Talk:Cannabis (drug)/Archive 7

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Merit to mentioning death count or toxicity

I haven't found any mention in the entry that draws attention to the near-non existent death count attributed to marijuana overdoses. This may be an important piece of information to integrate into the article. Perhaps we could site this source, which mentions "cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning", or this source, which states "deaths by overdose of cannabis are exceptionally rare. Fatalities happen most often after intravenous injection of hashish oil."

Death rates attributed to overdoses are mentioned in the general entries for other psychoactive and often-illicit substances, such as Cocaine, Amphetamine, Xanax, LSD, for instance. As such, there seems to be merit to integrating it into the entry for marijuana as well. Therewillbefact (talk) 22:26, 12 February 2012 (UTC)

I'd like to get input on this before editing the page. Anyone? Therewillbefact (talk) 07:10, 23 February 2012 (UTC)

Let's try it on for size, I guess. Part of me thinks that the absence of a death rate associated with marijuana is enough, but I suppose that a well written explanation using the sources you mentioned would benefit readers. KLP (talk) 19:14, 23 February 2012 (UTC)

I think an explicit note about the lack of toxicity-related deaths is valid and important. I suggest very careful phrasing to avoid edit wars. There are a number of studies that include proposed statistical links with non-toxicity deaths. For instance, a traffic death might be associated since THC appeared in the ME's tox panel; suicide might be related (whether causally or not) since drug use is higher among suicidal teens than non-suicidal ones, etc. Kevin/Last1in (talk) 19:44, 23 February 2012 (UTC)

Agreed. We should be clear that these death rates are only associated with overdose. Perhaps we can summarize this text, which mentions "deaths by overdose of cannabis are exceptionally rare. Fatalities happen most often after intravenous injection of hashish oil." I think this unambiguously tells readers that this rate is associated with overdose only. Therewillbefact (talk) 22:27, 25 February 2012 (UTC)

I'e gone ahead and made the edit under the Long-term effects section (third paragraph), as it seemed appropriate there. If it could use rewording or moving to another part of the article, please don't hesitate to edit. Thanks, Therewillbefact (talk) 00:01, 26 February 2012 (UTC)

Perfect summary. Based on other articles, however, I think toxicity/overdose info would fit better in 'effects' since it is related to immediate impact of exposure, not to long-term use. For instance, someone injecting hash oil (yuck!!) who has never been exposed to cannabis is as likely to achieve toxicity as one who injects it (still yuck) after a decade of weed-smoking. I will be editing the section tomorrow anyway (see Depersonalization mess, above) and will wait for feedback until then to make the change. Kevin/Last1in (talk) 15:59, 28 February 2012 (UTC)

Hmm, it does seem like it may be a better fit under Cannabis_(drug)#Effects. I take no issue with it, Kevin. Therewillbefact (talk) 01:23, 29 February 2012 (UTC)

• Change made today. Please discuss here before reverting. Kevin/Last1in (talk) 20:55, 8 March 2012 (UTC)

Marijuana: From Mexican Spanish?

Why does it say that the word marijuana comes from the Mexican Spanish word marihuana? I am a native Spanish speaker (not from Mexico), and, as far as I know, the word marihuana is used by Spanish speakers all around the world. At least I am sure that it is also used by speakers in Argentina, Colombia, and Spain, and it is actually the most usual word to refer to it in these three countries. — Preceding unsigned comment added by 190.156.105.135 (talk) 23:36, 17 April 2012 (UTC)

Nabiximols (Sativex): is it cannabis in UK law?

I have yet to find any UK government statement that nabiximols is cannabis for purposes of either the Misuse of Drugs Act 1971 (MDA), where cannabis is class B, or the Misuse of Drugs Regulations 2001 (MDRs), where cannabis is schedule 1, and government departments seem reluctant to respond to freedom of information requests on the issue

Generally, G W Pharma and the UK government are creating the impression that nabiximols is not cannabis, but for MDA and MDR purposes there seems to be nothing else it can be

See also Which ‘Controlled Drug’ is Sativex? at http://www.whatdotheyknow.com/request/which_controlled_drug_is_sativex, Is Sativex cannabis? at http://www.whatdotheyknow.com/request/is_sativex_cannabis and Sativex ingredients at http://www.whatdotheyknow.com/request/sativex_ingredients_2

The Advisory Council on the Misuse of Drugs (ACMD) has been adbvising since 2003 that 'Sativex' should be in schedule 4 part I of the MDRs

The MDRs are intended to regulate medicinal use of drugs classified as ‘controlled drugs’ in the MDA, and have five schedules, such that the degree of regulation is very high for schedule 1 drugs and very low for schedule 5 drugs

The opiates codeine and dihydrocodeine in ‘undivided doses’ of not more than 100mg, for example, are class B in the MDA and schedule 5 in the MDRs

There seems to be no crime of simple possession for schedule 5 drugs or schedule 4 part II drugs

Laurel Bush (talk) 12:55, 17 February 2012 (UTC)


See also my Sativex: a new tincture of cannabis article at http://www.spanglefish.com/laurelbush/index.asp?pageid=375588
Laurel Bush (talk) 12:22, 22 February 2012 (UTC)

Second hand smoke

The "Detection" section needs to be expanded to include discussion as to whether second hand smoke from marijuana can be detected. I just did a Google search and the results are about 50/50 yes and no, depending on the site (and often its bias). There is precedent where an Olympic athlete successfully defended his medals after being almost stripped of them during a Winter Olympics after he claimed he was exposed to second-hand marijuana smoke. There is also debate over whether a "contact high" is possible. I think adding this information is vital because with so many legalization efforts underway, it is inevitable that this issue will come up. And while it would be covered in the article on the topic of second hand smoke, I feel it's germaine to this topic too. There's certainly enough reputable sources and research out there to present it in an NPOV manner. 70.72.223.215 (talk) 15:25, 20 April 2012 (UTC)

Request for an addition

I am not able to edit this article, but there is an addition that you may find worthy of inclusion. This sentence appears in the "zinc" article - "In 2011, researchers at John Jay College of Criminal Justice reported that dietary zinc supplements can mask the presence of drugs in urine. Similar claims have been made in web forums on that topic.[135]" The reference is to a published report from a respected clinical journal and done by a very reputable school. Here is the reference: http://jat.oxfordjournals.org/content/35/6/333.short — Preceding unsigned comment added by Thenhl15 (talk • contribs) 17:36, 23 April 2012 (UTC)

Seeing as I don't know how to make new sections or really how this shit works at all, I thought it would be prudent to provide this information here for better or worse: http://digg.com/newsbar/topnews/how_cannabis_use_during_adolescence_affects_brain_regions_associated_with_schizophrenia

This links to ScienceDaily and provides the following information:

New research from the Royal College of Surgeons in Ireland (RCSI) published in Nature's Neuropsychopharmacology has shown physical changes to exist in specific brain areas implicated in schizophrenia following the use of cannabis during adolescence. The research has shown how cannabis use during adolescence can interact with a gene, called the COMT gene, to cause physical changes in the brain.

Inaccurate side effects subsection.

The subsection side effects has questionable info from only one source. Cannabis is known to reduce nausea and vomiting. The part about leukemia is from a secondary source and not actually from the cancer research institute. Information needs to be checked or removed. — Preceding unsigned comment added by 180.191.29.55 (talk) 09:58, 25 April 2012 (UTC)

The section was created yesterday and cites a single, tertiary source (Medscape, a subsidiary of WebMD) that does not provide links to substantiating primary or secondary sources. Per WP:RSMED (emphases added), "Peer reviewed medical information resources such as WebMD... are usually acceptable sources in themselves, and can be useful guides about the relevant medical literature and how much weight to give different sources; however, as much as possible Wikipedia articles should cite the more established literature directly." As contentious as the cannabis debate is, I think any proposed Side Effect section must reference verifiable and peer-reviewed sources that readers can use. I also have grave doubts about the section name; cannabis has no "on-label" uses, so how do we delineate between effects and "side" effects? I am parking the section here until reliable, secondary, verifiable sources can be added. Let's find some solid evidence and come to consensus on whether (and where) this info should go in the article. Please do not re-add this section or this info to the article without discussion here. Cheers, Kevin/Last1in (talk) 19:09, 25 April 2012 (UTC)

• While cannabis has many medical uses, it also has many severely negative side effects. These include but are not limited to; Vomiting, Nausea, Anxiety, Paranoia, Hallucinations, Fatigue, Dizziness, Anorexia, Tooth discoloration, and Diarrhea.
• The Children’s Cancer Study Group reported a 10-fold increase of Leukemia among children whose mothers used cannabis while pregnant.

[This article] discusses Cannabinoid Hyperemesis Syndrome, which includes nausea and vomiting as symptoms. The Children's Cancer Study is real, but [here is a study] which came to the opposite conclusion. There's plenty of information on pot causing anxiety and paranoia. I didn't see anything showing a positive association between marijuana use and anorexia (just the opposite, actually.) I found a small study on chronic, heavy users experiencing hallucinations, but would like to see more on this. I didn't look for fatigue or dizziness, but I'm guessing it could be found.

In short, I think what was posted is mostly accurate, but needs to be reworded and we can add better citations.

Side-effect doesn't have to be used in the clinical sense. I don't think anyone uses pot because they want to feel nausuous, so I think it'd be safe to label that a side-effect. But, if that's an issue, we can just label everything as a "potential effect" or something along those lines.

Finally, I've said it before and I'll say it again -- there appear to be editors on this page who seem to fall into one of two camps: Those who think pot is evil, highly addictive, and must be publicly denounced; and those who think pot is completely benign, and will cure a host of illnesses, solve deforestation issues, etc. etc. The science shows both of these arguments to be false. Pot has active ingredients, some of which are harmful to humans; there is also evidence that it can have some positive impacts for certain illnesses. If you disagree with this statement, you shouldn't be editing this page because you lack objectivity on this issue. (I am NOT directing this rant to any one in particular, just a general statement to any editors working on this page.)JoelWhy (talk) 20:04, 25 April 2012 (UTC)

Agreed on all points, especially the last. Contentious articles seem to have been polarised over the last couple years. Where previously there were a dozen positions jostling for neutrality, everyone has suddenly decided to pick either "us" or "them" and fight to the death. Black-and-white thinking is incredibly dangerous in a particolour world - I use the neologism Wikibivalence for it's prevalence here. On this article, I lean toward a rather Prefectian view on cannabis. However, I mainly care about keeping invective (on both sides) out and trying to find valid science to support whatever ends up here.

I am allergic to the pseudoscientific propaganda (on both sides) that seem to clog the debate. I distrust studies funded by any group (like NORML or the post-1937 US Government) with a vested stake in the outcome. I pulled & parked the new info because the single source reeks with hints it falls into that category. <snark> Begin snarky comments; feel free to ignore: Medscape lists hypotension and hypertension as well as diarrhea and constipation as adverse effects. Cannabis causes AND cures the same condition? Cool! They also list drugs where cannabis should be avoided or closely monitored. The list is over 450 drugs long. Seriously? No one can find a single reliable source for carboxyhemoglobin (which is something of a given with any inhaled smoke) but Medscape has definitive proof of "Significant" interference between cannabis and Temsirolimus - a drug that didn't even exist six years ago? Sorry, but I don't buy it without reputable sources that I can read for myself, and I shy away from anything that does not offer the reader a way to evaluate their conclusions. </snark> I think that cannabis has definite effects, some of which are inimical or undesired; I just don't think that this cite is a valid foundation on which to build a section. Cheers & Thanks, Kevin/Last1in (talk) 00:52, 26 April 2012 (UTC)

The editing by Jakebarrington (talk · contribs) is pushing a negative POV with sources that don't meet WP:RSMED.

1. The medscape source, who knows where that info comes from. Do they accept user submitted content? Because I don't see any evidence backing up those claims.
2. EGetGoing, a website dedicated to drug treatment. Not NPOV.
3. Livestrong, which we all know is dedicated to cancer, which cites references that are clearly anti-cannabis.
4. This Harvard source appears to be someone affiliated with the universities' personal web page, and not based on hard science. It also references some articles with a clear anti-cannabis slant and nothing to balance it out.
5. A California government source that rehashes some evidence in a political manner. We don't know that the politicians involved assessed all of the evidence, or selected only the anti-cannabis data. The research articles it references could be included, but not this report.

– Muboshgu (talk) 20:34, 27 April 2012 (UTC)

Completely agree, those sources could be biased. We must use only reliable medical sources, as explained in Wikipedia:Identifying reliable sources (medicine). --KDesk (talk) 21:29, 27 April 2012 (UTC)

Would you mind removing the last edit then? I would, but I don't want to cross 3RR myself. – Muboshgu (talk) 21:40, 27 April 2012 (UTC)

Done, content removed. User:Jakebarrington has already broken the 3RR rule. --KDesk (talk) 17:48, 28 April 2012 (UTC)

You broke the 3RR rule too. — Preceding unsigned comment added by Jakebarrington (talk • contribs) 01:53, 29 April 2012‎

I posted what I thought was a nice, non-confrontational note on Jakebarrington's talk page commending his efforts and invited him to discuss it here so we could reach consensus: "The edits you made to Cannabis (drug) need some refinement in order to get them up to WP:RSMED. Rather than watch an edit war unfold (something far too common in that article), I moved your work to the Talk Page until it can be beefed up with secondary sources. I did not do this because I disagree with the conclusions (I do, actually, but my beliefs don't really belong in an encyclopedia). As written, though, it was almost certain to be reverted. I look forward to working with you on the article" In response he posted to my talk page, "Don't take it down again."

I see that Jakebarrington reverted again, an I will once again remove the section until it can be substantiated. I oppose the section as written for the reasons enumerated above. I am posting a conciliatory message aboutWP:CYCLE and WP:FAITH to Jakebarrington's talk page along with a suggestion to read WP:COOL and WP:CIVIL. In the mean time, I continue to search for secondary sources that support the tertiary ones cited. I still feel that the Side Effect header is unnecessary as many of the effects discussed in existing sections are clearly undesired (or I'd THINK psychosis and lung disease would be undesirable to most people, but who am I to judge). Cheers & Thanks, Kevin/Last1in (talk) 21:02, 28 April 2012 (UTC)

Addressing the sources:

Medscape does not accept user content, it is run by MD and PHD trained doctors. The Harvard information is based on research and scientific evidence found by Harvard students and their respective professors. Live Strong and egetgoing.com: Yes, anti-cancer organizations but the articles are based on scientific evidence, knowledge, and research. California website: Yes, linked to the government, but once again, scientific evidence. If you would like me to find new sources feel free to ask.

Alright listen, apparently somehow my statements (even though backed by science) are false. So, I will change it based on clinical evidence provided by the mayo clinic (linked to one of the top medical schools in the nation). See below.

Proposed replacement: Although cannabis has several medical benefits it also has a chance of causing some negative side effects. These include; low blood pressure, increased risk of bleeding, and drowsiness or sedation. Health-care professionals are advised to closely monitor the blood sugar levels of patients who have taken, are taking, or plan to take cannabis.

Is this good? How about the sources? Where should it go in the document? — Preceding unsigned comment added by Jakebarrington (talk • contribs) 02:05, 29 April 2012 (UTC)

THANK YOU for discussing this here on the Talk Page. It is greatly appreciated. The problem with your original citations, and with the current source, is that the only thing that can be verified is that MayoClinic.com, certainly an excellent source, says something. The reason that WP:RSMED is so different from other topics is the needs for an encyclopedia to be a resource that leads people to understanding a subject. If the article were about an historical event, a citation from an eminent historian would lead the reader to the books or articles the historian has written so the reader can obtain a deeper understand of the subject. With medical research, the reason secondary sources are preferred because they give the reader a summary and several primary sources to go to for more. The sources you're using are dead ends - it's a rhetorical fallacy called argumentum ad verecundiam; Mayo Clinic (or Medscape or LiveStrong or Harvard Law) say X and since things they say are often true, X must be true.

JoelWhy's addition above regarding Cannabinoid Hyperemesis Syndrome is a great example. His link led to this summary, a great synthesis of a half-dozen studies including the primary source JoelWhy cites that calls into question the conclusions of that single study and lets the reader pursue the research. I found several other, similar secondary sources. We might include it in the Long-term Effects section, but it will likely be reverted as undue weight considering the amount of counter-info available.

To add the info you propose, you need secondary sources that lead back to viable, verifiable, peer-reviewed medical studies. I'd suggest you read through the citations and Talk Pages for Effects of cannabis and Long-term effects of cannabis to avoid repeating the same gaffs that tripped folks up in those articles.

Lastly, Jakebarrington, you have reverted this information six times. The section was in consensus prior to the edits you made. The section you added is not viable as written, is likely not worthy of its own section at all and the sources are definitely not compliant with WP:RSMED. It really must be discussed here and reach consensus. I will ask an Admin to strike the section again and ensure that it does not get added again until this conversation reaches consensus. As I asked on your Talk Page, please consider the info on WP:CALM and WP:CYCLE. You are obviously a talented and passionate editor, but PLEASE read and abide by the Five Pillars. Cheer & Thanks, Kevin/Last1in (talk) 13:31, 29 April 2012 (UTC)

I am in the process of gathering sources. I will consult here before making any changes to the actual article. Jakebarrington (talk) 14:17, 29 April 2012 (UTC)

Marijuana and Memory

Smoking cannabis has a significant effect on the user’s ability to recall information from memory, specifically larger sequences or amounts of words. THC receptors are prevalent in the hippocampus, a structure that consolidates short-term memories to long-term. Cannabis activates pyramidal hippocampal cells that play a role in long-term potentiation of memories, and over-activation of these cells disrupts normal cell functions. THC use has shown to have a more sever effect on memory processes necessary to share stories, and more simply, remember lists of consecutive words. One test composed of twelve subjects showed significant evidence of impaired immediate and delayed recall. Subjects were given three attempts to memorize a list of ten semantically unrelated words. The subjects averaged twice as many omissions and nearly six times as many intrusions while trying to remember those words five minutes later. An intrusion was defined as the mistake of recalling a word or phrase used in a prior test, but not for the test at hand. A study performed on adolescent marijuana users claimed that subjects exhibit a loss in short-term memory performance for at least six weeks past last marijuana use. 128.173.58.231 (talk) 07:12, 1 May 2012 (UTC)

And, how does it compare to the effects of alcohol on memory? Alcohol dementia? Viriditas (talk) 09:09, 1 May 2012 (UTC)

Mentioned already in the article: "Aside from a subjective change in perception and, most notably, mood, the most common short-term physical and neurological effects include increased heart rate, lowered blood pressure, impairment of short-term and working memory,[11] psychomotor coordination, and concentration."--Louiedog (talk) 19:40, 1 May 2012 (UTC)

Overdoses/toxicity

We currently reference this paper for:

There are no verified human deaths associated with cannabis overdose. Recorded fatalities resulting from cannabis overdose in animals are also exceptionally rare, generally only after intravenous injection of hashish oil.

This isn't a very good source for these reasons:

• I'm not sure that anyone has got hold of a copy of the full paper - I have access to a very large academic library and can't even find a paper version, let alone a pdf. Searching for the journal name in google doesn't bring anything up either.
• Judging from the title and abstract, the paper is about detecting cannabis, but not really about the toxicology. If the quote above is correct then there should be plenty of other papers that say the same thing that we can access. A search in google scholar for various terms like "intravenous hashish toxic" "intravenous cannabis toxic" etc. bought up nothing.

Can anyone find some better sources for any of this? I'll also ask at WP:REX to see if anyone can find the source we use at the moment. SmartSE (talk) 21:23, 14 May 2012 (UTC)

For some context on this edit, please see this discussion. We had some trouble finding sources that were explicitly dedicated to stating marijuana overdose rates. If you would like to propose any revisions, or if you have a more appropriate source in mind that you would like to use, please don't hesitate to make suggestions. FactoidDroid (talk) 02:54, 15 May 2012 (UTC)

Thanks for the link. Am I correct that you haven't read a full copy of the source then? If that's the case then we should remove the content - using abstracts as sources is a very bad idea, particularly for something like this - if there aren't any sources dedicated to it then we shouldn't be trying to cover it. It doesn't fit in with Effects_of_cannabis#Toxicity and Tetrahydrocannabinol#Toxicity either. I'll try and get a copy of the paper from the author to see what it references. SmartSE (talk) 12:25, 16 May 2012 (UTC)

I try to read through the articles when I find them. But, I admit that I sometimes am not able to access the full articles and must rely upon the abstracts on Pubmed. I recognize that this isn't the ideal option, but it's sometimes the only option available. Ultimately, I believe the issue boils down to there not being substantial research on the subject. My main concern is trying to keep this article accurate and NPOV. This page seems to attract a good number of zealots on both sides of the debate, but I do believe the edits of late have been much improved.JoelWhy (talk) 12:52, 16 May 2012 (UTC)

Gateway drug theory

The content in question: "A new user of cannabis who feels there is a difference between anti-drug information and their own experiences will apply this distrust to public information about other, more powerful drugs." There is no source for this information. It also sounds more like a conclusion based on one's own opinion/experience than fact. Thoughts? ZacJB (talk) 03:24, 25 May 2012 (UTC)

Agreed, content removed.JoelWhy (talk) 12:26, 25 May 2012 (UTC)

Thank you for the consideration. ZacJB (talk) 19:14, 25 May 2012 (UTC)

"Long term effects are less clear"

This is a clear example of bias in favour of anti-marijuana groups, there is absolutely no scientific evidence to support the belief of long term effects specific to use of marijuana and so the existence of them should not even be suggested in a neutral encyclopedia. Please edit this section to better describe the nature of long term effects of marijuana (no evidence), obvious bias have no place in a neutral encyclopedia. — Preceding unsigned comment added by 74.216.38.222 (talk) 01:48, 28 June 2012 (UTC)

No evidence? Dude, don't be ridiculous. Everything in that section is backed up with references (in other words, "evidence"). To try to make a blanket statement that there is "no evidence" seems pretty biased to me. (Full disclosure: I use cannabis, and I advocate for its legalization and de-stigmatization in society. But I stand firmly against trying to suppress evidence brought forward by scientists.) Belchfire (talk) 04:08, 28 June 2012 (UTC)

Cannabinoid hyperemesis syndrome should be included in the long term effects of this article. — Preceding unsigned comment added by 90.199.4.240 (talk) 17:01, 15 July 2012 (UTC)

Edit request on 16 June 2012

please add "From what we know, it seems that any amount of marijuana, however small or infrequent, has the potential to trigger chronic depersonalization in a person who is particularly vulnerable." the reliable source is Feeling Unreal: Depersonalization Disorder and the Loss of the Self By Daphne Simeon, Jeffrey Abugel Mmarcus100 (talk) 06:56, 16 June 2012 (UTC)

Not done: Article already says this, in a way. We need to keep neutral, so we can't just say that Mdann52 (talk) 16:11, 16 June 2012 (UTC)

Cannabis use damaging DNA

I'm fine with not using the previously cited source. Here are some better sources we can use:

http://www.sciencedaily.com/releases/2009/06/090615095940.htm http://www.cosmosmagazine.com/news/2926/marijuana-smoke-more-damaging-thought JoelWhy? talk 13:05, 18 June 2012 (UTC)

I don't see why there can't be a sentence mentioning that cannabis smoking has some risks that are similar to smoking other vegetable substances (especially since there are sources), but the string of "cannabis vs. tobacco" comparisons removed yesterday was obvious anti-drug propaganda that doesn't have a place in a neutral encyclopedic article. Belchfire (talk) 19:45, 18 June 2012 (UTC)

History: dope vs rope

In the last paragraph of the section "History", does anything after “In 1937 in the United States, the Marihuana Tax Act was passed” actually relate to marijuana? Isn't “and prohibited the production of hemp ... material.” referring to rope? The first sentence of the article has “intended for use as a psychoactive drug and as medicine.” Isn't the Mellon/Hearst/DuPont angle a plausible, but unrelated, urban myth? It is common now to hook unrelated garbage on to the end of a bill, these three were certainly aware of the idea in '37, correct? The law was aimed at getting high, these guys just got greedy? Two birds with one stone? Enough real controversy here? — Preceding unsigned comment added by 99.36.25.10 (talk) 15:09, 11 July 2012 (UTC)

• This section has not been addressed since 31 Jul 2009. — Preceding unsigned comment added by 99.36.25.10 (talk) 17:05, 27 July 2012 (UTC)

You've phrased that as a series of questions, but it seems like you think some action ought to be taken. Can you be clearer about what action you think is called for? Looie496 (talk) 17:18, 27 July 2012 (UTC)

I propose that everything after "In 1937 in the United States, the Marihuana Tax Act was passed" be deleted. In addition, reference 101, 102, and 103 only mention the act in passing, focusing on the "conspiracy" instead. Although they do source the act's passage, could a cleaner (less conspiratorial) source be used?

The act of '37 may need elaboration, but is corporate greed the way to go? Just an opinion.

I hoped to promote a discussion, other parts of this article are active. But that's about my limit, I cannot effectively edit. — Preceding unsigned comment added by 99.36.25.10 (talk) 19:31, 27 July 2012 (UTC)

Two topics not covered

This rather comprehensive article is missing a couple of topics that may be touched on elsewhere but should perhaps be touched on here as well. First is the topic of passive/second hand exposure. When Ross Rebagliati was briefly stripped of a gold medal at the Nagano Olympics on the basis of having THC in his system, he claimed that it was due to second-hand exposure which set something of a precedent for such exposure perhaps triggering drug tests. So what, if anything, is the impact of passive marijuana smoke? Can one get a second-hand high from it or is it diluted significantly once it exits someone's lungs? What about someone living in an apartment next door to one where a vaporizer is used? This would be an interesting topic of discussion. The second has to do with the pricing section, where it mentions how much it costs per gram to buy the stuff. But how many grams go into the average joint? Or a vaporizer. Or a brownie? It might provide more context as to how much people pay to smoke a joint, and would also possibly tie into other discussion in the article about how some combine marijuana with tobacco cigarettes. I think both topics can be discussed in an NPOV fashion. 70.72.211.35 (talk) 01:28, 22 August 2012 (UTC)

Effects of Cannabis

Hello, I just figured out how to add a new heading. Please forgive any perceived stubbornness in my reposting of the following disputed text:

Every year, dozens of deaths linked to marijuana are recorded across the USA in every major metropolitan city by medical examiners and coroners in association with the Drug Abuse Warning Network. Their lists of mortality publications even includes two instances of death directly considered as marijuana overdoses by the attending coroner.

I was told by ohonoitsjaime and that I needed to do a better job sourcing. What is meant by this? My citations need to be better written? The sources aren't formatted properly?

The text as it stands now is simply factually incorrect: "There are no verified human deaths associated with cannabis overdose." The DAWN network has coroners and medical examiners participating from 13 states in the USA that all confirm marijuana related deaths every year since they have been keeping track. What is the best way to format these facts into this page?

Thank you. — Preceding unsigned comment added by GUIB Corrector (talk • contribs) 05:03, 29 August 2012 (UTC)

Doesn't seem like a very reliable source. --John (talk) 05:37, 29 August 2012 (UTC)

It doesn't seem like a reliable source? Coroners and medical examiners from 13 states, a total of 450 counties participated in 2010 alone to collect this mortality data. http://www.samhsa.gov/data/2k12/DAWNMEAnnualReport2010/DAWN-ME-AnnualReport2010.htm#Part Who is more reliable than a coroner or a medical examiner to determine what the cause of death is?

Again, from the previous link, it was prepared by the following: This report was prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), and by RTI International (a trade name of Research Triangle Institute, Research Triangle Park, NC). Work by RTI was performed under contract number HHSS283200700002I with SAMHSA. I am sorry, but to say that data from thirteen US states over the past decade is not a reliable source seems disingenuous. What would you consider a reliable source if this isn't? GUIB Corrector (talk) 12:07, 29 August 2012 (UTC)

The source seems to be OK. It certainly negates the present statement that "There are no verified human deaths associated with cannabis overdose." The claimed safety of the drug is not supported. Rlsheehan (talk) 13:51, 29 August 2012 (UTC)

No, Drugwatch is an advocacy website which states that it "promotes the creation of healthy drug-free cultures in the world and opposes the legalization of drugs". If this is real data it should be possible to source it from a non-advocacy source. Can we? --John (talk) 17:23, 29 August 2012 (UTC)

Yes, The Drugwatch data can be backed up by other reliable sources that document deaths attributed to cannabis usage. Here are two: Forensic Science International [1] and Pediatrics [2].

This is a case where there are good sources that say different things. Some say there are documented deaths while others are not aware of deaths. Wikipedia readers should be aware of both sides of this issue. Based on this I have revised the text of the article and included citations. I have included your DEA source that does not document overdose deaths.

Rlsheehan (talk) 11:47, 30 August 2012 (UTC)

Thank you for allowing me to contribute. I would like to add that although "Drugwatch" posted the 2002 PDF, they did not compile and collect the data. The data was compiled by the Drug Abuse Warning Network who simply tallied the deaths that coroners and medical examiners deemed to have been related to or caused by marijuana. The fact that the facts happen to support their aims should not be used to discount the facts.

PS - I added dashes between comments to make it easier to read. I hope that isn't bad form.

PS PS - Would it be to much to ask to add the data page of SAMHSA or is it better to link to individual publications? There are so many publications on this page that it would probably be easier to just add the one page for people to sift though. GUIB Corrector (talk) 16:03, 30 August 2012 (UTC)

• I'm sorry, but I still don't buy that. The sources Rlsheehan posts use language like "may" to describe the causality involved. Sources like the DEA one state unequivocally that there "are" no proven cases of death linked to cannabis ingestion. The problem with the data GUIB Corrector refers to is that it assumes that every death where cannabis has been used is "related" to cannabis. Only advocacy sites like the really poor one we already discussed try to make this link a direct one when in reality it is not and no reputable source (that I have found) makes a link. Per WP:FRINGE, we can argue about whether these far-out and tenuous claims (often from advocacy sites) deserve a mention or not, and we can have this argument if you like. But we have to ensure that our coverage reflects the real-world coverage. When the vast majority of sources state that no causal link has been proved, our coverage has to reflect this. And yes, GUIB Corrector, it is bad form to format others' comments; I've removed this with no hard feelings. --John (talk) 18:15, 30 August 2012 (UTC)

• What?! How can you claim that respected medical journals are Fringe? You had asked for reliable sources and you have them now. If you are unwilling to consider facts then we will have to go to arbitration. Rlsheehan (talk) 20:10, 30 August 2012 (UTC)

• • Did you read the sources you found? Could you find an unequivocal statement of causality? Or are they saying "may"? If you like, an RfC would be the next step. Arbitration is not for content disputes. --John (talk) 20:31, 30 August 2012 (UTC)

There's a very simple solution here. The text should read something along the lines of "although there have been no verified deaths from overdose of cannabis, some studies have found that extensive use of marijuana may have been the cause of death for a small number of cases." (I'm just writing this off the top of my head; you can obviously play with the language. But, bases on the conflicting information, this isn't a case where it should be either/or.)— Preceding unsigned comment added by JoelWhy (talk • contribs)

The present wording is “There are no verified human deaths associated with cannabis overdose” This has been demonstrated to be false based on two refereed medical journal articles: Forensic Science International [3] and Pediatrics [4]. As always with academic research, the authors use words such as ‘’associated” and “likely” rather than making wild overstatements. Another good source from Drugwatch also reports deaths. Even the US DEA is somewhat careful with words by saying that no death has been reported to them; They cannot claim that there have been no deaths.

This is a clear case of reliable sources with somewhat contradictory information. The readers of Wikipedia should have access to both. Again, I offer a very reasonable compromise.

Proposed Revision

Deaths attributed to cannabis usage are infrequent but have been documented. Some sources are not aware of documented deaths. (with appropriate citations)

Rlsheehan (talk) 00:55, 31 August 2012 (UTC)

...... Arbitration should be available for fact checking correct? Wikipedia should hold accurate information right?

A few points:  It is not unheard of for one government agency to be disconnected from another in terms of information sharing, and it seems that this is the case between SAMHSA and the DEA. 

The DEA has this single source of info that you are clinging to, in spite of the fact that the DEA is not a medical institution. It seems to me that this single DEA PDF is the fringe element. 

SAMHSA has posted ten years worth of data collected directly from coroners and medical examiners in thirteen states. I think that ten years of medical data across thirteen US states trumps one PDF from a non-medical institution. 

This DEA PDF you are using is just embodiment of logical fallacy of the "argument from authority" because it isn't backed by any data (or rather, since it is claiming a negative, is ignoring a clear decade of data from thirteen states). GUIB Corrector (talk) 01:04, 31 August 2012 (UTC)

Rlsheehan, I like your proposed wording and I think it is fair, even though the amount of evidence seems to indicate that the single PDF hosted by the DEA is out of touch with the rest of the medical literature, and hardly merits inclusion on the page at all. It seems that if it isn't included, however, there will be no hope of appeasing those who want to water down any negative facts about marijuana, and we will never have the page edited to be more factual. I am wondering though, would it be bad form to include the overall SAMHSA data page that has dozens of publications supporting the fact that marijuana has caused death for many people? Or would it be better to link directly to five or six individual publications that list the number of marijuana-related deaths as determined by coroners and medical examiners? I give as an example this 2008 PDF that has 12 states participating, and counts hundreds of verified marijuana related deaths across many cities. Drug Abuse Warning Network, 2008: Area Profiles of Drug-Related Mortality GUIB Corrector (talk) 18:22, 31 August 2012 (UTC)

• Again, the problem with the wording you proposed is the mismatch between "Deaths attributed to cannabis usage" and the sources' claims of "cannabis-related" deaths. I really don't wish to be offensive, but if you cannot see this mismatch, perhaps you should not be editing in a medical article. JoelWhy seems closer in his proposed wording to a viable compromise. --John (talk) 20:41, 31 August 2012 (UTC)

I am glad you brought up the fact that this is a medical article, because the DEA PDF that you are clinging to as your sole source of authority is not medical. For that reason alone it should not be in the "Effects of Cannabis" section.
A second reason is because it is claiming a negative, which is not logically provable. JoelWhy's proposal is unacceptable because multiple deaths have been verified in the literature proposed by myself and Rlsheehan.
Here is what I propose based upon Rlsheehan's previous suggestion:
Deaths attributed to cannabis usage are infrequent but have been documented[5] [6][7], cannabis related deaths are more widespread. [8] [9] [10].[11]
GUIB Corrector (talk) 12:46, 1 September 2012 (UTC)[12]

It seems we disagree. At this point it is probably best to seek the advice of other editors. --John (talk) 12:50, 1 September 2012 (UTC)

• I agree with the proposed wording by GUIB Corrector. Rlsheehan (talk) 16:13, 3 September 2012 (UTC)

I see that the problem is "Deaths attributed to cannabis usage" and "cannabis-related deaths" are not the same. "Related" could be anything.--KDesk (talk) 22:10, 3 September 2012 (UTC)
....
"Deaths attributed to cannabis usage" and "cannabis-related deaths" are purposely different and included as a compromise with John to highlight the differences in two kinds of deaths. They are not supposed to be the same because they imply different things.
The sources highlighting "Deaths attributed to cannabis usage" are cases where the coroners and medical examiners held the firm professional opinion that marijuana caused the death of the individual in question.
The sources highlighting "cannabis-related deaths" cover a much broader range of data to include a wider range of professional opnions from the hundreds of coroners and medical examiners participating in the data collection. From the 2010 report on the data collected in 2008:
[http://www.samhsa.gov/data/2k10/2k8DAWNME/ME08FullReportMay2010.pdf From Page 11

• Drug-related deaths
  
• Since 2003, a DAWN case is any death reviewed by an ME/C that was related to recent drug use. Findings in this publication pertain to drug-related deaths and drug-related suicide deaths reported by participating death investigation jurisdictions as DAWN cases.1 The data items submitted on drug-related deaths are described in Appendix C.
  
• DAWN cases are identified through a retrospective review of decedent case files in each participating death investigation jurisdiction. A DAWN case is any death that is determined by the ME/C as being related to drug use. The relationship between the death and the drug need not be causal; the drug need only be implicated in the death. The drug use may have been for legitimate, therapeutic purposes or for the purpose of drug abuse or misuse, but in either case, the drug use must have been recent.
  
• These eligibility criteria for a DAWN case are intentionally broad and inclusive. Since death record documentation varies in clarity and comprehensiveness across jurisdictions, broad criteria reduce the potential for judgment calls that could cause data to vary systematically and unexpectedly across reporters and jurisdictions. Broad criteria also capture a diverse set of drug-related deaths that support a wide variety of analytical purposes and interests.]
  

Both groups of sources, with their difference purposely highlighted by the distinct phrasings of "Deaths attributed to cannabis usage" and "cannabis-related deaths," provide important information that Wikipedia readers should have access too, and both groups of sources demolish the non-medical PDF by the DEA which is not logically tenable because it claims a negative.
I am updating my proposed wording to include more sources in the "cannabis-related deaths" group of sources

Deaths attributed directly to cannabis usage are infrequent but have been documented[13] [14][15], cannabis related deaths are more widespread. [16] [17] [18] [19] [20].[21] [22] [23]
GUIB Corrector (talk) 15:10, 5 September 2012 (UTC)

• This looks good. It is based on solid reliable sources and uses the language of the sources in the statement. No persuasive arguments against this have been given. This should be included in the article to correct the present false claim. Rlsheehan (talk) 17:44, 6 September 2012 (UTC)

Crime

In view of the accidents and crime caused by cannabis, the reduction in fatness is not important. — Preceding unsigned comment added by 86.164.96.47 (talk) 14:47, 30 September 2012 (UTC)

Clasification

When LSD is the state of art for what a hallucigenic drug should be, marihuana fails to meet the requierements. — Preceding unsigned comment added by 186.14.149.185 (talk) 19:31, 11 October 2012 (UTC)

Producing countries

I added a section to speak about producing countries of cannabis such as Afghanistan and Morocco. Valuable information is available in some UN reports...Fort-Henry (talk) 12:36, 14 October 2012 (UTC)

Edit request on 14 October 2012

203.167.209.42 (talk) 20:45, 14 October 2012 (UTC) marijuana gets produced from most countrys new zealand has indoor and outdoor weed aswell as prple haze etc

Not done: please be more specific about what needs to be changed. RudolfRed (talk) 21:40, 14 October 2012 (UTC)

Cannabis(plant) should be called as such

Cannabis is only a drug by coincidence. It is a plant first and foremost. Much like a poppy or a tulip. PortlandOregon97217 (talk) 09:48, 8 November 2012 (UTC)

And as a matter of fact, our article cannabis is about the plant. The article this talk page is attached to is cannabis (drug). So it looks like our arrangement of titles already agrees with you. Looie496 (talk) 16:30, 8 November 2012 (UTC)

No. It clearly says cannabis(drug). — Preceding unsigned comment added by PortlandOregon97217 (talk • contribs) 10:14, 9 November 2012 (UTC)

Yeah, this article is about cannabis in terms of its use as a drug. Just like there is one article about the Coffea plant, and another about the drink coffee, there is one article about the cannabis plant ("cannabis"), and another about the drug ("cannabis (drug)"). What would be a better way to title the two articles? -GTBacchus^(talk) 00:27, 10 November 2012 (UTC)

They should be the same article. I don't know why people are hung up on this plant being a drug? It's like having two articles for coffee and two for tea. 208.54.5.198 (talk) 07:15, 10 November 2012 (UTC)

We've got two for coffee: Coffea and coffee, and two for tea: Camellia sinensis and tea. -GTBacchus^(talk) 23:55, 13 November 2012 (UTC)

The bud in the picture doesn't even look all that dank

Sure it could be some fire. But it doesn't really look like it. Someone should track down some really dank pictures. 208.54.5.147 (talk) 10:20, 9 November 2012 (UTC)

Hash oil

The article states that "Hash oil, or "butane honey oil" (BHO), is a mix of essential oils and resins extracted from mature cannabis foliage through the use of various solvents." The section in commas should be removed. Hash oil is a superset of butane honey oil, not the same thing as butane honey oil. This is acknowledged in the article on hash oil, so wiki itself is being inconsistent here.

(Apologies if I didn't format this correctly. I'm still very new to wiki).

RoseHelene (talk) 21:09, 16 November 2012 (UTC)

Cannabis "deaths"

INPUT: I agree upon this not being well documented enough, as the source suggesting this does not justify the term of actually say what is proclaimed in that section, nor is it a source at all. There is no evidence, and thus the section should be removed, as it is NOT prowen to be truthfull. — Preceding unsigned comment added by 83.109.123.191 (talk) 18:41, 11 December 2012 (UTC)

I suggest we change the wording of this article. The one scientific study cited to "prove" cannabis can cause death merely suggests that trace amounts of cannabis were found in the blood of SIX people who died from acute cardiovascular events. It does NOT say cannabis caused the deaths. It's inappropriate to pair that information with fake, unattributed data collected by prohibition groups.

For now, I think we should clarify that there is no scientific evidence that cannabis can cause death. Instead, we might say something like "although no scientific literature supports a causal effect between cannabis consumption and death, some groups allege a link..."

Thoughts?

--Rob Shepard (talk) 20:16, 15 October 2012 (UTC)

I agree with you. And correlation does not imply causation. --KDesk (talk) 21:14, 15 October 2012 (UTC)

There are two medical journals that discuss this. The present wording does not say "prove" but " attributed". There are also two groups (one governmental) that indicate a relationship with occasional death. We cannot ignore or throw away the evidence. What wording would you suggest? Rlsheehan (talk) 22:36, 15 October 2012 (UTC)

On this topic, I am cutting the following from the effects section:

Cannabis-related deaths are more widespread. [24] [25] [26] [27] [28].[29] [30] [31]

The sentence is unclear - more widespread than what? - and the sources (really one source in 8 annual reports) are difficult to get that conclusion from without original research. Furthermore, the same source is summarized in one of the links on the previous sentence which is much clearer and supports the point more strongly and succinctly. If this material is to be readded, I suggest editing the sentence to make a clearer assertion, one which is unambiguously supported by source material, as well as more appropriately formatting the sources. -GTBacchus^(talk) 17:11, 21 October 2012 (UTC)

Please do not just delete the whole thing. I agree that we can simplify the several annual reports to just the most recent; they all report similar findings. I have restored the one most current citation. Rlsheehan (talk) 19:10, 21 October 2012 (UTC)

I agree with your edit. Good call, and thanks. :) -GTBacchus^(talk) 00:20, 10 November 2012 (UTC)

Legality

As of November sixth, 2012, marijuana is legal to possess and consume by persons over the age of 21 in Colorado and Washington state. Would someone please add that into the legality section? — Preceding unsigned comment added by 174.98.47.13 (talk) 19:07, 7 November 2012 (UTC)

http://seattletimes.com/html/localnews/2019631839_marijuanafolo08.html It is a crime until december 6th so don't have too much fun! You wont have a license to sell until december 2013. Soo on the 6th you will be able to carry up to an O. Public use will become an infraction. PortlandOregon97217 (talk) 09:53, 8 November 2012 (UTC)

i heard the feds are trying to override state law legalizing hemp. why can they do that? we voted in hemp by a big margin.Rainyhemptree (talk) 08:18, 24 November 2012 (UTC)

the governor of Colorado has made it official on December 10, 2012. http://www.9news.com/news/story.aspx?storyid=304266 71.22.115.39 (talk) 19:50, 16 December 2012 (UTC)

Legalizing Marijuana

There is alot of controversy when it comes to the topic of legalizing marijuana. Most people are not properly educated on the advantages and disadvantages of legalizing marijuana. There is not enough research out there to state the effects of marijuana used medically. The reason for this is that the federal government will not provide the funds needed to do the extensive research to find out the facts on medical marijuana. There is another argument that comes into play when discusing the legal status of marijuana, and that is will it help boost our economy. In many parts of the world there have been studies that show that marijuana brought in great revinue. On the other hand our president believes that the legalization of marijuana will do nothing for our economy. Therefore there are still many questions to be answered about legalizing marijuana does it truely benefit the ill, and could it possibly improve our economy? — Preceding unsigned comment added by Caycay19 (talk • contribs) 02:28, 10 December 2012 (UTC)

This talk page is intended for discussions related to how to improve the article. It is not a forum. There are plenty of other websites for that. yonnie (talk) 17:14, 16 December 2012 (UTC)

Merge section from Cannabis (drug)

The section "Breeding and cultivation" in the Cannabis (drug) article is about the plant itself, which belongs in the Cannabis article and the Cannabis cultivation article.

To discuss psychoactive compount contents found in different varieties and strains, that shoud be discussed in its own section at the Cannabis (drug) article. Stephen Charles Thompson (talk) 11:52, 2 January 2013 (UTC)

Obesity study

This piece doesn't seem to fit into any existing category; I'm leaving it here for now. It likely needs a secondary source, and the section "Non-therapeutic effects" might need a more inclusive title. petrarchan47tc 10:00, 5 January 2013 (UTC)

"A study published in the American Journal of Epidemiology in 2011, concluded that the prevalence of obesity is lower in cannabis users than in nonusers." [abstract]

Thanks. petrarchan47tc 00:46, 9 January 2013 (UTC)

Added with secondary sources. petrarchan47tc 08:19, 9 January 2013 (UTC)

Secondary sources say NO deaths have occurred from cannabis

Wikipedia cannot be in disagreement with mainstream sources that say, overwhelmingly, cannabis has never caused a human fatality. You can find primary sources which say all sorts of things, but you cannot add them here and make a claim that is contrary to what experts say in good WP:RS. petrarchan47tc 19:43, 2 January 2013 (UTC)

This is an example why Wikipedia requires secondary sources (see WP:secondary and WP:NOR ): the first abstract used to support the "deaths by cannabis" statement, which I have reverted, says "six cases of possible acute cardiovascular death in young adults, where very recent cannabis ingestion was documented". If this is to be re-added to the page to support a case for cannabis deaths, there needs to be (secondary) RS discussing the findings and explaining them with the same conclusion as the Wikipedia editor who added this has found. petrarchan47tc 20:09, 2 January 2013 (UTC)

From WP:NOR "Wikipedia articles should be based on reliable, published secondary sources and, to a lesser extent, on tertiary sources. Secondary or tertiary sources are needed to establish the topic's notability and to avoid novel interpretations of primary sources, though primary sources are permitted if used carefully. Material based purely on primary sources should be avoided. All interpretive claims, analysis, or synthetic claims about primary sources must be referenced to a secondary source, rather than to the original analysis of the primary-source material by Wikipedia editors." petrarchan47tc 22:14, 2 January 2013 (UTC)

Yes, there are sources that say they have not found any deaths. And also, there are reliable sources that do report (occasional or rare) deaths. You cannot resolve the apparent conflict by just deleting the citations you do not like. Wikipedia readers should have access to BOTH sets of citations so they make an educated decision. Wikipedia must have a neutral point of view. Rlsheehan (talk) 13:20, 4 January 2013 (UTC)

But you have posted an abstract that says six cases of possible acute cardiovascular death and used it to support "death by cannabis". This is why secondary sources are needed. A Wikipedia editor, cannot be the lone soul to describe these findings in this way. No respectable scientist would take this abstract and use it to support your stance. Further, it is expecting the reader or other editors to go to the primary source to find out whether your stance is true. This is against Wikipedia guidelines, as outlined above. Find a secondary source that makes the claim you are trying to make about ANY deaths being directly attributed to cannabis. I will move the citations to a more appropriate spot, and remove the claim made in direct contradiction to reliable secondary sources, pending good RS from you. petrarchan47tc 20:04, 4 January 2013 (UTC)

One user delted the folling text:.. but autopsies of a large number of sudden deaths among younger people has shown that there is a connection between the consumption of cannabis and death when someone suddenly jumped from high height or other types of accidents in which the person has been so severely injured that he or she died. This is believed to be associated with an occasional cannabis-induced psychosis...Anna Fugelstad: Akuta narkotikarelaterade dödsfall, Karolinska Institute 2011 Why??? The text has a good source (from a first class university) The report also include numbers for this type of deathsDala11a (talk) 01:10, 5 January 2013 (UTC)

It needs to be accompanied by the source itself, if you could leave it here, it could be added to the page in the appropriate spot. petrarchan47tc 01:16, 5 January 2013 (UTC)

More importantly, it must adhere to guidelines regarding WP:FRINGE. petrarchan47tc 01:20, 5 January 2013 (UTC)

I have added more reliable sources based on medical journals. Yes cannabis does sometimes lead to death. Rlsheehan (talk) 20:21, 8 January 2013 (UTC)

Fantastic, but those are still not secondary sources DISCUSSING the studies. Please read the Wiki guidelines. You cannot make claims about what those studies say without a secondary source. Period. petrarchan47tc 23:33, 8 January 2013 (UTC)

Now your sources are still in the article, but they are placed within the context of what good secondary sources say. Pending secondary sources from you, they should remain that way.

From WP:NOR " Material based purely on primary sources should be avoided. All interpretive claims, analysis, or synthetic claims about primary sources must be referenced to a secondary source, rather than to the original analysis of the primary-source material by Wikipedia editors

Please ask if you don't understand this requirement. petrarchan47tc 23:45, 8 January 2013 (UTC)

I've also changed the wording of your first study, and based on its population size (1) and lack of information available (without paying $31), I placed it near the bottom. The wording is closer to what the abstract says. It needs a WP:secondary source to explain what the study means, and in context. The reader can't be expected to do this. It's a good example of why Wikipedia has the guidelines I've quoted. petrarchan47tc 00:44, 9 January 2013 (UTC)

Please take a little time to read the articles before you delete them! You will find that most of articles are from medical journals and indeed are secondary sources. Many of your sources are not journals but merely Time magazine or other very weak sources. You cannot keep deleting reliable sources just because you disagree with the information. Rlsheehan (talk) 01:52, 9 January 2013 (UTC)

We need to rely on WP:MEDRS-compliant secondary sources. You should also be careful to not delete some random content, like you did with the obesity section or the other content.--KDesk (talk) 03:04, 9 January 2013 (UTC)

Please show me a secondary source that talks about death related to cannabis. This is what you need. That source would also need to explain also why these reports exist when the prevailing message is that there have positively been no deaths directly related to cannabis. It is possible we will need to take this problem to one of the noticeboards. As it stands now, your edits are looking like WP:NOR and WP:UNDUE. It is also a violation of WP:FRINGE.

Wikipedia cannot be so out of alignment with mainstream media and mainstream understanding, or it becomes a joke. I am not interested in whether this page says cannabis does or does not kill people, only that it is reflective of good reliable science, placed in context with the help - not of other editors, but - of sources like Time magazine. These sources are written for the average reader, one who may not have a science degree. That is who Wikipedia is written for as well. petrarchan47tc 03:11, 9 January 2013 (UTC)

From WP:MEDREV "Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources. Synthesis of published material that advances a position is a form of original research and should be avoided in Wikipedia articles, which are not a venue for open research. Controversies or areas of uncertainty in medicine should be illustrated with reliable secondary sources describing the varying viewpoints. The use and presentation of primary sources should also respect Wikipedia's policies on undue weight; that is, primary sources favoring a minority opinion should not be aggregated or presented devoid of context in such a way as to undermine proportionate representation of expert opinion in a field." petrarchan47tc 03:17, 9 January 2013 (UTC)

This is an example of the first supposed source to support 'death by cannabis'

"We report six cases of possible acute cardiovascular death in young adults, where very recent cannabis ingestion was documented by the presence of tetrahydrocannabinol (THC) in postmortem blood samples. A broad toxicological blood analysis could not reveal other drugs. Similar cases have been reported in the literature, but the toxicological analysis has been absent or limited to urine samples, which represent a much broader time window for cannabis intake. This paper presents six case reports, where cannabis alone was detected in blood."Abstract

It does not say that cannabis caused those deaths, it is NOT a secondary source. The second link said "associated" not 'caused'. Look, there is no arguing - you need to have a proper source or these links cannot go back into the article. I'm removing all of them until we have a secondary source. petrarchan47tc 03:36, 9 January 2013 (UTC)

References in need of WP:MEDRS-compliant secondary sources

• abstract
• Infarction in Adolescent Males Associated with Acute Marijuana Use
• drug watch report
• drug abuse warning network report petrarchan47tc 03:42, 9 January 2013 (UTC)

More references in need of secondary sources (also removed from article)

• Bachs, L; Henning Mørland (27 Decmeber 2001). "Acute cardiovascular fatalities following cannabis use". Forensic Science International 124 (2-3): 200-203.
• Cannabis-induced cerebral and myocardial infarction in a young woman
• Cannabis-Related Myocardial Infarction and Cardioembolic Stroke petrarchan47tc 03:56, 9 January 2013 (UTC)

Again, I ask that you read the cited articles before you delete or challenge them. Several are respected medical journals and are secondary sources.

Your sources on the relative safety of THC belongs in the THC article, not here. TCH is only one of thousands of chemical compounds in cannabis smoke.

Your logic does not make sense. You seem to claim that sources reporting occasional deaths or indicating caution must be wrong because they challenge your view.

Many of your sources are very weak. Even a judge is not a good medical source.

This discussion is not fruitful; we need more input.

Rlsheehan (talk) 16:43, 9 January 2013 (UTC)

As an editor uninvoled in this dispute, I can say that:

• Best sources we can have to settle the dispute are academic literature reviews in high impact peer reviewed medical journals: can Rlsheehan provide these?
• The "Safety" paragraph is quite redundant and its style looks like propaganda (even if I largely agree with the stance and the science therein described). It would benefit from some trimming and re-editing. I'll try to have a look at it.

Hope it helps. --Cyclopia^talk 16:57, 9 January 2013 (UTC)

Please do have a look at the safety paragraph. Wikipedia cannot declare 'deaths by cannabis' without one single secondary source, and against prevailing knowledge. I was attracted to work on this page when I saw that this article used 4 flimsy studies against WP:NOR to promote the idea that people do die from Cannabis - which would be fine if that were represented in RS but it absolutely is not. I Googled "Deaths from Marijuana" and "No deaths from Marijuana" and in both cases, I got pages full of articles that said "no one has ever died from marijuana". So in my understanding, 'death by cannabis' is a fringe theory.

If it takes combing through medical journals to find claims of death, but the mass of literature, including the top drug researchers and even a DEA judge, says without a doubt there are no deaths directly attributed to cannabis, you're going to need a good secondary source discussing the errant claims you may dig up. I have no objection to those claims being in this article but they must be accompanied by secondary sources that put the claim into perspective regarding prevailing knowledge, ie, why everyone is saying no one has died when actually some respectable studies say otherwise. If you cannot find an RS commentary it's a good indication it should not be promoted here. The Safety section grew each time another editor tried to re-submit the deaths claim - I admit it needs trimming at this point. petrarchan47tc 18:15, 9 January 2013 (UTC)

Example, from IBT: There are no deaths from cannabis use. Anywhere. You can't find one," said Dr. Lester Grinspoon, professor emeritus at Harvard Medical School. Believe it: In 10,000 years of known use of cannabis, there's never been a single death attributed to marijuana. Meanwhile, it's a fact that anyone can die from ingesting too much aspirin, or too much coffee, or too much wine. Marijuana, on the other hand, medical or not, is not only non-lethal, but likely beneficial. Lester Grinspoon studied marijuana for 30 years at Harvard and is most highly respected. If there were facts available to disprove these statements, do you really think Wikipedia is going to be the first to break the news? If a study did prove the prevailing understanding about safety of cannanbis wrong, there would be ample secondary RS. petrarchan47tc 18:32, 9 January 2013 (UTC)

Sweden has a register containing details of acute deaths. An autopsy is routinely done by all acute deaths in unclear circumstances or by an accident. For year 2010 showed the autopsies traces of illegal drugs or methadone in the body of 421 people. Of these, 122 were categorized as as morphine/heroin, 104 as amphetamine, 94 methadone, 63 as THC (cannabis) and 38 as other drugs. The 63 deaths classified as THC had no other illegal drug in the body. Some of the other dead persons had THC with one or more other drugs. The report does not claim that THC was the direct cause of 63 deaths, but it is any case very clear that THC is commonly associated with acute drug-related deaths.[Page 3]Dala11a (talk) 21:09, 9 January 2013 (UTC)

But you need secondary reliable sources before entering it into this article. petrarchan47tc 21:30, 9 January 2013 (UTC)

Petrarchan47, I understand all of this and I agree with the sources, you don't need to obsessively repeat this all a thousand times. My issue is only a matter of style, that is: repeating 100 times practically identical statements from slightly different sources is not the way to write a paragraph. We just have to state the facts, we don't need to convince anyone. --Cyclopia^talk 09:56, 10 January 2013 (UTC)

You're absolutely right. Thanks for stepping in. petrarchan47tc 21:04, 10 January 2013 (UTC)

POV Tag, call for Comments

I have added a POV Bias tag to the article. Recent edits to Cannabis (drug) have added a section on Safety which is strongly biased toward cannabis being a risk-free drug. Emphasis is on a claim that no marijuana related deaths have ever occurred. Yes, there are some sources where the author states no cannabis deaths to report, but using these claims selectively is misleading. Several reliable sources have reported infrequent deaths and also list cannabis smoke as a carcinogen (links to these articles or to abstracts are provided in the deleted history or on the Talk page). Summary:

• Forensic Science International

“Acute Cardiovascular Fatalities Following Cannabis Use”

• Journal of Pediatrics

“Cerebellar Infarction in Adolescent Males Associated with Acute Marijuana Use”

• Cancer Research, UK

“Does smoking cannabis cause cancer?”

• Revue Neurologique (French)

“Cannabis-induced cerebral and myocardial infarction in a young woman”

• Journal of Stroke and Cerebrovascular Diseases

“Cannabis-Related Myocardial Infarction and Cardioembolic Stroke”

• UCLA School of Medicine

“Effects of marijuana on the lung and its immune defenses”

• U.S. Department of Health and Human Services, SAMHSA, DAWN

“Area Profiles of Drug-Related Mortality” (this is a government tertiary source)

• State of California

“Chemicals known to the state to cause cancer or reproductive toxicity” (This is a government tertiary source)

• Center for Effective Drug Abuse Research & Statistics, Drugwatch

“Marijuana-only drug abuse deaths” (This is a tertiary source)

A marijuana supporter will not accept published medical journals and government reports that raise any safety concerns about cannabis usage. Wikipedia requires a neutral point of view and an unbiased handling of divergent sources. Certainly, cannabis is not as dangerous as several other hard drugs, but that does not result in absolute safety. Wikipedia should include both sources that discuss safety and sources that indicate problems. A balanced and neutral view is required.

Additional input and comments are welcome.. Rlsheehan (talk) 18:26, 9 January 2013 (UTC)

The safety section includes a large paragraph about the dangerous substances in cannabis. The claims of no deaths directly attributed to cannabis are far from cherry picked. They are everywhere, and RS claiming the opposite are nowhere to be found. You cannot add studies just to make cannabis seem more dangerous or to 'even things up'. You can add any claim/study you want if you have the proper RS. Some of your studies may come from biased sources, or have small print (which government studies do) saying that these deaths include accidents that happen with cannabis in the system. A good WP:secondary source will uncover this type of thing and present findings IN CONTEXT. The sources you are providing require the reader to just trust you, or to comb through these studies and somehow determine if they are correct. But the reader would still be left with questions, like why haven't the experts commented on these findings and reversed their positions? petrarchan47tc 18:40, 9 January 2013 (UTC)

Why would TIME magazine print [32] if death by cannabis is a fact? petrarchan47tc 18:43, 9 January 2013 (UTC)

Non of the sources you provide show deaths directly attributed to cannabis. For example:

In the 2002 Drug Watch report: "This report presents only the numbers of deaths where marijuana was the only drug involved (although alcohol may also have been used".

In the 2010 Drug Watch report: "Not every reported substance (drug) is, by itself, the cause of death or even a contributor to the death. DAWN’s broad definition of drug involvement requires only that the drug is related to the death. Therefore, even in single-drug deaths, reported drugs may not be a direct cause of death".

Your summery about the deaths articles have also other articles like "Chemicals known to the state to cause cancer or reproductive toxicity" which is already in the article, and is not related to deaths directly attributed to cannabis.

The others, as already stated, are not seconday sources, which are needed. Please, read about Identifying medicine reliable sources. --KDesk (talk) 21:26, 9 January 2013 (UTC)

I've changed the tag to reflect your concern with the safety section. petrarchan47tc 08:29, 10 January 2013 (UTC)

The article is making some progress. We cannot, however, ignore reliable secondary sources which discuss occasional deaths: stroke, heart attack, etc. Medical journals trump the popular press. I am OK with a cautionary statement. How about; "Occasional deaths have been reported <refs> but definitive causal relaltionships are not fully proven." Rlsheehan (talk) 15:01, 11 January 2013 (UTC)

If you can find a statement like that made by someone other than you, and published in RS, I'm good with it. As it stands, we already have a very similar statement in the section. petrarchan47tc 22:08, 11 January 2013 (UTC)

Better to reply here first, though. petrarchan47tc 23:56, 11 January 2013 (UTC)

I ask editors to please read the peer reviewed medical journals which meet the gold standard for medical reliable sources. Three are summarized here:

1) Forensic Science International is a peer reviewed international journal, [[33]]. The abstract of “Acute Cardiovascular Fatalities Following Cannabis Use” can be found at : [[34]].

The authors, Bachs and Morland, are with the National Institute of Forensic Technology in Oslo, Norway. They discuss their analysis of six sudden deaths where “cannabis was the major toxicological finding”.

One summary is Figure 1 on page 202, titled “Cardeovascular mechanisms of cannabis”. “Increased myocardial oxygen demand” and “Decreased oxygen delivery” lead to “Ichaemia”; results can be “Tachycardia, Peripheal vasodialation, Peripheral vascular reflex failure, and Arrhyhmia?”

Conclusions on page 203 include : “Several reports of cardiovascular episodes associated to cannabis use have been published in the last 20 years and underlying patho-physiological mechanisms have been discussed. Cannabis is generally considered to be a drug with very low toxicity. In this paper, we report six cases where recant cannabis intake was associated with sudden and unexpected death, An acute cardiovascular event was the probable cause of death. In all cases, cannabis intake was documented by blood analysis.” As always in good research, the authors call for “further investigations of clinical, toxicological, and epidemiological aspects”.

2) PEDIATRICS is an official peer-reviewed journal of the American Academy of Pediatrics. The full article, “Cerebellar Infarction in Adolescent Males Associated with Acute Marijuana Use”, can be found at [[35]]

Conclusions include; “From the literature, it is clear that marijuana use can cause systemic hypotension, impair peripheral vasomotor reflexes, and may alter central nervous system blood flow and cerebral vascular autoregulation. Marijuana use has been associated with stroke in adults, but acute central nervous system infarction related to marijuana use is not well described in children. Although the mechanism of neurologic injury and its localization to the posterior circulation in these cases remains uncertain, our observation of acute cerebellar infarction in 3 adolescents shortly after marijuana use suggests that this drug may contribute to cerebellar vascular injury, possibly by causing vasospasm, especially in the inexperienced or episodic user, resulting in cerebellar ischemia.”

3) Revue Neurologique is the officlal journal of the French Neurology Society. The abstract of “Cannabis-induced cerebral and myocardial infarction in a young woman” can be found at [[36]]. The article is in French but the abstract includes an English summary.

Wikipedia requires a balanced point of view. Claims that there has never been reported marijuana deaths have been published, but also, medical journals and government summaries have reported marijuana deaths. The Wikipedia article must include both. Rlsheehan (talk) 15:07, 12 January 2013 (UTC)

Thanks for the sources. I'll give them a look and I feel they deserve some inclusion; it would help if you could find reviews,however. --Cyclopia^talk 15:29, 12 January 2013 (UTC)

I have also done a PubMed research for academic peer-reviewed literature reviews on cannabis and risk of death, that should be good enough for WP:MEDRS, and I feel there is material that is worth inclusion. I have to go now, but I'll be back to help fix the issue --Cyclopia^talk 15:35, 12 January 2013 (UTC)

I would argue though, that if reviews are this difficult to find, we are verging into *fringe* territory. petrarchan47tc 20:30, 12 January 2013 (UTC)

How is a trivial PubMed search "difficult to find"? Regardless, what matters is the journals and the type of publication. I have reviews open in my tabs, I just have to look into them before adding something. --Cyclopia^talk 00:13, 13 January 2013 (UTC)

I was not referring to anything trivial. From your comment, "it would help if you could find reviews,however" I thought by reviews you meant a review of the studies by experts or others in the field. If "no deaths by cannabis alone" is truly being disputed, there should be articles discussing this. I haven't found them after a good search, but only copious sources saying the contrary, leading to my suggestion this may be a fringe theory. petrarchan47tc 00:26, 13 January 2013 (UTC)

For what it's worth, David Nutt in his essay about British Lung Foundation's study, recommended this site as trustworthy. No threat of death by any cause is mentioned as a possibility. Interestingly, he also mentioned, "...as I write, the BLF’s claim about cannabis cigarettes being more carcinogenic than tobacco ones has already found its way onto Wikipedia’s information about cannabis harms, so Wikipedia currently reports, on different pages, the same claim as an evidenced fact and as a popular myth". petrarchan47tc 01:51, 13 January 2013 (UTC)

I think we should all stick to using scientific literature reviews (and yes, "I thought by reviews you meant a review of the studies by experts or others in the field", I was referring to that), in both camps, instead than quotes or professors' blog posts. It's not like there's no academic literature. A simple PubMed or Google Scholar search can do, as a start. I've found stuff that should be more than OK per WP:MEDRS on cannabis safety (e.g. [37], [38], [39], [40], [41] -but there is more, they're just random examples); as soon as I have a couple hours in a row I can spend on this I'll start adding/restructuring stuff according to them. --Cyclopia^talk 17:55, 13 January 2013 (UTC)

I'm referring to "review articles" per WP:MEDSCI that put findings into context, and will mention controversies, if any, related to the studies. As for David Nutt, as an expert in this field, whether his words are written in his blog or at the Guardian makes little difference per WP:SPS, in my understanding. petrarchan47tc 18:38, 13 January 2013 (UTC)

• "I'm referring to "review articles" per WP:MEDSCI that put findings into context, and will mention controversies, if any, related to the studies." - Yes, exactly. I am an academic in biosciences, I know what a review is .
• "As for David Nutt, as an expert in this field, whether his words are written in his blog or at the Guardian makes little difference per WP:SPS, in my understanding." - David Nutt is one guy. We don't need single researchers' opinions, no matter how experts they are. We need the academic consensus. In general, since this topic appears to be controversial, it's better to stick with the most solid of sources -academic literature reviews on established peer-reviewed journals. --Cyclopia^talk 21:56, 13 January 2013 (UTC)

Agree in theory, though with the example of Nutt, we find that the British Lung Assoc.'s study was majorly biased to the point of being dangerous. I think he alone blew the whistle on this widely quoted study. Just one guy can be pivotal. But his findings weren't published in PubMed. petrarchan47tc 22:21, 13 January 2013 (UTC)

The more you talk about it, the more it seems it's just that guy's opinion, and as such it really doesn't belong. If a study is widely quoted and it got only lonely criticism from one single expert, that aren't even peer reviewed -well, we should avoid putting undue weight on it. --Cyclopia^talk 00:10, 14 January 2013 (UTC)

If you have read the article, in which he does debunk, step by step, the findings of BLF, you can't rightly call it an opinion at all. But you are right, there should be mention of his debunking in RS, and as yet I can't find it. Based on his history in the field of drugs and with the British government, his statements do deserve a mention. And given they are merely a mention, I don't see undue weight. petrarchan47tc 00:23, 14 January 2013 (UTC)

I've found: A storm over spliffspetrarchan47tc 00:35, 14 January 2013 (UTC)

And an article in TIME which also brings the BLF findings into question and cites Tashkin's work: "A recent report by the British Lung Foundation made the headline-grabbing claim that the risk of developing cancer was 20 times higher per marijuana joint than per cigarette. However, the scientific data simply do not support this contention. Dr. Donald Tashkin, professor of medicine at University of California, Los Angeles, is among the foremost researchers studying the effects of marijuana on the lungs. His 2006 study, one of the largest to look at marijuana use and lung and upper-airway cancers, found that the “association of these cancers with marijuana, even long-term or heavy use, is not strong and may be below practically detectable limits". petrarchan47tc 01:39, 14 January 2013 (UTC)

Possible links of interest: Ranking of drugs per Nutt study Tomographic scans Cognitive effects Schizophrenia risk Effects on IQ petrarchan47tc 19:46, 13 January 2013 (UTC)

Question: "there are isolated medical reports of rare lethal cerebellar infarction associated with marijuana use." This new sentence is supported by this abstract, from which comes:

“ Conclusions. Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity. ”

The one reference for this points to 3 cases of stroke after marijuana use. How did we get "lethal" in there? And does "associated" really merit mention in the first paragraph? Do three cases deserve this kind of a mention? I'm just not seeing it. petrarchan47tc 22:11, 16 January 2013 (UTC)

A study of 48 subjects which cites the one above concluded:

“ Multifocal angiopathy associated with cannabis consumption could be an important cause of ischemic stroke in young people ”

I would rather quote a larger study from last year. As it is, the 2003 study is problematic: WP:MEDDATE and undue weight. Is there a secondary source that could help determine due weight on this issue? In other words, if there is a controversy within the scientific community over whether cannabis causes death or not, I haven't seen proof of it. If there were credible reports of cannabis-caused-deaths, where is the discussion of that fact?petrarchan47tc 22:19, 16 January 2013 (UTC)

No, the journal article says: "In this paper, we report six cases where recent cannabis intake was associated with sudden and unexpected death. An acute cardiovascular event was the probable cause of death." This is not a lone reference, others are are available. Rlsheehan (talk) 01:29, 17 January 2013 (UTC)

The abstract I was asking about is regarding stroke. The abstract you added today said "six cases of possible acute cardiovascular death in young adults..." If this is to be reported in the article, you need to stick to what it says. You need to add "possible" and the number of cases so that people can make up their own minds as to the weight of this information, since its placement now indicates this study is equal in weight to the RS saying cannabis has never killed anyone. petrarchan47tc 01:55, 17 January 2013 (UTC)

The wording is consistent with the references. Rlsheehan (talk) 02:03, 17 January 2013 (UTC)

Please do not continue deleting legitimate edits and references to medical journal articles. Rlsheehan (talk) 02:43, 17 January 2013 (UTC)

Those are not reliable secondary sources, WP:MEDREV. They don't even know the cause of the death! Possible is not enough, those are isolated cases of possible acute cardiovascular death. There is no academic consensus which supports this, more like the other way. --KDesk (talk) 05:13, 17 January 2013 (UTC)

• We cannot ignore peer reviewed medical journals. These reports of occasional stroke and heart attack need to be included. Rlsheehan (talk) 15:13, 17 January 2013 (UTC)

• • Having added that reference myself, I think I can add something. Yes, the academic consensus is that no death has been clearly connected to marijuana use. I'm fine with this, personally. However a peer-reviewed case report on a reputable journal is not to be ignored, provided we don't give undue weight to it. Now, here we mention it briefly, after the academic consensus (which is given much, much more space, as it should be), and I feel it's exactly fine: we say "overwhelming consensus is this, a few studies disagree". Notice we don't give the minority view the status of consensual; we don't say "Marijuana causes strokes and death" - we just say that there are isolated reports that suggest this. I see if I can edit to clarify the issue. --Cyclopia^talk 15:29, 17 January 2013 (UTC)

That's all fine, however I did not see mention of deaths in your reference, only strokes. Can you help me with this? I only saw the abstract. As for the heart-related deaths added by Rlsheehan, it said "possibly" related to cannabis use. But the wording to insert this into the article insinuated some studies linked death with cannabis. I am not seeing it in the studies provided so far. How much weight should one single study with 6 "possible" cases be given? petrarchan47tc 17:48, 17 January 2013 (UTC)

I realize this section was a "call for comments", but it might be time for a more formal RfC. What do others think? petrarchan47tc 17:52, 17 January 2013 (UTC)

I agree that a more formal Request for Comment would enable the page to move on from the medically moot point of 'death by cannabis.' It is a catchy slogan, but there is no reputable research substantiating any causal relationship. Here, we seem to have one reader's/editor's opinion effectively stagnating the integrity and growth of the page, which is supposed to be determined by a community. Others? 184.153.188.249 (talk) 07:11, 18 January 2013 (UTC)dvl

This study was added today to support this phrase: "though there are isolated medical reports that suggest a possible association of rare lethal cerebellar infarction with marijuana use". There is no mention in the article of the heart attacks following cannabis use, and this study is simply a very small population who happen to have only cannabis in their system when they died. I bet there is a larger study of people who wore blue jeans that were too tight before they died. Correlation does not prove causation. Again, if this study is to be added, it would need its own introduction. petrarchan47tc 22:25, 19 January 2013 (UTC)

As you requested, I have provided an introduction to the journal and a short quote. This should improve this Wikipedia article Rlsheehan (talk) 01:23, 20 January 2013 (UTC)

I said if this study is to be added. This study needs to be taken to Reliable Sources noticeboard. You - and only you - are the single editor who wants this study added. I am exhausted talking about it. We need to ask if it's applicable, how it should be presented and what weight it has. Does anyone have time to do this? petrarchan47tc 01:26, 20 January 2013 (UTC)

Him and only him? Wrong. I support the inclusion and I did reinsert it. Cantaloupe2 (talk) 07:47, 21 January 2013 (UTC)

• I added this quotation: Researchers at the National Institute of Forensic Technology in Oslo, Norway have reported in Forensic Science International : " . . we report six cases where recent cannabis intake was associated with sudden and unexpected death. An acute cardiovascular event was the probable cause of death. In all cases, cannabis intake was documented by blood analysis" You had requested that I provide the introduction. Now you say not... . Again, this is a peer reviewed medical journal and is information relevant to the article. Please provide any logic why you reject this. Rlsheehan (talk) 01:35, 20 January 2013 (UTC)

I have said nothing new and I am done talking about this with you. Again, this needs to go to a noticeboard. We already had help from Cyclopia, and you have decided that wasn't good enough. I'm not going around and around with you. When I have time (working right now) I'll bring this to the proper noticeboard and go from there. Or whoever has time can do so. petrarchan47tc 01:44, 20 January 2013 (UTC)

Rlsheehan doesn't seem to understand the difference between primary and secondary studies, and he doesn't seem to understand that he can only include secondary studies in Wikipedia.

Here's the rule: WP:MEDRS "Ideal sources for biomedical material include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally recognised expert bodies." "All Wikipedia articles should be based on reliable, published secondary sources. Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse."

Rlsheehan, do you agree with that? --Nbauman (talk) 07:57, 21 January 2013 (UTC)

PNAS study

Here's a good review in Nature of the debate over whether cannabis causes a decline in IQ or is just associated with a decline in IQ.

http://www.nature.com/news/pot-smokers-might-not-turn-into-dopes-after-all-1.12207 Nature | News: Explainer

Pot smokers might not turn into dopes after all Revisiting data casts doubts on link between heavy cannabis use and declining IQ.

Arran Frood

14 January 2013

Last year, a paper published in Proceedings of the National Academy of Sciences (PNAS)1 suggested that people who used cannabis heavily as teenagers saw their IQs fall by middle age. But a study published today2 — also in PNAS — says that factors unrelated to cannabis use are to blame for the effect.

Ole Røgeberg, a labour economist at the Ragnar Frisch Centre for Economic Research in Oslo and the author of the latest paper, ran simulations which showed that confounding factors associated with socioeconomic status could explain the earlier result. For example, poorer people have reduced access to schooling, irrespective of cannabis use.

Past research on the Dunedin cohort shows3 that individuals from backgrounds with low socioeconomic status are more likely than others to begin smoking cannabis during adolescence, and are more likely to progress from use to dependence. Røgeberg says that these effects, combined with reduced access to schooling, can generate a correlation between cannabis use and IQ change.

--Nbauman (talk) 19:28, 15 January 2013 (UTC)

This should be included per WP:NPOV. If factors unrelated to cannabis are the cause, then the cohort study (Meier, 2012) would undue weight. --KDesk (talk) 20:56, 15 January 2013 (UTC)

Refs: ABSTRACT mainstream media: CBS petrarchan47tc 22:02, 15 January 2013 (UTC)

Re: Cannabis ("drug"); hot burning photo deletion

Because the prevailingly misinformed public believes cannabis is a drug, this present title is instrumental in guiding readers to whatever has merit in the article, which has many more hits per day than any other cannabis-related WP source. However, there ought to be discussion, up to and including refutation, of the false attribution to cannabis use of health and behavior issues that arise from grossly improper hot burning use procedures which have been promoted by cigarette industry advertising for over a century and bolstered by anti-cannabis laws which make an easy-to-hide joint safer to possess than easy-to-detect harm reduction equipment.

Opposition to listing, in the photo captions, approximate dosage sizes (in milligrams) that give an indication of the gross disparity between a 25-mg. serving size (as in a miniature pipe) and a 500-mg. serving size (as in a hot-burning joint) appears to be based on the unfortunate fact that to date no studies can be cited addressing this issue or that of burning temperature (which has been found to be up to 700°-C. in a tobacco cigarette; the combustion points of tobacco and cannabis are not far apart). Absence of funding for such a study may suggest that the worldwide tobacco industry has enough power to prevent publication of any findings which would (a) discredit the profitable cigarette dosage size or (b) suggest that a substitution of cannabis for tobacco is in any user's interest.

Therefore the question remains, whether any inclusion of a photo of a joint serves any purpose other than that of advertising spam for the tobacco industry which benefits from the role of the joint in helping orient youngsters worldwide to a mythical notion of the normalcy of a 500-mg. joint rather than a 25-mg. low temperature serving device for cannabis use, from which many "graduate" to tobacco addiction (especially in Europe and the middle East where many are taught to mix cannabis with tobacco in the same joint).

Photos of a joint, including how to make one, are properly included in the article Joint, to which links are presently provided.— Preceding unsigned comment added by Tokerdesigner (talk • contribs) 02:06, 16 February 2011

I would like to suggest Cannabis (illicit substance) as a better title. It avoids the incorrect classification of drug but still indicates the topic is about a controlled substance. — Preceding unsigned comment added by 176.25.36.170 (talk) 17:02, 10 February 2013 (UTC)

I'd also like to question why the wild and disputed information on dependency and harm is allowed to continue. UK medical council state Nicotine is more addictive than Heroin. LSD as no addictive or physically harmful effects (but may exacerbate dormant mental conditions). Khat causes bleeding of the gums and tooth loss very quickly. I could go on but even the weighting of the graph is meaningless rubbish. Cannabis has a dependency of 1.5? 1.5 what exactly? this image is completely made up. Furthermore it is contradictory to the text of the article. "AddictivenessDr. Jack E. Henningfield of NIDA ranked the relative addictiveness of 6 substances (cannabis, caffeine, cocaine, alcohol, heroin and nicotine). Cannabis ranked least addictive, with caffeine the second least addictive and nicotine the most addictive.[65]" — Preceding unsigned comment added by ANON (talk • contribs)

Removal of DEA Judge words from article

Good faith edits today saw the removal of the quotation by DEA judge in the safety section. This is a massively POV edit that has no basis in Wikipedia guidelines and is verging on vandalism. petrarchan47tc 17:50, 17 January 2013 (UTC)

Legal petition is not really medically reliable source. Accusing edits you do not agree with as vandalism is WP:UNCIVIL. Cantaloupe2 (talk) 00:54, 18 January 2013 (UTC)

But is medical the only aspect that has bearing on the subject. Given it's almost global classification I think statements made by legal authorities have bearing.WP:ANON — Preceding unsigned comment added by 176.25.36.170 (talk) 16:59, 10 February 2013 (UTC)

Cannabis is under the control of the DEA, so a DEA judge speaking on the totality of the findings he has seen in his years as a judge most certainly belongs in this section (which is the subject of the section above). I will ask the other editor to comment here. I do feel that hacking away this section because a DEA judge said something you may not like to be verging on vandalism. Please do not continue to revert this before we have come to a consensus on the talk page. petrarchan47tc 01:14, 18 January 2013 (UTC)

Yes, in the field of United States controversy, but medical effect of a substance knows know geographical boundaries and his opinion is legal point of view as opposed to scientific. Please do not continue to add contentious materials that advance in favor of marijuana use. Cantaloupe2 (talk) 01:21, 18 January 2013 (UTC)

You are the only editor to call this contentious. I am adding reliable sources and science to an article that is certainly controversial, so it's understandable some editors might find any positive words about cannabis to be offensive. But as this is an encyclopedia, we have to include all major points of view and findings from reliable sources. petrarchan47tc 01:28, 18 January 2013 (UTC)

I think I lean towards Cantaloupe2 position here. Words of a DEA judge on a medical matter are probably informed, but not as authoritative as medical sources. Also, it is horribly sourced -the website from which the quote comes from looks far, far from being a RS, let alone good for WP:MEDRS. Being also a possibly controversial quote of a probably living person from a non-reliable source, there are also WP:BLP issues here. On this basis, I feel the quote should go. At the very least, better sourcing is needed. In that case, it could be perhaps re-added as a footnote, but I'm unsure about it. --Cyclopia^talk 09:38, 18 January 2013 (UTC)

It is somewhat of a landmark case and seems a very important and encyclopedic entry on the subject of cannabis safety. The original document from the government website is easily found (I assume), and I could see cutting the entry down by 2/3, but a little intro is needed to explain how he came to have these beliefs. In the States, the DEA is the ultimate authority on cannabis, adding to the notability.

In a country of the world United States, its division of DOJ called DEA is the ultimate authority on legal affairs within that country. Argument someone else provided that decisions in US "affects the world" is a biased point of view. There's also an issue with relevance. It is undue weight for USA legislative matter in this article. It belongs in Legal_history_of_cannabis_in_the_United_States Cantaloupe2 (talk) 22:41, 19 January 2013 (UTC)

From Removal of cannabis from Schedule I of the Controlled Substances Act In the summer of 1986, the DEA administrator initiated public hearings on cannabis rescheduling. The hearings lasted two years, involving many witnesses and thousands of pages of documentation. On September 6, 1988, DEA Chief Administrative Law Judge Francis L. Young ruled that cannabis did not meet the legal criteria of a Schedule I prohibited drug and should be reclassified. He declared that cannabis in its natural form is "one of the safest therapeutically active substances known to man. (T)he provisions of the (Controlled Substances) Act permit and require the transfer of marijuana from Schedule I to Schedule II (they used the Shaffer report as a ref)

What I am thinking is that we should consider splitting the safety section off and make a new article, based on the wealth of information available on the subject and the need to discuss all aspects of it. It is not appropriate to add much more bulk to the safety section in this article. You wrote 'we don't need (the DEAs statement) to get the point across', I understand this, but my edits are intended to add encyclopedic value and edge this article closer to the truth as seen in literature. (This is 'for the record' and not actually a response to Cyclopia --> ) I didn't come here to make a point. I came because this page was proudly declaring that multiple people had unquestioningly died from cannabis and it was massively misquoting some dubious studies as support. The page on Dec 22, 2012 was heavily spun.

The problem here may be that cannabis is a relatively benign herb. And that fact is showing up in science. Yet there are multiple editors who don't want cannabis seen as safe, so this page could be a constant battlefield. I wonder how that can be prevented. petrarchan47tc 19:11, 18 January 2013 (UTC)

There are several issues here.

• I think Judge Francis Young's statements would meet WP:MEDRS, since it's a secondary source that reviewed the literature, after taking expert testimony on both sides of the argument. Actually, this article cites primary sources, like the Meier study in PNAS, which doesn't meet WP:MEDRS because it's a primary study.

• I'm not sure that WP:MEDRS is the appropriate standard. The debate over marijuana isn't based exclusively on scientific sources or evidence, it's also based on judicial or legislative determinations, of which this is one. The important issue here is that a legal body tasked with determining the safety of marijuana came to this conclusion, and it was ignored by other legal bodies.

• In this context it is. Petrarchan47 is attempting to advance the position that marijuana's health safety, a medical topic. Not a position about the US Government's position on it. Therefore, WP:MEDRS is the proper standard for the position he's trying to advance. Cantaloupe2 (talk) 22:45, 19 January 2013 (UTC)

• WP:WEIGHT is established by multiple WP:RSs. If you don't accept the Schaefer library as a WP:RS, there are thousands of WP:RSs that cite the same study. For that reason alone it belongs in the article. You could even add the primary source.

Yes it is, but clustering a bunch of sources to advance a position still run a foul of NPOV. Strong proponents and opponents, marijuana users/abusers may not have the ability to edit without bias. It is also important to not use sources that have inherent WP:COI such as vendors and I believe NORML would be along a biased source/extremist and should be used with extreme care. Cantaloupe2 (talk) 22:41, 19 January 2013 (UTC)

• There are no WP:BLP issues here. This is the decision of an Administrative Law Judge performing his job, recorded in the official legal record and multiple WP:RSs. No one has ever suggested that he was incorrectly quoted.

• Wikipedia is a worldwide encyclopedia. That means it doesn't exclude the United States. Medicolegal issues involving cannnabis are affected by geographical borders. The U.S. situation has unique features, and the U.S. affects the world and imposes its policies on the rest of the world. So this aspect of U.S. law belongs in this article.

How do we resolve this under Wikipedia rules? Young's statement was in the article. I think it's properly sourced, but if you don't, you can find a source more to your liking. Wikipedia rules say that viewponts widely quoted by WP:RS should go in, so it meets that test. In order to delete that quote, you need a consensus. We don't need a consensus to keep it in. So the Young quote should go in the article. --Nbauman (talk) 01:44, 19 January 2013 (UTC)

"The problem here may be that cannabis is a relatively benign herb. And that fact is showing up in science." - Personal POV disclaimer: I am a molecular biologist, I totally agree with that sentence. I also support cannabis legalization. Now, nobody is saying we should deny the general scientifical consensus. What worries me is that the "Safety" section of the article is a pile-up of stuff in support of this, without any consideration for what is reliably sourced and what is instead not, for example.

Now, about the quote, the points I considered, with my opinions, are:

1. Is the quote reliably sourced?

It appears to me it wasn't -not enough for a BLP-controversial claim, at least (remember that quotes can be misleading, out of context).

1. Is the quote a valid statement for the safety of cannabis?

Yes and no. It is an interesting statement from someone who is conceivably an expert on the subject. However (1) It's a single individual statement, that in theory could only be his own opinion. I'm not saying it is only his opinion, but alone it has little merit. Also, it could sound like suspicious cherry-picking -it creates thus more troubles with editors who disagree on cannabis safety than anything else. (2) The judge is not a researcher on the topic. He may well not know/understand completely the bulk of scientific literature.

1. Is the quote necessary?

It appears to me that it isn't. Even without it, we still have plenty of more robust and less controversial sources and studies that still point in exactly the same direction.

That's how I decided it's better to keep it away from the article. As for Nbauman comments, in a few words: First of all, we need a consensus for everything, keeping or removing. The paragraph is about marijuana safety, and that's an eminently scientifical question -what bodies of law think of it is important, of course, but not there. Also you have the burden to prove that it is reliably sourced and reliably quoted. --Cyclopia^talk 15:45, 19 January 2013 (UTC)

I've added Lester Grinspoon with different links. Grinspoon studied cannabis for 30 years and wrote several books on the subject (and was involved in over 160 studies), and should be mentioned given the references hold up. The comment about "Sativex" being safe - we are getting into cannabinoids now - Sativex consists of only 2 out of over 100 cannabinoids, so I'm not entirely sure whether it belongs in this section. For instance, although "Marinol" is just THC, the drug has at least 4 deaths directly attributed to it, whereas natural THC has none. So we do have to tread carefully when trying to make direct correlations between pharmaceutical preparations and the topic of this article, in my opinion. As for the pileup of support, references about its dangers also fit into this section - whatever evidence we find either way, presented properly and in context, should be part of this section. Another thing about the pileup, it led to the discovery that safety information is somewhat abundant, and the topic's importance should eventually make for its own article where there is room to explore all important studies, etc. petrarchan47tc 18:43, 19 January 2013 (UTC)

I still feel uncomfortable with every quote put on like that, no matter if it's about cannabis or asteroids or pink unicorns: because they always smell of cherrypicking, and they are individual opinions, no matter how expert on the topic is the person. We should stick to the scientific studies. About the pharmaceutical preparations: we have a sub-section on THC toxicity (which by the way does not mention the important Marinol thing, now that you let me know), so I felt that other individual components' safety would make sense too. Either we remove them all, or we put them all. --Cyclopia^talk 19:25, 19 January 2013 (UTC)

Understandable, but these are far from cherry-picked examples. Grinspoon is an authority on cannabis research and certainly one of a handful who have studied the herb for decades. So yes, studies are RS but so are quotations (well sourced) from top researchers and thinkers in the field. Another example would be Oxford's Iversen, who also wrote an influential book on cannabis. Now, I will grant you that there were two quotations I originally added that are not from extremely well-known people in the field. Those quotations were regarding the studies we presented here which seemed contrary to prevailing knowledge regarding cannabis deaths. They were the only two references to this discrepancy that I was able to find. But when it comes to someone like Grinspoon, the DEA judge and Iversen, it would be silly to avoid quoting them in lieu of *only* studies. This encyclopedia has to be readable for those without a degree in microbiology. Quotations from these top researchers (which won't be found in a study) are absolutely perfect for this article and section as well as for the typical reader. This was studies-only section when I first saw this page (12.31.12), and the editors has falsely concluded that those studies showed deaths by cannabis. So you can see one reason for my trepidation about a 'studies only' section. petrarchan47tc 19:47, 19 January 2013 (UTC)

Re Sativex. I am not saying we can't mention separate cannabinoids and formulations made from them, but to proceed with caution. Yes, we should update the Marinol information. The medical cannabis article can be a good reference for this. petrarchan47tc 19:52, 19 January 2013 (UTC)

"but these are far from cherry-picked examples" - If they're common statements out of many, then we don't need to quote a specific one, since we have the bulk of sources explaining that same position. If they're odd out statements, then they're cherry-picked. Either way, I don't see a reason to use them. The paragraph is very clear on the fact that cannabis is safe. Why more pushing?

"But when it comes to someone like Grinspoon, the DEA judge and Iversen, it would be silly to avoid quoting them in lieu of *only* studies" - Not silly at all, IMHO. Also, the paragraph can be made more readible without resorting to quotes.

I agree with the caution for the individual components and pharmaceutical formulations stuff. --Cyclopia^talk 02:22, 20 January 2013 (UTC)

"Why more pushing" - I'm exploring. Like with the Corexit article, now that we've determined and cleary stated it's dangerous stuff, should I stop adding new information to the article? What if we find out more ways in which it's dangerous, or helpful? All if it should be added given due weight.

You would love a studies-only section because that is your language. Frankly, one of the more recent edits you made to the page sent me to the dictionary three times - for one sentence. I represent the average reader in that the majority of us are not trained scientists or in academia. I understand Grinspoon talking about his 30 years of research much much more than I would looking at the actual studies. But for Wikipedia, offering both of these is my idea of a good article. petrarchan47tc 19:50, 20 January 2013 (UTC)

• "What if we find out more ways in which it's dangerous, or helpful?" - New evidence for safety or unsafety of cannabis should be added. Quotes that just repeat the same scientific consensus over and over are useless.
• "You would love a studies-only section because that is your language." - Not really. Honestly quotes are nicer to read, I agree. But they are also problematic, and as such I prefer to have a dry but less controversial and more neutral text, than a lively but problematic one.
• "one of the more recent edits you made to the page sent me to the dictionary three times - for one sentence." - Which one? I am sorry, I am absolutely ready to fix the wording so to make it more readable. Remember however that, while we have to strive to make things reasonably simple, we're not the Simple Wikipedia. A moderate amount of jargon, in certain contexts, is unavoidable. --Cyclopia^talk 16:30, 21 January 2013 (UTC)

What does WP:BLP have to do with Judge Francis Young's statements? This isn't a biography.

(Even if it was, the passage was quoted by multiple WP:RSs http://www.newyorker.com/archive/1997/01 /06/1997_01_06_004_TNY_CARDS_000376422 http://www.nytimes.com/1997/01/06/opinion/immune-to-reason.html , which establishes first its accuracy and second its importance for the article.) --Nbauman (talk) 20:25, 19 January 2013 (UTC)

WP:BLP applies everywhere, not only on biographies, despite the name of the policy (heck, it even applies on talk pages!). Attributing potentially controversial statements to a living person without a less than rock-solid source is a BLP violation. The New Yorker and NY Times sources seem good however, thanks. --Cyclopia^talk 02:24, 20 January 2013 (UTC)

From WP:MEDRS Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies.

• The DEA, with its control of cannabis in the US and its global "war on drugs" would fall under the Internationally recognised expert bodies category, especially the Judge's findings after hearing such a large body of evidence from scientific studies (we can find a different source for his statements). It would also make sense to mention position statements from all that fall into this category. Medical Associations, governmental bodies, etc.

• Grinspoon's book is printed on Harvard Press, and Iversen on Oxford. We can't really be expected to offer the whole book here as a reference, though it would be nice, so to quote the authors or articles referring to their publications should qualify as MEDRS.

At this point we can consider a split and/or adding subsections such as "studies", "position statements", and (something about 'experts in the field'). To categorize the information this way would be an improvement and help alleviate POV and undue weight issues. But, this section might be too large and in-depth at this point to sit at the top of the page. It might be better to move the section deeper into the body of the article as it matures.

Regarding the question "is it necessary?" when evaluating potential additions to the "safety of cannabis" discussion (assuming wiki requirements are met), I would argue that this is an extremely important subject that is not already covered in this encyclopedia. The controversy over this section is probably due to the fact of a growing acceptance and legality of the drug, with factions unwilling to accept this shift within the population. (It may represent a loss of profits for some, control for others... but the reasons the safety of cannabis might be a threatening idea are beyond the scope of this talk page.) petrarchan47tc 20:50, 19 January 2013 (UTC)

Cyclopia, what is the Wikipedia guideline or rule to support your claim that "we need a consensus for everything"? --Nbauman (talk) 06:52, 21 January 2013 (UTC)

WP:CONSENSUS. Read it well. In a few words: Consensus is implicit if there is no disagreement; if there is (like here), then you have to seek it. --Cyclopia^talk 16:21, 21 January 2013 (UTC)

I'm not that user... but let me see if this is helpful. Some considers it an expected etiquette to consult before making change, but its not required. Anyone may add/remove contents at their discretion but they're expected to comply with policies like not inserting prohibited links. The ultimate decision to keep or retain, as well as most other decisions are determined by consensus. Note that consensus is not a vote count unanimous(everyone concurs). Cantaloupe2 (talk) 07:35, 21 January 2013 (UTC)

According to WP:NOCONSENSUS "In deletion discussions, no consensus normally results in the article, image, or other content being kept." Therefore the Francis L. Young quote should be kept. Correct? --Nbauman (talk) 16:16, 21 January 2013 (UTC)

Incorrect. That refers to the deletion of whole articles or any other kind of pages, not individual snippets of content; and "no consensus" has a slightly different meaning (that is, it means the discussion is stuck, not that one can keep content against consensus). --Cyclopia^talk 16:21, 21 January 2013 (UTC)

(The addition of the Judge's statement (as well as the one claim we have in the safety section about possibly deadly strokes) can always go through an RfC process if we can't come to an agreement.) petrarchan47tc 19:32, 21 January 2013 (UTC)

WP:NOCONSENSUS says: "In deletion discussions, no consensus normally results in the article, image, or other content being kept." (Emphasis added.) "Other content" includes quotes like the Young quote.

Can you cite any Wikipedia guidelines or rules that say otherwise? --Nbauman (talk) 02:54, 22 January 2013 (UTC)

Facepalm I already explained above this is not a deletion discussion. See what's linked there at "deletion discussion". We're not talking of deleting a page -other content refers to templates, files and other kind of pages. Feel free to ask on the talk page of the policy if you are still unsure on the interpretation. --Cyclopia^talk 15:09, 22 January 2013 (UTC)

What you're looking for is the second point: "In discussions of proposals to add, modify or remove material in articles, a lack of consensus commonly results in retaining the version of the article as it was prior to the proposal or bold edit." (emphasis mine). Which incidentally in this specific case would have kind of the same effect, but in general it doesn't mean that you can go against consensus to randomly add stuff. --Cyclopia^talk 15:20, 22 January 2013 (UTC)

Yes. That says we should retain the version of the article as it was prior to the edit that removed the Young quote, because we don't have consensus to remove it. --Nbauman (talk) 01:49, 23 January 2013 (UTC)

So, what is the consensus? petrarchan47tc 02:21, 26 January 2013 (UTC)

I do not see a strong consensus. Since the quote was only added to the article on January 5 of this year, it does not have a strong history in this article. It really does not add much because a judge is not a medical source. Rlsheehan (talk) 12:54, 26 January 2013 (UTC)

RfC for content dispute in "safety" section

Does this study deserve mention in the "safety" section (and what would be reasonable to say)?

Notes

1. Here is the previous discussion on this issue. At the time, editors were trying to use multiple references to support the "death by cannabis" statement. After discussion, only this study is still being added to the article. What does the study say? How much weight should it have?
2. This has been as issue since (at least) July 2012.
3. (regarding the study) Cannabinoids are detectable for up to 45 days after use. petrarchan47tc 03:18, 20 January 2013 (UTC)
4. The study in question was again added to the article without having attained consensus. Notes from a biochemist friend who looked at the study:

The Forensic Journal abstract was very tentative; saying possible cardiovascular death, and possible patho-physiological mechanisms. Sounds like they don’t know anything for sure. If there were any certainty about these observations, we would see it in the article. There are a lot of ways we can die besides having drugs in our system, like atherosclerosis. There didn’t seem to be any other post-mortem physiological examination aside from toxicology. In any report like this I would need to see the exact mechanism by which cannabis causes death. There seems to be no information about this. So I reserve judgement.

This RfC was added to two noticeboards at which conversations are also taking place: NOO and OR

Comments:

A call for comment is welcomed. Yes, this journal should be referenced. The Wikipedia article is now biased toward cannabis being totally safe. Some documented risks should be included to allow for balance and neutrality. Forensic Science International is a peer reviewed international journal, [[42]]. The abstract of “Acute Cardiovascular Fatalities Following Cannabis Use” can be found at : [[43]].

The authors, Bachs and Morland, are with the National Institute of Forensic Technology in Oslo, Norway. They discuss their analysis of six sudden deaths where “cannabis was the major toxicological finding”.

One summary is Figure 1 on page 202, titled “Cardeovascular mechanisms of cannabis”. “Increased myocardial oxygen demand” and “Decreased oxygen delivery” lead to “Ichaemia”; results can be “Tachycardia, Peripheal vasodialation, Peripheral vascular reflex failure, and Arrhyhmia?”

Conclusions on page 203 include : “Several reports of cardiovascular episodes associated to cannabis use have been published in the last 20 years and underlying patho-physiological mechanisms have been discussed. Cannabis is generally considered to be a drug with very low toxicity. In this paper, we report six cases where recant cannabis intake was associated with sudden and unexpected death, An acute cardiovascular event was the probable cause of death. In all cases, cannabis intake was documented by blood analysis.” As always in good research, the authors call for “further investigations of clinical, toxicological, and epidemiological aspects”. This information is from a reliable medical source, is relevant to the subject, and is important for Wikipedia readers to be aware of. Rlsheehan (talk) 02:43, 20 January 2013 (UTC)

Comment Just linking to pre-existing NPOV noticeboard discussion here Cantaloupe2 (talk) 07:41, 20 January 2013 (UTC)

Comments from uninvolved editors:

• A single 2001 study of six fatalities with no mention of the amount of cannabis found violates WP:UNDUE, unless those factors are also disclosed. I don't think the research is extensive enough for inclusion in this general article. All the best, Miniapolis 19:18, 20 January 2013 (UTC)
• Do not include - Strongly agree with Mini. The health effects of cannabis have been widely, widely studied. Inserting mention of some result from a small study out of Norway strikes me as grossly WP:UNDUE. NickCT (talk) 13:52, 21 January 2013 (UTC)
• Grossly UNDUE and shade of beating a dead horse. --John (talk) 13:57, 21 January 2013 (UTC)
• Note that this primary source has been cited by a number of usable secondary sources, including PMID 12648025 and PMID 12412837. Per MEDRS it would be much better to cite those secondary sources than the primary source. Looie496 (talk) 01:05, 22 January 2013 (UTC)
  • PMID 12412837 seems especially interesting, given that it is MEDRS-compliant and also says from the abstract "Marijuana's cardiovascular effects are not associated with serious health problems for most young, healthy users, although occasional myocardial infarction, stroke, and other adverse cardiovascular events are reported." - both concepts could enter the article IMHO, without having to resort to individual studies. --Cyclopia^talk 15:15, 22 January 2013 (UTC)
  • I agree. Rlsheehan (talk) 22:03, 22 January 2013 (UTC)
  • We still haven't answered: how much weight should this study/finding be given? How often are these cases reported? petrarchan47tc 06:55, 23 January 2013 (UTC)
  • I'm concerned that: (1) These studies are over 10 years old. If there were any merit to the arguments, somebody would have followed it up since then with stronger evidence. (2) They're second- or maybe third-tier journals. If there were an article in NEJM, JAMA, Lancet, or BMJ, I would put it in. But it's unacceptably weak evidence to say that someone, somewhere in the world published 6 case histories of death associated with cannabis. WP:MEDMOS discourages individual case reports. The basic problem here is establishing causation. Is there any solid evidence that smoking cannabis increases deaths from cardiovascular disease? You haven't shown any, by the standards of either evidence-based medicine or by the standards of Wikipedia. All you have is 6 case reports. There are hundreds of associational studies published every day. There are computer programs that scan medical records databases for associations. We could fill every major medical article in Wikipedia with associations. 6 case histories of association doesn't meet WP:WEIGHT. The "Cardiovascular mechanisms of cannabis" doesn't add anything to the conversation. As scientists pointed out when those effects were first reported, you would have the same cardiovascular results from shoveling snow. --Nbauman (talk) 18:45, 23 January 2013 (UTC)
• "Cite a secondary source" that reviews the Swedish study (or leave it out). The n is too small to be relevant without a reviewer assessing it.Markewilliams (talk) 15:35, 23 January 2013 (UTC)
  • Yes, that alone is a reason to leave it out. The n is too small. --Nbauman (talk) 18:45, 23 January 2013 (UTC)

Resolution

The RfC was successful. The quote identified by Cyclopia captures the essence of the medical position. We would be remiss not to include this information: “Marijuana's cardiovascular effects are not associated with serious health problems for most young, healthy users, although occasional myocardial infarction, stroke, and other adverse cardiovascular events are reported.”

This [44] is at least one good secondary source documenting “occasional myocardial infarction and stroke”. Another medical review and secondary source [45] also supports this but I do not see a need to reference it. Several other primary sources are available but need not be listed. We do not have to over cite.

In an effort to resolve the question of what to say in this Wikipedia article, I am willing to withdraw the tie to rare deaths (although true) and just include the quote from the RTJones medical review. Rlsheehan (talk) 18:34, 23 January 2013 (UTC)

Well, I don't agree. I wouldn't mention MI or stroke unless it could be supported by a reference to a major medical journal. The best would be NEJM, JAMA, BMJ or Lancet. I define a major medical journal by the Brandon–Hill list. The Journal of Clinical Pharmacology and the International Journal of Cardiology are not on the Brandon-Hill List. If they had solid evidence that marijuana has risks of MI or stroke (any more than walking up a flight of stairs), they would have published it in a major journal. --Nbauman (talk) 19:08, 23 January 2013 (UTC)

You wouldn't, but it's policy- and WP:MEDRS-compliant nonetheless. It's a literature review on a respectable peer-reviewed journal, that's enough for "solid evidence". While the original object of the RFC was a primary-sourced study, this is a wholly different beast. I see no reasonable objections that can be had against this. --Cyclopia^talk 13:32, 24 January 2013 (UTC)

For this very reason, we should take another look at the claim and study which exists in the article as we speak: Cannabis is considered to never have led to overdose death though there are medical reports that suggest a possible association of rare lethal cerebellar infarction with marijuana use. petrarchan47tc 19:46, 23 January 2013 (UTC)

Which very reason, and what kind of look? --Cyclopia^talk 13:32, 24 January 2013 (UTC)

Side-note on deaths by cannabis from my biochemist friend: if you map the cannabinoid receptors in the body, you will find that there are no CB-1 receptors in the parts of the brain that control respiratory rate and heart rate. Thus if one takes an enormous amount of cannabis, there will be no depression of breathing or heart rate. There is essentially no way to die from overdose. There may be other complicating factors, but cannabis is utterly safe even in large amounts. petrarchan47tc 19:49, 23 January 2013 (UTC)

WP:OR, WP:SYN, plus the nervous system is not such a simple beast ;) --Cyclopia^talk 13:32, 24 January 2013 (UTC)

We have 5,000 years of history, all the experts, including the DEA Judge's findings saying one thing... what justification is there to include such a fringe theory here on Wikipedia? Because still this article remains the only place one will find mention of cannabis deaths, unless they stumble across this or the 2 articles that cite it. That is not in keeping with Wiki guidelines. This issue as a whole may need another noticeboard for further help. petrarchan47tc 23:14, 24 January 2013 (UTC)

• "what justification is there to include such a fringe theory here on Wikipedia?" - Reliable, secondary sources. We don't care of tradition (5000 yrs of history), we don't care of unreliable sources (DEA judge quotes), but we care about the reliable sources. All of them say that cannabis is basically safe, but some of them also point that there's been evidence of the odd bad side effect. Undisputable sourcing has been found now, and at this point there are no policy or guideline-based arguments to keep that stuff away.
• "this article remains the only place one will find mention of cannabis deaths, unless they stumble across this or the 2 articles that cite it" That's what encyclopedias are for: bringing specialized, technical knowledge to the general public. --Cyclopia^talk 10:41, 25 January 2013 (UTC)

Your opinion is in contrast with documented medical evidence which meets Wikipedia requirements. A DEA judge is not a medical source. Again as I offered in the resolution: In an effort to resolve the question of what to say in this Wikipedia article, I am willing to withdraw the tie to rare deaths (although true) and just include the quote from the RTJones medical review. Do you want to resolve this or do you want to keep on with this fruitless argument? Rlsheehan (talk) 03:06, 25 January 2013 (UTC)

I thought that I had read an article in the NEJM about marijuana as a trigger for heart attacks, so I searched the NEJM for "cannabis" and "marijuana". If the NEJM had published such an article, I would have to agree to mention it in the article, even though I don't think it's medically significant. I didn't find such an article. Instead, I found the following:

Exposure to Traffic and the Onset of Myocardial Infarction

http://www.nejm.org/doi/full/10.1056/NEJMoa040203

October 21, 2004

Peters A., von Klot S., Heier M., et al.

N Engl J Med 2004; 351:1721-1730

Free Full Text

This study examined exposure to traffic in urban areas as a potential trigger of myocardial infarction. A significant association was found between exposure to traffic and the onset of a myocardial infarction one hour later, whether the time spent in traffic was in a car, on a form of public transportation, or on a bicycle.

Myocardial infarction is one of the main causes of death from cardiovascular disease. A myocardial infarction has a sudden onset, and factors related to lifestyle have been identified as potential triggers of myocardial infarction. These include strenuous exercise,1-3 anger,4 and the use of cocaine5 and marijuana.6

6 Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 2001;103:2805-2809

In other words, myocardial infarctions can be triggered, in people who already have heart disease, by stresses such as strenuous exercise, anger, cocaine, and marijuana.

I think the significant points are:

1. Marijuana doesn't cause MIs in healthy people

1. Marijuana can trigger MIs in people who are already predisposed to MIs.

1. The MIs are not caused directly by MI, but indirectly by the metabolic effects of marijuana, in the same way that strenuous exercise or anger can trigger a heart attack.

I would not object to an entry that included those points. But I still think it's justified to demand a review article in a major journal. WP:MEDRS has a discussion that begins, "The Abridged Index Medicus provides a list of 114 selected 'core clinical journals' ..." which discusses all this (basically what I said above). I don't think it's WP policy to base a claim entirely on non-core journals like The Journal of Clinical Pharmacology and the International Journal of Cardiology.

I think of this issue as "the myth of marijuana and heart attacks." I think the evidence shows that marijuana may trigger a heart attack to the same degree that shoveling snow may trigger a heart attack. It may be valuable to clarify in the article the basis for and the weakness of that claim. --Nbauman (talk) 18:03, 25 January 2013 (UTC)

I'm fine with that, as long as the position that said claim is weak is supported by WP:MEDRSCantaloupe2 (talk) 19:25, 25 January 2013 (UTC)

Seems like a reasonable subsection could be formed from this information. I still wish we had more context to offer the reader - how rare or common are these reports? petrarchan47tc 01:50, 26 January 2013 (UTC)

We do not need a whole subsection on this subject. Just a statement that there are occasional medical issues (stroke, MI, etc) is sufficient. Rlsheehan (talk) 12:59, 26 January 2013 (UTC)

A simple statement that "there are occasional medical issues" is misleading. We have to make it clear how strong (or weak) the evidence is. We have to put it in the perspective that the only danger is to people with pre-existing heart disease, and for them, it's the same kind of danger they have from shoveling snow, getting angry, or air pollution from traffic.

I would like to read the full text of those studies and see if -- like all studies in major journals -- they have a section on the limitations of the study, and what those limitations are. --Nbauman (talk) 15:25, 26 January 2013 (UTC)

I'd say the current version agrees with both Rlsheehan and Nbauman general issues. About "We have to put it in the perspective that the only danger is to people with pre-existing heart disease, and for them, it's the same kind of danger they have from shoveling snow, getting angry, or air pollution from traffic." - we have to put it in that perspective if that's what sources explicitly say, otherwise it's WP:SYNTHESIS. We don't "have to" do anything but report what reliable sources say. --Cyclopia^talk 17:01, 26 January 2013 (UTC)

The present wording is:" Cannabis is considered to never have led to overdose death[31] though there are medical reports of occasional infarction, stroke and other cardiovascular side effects.[32] Marijuana's cardiovascular effects are not associated with serious health problems for most young, healthy users.[32] ". This is OK with me and should be acceptable to all. Rlsheehan (talk) 03:12, 27 January 2013 (UTC)

The one source from a major medical journal says, "factors related to lifestyle have been identified as potential triggers of myocardial infarction. These include strenuous exercise,1-3 anger,4 and the use of cocaine5 and marijuana.6" That's what the major sources explicitly say. To ignore that is cherry-picking and WP:POV. To say that "there are medical reports of occasional infarction" is to imply causation. That's misleading. The problem here is that you're doing WP:OR by searching obscure journals for reports of deaths. You haven't found one good review article in a major medical journal that deals with the issue, so you're piecing it together from your understanding of these second- and third-tier journals.

Anything that says or implies that marijuana per se is a cause of myocardial infarction goes beyond the published evidence. The only thing the evidence says is that marijuana is a potential trigger of MI, such as strenuous exercise and anger. Also, some of the cited studies don't seem to distinguish between association and causation. --Nbauman (talk) 19:56, 27 January 2013 (UTC)

I've added an WP:OR tag on the claim in question. Your research certainly supports what all of the experts say, and would solve the cognitive dissonance the safety section causes by claiming some deaths have occurred from cannabis, whilst everyone says there haven't been. What would you suggest for wording and citation? We can try to get consensus and close this discussion. petrarchan47tc 23:09, 30 January 2013 (UTC)

Feeling extremely frustrated here. Rsheehan has gone to related pages Medical cannabis and Effects of cannabis and, although this whole question is still under discussion here, has added "Indeed, marijuana may be a much more common cause of myocardial infarction than is generally recognized" and more here and "There are medical reports, however, of occasional infarction, stroke and other cardiovascular side effects." here. I am going to revert those edits until we have figured out what claims regarding heart attacks and cannabis can be safely made on Wikipedia. petrarchan47tc 20:18, 31 January 2013 (UTC)

Feeling extremely frustrated here. We have established legitimate secondary medical sources for views of the medical community. I have agreed to limit edits to cardiovascular effects and not get into "deaths" (although reported in the literature). My edits have used the language of the medial sources and quotations from them, yet Petrarchan47 seems to want to control this and all related articles. I thought we were making progress toward a reasonable consensus but that is not the case. Do we need to get into a formal dispute resolution? Rlsheehan (talk) 20:45, 31 January 2013 (UTC)

Yes, I think we do. And I think you are very well aware we have not reached a consensus on what the science says, though we are actively trying to, which makes me question why you are frantically trying to add these same questionable claims to other articles. I am going to revert them until we have reached consensus. petrarchan47tc 22:02, 31 January 2013 (UTC)

Safety section: coming to a resolution

We have this section tagged, and still the unresolved RfC about what good science says regarding cannabis and its effects on the heart remains. Can we bring this to a closure? If editors involved could please look over the safety section, and any problems you see, bring it here for discussion, that would help. Then we can be reasonably sure once we've reached consensus, this section should remain fairly stable and we can get back to our other work. In other words, we shouldn't expect to walk away and then have presently active editors removing agreed-upon bits from this section (in a perfect world, that is).

The issues I have with the safety section are:

• The science and understanding Nbauman offered should be swapped with what we have now regarding cannabis and cardiovascular effects (which seems to say that science shows cannabis causes heart attacks, and which uses lower quality sourcing).
• The DEA Judge's statements should be re-entered (I've already argued both points on this page). petrarchan47tc 04:50, 4 February 2013 (UTC)

We have previously mentioned a formal process of dispute resolution. I still believe that is our best option after all this nonproductive dispute. Having a formal neutral process seems to be the best bet of hearing positions from all interested parties and coming to a resolution. I can start the process within a day. Rlsheehan (talk) 08:29, 4 February 2013 (UTC)

Rlsheehan, I see that you have not mentioned your problem with Dr Lester Grinspoon's statement which you removed yesterday. Please, if you have concerns with anything in the safety section, bring it up now so that we can look at it as a group, rather than when no one's looking. Thanks. petrarchan47tc 00:42, 5 February 2013 (UTC)

I've asked the other involved editors to weigh in here too. petrarchan47tc 08:44, 4 February 2013 (UTC)

My position on DEA judge comment has not changed. It should not be included for the reason I've already given. Cantaloupe2 (talk) 09:01, 5 February 2013 (UTC)

Thanks Petrarchan for calling me.

• N I don't understand what "science and understanding" Nbauman offered. We have a clear-cut secondary peer-reviewed medical review that says things clearly on marijuana cardiovascular effects. I see nothing of similar quality from his part: he offered a primary source that also cited a secondary source on marijuana: if anything ,we should directly cite that one. The rest he offers is clearly original research. By the way, there is a nonsense OR tag in the current version (and I'm going to remove it): it is nonsense since the sentence is as 1:1 to the source as it can without introducing copyvios. The "contradiction" that some editors see does not really exist. Saying that something is generally safe is not the same to say that it never has side-effects, and saying that no death has been directly caused by marijuana doesn't mean deaths can't be linked to marijuana use as a concomitant factor, for example. If there are directly conflicting reports, then we ought report that there are conflicting reports in the literature, and that's it.

• N I still think we must not include any quote of any single individual, whatever it says, and especially not a quote from a non-medical specialist. That can easily be construed as cherrypicking (and indeed IMHO it is, regardless of the fact that I personally largely agree with the quotes).

There are serious NPOV problems here, if not much in article content, more in attitude. While the POV being pushed is basically scientific consensus, and as such it's mostly okay, the fact that editors are squirming to remove any mention of scientific sources that cast even remote doubts on the safety of marijuana (while the samesources, indeed, state that marijuana is safe in general, so that's even more ridicolous) is a problem. Nbauman and Petrarchan47 seem hell-bent on removing every reference on even the remote possibility that for some people, in some rare cases, marijuana can have side effects. (I remember when Petrarchan said: "Because still this article remains the only place one will find mention of cannabis deaths, unless they stumble across this or the 2 articles that cite it. " - if this isn't explicit cover up, I don't know what it is).

If this is not settled quickly, I would:

• • go on RS/N to clarify the status of the review about cardiovascular effects of marijuana
  • open a whole new RFC on that source and its inclusion.

Hope it helps. --Cyclopia^talk 15:57, 4 February 2013 (UTC)

OK. My position is that The Journal of Clinical Pharmacology is not a major medical journal, but I agree that the International Journal of Cardiology is -- and the authors are from Massachusetts General Hospital, which gives them more authority. I checked and I have access to IJC, and I just downloaded a PDF of the full article. If anyone needs a copy, I can email it to you. I have to read the full article, but here's the conclusions. I have to go with the medical evidence. There does seem to be fair evidence that marijuana sometimes is a trigger for MI.

4. Conclusions

Marijuana use by older people, particularly those with some degree of coronary artery or cerebrovascular disease, poses greater risks due to the resulting increase in catecholamines, cardiac workload, and carboxyhemoglobin levels, and concurrent episodes of profound postural hypotension. Indeed, marijuana may be a much more common cause of myocardial infarction than is generally recognized. In day-to-day practice, a history of marijuana use is often not sought by many practitioners, and even when sought, the patient's response is not always truthful. Thus, clinicians should be more vigilant in inquiring about use of marijuana in their patients, particularly among the younger adults who may present with cardiac events in the absence of cardiovascular disease or other obvious risk factors.

[Future areas of research]

My problem is that I don't want to exaggerate the strength of the evidence. These seem to be uncontrolled case series Evidence-based_medicine#Assessing_the_quality_of_evidence, AHA which is a relatively weak level of evidence. Doctors would normally not recommend a treatment based on uncontrolled case series (unless the risks of treatment are very low and the benefits very high).

I'm trying to figure out a way to say that without violating WP:OR. There may be something in the full IJC article.

I'd like to find a statement like that in a major medical journal, and the NEJM came close.

I think Young's statement is a WP:RS and would provide adequate balance,

My problem, to put it another way, is that there is evidence that marijuana causes MIs, but it's weak evidence. It's supported by the scientific literature, but there's very little literature. (I could only find one good source.) I heard academic doctors (like Donald Abrams) say in a lecture that there's a bias in the funding sources against anything that could be favorable to marijuana (and indeed federal law says that).

My problem is that I don't want WP to make a stronger (or weaker) statement than than is justified by the literature. The literature -- that is, the one article in IJC -- doesn't just say "linked" and "associated", it says "cause." I'm willing to paraphrase the claim from IJC that marijuana "may be a cause" of MI, or maybe even that it "may be a common cause" of MI, provided that we also say that it was based on uncontrolled case studies and link to the Evidence-based medicine article. I also want to read that IJC article and see whether their cases are of people with pre-existing cardiovascular disease or of young people with no risk factors. If the IJC article says that these were MIs, but not deaths, we should make it clear that these were not deaths.

If I had a friend with cardiovascular disease, and he asked me whether it was safe for him to smoke marijuana, I'd tell him that there were rare cases in which it precipitated a heart attack, and it had the same kind of risks as he would have shoveling snow. That's what I'd like to convey in the article, in a way that avoids WP:OR. --Nbauman (talk) 19:36, 4 February 2013 (UTC)

I just looked at the article cited in the NEJM. This is a case-control study in Circulation, which I have to admit is stronger evidence. I'll have to read the full article (which is free text) before I come to any final conclusions.

Triggering myocardial infarction by marijuana. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Circulation 2001;103:2805-2809 --Nbauman (talk) 20:02, 4 February 2013 (UTC)

Most of these articles use the word "trigger" than a stronger "cause" relationship. I recommend that this Wikipedia article mention a link to occasional MI or stroke as we were previously discussing. More could be located in the Effects of cannabis article in the Short Term, Cardiovascular section. I have already attempted to add some of this discussion there. Rlsheehan (talk) 20:25, 4 February 2013 (UTC)

Nbauman: "there is evidence that marijuana causes MIs, but it's weak evidence." - Then let's just write that. Something like in the medical literature there are only a few reports linking cannabis to MIs. --Cyclopia^talk 22:48, 4 February 2013 (UTC)

I don't count the number of times a term is mentioned in the journals. I weigh the major journals more heavily than minor journals.

2 articles in major cardiology journals used the term "cause." That should be enough to use the term "cause." We could also mention "trigger." But the issue is causality.

"Linking" is not a precise term. What does it mean? Coffee was linked to heart attacks. That's because people who drank coffee were more likely to smoke cigarettes. Coffee didn't cause heart attacks.

The issue is not whether there are a "few" reports. The issue is whether there are studies that establish cause with scientific validity. There are, but the evidence is weak (and the magnitude of the effect may be small). But we can't say that without a WP:RS. We can say that they are case-control studies, and link to the discussion of case-controlled studies in Evidence-based medicine. I think we should. --Nbauman (talk) 00:06, 5 February 2013 (UTC)

Nbauman, if we were talking in a pub or at a scientific conference, I'd agree. But here it is different. We're not here to second-guess sources. "2 articles in major cardiology journals used the term "cause." That should be enough to use the term "cause."" - And in fact, yes it is. Even if I agree with all your doubts: if sources do, we ought to use that term. The issue is causality? Excellent: debate it in the academia. On Wikipedia, if sources say something, we repeat what they say, we don't do original research. That said, I agree with your last 2 sentences. --Cyclopia^talk 00:12, 5 February 2013 (UTC)

(Reply to first comments by Cyclopia) I am not hell-bent on removing anything unless it fails to meet RS. My recent removal of the line about CBD was because it's too problematic to try and equate CBD with cannabis. Few have yet heard of CBD, so to mention related "side effects" when they aren't specified in the article or found in the single in-vitro study referenced added little clarity to the section. (The only side effects from CBD of which I am aware are all extremely positive.) The CBD information could be explored in another section or article, but I don't think this one is the place for it. IF i were hell bent on removing anything about cardiovascular effects I would have done so, just as others have removed the DEA Judge and Lester Grinspoon's comments. Instead, I simply tagged it WP:OR. I truly want to report whatever good science is saying, but it needs to be presented accurately and thus far has not been. It's interesting you have no grief with the editors who actually claimed cannabis killed people - that's the POV I am worried about. Yes, this is the only page that claimed cannabis has killed people other than the cherry-picked studies - which means that they aren't being cited and therefore should not be here - unless they are presented in context, as you all are discussing. This is far from a "cover-up" - it's the proper application of Wiki guidelines to not present fringe as well established fact. If there is no science supporting "cannabis has killed people", then anyone who cares about Wikipedia and RS should be thanking me for putting an end to that ridiculous unsupported claim once housed here. Instead I'm the bad guy? petrarchan47tc 01:34, 5 February 2013 (UTC)

• "Instead, I simply tagged it WP:OR." - Which makes even less sense. It surely isn't original research -it's sourced 1:1 to the abstract of a medical literature review!
• "I truly want to report whatever good science is saying, but it needs to be presented accurately and thus far has not been." - Why?
• "It's interesting you have no grief with the editors who actually claimed cannabis killed people" - Because that's what sources say. No matter how it runs against my deeply ingrained point of view about it, no matter how much it surprised me, it's not kook pseudoscience, it happens to be reported as a rare side-effect in a few authoritative medical reports. As such, it is worth mentioning. I mean, let's talk straight. Me and you agree, on a personal, POV level, that cannabis should be legalized, for example, and that it is basically extremly safe. This doesn't mean it cannot have some rare side effect, does it? Even drinking water can have serious side effects, this doesn't mean water isn't safe in general.
• "Yes, this is the only page that claimed cannabis has killed people other than the cherry-picked studies - which means that they aren't being cited and therefore should not be here" - This is nonsense. First of all, AFAIK, none of our WP:RS policies require that studies have to be widely cited to be considered reliable sources (even if for sure a widely cited source could be more authoritative, in some contexts). Second, it is false. Actually the review linked now in the section is widely cited in the medical literature, with >100 citations. (cfr. Google Scholar citation list for the paper -which by the way is a treasure trove of good papers on cardiovascular effects of marijuana, see for example [46].) The single study that triggered the first RfC is cited about 80 times, still according to Gscholar. Granted, Gscholar counts tends to err on the excess side, but even if only 50% of citations are genuine (usually it's more 75-85%, judging from citations of my own papers), it still would be respectably cited.
• "If there is no science supporting "cannabis has killed people"" - But there is, if not supporting it, at least suggesting it. No matter how uncomfortable we can be with this, we ought to report it. It's not a fringe theory: it's perhaps a minority position, but there are data, it's in the biomedical literature and, as shown above, cited by the medical community. Such stuff is mentioned in science articles. --Cyclopia^talk 11:12, 5 February 2013 (UTC)

i see great progress here. It sounds like we will be able to get a consensus very soon. One other problem I see in the Safety section is the current; "Dr. Lester Grinspoon, Associate Professor Emeritus of Psychiatry at Harvard Medical School and author of Marijuana, the Forbidden Medicine says that one day cannabis "will be seen as a wonder drug, as was penicillin in the 1940s. Like penicillin, herbal marijuana is remarkably nontoxic". Yes, the professor has credentials but the quote is from an Opinion page in a newspaper. That does not make the cut for a good medical source. A peer reviewed journal article would be good. Rlsheehan (talk) 02:11, 5 February 2013 (UTC)

Untrue, if the person is a recognize expert in the field, RS in and of themselves, you can reference even their own blog on Wikipedia. Yes, this article is RS and Grinspoon's findings after 30 years researching at Harvard is very worthy of our article. petrarchan47tc 00:45, 6 February 2013 (UTC)

According to WP:RSOPINION. it must clearly be described as an Opinion. the present wording does not do this. Rlsheehan (talk) 03:50, 6 February 2013 (UTC)

According to RSOPINION: "Some sources may be considered reliable for statements as to their author's opinion, but not for statements asserted as fact without an inline qualifier like "(Author) says...".... explicitly attribute such material in the text to the author to make it clear to the reader that they are reading an opinion."

Here is the present wording: " Dr. Lester Grinspoon.... says that one day cannabis... " - I fail to see the problem. petrarchan47tc 09:16, 6 February 2013 (UTC)

Cyclopia, if editors agree that the references you're wanting to cite say "if not supporting it, at least suggesting it" then let's say that. I am happy for this article to reflect the science - I just don't believe we have agreed on what should be used, and what exactly it says. The science doesn't say cannabis has killed anyone, is that right? Remember WP:TECHNICAL that we need to write highly technical section 'one level down'. The article is NOT clear about this and I guess that's a reflection of the editors' collective lack of clarity. The editors here have yet to agree on what references to use, and what they say. This is a controversial, for some emotional, subject. It may require another type of noticeboard. petrarchan47tc 00:45, 6 February 2013 (UTC)

Another source to settle this all?

Okay, now I'm looking at this, which is a review from The Lancet, possibly the most authoritative medical journal (I think Nbauman will agree on this). It is from 2009, and as such it supersedes the analogous 1998 review in The Lancet cited now in the article. It also cites directly the review discussed above (ref.56). I am in my university office and I can access full text. Here are a few quotes on side effects and risk of death:

• General side effects: "The most probable adverse effects include a dependence syndrome, increased risk of motor vehicle crashes, impaired respiratory function, cardiovascular disease, and adverse effects of regular use on adolescent psychosocial development and mental health." (abstract)
• Risk of vehicle accidents: "Gerberich and colleagues20 found that cannabis users had higher rates of hospital admission for injury from all causes than had former cannabis users or non-users in a group of 64 657 patients from a health maintenance organisation. The risk of motor vehicle accidents (relative risk 1·96) persisted after statistical adjustment in men. Mura and colleagues21 showed a similar relation in a study of THC in the serum of 900 individuals admitted to a French hospital for motor vehicle injuries and 900 age-matched and sex-matched controls. Drummer and colleagues,22 who assessed THC in the blood in 1420 Australian drivers killed in accidents, showed that cannabis users were more likely to be culpable than were non-users (odds ratio [OR] 2·5). Individuals with blood THC concentrations greater than 5 μg/mL had a higher accident risk (OR 6·6) than those without THC. Laumon and colleagues23 compared blood THC concentrations in 6766 culpable and 3006 non-culpable drivers in France between October, 2001, and September, 2003. The investigators showed increased culpability in drivers with THC concentrations of more than 1 μg/mL (OR 2·87). A dose–response relation between THC and culpability persisted after controlling for blood alcohol concentration, age, and time of accident. They estimated that 2·5% of fatal accidents in France can be attributed to cannabis and 29% to alcohol. Driving after having taken cannabis might increase the risk of motor vehicle crashes 2–3 times16 compared with 6–15 times with alcohol. The policy challenge is to specify a concentration of THC in the blood that legally defines impaired driving.24"
• Cardiovascular effects: Evidence exists to support the adverse cardiovascular effects of cannabis use. Cannabis and THC increase heart rate in a dose-dependent way. These drugs marginally affect healthy young adults who quickly develop tolerance,56 and 57 but concern exists about adults with cardiovascular disease.56 and 57 A case-crossover study by Mittleman and colleagues58 of 3882 patients who had had a myocardial infarction showed that cannabis use can increase the risk of myocardial infarction 4·8 times in the hour after use. A prospective study of 1913 of these individuals reported a dose–response relation between cannabis use and mortality over 3·8 years.59 Risk increased 2·5 times for those who used cannabis less than once a week to 4·2 times in those who used cannabis more than once a week. These findings are supported by laboratory studies that indicate that smoking cannabis provokes angina in patients with heart disease.60
• General disease burden: The public health burden of cannabis use is probably modest compared with that of alcohol, tobacco, and other illicit drugs. A recent Australian study96 estimated that cannabis use caused 0·2% of total disease burden in Australia—a country with one of the highest reported rates of cannabis use. Cannabis accounted for 10% of the burden attributable to all illicit drugs (including heroin, cocaine, and amphetamines). It also accounted for around 10% of the proportion of disease burden attributed to alcohol (2·3%), but only 2·5% of that attributable to tobacco (7·8%).

(Notice it also cites lots of studies supporting safety in most situations etc., but I just quoted what was considered controversial here about the possible risk of death associated with cannabis).

I made the full PDF available here. --Cyclopia^talk 15:42, 6 February 2013 (UTC)

This is most helpful! Now, what is the rate of increase of other activities that also raise heart rate, like shoveling snow? I ask because as I read the bit, I still don't have a sense of balance. It sounds very scary - risk of heart attack raised 4-8 times?! That's scary - there must be oodles of people falling over from smoking pot. Where is the data on that? In other words, we have some data that is usable, but we still need context. Again, Nnauman's contributions can really help here. We already knew that cannabis raises heart rate, which is usually no problem. I imagine that for a certain population, anytime the heart rate is raised, the risk of heart attack goes up. By how much? Is cannabis risk worse than or equal to other random (heart-rate-raising) activities for this population? You see where I'm going with this: if it's equal to shoveling snow, that understanding really needs to accompany the entry about cardiovascular effects (if we find RS for it). I can also look for experts in the field who may have commented on this specifically. That would be a good addition. IMO, people who aren't familiar with the medical field can benefit by hearing a real person talk about the science, helping to put it into context. Offering just the raw data can be very misleading, and in the case of cannabis-caused heart attacks, it would be. petrarchan47tc 20:42, 6 February 2013 (UTC)

Interesting, I just heard on the news "a half hour of shoveling snow increases risk of heart attack more than 4 times for anyone 55 and older". So it IS the same. Now to add this all to the article. (As for the driving risks, this is already in the article.) petrarchan47tc 23:42, 8 February 2013 (UTC)

Another study to add? "In May 2001, "The Chronic Cannabis Use in the Compassionate Investigational New Drug Program: An Examination of Benefits and Adverse Effects of Legal Clinical Cannabis" (Russo, Mathre, Byrne et al.) was completed. This three-day examination of major body functions of four of the five living US federal cannabis patients found "mild pulmonary changes" in two patients.

"This project provides the first opportunity to scrutinize the long-term effects of cannabis on patients who have used a known dosage of a standardized, heat-sterilized quality-controlled supply of low-grade marijuana for 11 to 27 years. Results demonstrate clinical effectiveness in these patients in treating glaucoma, chronic musculoskeletal pain, spasm and nausea, and spasticity of multiple sclerosis. All 4 patients are stable with respect to their chronic conditions, and are taking many fewer standard pharmaceuticals than previously. Mild changes in pulmonary function were observed in 2 patients, while no functionally significant attributable sequelae were noted in any other physiological system examined in the study, which included: MRI scans of the brain, pulmonary function tests, chest X-ray, neuropsy-chological tests, hormone and immunological assays, electroencepha-lography, P300 testing, history, and neurological clinical examination." petrarchan47tc 23:54, 8 February 2013 (UTC)

4 patients is a small sample size, it has no statistic significance. --KDesk (talk) 00:31, 9 February 2013 (UTC)

I wonder if this is a unique case though, "This project provides the first opportunity to scrutinize the long-term effects of cannabis on patients who have used a known dosage of a standardized, heat-sterilized quality-controlled supply of low-grade marijuana for 11 to 27 years". Even a small population can lend interesting data when we have so little to begin with. petrarchan47tc 00:38, 9 February 2013 (UTC)

TIME magazine covered this issue recently, and said "the hour after smoking marijuana is associated with a two-fold to five-fold increase in the risk of heart attack, roughly the same risk seen within an hour of sexual activity." That's what we've been coming up with here. (The article also mentioned the link between stroke and cannabis use was looked at again, but it was confounded by cigarette use.) Does anyone object to my adding this to the article? Yes, a study of cannabis diluted with a cocktail of substances (tobacco/paper) in an uncontrolled environment. — Preceding unsigned comment added by 176.25.36.170 (talk) 17:09, 10 February 2013 (UTC)

Also, are there any more problems with this section, or can we remove the tag now? petrarchan47tc 06:47, 10 February 2013 (UTC)

The issues are:

• I am content to have close to the minimal coverage of health issues in this overview article. Potential risks need to be included, however.
• More discussion can be (and needs to be) in Medical cannabis, Effects of cannabis, and Long-term effects of cannabis. There are sources to update and POV issues in these.
• About deaths; If the present claim "no deaths" remains, it needs to be balanced with reported but rare deaths. Perhaps it is best not to get into the death question.
• I am still not comfortable with a newspaper Opinion piece as a reference for a medical source.
• Time magazine is not a medical source.

Rlsheehan (talk) 18:17, 10 February 2013 (UTC)

TIME can be used in conjunction with other studies (to which we've been referring above). Please specify "opinion piece" and please don't be talking about Grinspoon again. If you have a problem with his inherent RS and how that works, take it to the noticeboard and let us know the result. Please stick to discussing one article on this talk page, we have enough on our plate.

I am asking you specifically what issues you have with the safety section in this article. The reason is that the last two times it seemed like a consensus had been reached, after a few quiet days you went about removing positive things from the safety section (which throws off the whole balance/truth thing). petrarchan47tc 06:45, 11 February 2013 (UTC)

"About deaths; If the present claim "no deaths" remains, it needs to be balanced with reported but rare deaths." Not this again. I still wonder if this issue needs a more formal noticeboard for help. I believe it does. We are grappling with an issue very controversial and important, on a page that gets roughly 10K views a day. And 4 editors are trying to figure out of cannabis did kill people while everyone is saying it hasn't? This is getting ridiculous. I think we need to get a little humility and realize this issues might be bigger than us. petrarchan47tc 06:49, 11 February 2013 (UTC)

A newspaper Opinion is not a reliable source. WP:MEDRS says "Ideal sources for biomedical material include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally recognised expert bodies." Rlsheehan (talk) 14:47, 11 February 2013 (UTC)

Agreed. If we go cherrypicking quotes, we can find everything and its opposite. They're good RS for other kinds of claims and topics, not medical ones. Let's stick to scientific sources, no matter what newspapers say, on one side or the other. --Cyclopia^talk 15:50, 11 February 2013 (UTC)

Lester Grinspoon researched cannabis, specifically looking for its dangers so he could help his Harvard students to not hurt themselves. He studied the herb for three decades and wrote two books published by Harvard Press. To quote him here regarding his findings is "cherrypicking"? That assumes there are tons of similar cherries out there, I'd love to hear of all the other researchers you are referring to who fit this description. To my knowledge there are VERY few people who have researched cannabis to this degree. petrarchan47tc 20:36, 12 February 2013 (UTC)

Lancet is a good source, and it's the first place I would go to, but one of the reasons is that they have a good correspondence section. This letter raises some of the objections that came to my mind:

http://www.sciencedirect.com/science/article/pii/S0140673610600864

Correspondence: Adverse health effects of non-medical cannabis use

William Tormey, Department of Chemical Pathology, Beaumont Hospital, Dublin 9, Ireland

http://dx.doi.org/10.1016/S0140-6736(10)60086-4

In their Review of the adverse health effects of non-medical cannabis use, Wayne Hall and Louisa Degenhardt (Oct 17, p 1383)1 cite a study by Mittleman and colleagues2 which suggests that smoking marijuana may be a rare trigger of myocardial infarction. However, in that study, only 37 of 124 marijuana-smoking patients reported smoking within 24 h of infarction and more than half the whole study group were cigarette smokers. Mittleman and colleagues do acknowledge limitations to their study.

The Review ignores contrary evidence of the beneficial effects of cannabinoids on the cardiovascular system. These include a protective role in atherosclerosis progression and in cerebral and myocardial ischaemia. Acute exposure to cannabinoids is associated with tachycardia and a small pressor effect, whereas longer-term use is associated with bradycardia and hypotension.3 Such cardiovascular tolerance can occur within 2 days of frequent exposure but disappears quickly when cannabis use is stopped.4

Cannabis smoking, rather than Δ9-tetrahydrocannabinol per se, may be the villain. At this juncture, it is fair to say that the jury remains out on cannabinoids and the heart.5 ...

--Nbauman (talk) 18:32, 13 February 2013 (UTC)

I think Maia Szalavitz in Time is a good WP:RS. Her articles are like a Wikipedia story -- she cites her sources and you can look them up. Her sources are in the medical literature. She does a good job of reporting the medical literature. As the Lancet article also said, one of the difficulties in this kind of research is that marijuana users also frequently smoke cigarettes.

You or I can read The Lancet or Circulation, but when we reference them in the article, we have to do a lot of selection, and that selection doesn't necessarily wind up as NPOV. Sometimes a journalist can write a better, more objective summary of a peer-reviewed article, and the peer-reviewed literature, than we can.

Szalavitz says:

Earlier research, however, found that the hour after smoking marijuana is associated with a two-fold to five-fold increase in the risk of heart attack, roughly the same risk seen within an hour of sexual activity. The authors conclude, “[I]t seems prudent to caution patients with coronary heart disease and those at high risk for cardiovascular disease to abstain from smoking marijuana.”

I think that's a fair summary of the evidence. Marijuana is associated with the same risk as an hour of sexual activity. I don't mind if you quote Mittleman as saying that heart attacks are caused by marijuana, as long as you make it clear that other people believe that it's merely an association. --Nbauman (talk) 18:48, 13 February 2013 (UTC)

I am a member of Wikipedia:WikiProject Bibliographies and received an email that my program I use to find BOOK sources may be useful here (sorry the email is a week old). The list below is small sample of digitizes books on the topic of cannabis and cardiovascular effects - there credibility should not be a problem (scholarly for the most part)- that said they should be view in terms of by whom (author(s)) by publisher and year of publication. Most should be able to view the pages linked below in the titles. Hope this was helpful all the best.Moxy (talk) 19:16, 13 February 2013 (UTC)

• Jeffrey K Aronson (5 January 2012). Side Effects of Drugs Annual: A Worldwide Yearly Survey of New Data in Adverse Drug Reactions. Elsevier. pp. 56–. ISBN 978-0-444-53741-6.
• Wayne Hall; Rosalie Liccardo Pacula (28 November 2003). Cannabis Use and Dependence: Public Health and Public Policy. Cambridge University Press. p. 60. ISBN 978-0-521-80024-2.
• Hamid Ghodse (11 February 2010). Ghodse's Drugs and Addictive Behaviour: A Guide to Treatment. Cambridge University Press. pp. 96–. ISBN 978-1-139-48567-8.
• Donna R. Falvo (30 January 2005). Medical and Psychosocial Aspects of Chronic Illness and Disability, Third Edition. Jones & Bartlett Learning. pp. 217–. ISBN 978-0-7637-3166-3.
• Franjo Grotenhermen; Ethan Russo (2002). Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. Psychology Press. pp. 60–. ISBN 978-0-7890-1508-2.
• Glen Hanson; Peter Venturelli; Annette Fleckenstein (29 September 2008). Drugs and Society. Jones & Bartlett Publishers. pp. 364–. ISBN 978-0-7637-5642-0.
• Tatiana Shohov (2003). Medical Use of Marijuana: Policy, Regulatory, and Legal Issues. Nova Publishers. pp. 3–. ISBN 978-1-59033-754-7.
• Thomas Nordegren (1 March 2002). The A-Z Encyclopedia of Alcohol and Drug Abuse. Universal-Publishers. pp. 155–. ISBN 978-1-58112-404-0.
• Michelle Riba; Lawson Wulsin; Melvyn Rubenfire (24 January 2012). Psychiatry and Heart Disease: The Mind, Brain, and Heart. John Wiley & Sons. pp. 234–. ISBN 978-0-470-97512-1. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Joyce H. Lowinson (2005). Substance Abuse: A Comprehensive Textbook. Lippincott Williams & Wilkins. pp. 270–. ISBN 978-0-7817-3474-5.

Thank you for the sources. It seems that the medical community is relatively united on the existence of a small increased risk of MI and stroke, particularly when users have existing cardiovascular problems. I am willing to go along with the consensus here regarding the exact wording and which references to use. Rlsheehan (talk) 21:31, 13 February 2013 (UTC)

So it looks like we just need a proposal for exactly how to present the science, and what articles we're referencing. It has to be said: since the increase in heart rate raises risk of heart attack equal to risk from shoveling snow, or having sex, for those over 55, do scientists also warn people to refrain from the latter activities? What makes cannabis an exclusion, what makes it more dangerous, dangerous enough to deserve a warning like that? Just pointing out that even the most sane arguments can be heavily tinged with what appear to be 'reefer madness' rather than scientific points. Though let me be clear, I do support the TIME piece's affirmation of Nbeuman's take on the study he found, that cannabis raises heart rate = to shoveling snow (4 times).

As for the 2 remaining issues, the Grinspoon comments (which don't need to be in the form of a quotation) and the DEA Judge's:

One interesting fact, the Daily Beast used the DEA's findings as their "Exhibit A" for "Cannabis kills no one" (also there was no consensus for the removal of this bit).

As for Grinspoon, his comments were called cherry-picking, but I still argue, that would require there being other cherries. I am waiting to hear about others who studied cananbis for decades, for an institution like Harvard, and wrote two books on the subject, as Grinspoon has... petrarchan47tc 01:45, 14 February 2013 (UTC)

Not sure whats being asked as the gigantic wall of text above is not a thing i want to spend 4 hours reading - I hope Cannabis kills no one" is not a source. If the question is Cannabis overdose --Moxy (talk) 04:47, 14 February 2013 (UTC)

Sorry, Moxy, I was addressing the editors who've been reading along, it didn't seem like you were joining the talk but rather dropping off links (and thank you, btw). No, I didn't mean to use the Daily Beast as a source. petrarchan47tc 05:07, 14 February 2013 (UTC)

• Lawrence S. Neinstein (2008). Adolescent Health Care: A Practical Guide. Lippincott Williams & Wilkins. p. 911. ISBN 978-0-7817-9256-1.
• David Myland Kaufman (2007). Clinical Neurology for Psychiatrists. Elsevier Health Sciences. p. 524. ISBN 978-1-4160-3074-4.
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Well after a little time off, its time to apply the research that has been revealed and improve the section to have a neutral point of view. One of the offending sections was an newspaper editorial (not a medical journal) from a retired Harvard prof. I have kept the citation but cleaned up the quote and put it in a more appropriate location. i think this is a reasonable compromise on this item. Lets look at the rest of the section and finish the clean up. Rlsheehan (talk) 19:26, 17 March 2013 (UTC)

This change "(Cannabis has not been proven to have caused deaths) but an association is currently being researched" is being supported by a study which states in the abstract, "Cardiovascular complications in association with marijuana use have been reported during the past three decades. In view of the elevated public interest in this drug's role in pharmacotherapy in the recent years and the aging population of long-term marijuana users from the late 1960s, encounters with marijuana-related cardiovascular adversities may be silently on the rise. The purpose of this article is to increase awareness of the potential of marijuana to lead to cardiovascular disease." Where does it say anything about death, and how is this addition meant to " improve the section to have a neutral point of view"? 174.71.84.85 (talk) 05:37, 20 March 2013 (UTC)

Please read the entire article; Publisher's copywrite does not allow entire text to be linked. Also read [[47]]. Rlsheehan (talk) 12:02, 20 March 2013 (UTC)