair, because prohibition is what makes weed harder to find!]
• Important social, occupational, or recreational activities given up or reduced [Unfair as well, because sometimes a pee test forces us out!]
• Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous) [Or, say, being incarcerated?]

Or just forget about the DSM-IV and use your common sense: have you ever met someone who’s tried to quit tobacco, heroin, cocaine, or alcohol?  Have you ever watched their body being physically wracked by withdrawal symptoms?

COOPER: We got a text question I want to get to. Matthew from New Mexico asks, “Can we not obtain the medical benefits of marijuana without smoking it?” So, how about that? I mean, there is this federally-approved drug on the market, Marinol, that treats the same symptoms as the medical marijuana does. Some people say it doesn’t work fast enough. Is Marinol just not a decent substitute?

GUPTA: I don’t think we’re there yet. It’s a synthetic form of THC. So the advantage, you get rid of a lot of those other compounds that we don’t know a lot about. One of the disadvantages, you just mentioned, it’s a pill, so it may not work fast enough.

No, the disadvantage of Marinol is that “you get rid of a lot of those other compounds.”  THC is the most psychoactive of the compounds in marijuana and it lacks the antipsychotic cannabidiol to balance it out.  I’m a XL guy and I’ve smoked marijuana every day for years and the one time I tried a Marinol pill, it messed me up for the whole evening, throwing me into a really dark depressive suicidal mindspace.

I also think Matthew from New Mexico was trying to lead the discussion over to vaporization, edibles, and tinctures, not to Marinol pills.

One thing about using marijuana, either smoking it or vaporizing it, is you can titurate it a little bit more easily. So you can get the appropriate dose. With the pill, you may take too much or too little. It’s a little bit harder to triturate.

COOPER: All right. Interesting information, good facts.

Sanjay Gupta, appreciate it. Thanks, Sanjay.

GUPTA: Thank you, Anderson

Overall, a pretty surprising performance from Dr. Gupta.  I spoke on the phone with Paul Stanford this morning and he tells me he slipped a lot of this information for Dr. Gupta to Joe Johns during their interview because Stanford actually wanted to debate Dr. Gupta on his reefer madness from 2002 and 2006.  Stanford tells me that some of Dr. Gupta’s comments were word-for-word some of the information he passed along.