Eyeworld

EW NEWS & OPINION 18 March 2016 Insights by J.C. Noreika, MD, MBA suggest the malfeasance a fashion- able career move. Physicians have been interested in the products of hemp and Canna- bis sativa for centuries. Published in the Journal of Cannabis Therapeutics in 2001, Indalecio Lozano reviewed the role of hashish in Arabic medicine. In the 9th century, Ibn Masawayh was the first to describe curative properties attributable to hemp oil. Influenced by new transla- tions, he amplified the observations of Greek physicians Dioscorides and Galen written in the first and second centuries AD. Therapeutically, it was used as a purgative, diuretic, antiepi- leptic, analgesic, antipsychotic, and antiparasitic. In the 19th century, American physicians wrote of firsthand experi- ence with ingested hashish (hashish is extracted from the potent resin of the female cannabis flower). Dr. John Bell, Derry, N.H., published his findings in 1857. Writing in the Boston Medical and Surgical Journal, he prophetically asked, "Can this singular substance be put to any use- ful purpose, to illustrate any of the varied mental phenomena of health and disease? Is it worthy of a place in the medical armamentum, from its action alone upon the mind?" After personally experimenting with hashish, he thought it might pro- vide insight into psychosis and show therapeutic promise for depression (melancholia). Initially skeptical, he became fascinated by hashish's psychoneurological vibe. Over a hundred years later, UCLA ophthalmologist Robert Hepler and psychiatrist Ira Frank published a letter in the Journal of the American Medical Association attesting to marijuana's short-term and dose-dependent intraocular pressure lowering effect. In Part 2 of this series, I'll explore controversies muddling medical, political, and socioeco- nomic consequences of marijuana's legalization. Find the tie-dye, dust off the Grateful Dead vinyl, and don't bogart that doobie. EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for 35 years. Contact information Noreika: JCNMD@aol.com Although the sale of Cannabis sativa was restricted as early as 1860 in the U.S., the Marihuana (sic) Tax Act of 1937 essentially proscribed its use. Legislative maneuvering of its passage may resonate with today's physicians. The American Medical Association opposed the bill because it imposed a tax on doctors prescrib- ing cannabis. Pharmacists and cul- tivators of hemp products also were taxed. According to a July 12, 1937 transcript of the Library of Congress, the AMA's representative objected because "the bill had been prepared in secret without giving proper time to prepare (their) opposition to the bill." The bill was passed on October 1, 1937. Shortly thereafter, Moses Baca and Samuel Caldwell were arrested in Denver and convicted for not paying the tax. Both were remanded to Leavenworth Peni- tentiary—Baca for 18 months and Caldwell, the dealer, for 4 years. Arrested for possession of marijua- na in 1965, psychologist Timothy Leary took his case to the United States Supreme Court, which ruled parts of the Tax Act unconstitution- al. Subsequently, the U.S. Congress repealed the 1937 law upon passage of the Comprehensive Drug Abuse Prevention and Control Act of 1970. Possession of marijuana was illegal in all 50 states and a felony in 28. The list of stars, celebrities, athletes, and musicians—none more lionized than Bob Marley—who transgressed the 1970 law is extensive. Arrest, prosecution, and attendant publicity in Schlemm's canal, the trabecular meshwork and blood vessels of the ciliary body. CB1 receptors have been found in the retina. Do can- nabinoids offer a novel gateway to modulate aqueous production and outflow? The endocannabinoid sys- tem influences synaptic functional- ity and neuron survival after injury, inflammation and neurodegenera- tive disease. Research published in Finland and Britain postulates that cannabinoids have powerful anti- oxidant properties independent of CB1 and CB2 receptors. Intriguingly, neuroprotection may be afforded by reducing free radicals and subse- quent cellular apoptosis. Like much research involving cannabis, results are conflicting; other studies main- tain cannabinoids exhibit neurotox- ic effects. Pot, weed, dope, leaf, tea, grass, mary jane, ganja, sinsemilla, and wacky tabacky. Recreational drug use has been a human activity for millennia. In the literary tradition of Lord Byron, Baudelaire, Dumas, and Coleridge, the 20th century writers Allen Ginsburg, Jack Kerouac, and Hunter Thompson waxed lyrical- ly on its intoxicating properties. Steve Jobs, Carl Sagan, Steven Jay Gould, Oliver Sacks, and Richard Feynman are said to have indulged in its mind-altering capacity. Half of DNA's untanglers, Francis Crick, was a founding member of SOMA, a group founded by Oxford dons dedicated to marijuana's decriminal- ization. Future presidents have toked up, even if one famously didn't inhale. Part 1 of a 2-part series probes the medical, social, and political history of marijuana as states legalize its recreational use T he January 2016 issue of EyeWorld featured the article, "Are today's can- nabinoids therapeutic for glaucoma?" Although stud- ies date to 1970, its topic was timely. Twenty-three states and the District of Columbia have legalized the medical use of marijuana, ranging from possession limits of 1 ounce in Alaska, Montana, and Nevada, to a 60-day supply in Massachusetts. Sixteen other states have approved limited access to cannabidiols. Ballots in Alaska, Colorado, Ore- gon, Washington, and the District of Columbia have approved its recreational use. California voters who first approved medicinal usage in 1996 will decide legalization in November. Other states are certain to follow. Patients will query ophthal- mologists whether marijuana is a treatment option for glaucoma. Glaucoma is but a small piece of legalized marijuana's alchemy that, like the "Song of the Witches" in MacBeth, compounds components apocryphal, generational, political, unsettling, and ironic. Let's dispense with the ques- tion of marijuana for glaucoma. In 1999 and later updated, the Amer- ican Academy of Ophthalmology Complementary Therapy Task Force, chaired by Dr. Ivan Schwab, report- ed that, even if intraocular pressure is reduced by smoking or ingesting marijuana, there are better, safer drugs with far fewer side effects. Period, end of argument. Yet, a confounding question vexes researchers, viz., how does marijuana reduce intraocular pres- sure? Like the brain, the eye has CB1 and CB2 endocannabinoid recep- tors. These are tantalizingly found America's gone to pot J.C. Noreika, MD, MBA

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