Archive for the ‘Motor vehicle accidents’ Category

Marijuana controversies: Part 2, state laws, health issues and DUI

Wednesday, March 6th, 2013

When I was a Veterans Administration Research and Education fellow (1970-1972) working inTorrance, CA, at Harbor General Hospital, I volunteered at the Long Beach Free Clinic once or twice a week to keep up my clinical skills. One evening I made an emergency "house call" across the street from the clinic at the headquarters of the "Peace and Freedom Party." I didn't know anything about that group, but as I attended to the ill member of the Party, I realized that many of those in the rooms I passed through were smoking pot.

It was clearly an illegal drug then, even in California, but my role there was that of a physician, not a policeman, so I just took care of my patient, eventually calling an ambulance to take him to a local hospital.

Fast forward to the 21st century.

Should this be legal for adults? Voters in Washington state and Colorado said, "yes."

Should this be legal for adults? Voters in Washington state and Colorado said, "yes."

Now a Colorado state amendment has legalized the drug as of December 10, 2012 with 55% of voters approving use, possession, cultivation and distribution by anyone 21 and older. A group called "Sensible Colorado" has outlined the development of Colorado laws regarding pot. As of March 1, 2013  a state task force on recreational marijuana has recommended special sales and excise taxes on it as well as rulings barring smoking it in bars, restaurant and social clubs. The group also said the plant should only be grown indoors, but could be sold to those visiting from out of state and given away, an ounce, at a time to adults.

In late February the Colorado House Judiciary Committee unanimously passed a Marijuana DUI bill, setting a 5 nanograms (ng) per milliliter of blood as the THC level as which a person could be ticketed for driving while impaired.

In past legislation, the 5 ng limit was considered a “per se” limit, which meant that if a driver’s blood level is 5 ng per milliliter of whole blood, the driver is assumed to not be in a fit state to drive safely. Similarly a driver's blood alcohol content (BAC) of .08 per milliliter is sufficient to issue a DUI ticket.

HB 1114 states that in a marijuana DUI prosecution , a jury may "infer" that a defendant was under the influence with a 5 ng level, but that defendant has the opportunity to prove that he/she was not impaired.

The 5 ng limit is based on the amount of active THC (delta 9 THC) in whole blood,  This form of THC functions for a short period of time following ingestion, typically from two to four hours. Latent THC, the kind that remains in the blood after active THC has dissipated, can remain in the blood for days after ingestion, according to a toxicology expert who testified in the Colorado hearings on the subject.

In early December, 2012 the state of Washington also legalized recreational marijuana for adults over 21. An article in the Huffington Post online said that there would be state licensing for those who grow pot, process it or sell it in a retail setting. Although smoking it in public is still illegal, much like drinking in public places, the Seattle Police Department told its officers not to issue citations for those who do so...pending further notice. Instead police officers will advise people to smoke pot at home. Washington's Initiative 502, much like Colorado's Amendment 64, allows the state to regulate and tax the drug's sale and sets limits for DUI.

The website of the Office of National Drug Control Policy says the Justice Department is reviewing these state initiatives and has no further comment at present. Federal law currently doesn't permit even medical marijuana, much less recreational pot use.

Gallup polls, as reported in a December 10, 2012 online review, show nearly two-thirds of Americans surveyed (64%) believe the federal government should not take active steps to enforce its policy on marijuana in states that have legalized its use.  Amazingly forty percent of those who oppose the legalization of pot still think this should be a state by state decision, decided by voters. Overall 48% of those surveyed were in favor of the drug being legal and 50% were against it. This is a marked change from the 1969 poll where only 12% wanted it to be legal or even 2005  when about one-third favored legalization.

As I would have expected, the survey results varied by age. Sixty percent of those under 30 are pro-marijuana; those in the 30 to 64 age range are equally divided into pro- and anti-pot camps and sixty percent of those 65 and old are against the new state laws.

A number of studies conclude that heroin, cocaine, alcohol and cigarettes are more dangerous to those who use them than marijuana. That by no means implies there aren't potential major issues with smoking pot. One of the physicians who commented on the New England Journal of Medicine discussion on medical marijuana had a mid-twenties patient with a 10-year history of smoking marijuana frequently and now needed a tracheotomy for cancer of the larynx. An online review of the medical dangers of marijuana focused on negative effects on the immune system, potential for carcinogenesis, and effects on memory and brain function, but some of its conclusions have been denied by other scientists.
DUI is DUI, but maybe we need to develop a better test.

DUI is DUI, but maybe we need to develop a better test.

A High Intensity Drug  Trafficking Areas (HIDTA) website comments that 9% of Washington eighth grade students, a fifth of 10th graders and over a quarter of seniors in high school are current marijuana users. Teen drivers are involved in motor vehicle accidents (MVAs) disproportionally and  data strongly suggest that marijuana users who drive have significantly increased rates of increased rates of MVAs. The combination of teens smoking pot and then driving is scary.

Are we at a tipping point concerning marijuana? It seems like that may be true.

If so, what will the next few years show about the risks of recreational pot use?

Spinal cord injury: Amazing News

Friday, June 1st, 2012

I read an incredible article in The New York Times yesterday; scientists in a Swiss lab have been able to overcome an experimental spinal cord injury in rats, enabling them to walk again. Today I found the original scientific publication and decided it was a major breakthrough, well worth translating into human terms and language.

There may be rocks below

Let's start with the human statistics; there are about 12,000 non-fatal, but severe spinal cord injury (SCI) cases in the United States every year. Half of those SCI lead to chronic paralysis and a quarter of a million people with significant SCI were alive in the US in 2010. Most of those suffered their injury when they were relatively young and 80% of them are male.

Motor vehicle accidents account for roughly 40% of those cases; the next most common cause is termed "falls," but a typical story for a fall would be a young guy who dives into a pool or a water-filled abandoned quarry, not knowing its actual depth, and strikes the bottom or a rock.

I found a thoughtful blog post on diving. The author gave five suggestions of which one is clearly the most important: "Think First." The others included "Steer up," "Hands up and out" and "Control your dive." The last was also crucial, "Don't drink or take drugs and dive."

Let's go back to the rats. The article was published online in Science and is densely packed with medical terminology (I'd suggest you read the NYT article). The rodents had a partial severing of their spinal cords at two different levels, leaving normal tissue in between and connecting the parts of the spine involved. This corresponds to somewhere between 25% and 33% of human spinal injuries. A week after their SCI, the rats began training for 30 minutes a day.

They were fitted with little vests, held upright on their rear legs and given a goal, a piece of cheese to move toward. At the same time their spines were stimulated electrically above and below the spinal areas partially cut and they got a chemical infusion of several drugs that affect nerve cell activity.

The initial voluntary steps began after 2-3 weeks of daily training and, at that point, the time of exercise was gradually increased. Five to six weeks after the initial SCI all the rats could initiate full weight-bearing steps while the combined electrical and chemical stimulation was being applied. Eventually they could climb stairs and avoid obstacles. They also had anatomic evidence of new neuron (nerve cell) connections around the injury and, higher up, in the brain stem.

Control rodents placed on treadmills did not recover the ability for voluntary motion.

A neurologist from UCSF who was not involved in the research study was quoted as saying, "There's a huge potential to refine this model to mimic more humanlike conditions."

A Stanford medical school website captures the essence of what's going on; this is neural plasticity, the building of new wiring patterns in the nervous system.

Is it possible?

A simpler comment would be that this research, if extended and then repeated in human subjects, may possibly bring hope to some of those afflicted with spinal cord injuries and maybe even diseases. Perhaps some who otherwise would have been wheelchair bound will be able to walk again.

It's not at all clear to me that this will work in people who had a SCI some time ago and it doesn't appear to be applicable to those who have a complete transection (total severing) of the cord.

Time, as always, will tell.