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April 26, 2007
A Warning in the Mail
The other day, I received a ‘Dear Healthcare Professional’ letter from Sanofi-Aventis, makers of Ambien (zolpidem tartrate), a sedative/hypnotic drug heavily advertised in ‘Ask Your Doctor’ TV spots as an effective 'sleep aid' and claimed less problematic than old style sleeping pills. However, the letter from Sanofi-Aventis was a warning to prescribers that Ambien isn’t as safe as once believed. I was intrigued because my five year experience with cannabis applicants has made me very aware of insomnia; in fact, when specifically asked, ninety percent of my patients agree that cannabis helps them sleep and about 10% will cite it as the main benefit they derive from pot.
Among the several things I learned from the advisory letter is that insomnia, a symptom once ridiculed by Drug Czar McCaffrey as an indication for pot use, ‘may be the presenting manifestation of a physical and/or psychiatric disorder.’ Also, that Ambien, when combined with alcohol or other drugs may cause ‘abnormal behavior,’ so care should be taken not to use it with other therapeutic agents or alcohol. Patients should also only ingest it right before sleep, and even then, be alert to possible problems the next day (!).
All of which made me grateful my practice now deals only with the medical use of pot. For one thing, I have the peace of mind of knowing that all my patients are familiar with how it affects them; in fact most have been regular users for years. Additionally, pot has a unique safety record and its LD 50 has yet to be established. For the pharmacologically unintiated, the LD stands for ‘lethal dose’ and 50 is the percent of whatever experimental animal population one is working with. An LD 50 for mice would be the dose, expressed in grams or milligrams, of an agent required to kill half the mice in a colony of statistically significant size.
In other words, it’s been impossible to kill experimental animals with pot.
Nor have human human deaths from acute toxicity ever been reported; all of which renders the pejorative and highly speculative comments NIDA Director Nora Volkow offered in the wake of another of one of those now-famililiar ‘this is stronger than your father’s pot’ reports completely irrelevant. Besides, what I have learned beyond any reasonable doubt by directly questioning admitted users is that they prefer inhaling cannabis over eating it because it allows such precise control of its cognitive effects. I have also learned that once beyond their late teens, most minimized their consumption of both pot and alcohol.
Doctor Tom
Posted by tjeffo at April 26, 2007 07:17 PM