PRACTICING & LIFE MEMBER CATEGORY
2019 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST
Just half a mile from the railroad track…”
I saw many Westerners at Alice’s Restaurant at Kathmandu
wearing tie dye lungis or shawls in different stages of trance in the
evenings, with the smoke rising from their chillums in a serpentine
manner to meet the apocryphal dreadlocks of their celestial peace-
maker. I have treated a few of such seekers of Nirvana who managed
to have fallen from rooftops or ledges of buildings that they thought
could be bridged with their new found “out-of-body experiences.”
I have treated patients with Ganja BID, couple of puffs, to curb
the nausea associated with pain medicine prescribed by Western
doctors after performing operations for cancer. These were patients
in Nepal who appreciated the relief of pain and also the relief from
the expense.
I think as cannabis or cannabinoids become more readily avail-
able, their use will increase particularly for medical use as well as for
use as entertainment drugs. It is already known that cannabinoid
ligands have been reported to modulate TRP channels (6) and thus
may be used for analgesic purposes. But we have to remember the
Oracle of Delphi’s maxim in everything in life. More studies are
needed to understand the mechanisms of action of the cannabinoids.
There are several studies to indicate that Delta THC results in
dose dependent deficits in fine motor control and in motor timing.
Therefore, driving after consumption of the drug may lead to acci-
dents. We have to have strict regulations, and we have to inculcate
social responsibility to individuals who partake in this medicine.
This will be a challenge for ER physicians (7) as well, because we do
not have any antidote except time. We do not know the effect of the
drug in a person’s brain who has sustained head injury, although the
associated broken bones that may have occurred in the traumatic
event may not hurt as much. There are reports suggesting that can-
nabis allergy may be increasing. There is a case report of someone
having collapsed after injecting cannabis in a vein. Serum tryptase
levels were markedly elevated suggesting anaphylactoid reaction,
and not much else was found at autopsy (8).
Cannabinoids reduce intraocular pressure by reducing cere-
bral spinal fluid production. There are some studies suggesting
that the drug products in some form may be useful in Dravet or
Lennox-Gastaut syndromes. Randomized controlled studies have
suggested great potential for cannabinoids in drug resistant pedi-
atric epilepsy (9,10). We have to dissuade the youth against use of
marijuana during the stage of life when all the neuronal connections
are being formed.
There are some reports suggestive of its harmful effects on a
youthful brain. I have talked with many adolescents who smoke it
regularly during “chilling.” I feel concerned that they might be left
with “fractures” and “blown fuse” in neuronal connections and may
end up being like the “Terminal Man” of Dr. Michael Crichton. I
interact with many violent youths in our society on a daily basis.
use in pancreatic cancer treatment as well as to control the itch of
atopic dermatitis. Who knows, it may be found to be useful in cases
of malignant itch of T-cell lymphoma.
The soil in Kentucky, I have been told, is very suitable for growing
hemp, and the weed is grown in several places in Eastern Kentucky
and also in certain counties that are closer in proximity to Jefferson
County. We have the distinct honor of having the highest number
of smokers in the nation and therefore, I think, it will be easy to
introduce the concept of the benefits of marijuana to our public.
I work in the school system. I do not have the exact statistics, but
I wouldn’t be surprised to learn that at least 40% of high school
students smoke marijuana already. We are not growing as much
tobacco anymore and the new crop will generate income for our
state in a legal manner. I believe that if we take away the novelty of
it and make it legal and use it for medicinal purpose, then much
like in the Confessions of St. Augustine, the thrill of “stealing the
apple from the neighbor” will be gone. The forbidden tainted weed
will become validated indeed!
I believe that in modern American society, having separated
ourselves from the pompous British apple hearts, we should be
less like the British, and not worry about the “natives’ well-being”
and let the American public take responsibility for its use, and pay
taxes to purchase it, and let us market it with caution - Don’t “JUST
DO IT.”
Dr. Banerjee is the Clinical Professor of Neurosurgery at the University of Louisville.
References:
1. Chopra, I.C. and Chopra R.N.:The use of cannabis drugs in India.
Bull Narc. 1957. January, 4-29
2. Iverson, L.L. (2008) The Science of marijuana, New York: Oxford
University.
3. Dixit, Prajwal.: “How cannabis was criminalized” The Telegram No-
vember 20, 2018.
4. Chris Conrad: (1997) Hemp for health. Inner Traditions pp 43-44.
5. Todd Mikuriya (1994) Excerpts from the Indian Hemp Commission
Report. Last Gasp page 38.
6. Muller C, Morales P. et al: Cannabinoid ligands targeting TRP channels.
Front Molecular Neuroscience. January 2019
7. Lattanzi S, Brigo F et al: Efficacy and safety of cannabidiol in epi-
lepsy: A Systematic Review and Meta-Analysis. Drugs. November
2018:1791-1804.
8. Perucca E.: Cannabinoids in the treatment of epilepsy: Hard evidence
at last? J Epilepsy Research December 2017 pp 61-76.
9. Menahem S.: Cardiac asystole following cannabis usage-additional
mechanism for sudden death? Forensic Science Int December 2013,
233.
10. Singh A, Saluja S. Et al: Cardiovascular Complications of Marijuana
and related substances: A Review. J Cardiol Ther June 2018: 45-49.
There are reports in the literature suggesting possibility of its
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