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June 29, 2014

Ms Dowd's Rocky Mountain High, Part 2

In the last entry,I pointed out that edible cannabis is processed very differently than smoke, primarily because it is swallowed; which means it must be broken down by the gastrointestinal tract. Thus rather than traveling immediately to the brain like smoke, the cannabis in a pot confection is digested , a process that takes 20-40 minutes and– so far as I can tell– has yet to be studied in detail in the modern era.

As soon as I read Ms Dowd's account of her edible misadventure, I knew her prominence as a New York Times columnist would evoke considerable commentary and was curious as to whether it would reflect any better understanding of the edible-smoke difference than I'd encountered in my patient histories a few years ago. The first author to deal with what I've come to think of as Dowd's Rocky Mountain High was Steve Wishnia, a medical marijuana advocate whose piece in the Daily Beast included quotes from several prominent medical marijuana supporters, all of whom agreed that edibles and smoke are indeed different, but gave multiple conflicting opinions about why that was so. Read in sequence, the reasons offered were laughably out of synch with basic anatomy and physiology as well as with each other.

Wishnia started out well, "the pharmacokinetics of marijuana—the way it is absorbed and excreted by the body—are different for smoking and eating." However, he then quoted psychologist Mitch Earleywine, a pyofrssor at the State University of New York in Albany, “Smoked or vaporized cannabis bypasses the liver and doesn’t create the same 11-hydroxy-THC." Wrong. The 11-hydroxy-THC idea is a canard dating back to a paper published in the Journal of Clinical Investigation in 1973 which did not specify how the 11-hydroxy-thc is produced and certainly did not consider the effect of liver processing on the products of enteric digestion. We now know that a plethora of complex molecules are found in 2 different strains (indica and sativa) of cannabis, each with its own plethora of individual components. The truth is that the liver has the last word on edible effects, which are far more complex than smoke because the liver breaks down complex cannabinoid digestion products (that have also been incompletely studied). The liver is clearly the basis for the "body high" which on the basis of patient data, seems more likely to be responsible for the benefits cannabis provides important (and to date unrecognized) relief to people afflicted by a relatively recent cluster of illnesses known as autoimmune disorders.

One would think that with all of the medical interest in marijuana since California opted to vote for "medical" use in 1996, that the physicians charged with finding out what its users found so good about it might have done a better job of learning why its chronic users liked it so much. One of the reasons for the fog of persistent ignorance has been the malevolence of the DEA, but that still doesn't account for why such a stupid and irrational law should remain the global default on an herb that appears to be the richest source of natural medicine ever encountered.

All of which prompts a logical question: can a species this stupid be saved from itself?

Doctor Tom

Posted by tjeffo at June 29, 2014 11:18 PM