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Medical Marijuana: The Debate
Rages On
by: Katt Mollar
Marijuana is also known as pot, grass and weed but its formal name is
actually cannabis. It comes from the leaves and flowers of the plant
Cannabis sativa. It is considered an illegal substance in the US and many
countries and possession of marijuana is a crime punishable by law. The
FDA classifies marijuana as Schedule I, substances which have a very high
potential for abuse and have no proven medical use. Over the years several
studies claim that some substances found in marijuana have medicinal use,
especially in terminal diseases such as cancer and AIDS. This started a
fierce debate over the pros and cons of the use of medical marijuana. To
settle this debate, the Institute of Medicine published the famous 1999
IOM report entitled Marijuana and Medicine: Assessing the Science Base.
The report was comprehensive but did not give a clear cut yes or no
answer. The opposite camps of the medical marijuana issue often cite part
of the report in their advocacy arguments. However, although the report
clarified many things, it never settled the controversy once and for all.
Let's look at the issues that support why medical marijuana should be
legalized.
(1) Marijuana is a naturally occurring herb and has been used from South
America to Asia as an herbal medicine for millennia. In this day and age
when the all natural and organic are important health buzzwords, a
naturally occurring herb like marijuana might be more appealing to and
safer for consumers than synthetic drugs.
(2) Marijuana has strong therapeutic potential. Several studies, as
summarized in the IOM report, have observed that cannabis can be used as
analgesic, e.g. to treat pain. A few studies showed that THC, a marijuana
component is effective in treating chronic pain experienced by cancer
patients. However, studies on acute pain such as those experienced during
surgery and trauma have inconclusive reports. A few studies, also
summarized in the IOM report, have demonstrated that some marijuana
components have antiemetic properties and are, therefore, effective
against nausea and vomiting, which are common side effects of cancer
chemotherapy and radiation therapy. Some researchers are convinced that
cannabis has some therapeutic potential against neurological diseases such
as multiple sclerosis. Specific compounds extracted from marijuana have
strong therapeutic potential. Cannobidiol (CBD), a major component of
marijuana, has been shown to have antipsychotic, anticancer and
antioxidant properties. Other cannabinoids have been shown to prevent high
intraocular pressure (IOP), a major risk factor for glaucoma. Drugs that
contain active ingredients present in marijuana but have been
synthetically produced in the laboratory have been approved by the US FDA.
One example is Marinol, an antiemetic agent indicated for nausea and
vomiting associated with cancer chemotherapy. Its active ingredient is
dronabinol, a synthetic delta-9- tetrahydrocannabinol (THC).
(3) One of the major proponents of medical marijuana is the Marijuana
Policy Project (MPP), a US-based organization. Many medical professional
societies and organizations have expressed their support. As an example,
The American College of Physicians, recommended a re-evaluation of the
Schedule I classification of marijuana in their 2008 position paper. ACP
also expresses its strong support for research into the therapeutic role
of marijuana as well as exemption from federal criminal prosecution; civil
liability; or professional sanctioning for physicians who prescribe or
dispense medical marijuana in accordance with state law. Similarly,
protection from criminal or civil penalties for patients who use medical
marijuana as permitted under state laws.
(4) Medical marijuana is legally used in many developed countries The
argument of if they can do it, why not us? is another strong point. Some
countries, including Canada, Belgium, Austria, the Netherlands, the United
Kingdom, Spain, Israel, and Finland have legalized the therapeutic use of
marijuana under strict prescription control. Some states in the US are
also allowing exemptions.
Now here are the arguments against medical marijuana.
(1) Lack of data on safety and efficacy. Drug regulation is based on
safety first. The safety of marijuana and its components still has to
first be established. Efficacy only comes second. Even if marijuana has
some beneficial health effects, the benefits should outweigh the risks for
it to be considered for medical use. Unless marijuana is proven to be
better (safer and more effective) than drugs currently available in the
market, its approval for medical use may be a long shot. According to the
testimony of Robert J. Meyer of the Department of Health and Human
Services having access to a drug or medical treatment, without knowing how
to use it or even if it is effective, does not benefit anyone. Simply
having access, without having safety, efficacy, and adequate use
information does not help patients.
(2) Unknown chemical components. Medical marijuana can only be easily
accessible and affordable in herbal form. Like other herbs, marijuana
falls under the category of botanical products. Unpurified botanical
products, however, face many problems including lot-to-lot consistency,
dosage determination, potency, shelf-life, and toxicity. According to the
IOM report if there is any future of marijuana as a medicine, it lies in
its isolated components, the cannabinoids and their synthetic derivatives.
To fully characterize the different components of marijuana would cost so
much time and money that the costs of the medications that will come out
of it would be too high. Currently, no pharmaceutical company seems
interested in investing money to isolate more therapeutic components from
marijuana beyond what is already available in the market.
(3) Potential for abuse. Marijuana or cannabis is addictive. It may not be
as addictive as hard drugs such as cocaine; nevertheless it cannot be
denied that there is a potential for substance abuse associated with
marijuana. This has been demonstrated by a few studies as summarized in
the IOM report.
(4) Lack of a safe delivery system. The most common form of delivery of
marijuana is through smoking. Considering the current trends in
anti-smoking legislations, this form of delivery will never be approved by
health authorities. Reliable and safe delivery systems in the form of
vaporizers, nebulizers, or inhalers are still at the testing stage.
(5) Symptom alleviation, not cure. Even if marijuana has therapeutic
effects, it is only addressing the symptoms of certain diseases. It does
not treat or cure these illnesses. Given that it is effective against
these symptoms, there are already medications available which work just as
well or even better, without the side effects and risk of abuse associated
with marijuana.
The 1999 IOM report could not settle the debate about medical marijuana
with scientific evidence available at that time. The report definitely
discouraged the use of smoked marijuana but gave a nod towards marijuana
use through a medical inhaler or vaporizer. In addition, the report also
recommended the compassionate use of marijuana under strict medical
supervision. Furthermore, it urged more funding in the research of the
safety and efficacy of cannabinoids.
So what stands in the way of clarifying the questions brought up by the
IOM report? The health authorities do not seem to be interested in having
another review. There is limited data available and whatever is available
is biased towards safety issues on the adverse effects of smoked
marijuana. Data available on efficacy mainly come from studies on
synthetic cannabinoids (e.g. THC). This disparity in data makes an
objective risk-benefit assessment difficult.
Clinical studies on marijuana are few and difficult to conduct due to
limited funding and strict regulations. Because of the complicated
legalities involved, very few pharmaceutical companies are investing in
cannabinoid research. In many cases, it is not clear how to define medical
marijuana as advocated and opposed by many groups. Does it only refer to
the use of the botanical product marijuana or does it include synthetic
cannabinoid components (e.g. THC and derivatives) as well? Synthetic
cannabinoids (e.g. Marinol) available in the market are extremely
expensive, pushing people towards the more affordable cannabinoid in the
form of marijuana. Of course, the issue is further clouded by conspiracy
theories involving the pharmaceutical industry and drug regulators.
In conclusion, the future of medical marijuana and the settlement of the
debate would depend on more comprehensive and comparable scientific
research. An update of the IOM report anytime soon is well-needed.
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