Marijuana (Cannabis sativa) has been used for centuries to relieve pain, improve mood, and increase appetite. Outlawed in the United States in 1937, its social use continues to increase and public opinion is swinging in favor of the medicinal use of marijuana. There are an estimated 17.4 million current users of marijuana in the United States. Approximately 4.6 million of these users smoke marijuana daily or almost daily. A synthetic form of its active ingredient, tetrahydrocannabinol, commonly known as THC, has already been approved to treat side-effects of chemotherapy, AIDS-induced anorexia, nausea, and other medical conditions. With the recent legalization of recreational marijuana in two states and the legalization of medical marijuana in 19 states and the District of Columbia, physicians will increasingly encounter marijuana use among their patient populations.

A multicenter research team analyzed data obtained during the National Health and Nutrition Survey (NHANES) between 2005 and 2010. They studied data from 4,657 patients who completed a drug use questionnaire. Of these, 579 were current marijuana users, 1,975 had used marijuana in the past but were not current users, and 2,103 had never inhaled or ingested marijuana. Fasting insulin and glucose were measured via blood samples following a nine hour fast, and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated to evaluate insulin resistance.

Participants who reported using marijuana in the past month had lower levels of fasting insulin and HOMA-IR and higher levels of high-density lipoprotein cholesterol (HDL-C). These associations were weaker among those who reported using marijuana at least once, but not in the past thirty days, suggesting that the impact of marijuana use on insulin and insulin resistance exists during periods of recent use. Current users had 16% lower fasting insulin levels than participants who reported never having used marijuana in their lifetimes.

Large waist circumference is linked to diabetes risk. In the current study there were also significant associations between marijuana use and smaller waist circumferences.

"Previous epidemiologic studies have found lower prevalence rates of obesity and diabetes mellitus in marijuana users compared to people who have never used marijuana, suggesting a relationship between cannabinoids and peripheral metabolic processes, but ours is the first study to investigate the relationship between marijuana use and fasting insulin, glucose, and insulin resistance," says lead investigator Murray A. Mittleman, MD, DrPH, of the Cardiovascular Epidemiology Research Unit at the Beth Israel Deaconess Medical Center, Boston.

"It is possible that the inverse association in fasting insulin levels and insulin resistance seen among current marijuana users could be in part due to changes in usage patterns among those with a diagnosis of diabetes (i.e., those with diabetes may have been told to cease smoking). However, after we excluded those subjects with a diagnosis of diabetes mellitus, the associations between marijuana use and insulin levels, HOMA-IR, waist circumference, and HDL-C were similar and remained statistically significant," states Elizabeth Penner, MD, MPH, an author of the study.

Although people who smoke marijuana have higher average caloric intake levels than non-users, marijuana use has been associated with lower body-mass index (BMI) in two previous surveys. "The mechanisms underlying this paradox have not been determined and the impact of regular marijuana use on insulin resistance and cardiometabolic risk factors remains unknown," says coauthor Hannah Buettner.

The investigators acknowledge that data on marijuana use were self-reported and may be subject to underestimation or denial of illicit drug use. However, they point out, underestimation of drug use would likely yield results biased toward observing no association.

Editor-in-Chief Joseph S. Alpert, MD, Professor of Medicine at the University of Arizona College of Medicine, Tucson, comments, "These are indeed remarkable observations that are supported, as the authors note, by basic science experiments that came to similar conclusions.

"We desperately need a great deal more basic and clinical research into the short- and long-term effects of marijuana in a variety of clinical settings such as cancer, diabetes, and frailty of the elderly," continues Alpert." I would like to call on the NIH and the DEA to collaborate in developing policies to implement solid scientific investigations that would lead to information assisting physicians in the proper use and prescription of THC in its synthetic or herbal form."

 

Article orginally posted by Science Daily 

The regulation of medical marijuana in Los Angeles is a mess and has been ever since Proposition 215 was approved by California voters in November 1996.

The Senate passed House Bill 1325 on a 24-11 vote and it now heads to Gov. John Hickenlooper who has said he supports a marijuana DUI framework for the state.

Under HB 1325, drivers caught with 5 nanograms of THC, the psychoactive ingredient in marijuana which produces the "high" sensation, in their blood would be considered too stoned to drive and could be ticketed similarly to a person who was considered too drunk to drive.

The bill, which was just introduced last week, is an exact copy of another bill which was killed by the Senate earlier this year. Also last week, an identical measure which had been amended to House Bill 1317, the recreational marijuana regulatory framework proposal, was stripped from the bill in Senate committee. But this newly introduced stand-alone version appears poised to now become law.

As in previous years when marijuana DUI bills have come up for debate, opponents say that the 5 nanogram standard is too low for frequent pot smokers, especially medical marijuana patients, who regularly have this level of THC in the bloodstream and therefore, if passed, these people would lose their driving privileges, The Denver Post reports.

But HB-1325 allows for a person who has been charged with having 5 nanograms of THC in their blood to rebut the charge that they are too impaired to drive.

"For example, if you did not exhibit poor driving, you can put that on as evidence to say, 'Look my driving was not poor, I'm not unsafe to operate a motor vehicle,'"Rep. Mark Waller (R-Colorado Springs) said during earlier hearings of an identical bill which was killed.

All of the previous failed marijuana DUI bills were "per se" bills -- meaning if a driver tested above the legal 5 nanogram limit, the result would be an automatic conviction nearly every time.

But are drivers measurably impaired while under the influence of marijuana like they clearly are when under the influence of alcohol? That has been one of the core questions opponents of the bill have been asking about bills like these each year they are introduced. Westword spoke to Attorney Leonard Frieling in 2012 over last year's marijuana DUI bill who described the clear correlation between blood alcohol level and driving impairment -- the higher the blood alcohol level, the more impaired drivers are. But he questions the correlation between marijuana blood levels and driving impairment saying to Westword, "that appears not to hold true as cleanly with cannabis. So talking about impaired driving is one thing, but trying to give a number a meaning it doesn't have is something else entirely."

Last year Sen. Pat Steadman (D-Denver) spoke out about the issues that make marijuana blood limits problematic like the fact that THC is fat-soluable, so blood limits could remain above the 5 nanogram limit for days after the user last legally smoked pot, CBS4 reported. The user would not appear stoned, but legally they could still be considered impaired.

With this thinking in mind, Steadman tried to exempt medical marijuana patients in the bill -- as he'd done in years past -- but ultimately failed, according to Fox31.

This fact of THC's different effect on the body than alcohol's was stunningly shown in 2011 by Westword pot reporter William Breathes. After a night of sleep and not smoking pot for 15 hours, a sober Breathes still tested nearly three times higher than the proposed legal limit.

To add confusion to the matter, Washington state television station KIRO recently assembled a group of volunteers, had them smoke pot and set them loose on a driving test course to try and answer the question: How high is too high to drive?

The less-than-scientific results, while entertaining, unfortunately don't add much clarity to the question at hand. A regular smoker of marijuana tested above the legal limit to begin with, yet drove without much of a problem. Two casual smokers also navigated the course without incident. However, after smoking more marijuana, driving ability began to devolve quickly.

Washington state voters, along with voters in Colorado, passed recreational marijuana amendments last November, but Washington, unlike Colorado, already passed a marijuana DUI bill in 2012 setting the legal impairment standard at 5 nanograms in the state.

And in Washington, the enforcement of the law ultimately comes down to common sense. Explains Bob Calkins, a Washington State Patrol spokesman, to The Oregonian, "We don't just pull people over and draw blood... If you're driving OK, we're not going pull you over. But driving impaired is still driving impaired." Watch KIRO's full stoned driving segment here.

Article attributed to Matt Ferner, The Huffington Post