Sunday, August 10, 2014

Marijuana and Pregnancy: What are the Risks?

Birth Institute: Better Birth, Better World
Pamela McColl, Publisher/Author
The use of marijuana (cannabis) has become a widely debated topic in the United States in recent times, and most have strong opinions about the medicinal or recreational use of this powerful plant. As some women consider using marijuana to treat issues such as morning sickness they are left wondering about the effects of marijuana on themselves and their baby while pregnant. In this piece, author Pamela McColl shares a few reasons that using marijuana during pregnancy may have detrimental effects on the child, and why it should be avoided, even as a medical treatment, during this critical time.
The public discussion and debate over marijuana, both as a recreational drug and for medicinal use, rages on.  
Negotiating through the rhetoric has left many of us searching for an objective, evidence based discussion.
In the context of maternity and marijuana there are specific, recent scientific findings that can assist in making appropriate choices for the well-being of mother and child.
We now have solid scientific findings that demonstrate that marijuana is not harmless, but a potent drug that can cause harm to the brain maturation in the fetus. 
It is critically important to understand the science of marijuana use in pregnancy to protect both mother and child.
Marijuana use during pregnancy interrupts fetal brain development.
This can result in permanent damage and compromise the development of future cognitive abilities (1).
It is the tetrahydrocannabinol (THC), the active ingredient in marijuana, that impacts the growth of the brain and this stage of the brain’s development.
Research conducted at the Icahn School of Medicine at Mount Sinai Hospital in New York, along with studies at the Medical University of Vienna and the Karolinska Institute in Stockholm, demonstrated that fetuses exposed to cannabis showed significantly lower levels of the protein needed for the development of cognitive abilities required to conduct planning, memory, decision making and organization functions.
Pregnant women need to know of the risks associated with marijuana use on the fetal brain and if they are using this drug either recreationally or for a relief of nausea associated with morning sickness.
Smoking marijuana during pregnancy has been shown to decrease baby’s birth weight, most likely due to the effects of carbon monoxide on the developing fetus (2). 
According to Dr. Andra Smith, Associate Professor at the University of Ottawa, School of Psychology: Yes, it might make the morning sickness subside but at what cost?
The long term consequences may well be far more damaging than the short term relief.
Marijuana crosses the placental barrier and has subtle effects on the newborn baby.
However, it is the longer lasting and more delayed effects on cognitive processing that are most alarming.
The prenatal exposure to cannabis contributes to a vulnerability of neurocognitive functioning that has been observed as early as 3 years of age and most strikingly continuing into young adulthood.
The growing evidence for a negative impact of prenatal cannabis exposure originates from three longitudinal studies worldwide.
Due to the wide range of lifestyle variables that contribute to both brain, body and mental health, prospective studies are required to ensure control of as many of these variables as possible.
This is the methodology that has been used for the Ottawa Prenatal Prospective Study (OPPS; 9) in Canada, the Maternal Health Practices and Child Development Project (MHPCDP; 10) in the US and the Generation R study in Europe (11).
Each of these studies investigated prenatal marijuana exposure in varying samples with different testing measures, and for these reasons all results are not comparable.
However, the significant results that are consistent across the OPPS and MHPCDP, the two studies that have tested children for the longest period of time, and include neurocognitive challenges in the areas of short-term memory, as well as verbal outcomes, aspects of attention, impulsivity and abstract visual skills (9,10,12,13).
These deficits appear after age 3 and continue into young adulthood (14,15).
Most significantly, at 6 years of age, children exposed prenatally to marijuana showed more impulsive and hyperactive behaviour.
This continued into adolescence and was accompanied by problems in abstract and visual reasoning, as well as visuo-perceptual functioning.
These are the types of skills required to perform “top down processing”, such as good decision making, organizing behaviour, setting goals and putting into action a plan to accomplish the goals.
Each of these cognitive processes can be grouped under the umbrella term of executive functioning.
Executive functioning is required for success in life, including schooling, relationships and work life.
Struggles can occur in these facets when executive functions are compromised, something that can occur with prenatal marijuana exposure (16).
Regular use during pregnancy is cause for concern.
In summary, prenatal marijuana exposure does have negative consequences on both the mother and child.
This impact should be known so that expectant mothers can make informed choices about how to treat their morning sickness and ultimately care for the future of their children.
Pamela McColl is a doula, tobacco prevention activist, author and publisher. In 2012, she published the first smoke-free edition of the famous poem “Twas The Night Before Christmas” to generate more discussion and awareness of the cultural influences that impact young children and their future use of tobacco products. The publication won seven book awards including four Benjamin Franklin Book Awards, a Moonbeam, a gold for Mom's Choice Awards and a Global International Ebook Award. Working on Baby and Me Tobacco Free brought Pamela's experience as a labor support doula and prenatal yoga to the discussion of tobacco cessation. Pamela continues to promote the need for greater prevention, education and assistance to those who find themselves wanting to stop the use of tobacco products.
[1] Giedd, J.N. (2004). Structural magnetic resonance imaging of the adolescent brain. Annals of the New York Academy of Sciences. 1021, 77-85.
[2] Hall, W. & Degenhard, L. (2009). Adverse health effects of non-medical cannabis use. Lancet. 374, 1383-1391.
[3] Tetrault, J.M. (2007). Effects of cannabis smoking on pulmonary function and respiratory complications: a systematic review. Archives of Internal Medicine. 167, 221-228.
[4] Hoffman, D., Brunnemann, K.D., Gori, G.B. & Wynder, E.E.L. (1975). On the carcinogenicity of marijuana smoke. In: V.C. Runeckles, Ed., Recent Advances in Phytochemistry. New York: Plenum.
[5] Moore, T.H., Zammit, S., Lingford-Hughes, A. et al., (2007). Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet. 370 (9584), 319-328.
[6] Large, M., Sharma, S., Compton, M., Slade, T. & Nielssen, O. (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry. 68(6), 555-561.
[7] Arseneault, L., Cannon, M, Poulton, R., Murray, R., Caspi, A., & Moffitt, T.E. (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal. 325, 1212-1213.
[8] Wagner, F.A., & Anthony, J.C. (2002). From first drug use to drug dependence; developmental periods of risk for dependence upon cannabis, cocaine, and alcohol. Neuropsychopharmacology. 26, 479-488.
[9] Fried, P.A. (1982). Marihuana use by pregnant women and effects on offspring: an update. Neurotoxicology and Teratology. 4, 451-454.
[10] Goldschmidt, L., Day, N.L., Richardson, G.A. (2000). Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicology and Teratology. 22, 325-336.
[11] Jaddoe, V.W.V., van Duijn, C.M., Franco, O.H., van der Heijden, A.J. et al., (2012). The Generation R Study: design and cohort update 2012. European Journal of Epidemiology. 27, 739-756.
[12] Fried, P.A. Watkinson, B. (2000). Visuoperceptual functioning differs in 9-12 year olds prenatally exposed to cigarettes and marijuana. Neurotoxicology and Teratology 22, 11-20.
[13] Richardson, G.A., Ryan, C., Willford, J et al., (2002). Prenatal alcohol and marijuana exposure: effects on neuropsychological outcomes at 10 years. Neurotoxicology and Teratology. 24, 309-320.
[14] Smith, A.M., Fried, P., Hogan, M., Cameron, I. (2006). Effects of prenatal marijuana on visuospatial working memory: An fMRI study in young adults. Neurotoxicology and Teratology. 28, 286-295.
[15] Smith, A.M., Fried, P., Hogan, M., Cameron, I. (2004). Effects of prenatal marijuana exposure on response inhibition: An fMRI study of young adults. Neurotoxicology and Teratology. 26(4), 533-542.
[16] Fried, P.A. & Smith, A. (2001). A literature review of the consequences of prenatal marihuana exposure: an emerging theme of a deficiency in aspects of executive function. Neurotoxicology and Teratology. 23, 1-11.

Saturday, August 9, 2014

Should Marijuana Be Rescheduled?

 - Co-founder, Project SAM (Smart Approaches to Marijuana) and Asst. Professor, University of Florida

Posted: 08/09/2014

Thanks to legalization advocates, an issue mostly confined to scholarly and legal debates -- that of the scheduling of drugs as laid out in the Controlled Substances Act (CSA) -- has recently gained prominence.
I address this at length in a recent Law Review article I wrote called "Much Ado About Nothing."

In short, the reason marijuana hasn't been rescheduled is because no product of whole, raw marijuana has a "currently accepted medical use" in the U.S., which is part of the legal definition of Schedule I defined by the Controlled Substances Act.
By contrast, Schedule II substances have a currently accepted medical use in the U.S. or a currently accepted medical use with severe restrictions (and, like Schedule I drugs, a high potential for abuse).

More importantly, regardless of the schedule, any substance may be prescribed by physicians and dispensed by pharmacists only when incorporated into specific FDA-approved products.
That is why Schedule II opioid products can be obtained in pharmacies by prescription, but raw opium, despite being in Schedule II, cannot be prescribed.

This fact is sometimes articulated as follows: "Schedule II substances may be prescribed."
This abbreviated description, however, is incomplete and has caused significant confusion.

"An approved product comprised of a Schedule II substance may be prescribed" or even "An approved product based on ingredients found in Schedule I substances can be prescribed" would be accurate statements.

So why doesn't whole marijuana have a "currently accepted medical use"?

Well, there have not been scientific studies, of adequate size and duration, showing that a product comprised of raw, whole marijuana (smoked or vaporized or otherwise ingested) has medicinal value.
FDA has never approved crude plant materials as a prescription medicine, partly because there is no way to administer it in defined doses and without any toxic by-products.
However, there have been studies showing that components or constituents within marijuana have medical value.

This is where many people get confused.
That is why both statements "marijuana has no medical value" and "marijuana is a medicine" are both untrue.

Which components within marijuana have accepted medicinal value?

At least one, and maybe even more than that.
Right now, a capsule, Marinol, entirely containing lab-made THC, the active ingredient in marijuana (e.g. what gets you high) is in Schedule III and widely available (though not often prescribed) at pharmacies.

Marinol was approved first for nausea/vomiting from cancer chemotherapy and again during the height of the AIDS epidemic, specifically for people who could not eat (scientists have long known that THC boosts appetite).
THC has also been tested (but not yet approved) as an analgesic - meaning it helps lessen severe pain (like the pain associated with cancer).

But we know that THC isn't the only interesting component in marijuana.
Recently scientists have discovered that CBD (Cannabidiol) has powerful anti-seizure and other therapeutic properties.

CBD does not get you high and barely exists in the modern marijuana found on the street today.
Some US state-sanctioned medical dispensaries do contain expensive, specially grown strains of smoked/ingested/extracted (in an oil, for example) marijuana with very high levels of CBD (and low levels of THC - not enough to get you high).

These products have not been properly tested and standardized, however.
So what about CBD as a product?

Almost two-dozen countries have approved a product comprised of an extract of marijuana that mainly contains CBD and THC called Sativex.
Sativex is an oral spray that does not get you high, and has been shown to have positive effects on spasticity associated with MS and severe cancer pain.

Sativex is currently in late-stage Phase III trials with the FDA.
So where does that leave us?

While raw marijuana does not meet criteria for a Schedule II drug, that doesn't mean we can't harness the medicinal value contained within it.
We do this with several drugs today, including a drug like GHB (a powerful Schedule I drug associated with date-rape).

A product called Xyrem is not Schedule I and is based on the active ingredient in GHB, prescribed for narcolepsy and loss of muscle control.
The issue of "scheduling" is distracting and essentially meaningless, since the differences between Schedules I and II are mainly technical.

That is why rescheduling marijuana would mainly serve as a symbolic victory for marijuana advocates - since it would do nothing to change marijuana's non-placement in the pharmacopeia or even decrease marijuana-specific penalties for use or trafficking.
Marijuana's components have medicinal value, though, like the Institute of Medicine (IOM) concluded in the most sweeping independent review of this issue, its future as a medicine does not lie in its smoked or ingested raw form.

Rather than promote a non-accountable system of "dispensaries" run by non-medical staff with ties to the underground economy and who sell marijuana to anyone with a pulse, groups like Project SAM (Smart Approaches to Marijuana) are trying to work with federal and state agencies to ensure we can study marijuana's medicinal value and develop pharmacy-obtainable medications that are safe and effective, with reliable dosage and known composition.
In the meantime we could even enroll the seriously ill into research programs, as long as they understand potential risks, so they can get these promising products today (including children with uncontrollable seizures).

Don't the seriously ill deserve at least that much?
Working on drug policy issues for more than eighteen years, Kevin Abraham Sabet, Ph.D., is an internationally-acclaimed expert on substance abuse. From 2009-2011, he served in the Obama Administration as the Senior Advisor to Director Kerlikowske at the White House Office of National Drug Control Policy (ONDCP). Representing his non-partisan commitment to drug policy, he previously worked on research, policy and speech writing at ONDCP in 2000 and from 2003-2004 in the Clinton and Bush Administrations, respectively. He remains the only staff member at ONDCP to hold a political appointment in both the Bush and Obama Administrations.

He is the co-founder, with Patrick J. Kennedy, of Project SAM: Smart Approaches to Marijuana.

Through, Dr. Sabet is currently is a consultant to numerous domestic and international organizations and his past and present clients include the United Nations, the U.S. Department of State, the National Institutes of Health, Community Anti-Drug Coalitions of America (CADCA), the Canadian Centre on Substance Abuse (CCSA), and other governmental and non-governmental agencies. He also currently holds a position at the University of Pennsylvania as a Fellow at the Center for Substance Abuse Solutions and is an adjunct professor in the Department of Psychiatry.

Dr. Sabet has published widely in peer-reviewed journals and books on the topics of drug policy, cocaine sentencing, legalization, marijuana decriminalization, medical marijuana, addiction treatment, drug prevention, crime, law enforcement, and other issues. He is a contributor to editorial pages and the television news media, including the Washington Post, New York Times, San Francisco Chronicle, CNN, CNBC, and more than a dozen other media outlets. Dr. Sabet first offered testimony on drug policy to the U.S. Senate Judiciary Committee in 1996.

As a Marshall Scholar, he received his Ph.D. and M.S. in Social Policy at Oxford University and B.A. in Political Science from the University of California, Berkeley. He currently lives in Cambridge, Massachusetts with his wife, Shahrzad, a Ph.D. candidate and instructor at Harvard University.

 Follow Kevin A. Sabet, Ph.D. on Twitter:

Friday, August 8, 2014


Dear All,

This article was originally published a few days ago.  Since then, today, August 05, 2014, the County of Santa Clara, CA (Silicon Valley) Board of Supervisors voted unanimously to ban marijuana dispensaries.  So much for the popularity of marijuana in California.

Additional article:  #1,
Link to August 05, 2014 County of Santa Clara Board of Supervisors meeting when they voted to ban marijuana dispensaries.

Best regards,

Ron Kirkish

The City of San Jose, California recently passed a medical marijuana ordinance that the Pro-Marijuana Advocates say is really a ban on medical marijuana dispensaries. 

In-other-words, the ordinance is a round hole while the dispensaries are square pegs……..and a fit is impossible.

San Jose, being the 3rd largest city in the State of California and the 10th largest in America, was expected to be a huge prize for the Pro-Marijuana Advocates in the hope to further their agenda to ultimately legalize marijuana in California and to also use it as a propaganda tool to convince other states to legalize marijuana.

As was expected, the Pro-Marijuana Advocates fought hard to override the recently approved medical marijuana ordinance.  Their leaders; Dave Hodges (owner of the All Cannabis Club), John Anthony (marijuana attorney), threatened San Jose Mayor Chuck Reed and the city administration that they were going to organize a “Occupy San Jose” protest and bring in thousands of protesters and to also gather signatures to place a referendum on the November/2014 ballot to override the ordinance.

After all the bluster and threatening remarks the planned attack on San Jose was a fizzle; a total failure.   

And this failure is a “Stake in the Heart” of the Pro-Marijuana Advocates as Californians across the state are saying “NO” to marijuana and have been since the defeat of Prop 19 in 2010.

It is a fact (and a statistic that the pro-marijuana advocates are trying to keep secret) that the “large” majority of cities (>200) and counties across California have already banned marijuana dispensaries in their communities.  And every attempt by the pro-marijuana advocates to attack these cities in the courts to override their bans has failed; all the way to the California Supreme Court.

Then on November 2, 2010, the Citizens of California defeated Proposition 19,to legalize pot by 53.5% of the popular vote. 

Fast forward to the 2012 ballot and the Citizens of California witnessed that the pot advocates were barely able to gather enough signatures to place a marijuana referendum on the ballot for four separate cities, and the citizens in every single city voted overwhelmingly to ban them, including the cities in the County of San Diego and Palo Alto of:

1.     Solana Beach (61.93% voted to ban),

2.     Del Mar (56% voted to ban),

3.     Lemon Grove (60.3% to voted ban)

4.     and PaloAlto (62.11% voted to ban). 

Then it should be remembered that the pro-pot advocates tried gathering signatures to place four separate measures on the November, 2014 ballot to legalize marijuana and each one failed miserably to obtain the required 504,760 signatures.

This huge failure in San Jose is yet another example of the continuing downward trend showing the world the pot heads are losing city after city, up and down California.

The Citizens of California have seen enough, have had enough and they’re taking California back!

Ronald L. Kirkish

Coalition for a Drug Free California – Member of the Board of Directors

International Faith Based Coalition

Citizens Against Legalizing Marijuana

Monday, August 4, 2014

That Voice in the Wilderness



Robert Charles | Aug 02, 2014 - Bio


Robert B. Charles is the former assistant secretary of state at the U.S. State Department's Bureau of International Narcotics and Law Enforcement Affairs. He served under Secretary of State Colin Powell

Vox clamantis in deserto

"A voice in the wilderness"
That phrase is from the Bible (Isaiah 40:3), but also happens to be the motto of my alma mater, Dartmouth College.
Although both the Bible and Dartmouth – the latter founded before the American Revolution by a man who arrived, literally, in "the wilderness" with 500 bibles – use the Latin (originally Greek) to mean slightly different things, the spirit of the phrase however is clear: Even one voice, speaking truth on its own, can make a difference.
Today, that one voice is the average American.

It is you.
It is me.

And the time has come to speak.

Why do I say this?
In the grand scheme of things, what difference does one voice make?

I say this because, not so long ago, that one voice was issuing from a little place called Jamestown, Virginia.
It was the voice of John Smith.

Common name, uncommon man.
And then the little voice was heard in Plymouth, Massachusetts.

It was the voice of William Bradford.
And then the voice seemed to come from a clutch of men in Virginia again, people like Patrick Henry, George Mason, James Madison, Thomas Jefferson, and yes a man who chose his words carefully, George Washington.

To the North again, the voice rose in the mouths of men like Paul Revere, Henry Knox and Nathaniel Greene.
To the South again, the wilderness heard Robert Howe and Horatio Gates, two of Washington’s other distinguished generals.

And before long, that voice - the voice of individual freedom, transcendent hope and the call to restoring both, was no longer one voice.
It was a small chorus.

Standing up for simple, God-given rights – that is for natural law rights – has a way of uniting people, calling forth “the better angels of our nature” (the last words President Lincoln’s first inaugural address, later cited by Reagan), waking them up, infusing them with common purpose.
The sheer common sense of a call to speak up for timeless rights – at a town meeting, school gathering, in a hearing on some new regulation, on a street corner or in a local paper, these days on a blog or on Facebook – can be both liberating and compelling.

Once that person speaks, however, others chime in.
Where submissive silence ruled, there is a choral call.

Often it is for a course correction, a return of rights taken, a rebalancing in the direction of individualism, progress through merit, effort, attitude and faith – a call to stop government intrusion and largess.
This is not just true in our time, but of all recorded history.

So, by no accident do we have our Bill of Rights – a document unique in the world when it was created – and a compelling case made to protect us from Federal Government overreach.
It was framed to protect us from a potentially powerful national government, not from States, although today it applies to both types of government overreach.

And it started – just as it must be preserved – by voices in the wilderness.
Voices like yours and mine.

Some voices are quiet and hard to hear, like those of a family and child unjustly torn apart by an act of the state, or those of a film maker jailed on the pretense that he caused an Ambassador's death, or those of thousands of combat veterans who are deserving of our best care and fullest honor, who want very little but got tricked, given less than they deserve, made to wait longer than many can ... by a national government that either does not understand or does not care.
That is why we have our voices.

This is when the chorus must, as they say, sing together, project with one voice, use the diaphragm – and use the heart – to speak with a common voice.
This is when sober, strong and well-reasoned voices must put down what they are doing, stand up and speak up.

As the resonance of the chorus grows, it draws to it and draws over those who share the conviction that individual liberty and freedom from government overreach is seminal, central, and important.
Voices not heard before begin to speak.

This is when average Americans must speak, too.
All of us.

Do you recall that earnest young man, with a face creased by worry or concern, perhaps even by the fear of public speaking, that was drawn by our famous American illustrator Norman Rockwell?
The piece has become iconic, celebrated in the pantheon of Rockwell classics called "The Four Freedoms."

It is a simple piece.
It is entitled simply, "Freedom of Speech," and first appeared on the cover of The Saturday Evening Post on February 20, 1943.

Our Nation was at war then, too.
Rockwell found his subject in real life, at a simple town meeting in New England.

A lot of truth seeking – and truth finding – occurs in such places, locally.
Here is a solitary American, speaking from the heart.

He stands in his day's work clothes, firm chin and clear eyes, respectful yet resolved, humble in demeanor but unwilling to bend or sit by in silence.
He is America Herself in a single portrait, that epic voice in the wilderness, an average American drawn to his feet – one senses reluctantly – by concerns on which he feels he must speak.

It is compelling, and has been for 70 years.
Look at it again, if only on line.

He is our vox clamantis in deserto, as he rises to his feet and stands tall to speak.
And note this: Those around him are listening.

So, here is the secret - two of them really.
First, that average American immortalized by Rockwell is just like me and you - and he has summoned the courage now to say, to those who must hear him, enough or too much or let us stop this foolishness or reconsider what you are doing or you are on the wrong track or there are more of us than you know, or some other caution that issues from his lips - driven there by a heavy heart, deep convictions.

And the second secret is this: He is speaking, through Rockwell, to you and to me.
He is reminding us - that America and Rockwell, just as all those earlier voices did, that we must summon the courage to say what we believe, draw ourselves to our feet, and to protect the rights they defended for us so that we would for them, and for those who will follow us.

We must also explain why these rights matter to us, to posterity, to antiquity and modernity alike.
Some of us will speak like Rockwell, others like that lone American in his work jacket, others cautiously like Washington, and still others like Patrick Henry, James Madison or our own grandparents.

But the point is this: Even a voice in the wilderness can be heard.
From that lone voice can spring the inspiration and courage, as well as an invitation to education and reawakening of convictions that make us all stronger.

Using our voice preserves the right to use our voice.

And more than that: Using our voice is how our democracy – and the rights it protects – will survive.
Indeed, that is the only way it will survive.

So join me and become, if you would, if you could, if you will, if you can, another voice in the wilderness.
Looking back, I think we are in good company, indeed we are in some very good company.

They set the standard high.
It is our turn.