The primary intoxicating chemical in marijuana – delta-9 tetrahydrocannabinol, or THC – is also the active ingredient in Marinol, approved by the Food and Drug Administration as an appetite stimulant and anti-emetic and anti-nausea medication. At the same time, the government’s drug-abuse-prevention messages stress that THC is the most dangerous element in cannabis. Contemporary pot, we are told, is a much riskier drug than the material sold thirty years ago; it has more THC, and less cannabidiol (CBD), which partially counteracts the anxiety-provoking action of THC.
But we are also told that there’s inadequate scientific evidence to show that natural cannabis has medical value.
Somehow the official spokesmen manage to ignore obvious contradiction here. If high-THC cannabis is more dangerous than low-THC cannabis, then how can it be that pure THC is a medicine while natural cannabis, with less THC and at least some CBD, is “Cheech and Chong therapy”? The real answer seems to be that pure THC, taken orally, is so unpleasant that very few people will use it voluntarily except as medically directed.
Surely if THC has medical value, and the other chemicals in natural cannabis add a safety factor, then natural cannabis must also have medical value. That point is so obvious that it can be missed only by someone whose paycheck depends on not understanding it.
But “having medical value” isn’t the same thing as “being a medicine.” A medicine is a material of known chemical composition and dosage that has been shown in clinical trials to be safe and effective in the management of some condition in some patient population. By that standard, natural cannabis can’t be a medicine, simply because natural cannabis varies so widely in its chemical content: not only from one strain to another, but from one plant to another and even from one bud to another from the same plant.
If I have an infection and go to my internist, she does not say to me, “You have an infection. I have heard reports that antibiotics can treat infections. I recommend that you take some antibiotics.” No, she writes me a prescription for (say) 100 mg. of amoxicillin, three times a day, with meals, for seven days. “Blow some weed” is not a prescription. That’s the reason that “rescheduling” cannabis to recognize its medical value is a non-starter legally; rescheduling needs to follow clinical research, and would apply only to specific products, not to the plant generically.
In fact, the vast majority of ‘patients’ buying ‘medical marijuana’ aren’t doing so under any sort of active medical supervision… Many of them aren’t ‘treating’ anything but their desire to get high…-Mark Kleiman
In fact, the vast majority of “patients” buying “medical marijuana” aren’t doing so under any sort of active medical supervision; they simply bought a recommendation from a cooperative doctor (or, in Washington State, a chiropractor, naturopath, or physician’s assistant). Many of them aren’t “treating” anything but their desire to get high or their need to feed their cannabis habit. Some of them are buying “medicine” partly to resell it, with the “dispensary” acting more or less as a wholesale dope-dealership.
So what would it take to create real medical products from cannabis?
- Production technology to yield reproducible chemical profiles, which in practice probably means extracts rather than whole flowers.
- Development of specific products with specific chemical content.
- Clinical trials to verify safety and efficacy for specific conditions in specific populations.
That’s not an impossibly tall order; GW Pharmaceuticals has a genuine medical cannabis product, Sativex, an oral spray in a dosage-controlled device containing roughly equal amounts of THC and CBD, plus some of the other chemicals in natural cannabis. It’s already approved for limited indications in the UK, Canada, and Germany, and no doubt will be approved in the U.S. once the appropriate clinical trials have been done and presented to the FDA.
There’s no reason why other products couldn’t be developed and approved on the same model. That can’t, as a practical matter, be done in the United States today, because the federal government’s insistence on having a single monopoly supplier of research cannabis means that no would-be vendor of medical cannabis in the U.S. can demonstrate its capacity to produce a product under “good manufacturing practice”: that is, to make something where each dose has the same chemical content.
People who really want to make cannabis medicines ought to be arguing for freeing clinical research from its bureaucratic chains…-Mark Kleiman
People who really want to make cannabis medicines ought to be arguing for freeing clinical research from its bureaucratic chains, not pretending that taking an unknown amount of an unknown mix of chemicals is the same thing as taking a pharmaceutical drug. And as states move to legalize the sale of cannabis without a medical recommendation, the justification for having a parallel “medical marijuana” supply system disappears. Unfortunately, the people making money from running that system will fight to the bitter end against any threat to their business, and do so in the name of “protecting patients.” Those battles are already being fought in Colorado and Washington.
Now that “medical marijuana” has served – as the advocates intended – to legitimize non-medical legalization, perhaps it’s time to drop the mask and have that debate on its own merits.
Let’s move ahead with genuinely medical cannabis products, and stop using “medicating” as a euphemism for getting wasted.