12/23/20 Dr. Donald Tashkin

Cultural Baggage Radio Show
Donald Tashkin

From the International Conference on Cannabis Therapeutics: On today’s program we’ll hear from Dr. Donald Abrams from University of California, San Francisco. We’ll also hear from Dr. Donald Tashkin of NIDA, the National Institute on Drug Abuse and we’ll hear their opinions on the health consequences of using medical cannabis + "PoppyGate" with Glenn Greenway ++ 2 Drug Truth Network Editorials

Audio file

This is our interview, recorded at the International Conference on Cannabis Therapeutics held at the Asilomar facility on the beautiful, and windy, Monterey Peninsula, with Dr. Donald Abrams speaking about one of his major studies about the use of medical cannabis followed by an in depth interview with Dr. Donald Tashkin of NIDA whose studies show cannabis to be a safe medicine.

Dr. Abrams: And what we found in that study was that patients who were either smoking cannabis or taking the pill, compared to placebo, had no change in the level of the AIDS virus in their bloodstream, no significant change in the level of the AIDS drugs in their bloodstream, and if anything, the groups exposed to the cannabanoids may have had some improvement in their immune system.

We also found weight gain in both the people smoking and the people taking the dranabinol which, previously dranabinol had been shown to increase appetite but not weight, but this study was really too small and was not powered for that as an endpoint.

After that first NIDA study we were fortunate to be funded by the University of California Center for Medicinal Cannabis Research. The Center for Medicinal Cannabis Research allowed for funding of studies that may show that cannabis has a medical benefit, which NIDA, the National Institute on Drug Abuse, is really by a mandate of Congress is not allowed to fund.

They can only study substances of abuse as substances of abuse and not as therapies.

So with our funding from the Center for Medicinal Cannabis Research we did a randomized, double-blind, placebo controlled trial of cannabis, smoked cannabis, in patients with the AIDS related peripheral neuropathy, which is pain or tingling from nerve damage either from HIV itself or from the anti-viral drugs that we use to treat it.

And in this study we enrolled fifty patients, 25 smoked cannabis and 25 smoked placebo cannabis and we found that there was a statistically reduction in the symptom of pain from the peripheral neuropathy in the cannabis smokers compared to the placebo group. And we published that last year in the Journal of Neurology and that, I think, now makes it impossible for people to say that there’s no randomized placebo controlled clinical trial that shows that smoked cannabis has a medicinal benefit because that clearly shows it.

Dean Becker: There are those actors who roam the country, for instance Mr. John Walters, our nation’s drug czar, who ignore these stats and, as you say, indicate there are no recognized studies indicating positive benefits. What’s your thought in that regard?

Dr. Abrams: I think that, having worked now in this medical marijuana arena for the past 15 years, I’m not ever surprised that science does not win in the fight against politics.

We’re fighting a war on drugs in this country and it’s a shame that, unfortunately, we also are combatting patients who need the drugs at the same time. So we knew that, even if we showed that cannabis was effective for medical indication that people would still say ‘Well gee, patients don’t smoke a medicine.’

So another study that we completed that was published last year in Clinical Pharmacology and Therapeutics was a study in healthy marijuana smokers, aged 25 to 40, comparing smoking cannabis to vaporization, using a product called the Volcano Vaporizer.

This was the easiest study we ever enrolled because we paid these, you know, 25 to 40 year old marijuana smokers $600 for spending six days in our general clinical research center at San Francisco General and allowing them to either smoke or vaporize half of a NIDA cigarette on each day, three different strengths.

What we found in that study was that, checking the level of THC in the bloodstream it was really comparable in the patients who smoked compared to those who vaporized and the patients who vaporized had much less expired carbon monoxide, which is a marker for noxious products of combustion.

The interesting thing was that we also found that patients had very similar levels of the so-called ‘high’ and when we were getting the paper published one of the reviewers wanted to know how we measured ‘high’ and if there was a validated instrument for measuring ‘high’ and what the gold-standard was, which I thought was quite funny.

We just asked people to rate their ‘high’ on a 1 to 10 scale and, you know these reviewers are always interested in validated scales and what you compare it to.

We also found, and again this is using NIDA marijuana which is low potency and also freeze-dried that needs to be rehydrated, that out of the eighteen participants, fourteen actually preferred vaporization to smoking.

So with that data we’re now doing a study, which I think is really the sort of the end stage of the evolution of the studies that we’re doing and I think may be one of the most important ones, and that is looking for a potential interaction between cannabinoids and opiods.

So we’re taking patients with chronic pain who are on a stable dose of either morphine or oxycontin and we’re bringing them in to our general clinical research center at San Francisco General Hospital and we’re drawing on day one the levels of the opiod, the oxycontin or the morphine, in their blood stream and then we’re having them vaporize cannabis three times a day for four days and at the end of that period we’re again checking the level of the opiods in their bloodstream to see if there’s any interaction between the cannabinoids and the opiods.

And our hypothesis is that there will be an interaction and that, in fact, the cannabinoids will hopefully, or I think, will boost the levels of the opiods in the blood stream because anecdotally and in pre-clinical models people have suggested that cannabinoids and opiods work synergistically, that is the sum of the two is greater than additive, so you get a significant benefit to the pain relief from opiods if you combine it with cannabinoids.

And in this study, again, we’re using vaporization so that we don’t have to deal with peoples’ concerns about smoking. We’ve demonstrated that vaporization delivers equal amounts and is less toxic.

Dean Becker: You mentioned the use of the vaporizer and there’s also the edibles to cut down on the toxins, if you will, of normal smoking but it seems to me it’s all kind of hypocritical when you think of the damage done by the tobacco smoke in this country, the 400,000 people that die each year. Have you ever heard of a death from the use of marijuana?

Dr. Abrams: No. In fact I’ve been a doctor now, wow, how long have I been a doctor? I graduated medical school in 1977 so what is that? 31 years.

And what I always say is, working at San Francisco General Hospital where we see a lot of the ravages of people who are abusing substances, that I have admitted many, many patients due to consequences of the use of tobacco, alcohol, crack cocaine and heroin, and in my life over these past 31 years as a physician I can remember one patient admitted during my internship who had a complication from smoking marijuana that was laced with PCP, phencyclidine or angel dust, and had sort of a psychotic break but other than that, you know, I have not admitted a patient.

Nor have I seen, as a cancer specialist and somebody working with immunocompromised patients with HIV, any risk of aspersgillosis, which is the fungal lung infection that people always tout may be a risk of smoking marijuana--I think that might have come from the old days when marijuana was imported from Mexico on ships in palettes, the marijuana was sprayed with water to decrease the volume and put under tarps and was prone to get fungus at that time--but I don’t think that’s how most people are obtaining cannabis as medicine nowadays.

Dean Becker: If you would, talk to those doctors out there who may not be aware of marijuana’s efficacy, who may not be aware of the potential to cut down on the use of opiods and some of these other more harmful drugs. Give them a little pep talk. There’s information out there that might help them change their mind, right?

Dr. Abrams: So I’ve actually, myself, clinically stopped taking care of patients with HIV and I’m currently back to my roots and I’m taking care of cancer patients and what I do particularly is what I call integrative oncology.

I finished a two-year program in integrative medicine from Andrew Weil’s program at the University of Arizona where I learned much about nutrition, physical activity, botanicals and supplements, traditional Chinese medicine, mind-body medicine, the role of spirituality, so I see new cancer patients at our Osher Center for Integrative Medicine at the University of California, San Francisco, and I speak to them about integrating all of these other modalities into their cancer care.

And so very often I see patients in the beginning or the middle of their chemotherapy who are suffering from nausea, from vomiting, from weight loss, from pain from their cancer, from depression, from insomnia and, you know, it shocks me how their regular oncologist has failed to even suggest or comment that cannabis, one medicine, might be able to speak to all of these problems that their patients have.

I think, as far as a drug for symptom management, certainly in oncology, we don’t have much better than cannabis.

Dean Becker: That was Dr. Donald Abrams of University of California, San Francisco, talking about medical cannabis, speaking last week at the International Conference for Cannabis Therapeutics.

You are listening to the Cultural Baggage Show on the Drug Truth Network and Pacifica Radio.

(Musical Interlude)

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Made by God, prohibited by Man.

All right, next up we hear from Dr. Donald Tashkin, the UCLA lung specialist and government scientist funded by the National Institute on Drug Abuse. Here’s his take regarding tobacco as opposed to medical cannabis.

Dr. Tashkin: You are at risk of developing COBD, Chronic Obstructive Pulmonary Disease. This is manifested by an accelerated rate of loss of lung function over time as you grow older. We failed to find a similar relationship with marijuana. So that was one finding.

We are also interested in the, investigating the possibility that marijuana smoking might lead to lung cancer. Now lung cancer is largely attributed, mainly attributable to tobacco smoking.

And since marijuana and tobacco share similar ingredients including a number of carcinogens, it’s a reasonable hypothesis that smoking marijuana, at least heavily, over a long period of time could predispose to the development of lung cancer, maybe not to the same extent as tobacco but to a greater extent than if you didn’t smoke any marijuana or tobacco at all.

So we did a very large study which we call a ‘case-control’ study. And in that study we identified 600 patients who were diagnosed with lung cancer.

An additional 600 patients or so were diagnosed with, have neck cancer, throat cancer, lip cancer, tongue cancer, and over 1,000 control subjects who did not have cancer.

And then we administered a detailed questionnaire to all of these subjects including questions about marijuana use and tobacco use and family history of cancer and other putative risk factors that could predispose to cancer and the results were entirely negative--if anything, the risk for developing lung cancer was slightly less in relation to marijuana than no marijuana although not statistically significantly so.

Despite the fact that the study was designed as well as we could possibly design it and it included a large number of subjects, over 100 of whom smoked marijuana heavily, both among the cases and the controls, I think we can say with some confidence that there just is no evidence of an association between marijuana use and lung cancer.

On the other hand, very recently, earlier this year, another paper was published by New Zealand investigators who claimed that there was a positive relationship between marijuana smoking and lung cancer.

Now they studied far fewer patients than we did who smoked marijuana less heavily. In fact there were only about 79 cases of lung cancer and a few hundred controls. Their control subjects actually smoked less marijuana, about half as much marijuana, as our control subjects.

Yet they came to the rather amazing and implausible conclusion of a positive--quite a positive--association between marijuana and lung cancer which is similar to the association between tobacco and lung cancer, which is quite difficult to believe.

For example, in continuous analysis of their data they found that for each joint/year of marijuana, that is a joint a day for a year, the risk of developing lung cancer is increased by 8% over not smoking marijuana and it’s, the increase is similar for each pack/year of tobacco.

That means there, according to them, there is an equivalence between 365 joints and over 7,000 tobacco cigarettes with respect to the impact on the risk for developing lung cancer. I find that to be implausible.

Dean Becker: We are attending the International Conference on Cannabis Therapeutics and there are many here who think the government has, over the years, focused in the wrong direction--trying to impugn the good name, if you will, of marijuana and yet there are so many studies--even the American Academy of Physicians recently came out for changing our stance in that regard. Your thoughts, Sir. Has some of it indeed been propaganda over the years?

Dr. Tashkin: Well, I can say that the government agency that I deal with is a funding agency, it’s called the National Institute on Drug Abuse, and their funding policy I believe is quite fair because they have an independent body of scientists, for example my peers, who evaluate my research solely on the basis of science rather than on some agenda, some political agenda.

So I think it’s fair. Now that doesn’t say that there isn’t propaganda from other agencies of the government but the agency that I deal with I think is fair.

Dean Becker: Over the years the FDA has kind of dropped the ball in many instances in the last few years. Has it been a situation that the Administration has not focused so much on science and true regulation?

Dr. Tashkin: Well, that certainly is true of the present Administration which is the most disastrous Administration in the history of our country. (laughter) I’m going to get into trouble for this. (laughter)

Dean Becker: You are here to speak to this conference on cannabis therapeutics. I’m not asking you to relay the whole speech but could you give us a quick summary of what you’ll present?

Dr. Tashkin: Yes, actually I’m going to be presenting some of what I’ve already mentioned. I’m actually going to review the evidence regarding the question as to whether or not regular smoking of marijuana leads to Chronic Obstructive Pulmonary Disease--that consists of chronic bronchitis and emphysema, it’s the fourth leading cause of death in the U.S. and the world--and whether or not regular marijuana smoking leads to lung cancer, primarily.

And also there’s another question: does regular marijuana smoking predispose to pneumonia. We know that tobacco smoking does. And I could tell you that our own findings, our own findings from our own research, indicate that the answer to those three question appears to be negative.

Dean Becker: Doctor, I want to thank you for taking time to speak with us and I appreciate your candor. Now, I want to address one more thought. There are certain studies being conducted in Israel, Spain and other countries I believe which show that, I think, for brain gliomas and other cancers there are some indications that it may help in fact to prevent, or curtail, the growth of cancer cells. Why aren’t we doing more work like that in the U.S?

Dr. Tashkin: I believe that their work in that area is progressing and I’m not exactly sure where the investigators are located but there definitely are a number of studies that suggest an antitumoral effect of THC.

On the other hand, there are other animal studies, studies that we carried out, that actually suggest a protumoral effect of THC. So the bottom line is not what THC itself, which is only one ingredient in marijuana, does with respect to the growth and development of tumors or metastases of tumors but what happens in man.

And in order to determine what happens to man you really need to do population-based epidemiologic studies and that’s where our interest lies.

Dean Becker: I appreciate you coming to speak to this conference Sir.

Dr. Tashkin: Thank you.

(DTN promo) This is Gustavo de Greiff, former Attorney General of Colombia talking about the drug problem to the Drug Truth Network.

Dean Becker: Poppygate. Bizarre news about the U.S. policy on controlling heroin, featuring Glenn Greenway.

Glenn Greenway: The American-led mission to liberate Afghanistan has been hugely successful if one considers a 65-fold increase in heroin production 'success.' Since the U.S. invasion Afghan opium production has skyrocketed to unprecedented heights, its heroin filling the syringes of 19 of 20 consumers worldwide. The country's opium industry is responsible for over half its GDP and the illegal trade is by far its largest source of foreign investment.

Typically 10 grams of opium can be processed into one gram of heroin. New information from the UN indicates that Afghan poppies are now so morphine rich that only 7 grams of locally harvested opium are needed to produce one gram of heroin. Using this new conversion, if last year's entire Afghan opium bonanza had been refined, the country would have produced nearly 1,300 tons of pure heroin. In comparison, in 2001, the year of the America invasion, the impoverished country produced only about 20 tons.

Generally ranked as the fifth poorest country in the world, the average life expectancy of an Afghan is only 45 years. The American ambassador to Afghanistan, William Wood, puts it this way: "If you dropped Afghanistan into Africa, the Africans would wander around saying, 'That is a poor county.'"

Last week, Newsweek Magazine featured an article entitled 'The Opium Brides of Afghanistan' which tells the story of an Afghan farmer who had borrowed $2000 dollars from a local narcotics trafficker, promising repayment with 24 kilos of opium at harvest time. But just before harvest a U.S. backed eradication team plowed under his entire crop. In order to settle the debt, the local tribal elders are demanding his 10-year-old daughter be given to the 45-year-old trafficker in marriage.

The article continues, "No one knows how many debt weddings take place in Afghanistan. But Afghans say the number of loan brides keeps rising as poppy-eradication efforts push more farmers into default." In some districts as many as half of all marriages are said to be similarly transacted. Incredibly, girls as young as 2-months-old are reportedly being used to repay opium debts.

This is Glenn Greenway reporting for the Drug Truth Network.