WON'T GOVERNMENT LET US USE
MARIJUANA AS MEDICINE?
Lester Grinspoon, MD
12/07/2000 Boston Globe Op/Ed
High-ranking government officials in the United States have referred to the concept of medical marijuana as a hoax, a subterfuge by which proponents of a more liberal policy toward this drug will succeed in undoing the long-standing, harsh prohibition. Ignorant of the role cannabis played in Western medicine from mid 19th into the early 20th century, they and their many supporters view the notion that cannabis has medicinal properties as a new intrusion into allopathic medicine. The parochialism of this view is highlighted by ethno-historical studies which document not only how ancient is the use of this substance as a medicine, but as well, the multiplicity of cultures that have used it in so many different ways for the treatment of a large variety of human ailments and discomforts. Its use as a medicine is so widespread and reports of its toxicity so rare, the contemporary judgment of Western medicine seems deviant. One might ask why the government of the United States, the leading oppositional force, clings so tenaciously to this insular and harmful policy? The answer, of course, is the fear that as people gain more experience with cannabis as a medicine they will discover for themselves that its toxicity has been greatly exaggerated, its usefulness undervalued, and that it can be used for purposes the government disapproves of. Having made these discoveries, they will be less supportive of the present prohibition and its enormous costs, among which is the annual arrest of 700,000 people in the United States alone.
the publication of its report in March 1999, the Institute of Medicine of
the National Academy of Sciences grudgingly acknowledged that cannabis has
some medical utility but averred that because smoking it was too dangerous
to their health, patients would have to await the development of
pharmaceutical products which would eliminate this hazard. While the
report greatly exaggerates the danger of smoking cannabis, it fails to
provide a discussion of vaporization, a technique that allows patients who
wish to avoid the smoke to inhale the cannabinoids largely free of
particulate matter. Another
reason the authorities would have patients wait for the "pharmaceuticalization"
of marijuana is to allow for the development of cannabinoid analogs that
will be free of any psychoactive effects.
This goal is based on the assumption that the psychoactive effects
are both unhealthy and bad for the patient in the vague way in which the
"high" is thought by the prohibitionists to be deleterious.
It is an assumption that is not supported by the mountain of
anecdotal evidence that supports marijuana's usefulness as a medicine.
While there are some patients who do not like the psychoactive
effects, they are relatively rare; the vast majority, patients suffering
from serious illnesses, finds that smoking cannabis not only relieves a
particular symptom, but also makes them "feel better".
Helping patients, particularly those with chronic diseases, to feel
better is an important goal of the humane practice of medicine.
And there is a growing understanding in medicine that patients who
feel better do better.
resistance of government authorities to allowing the availability of
cannabis as a medicine is generally supported by the Western medical
establishment. This has not
always been so. Physicians in
the United States were enthusiastic about the medicinal uses of cannabis
from the middle of the nineteenth century until the passage of the first
of the Draconian legislation aimed at marijuana in 1937 (the Marihuana Tax
Act). Under pressure from the
Federal Bureau of Narcotics, the predecessor organization to the present
Drug Enforcement Administration (DEA), the Journal of the American Medical
Association published in 1945 a vehemently anti-marijuana editorial, which
signaled a sea change in the attitude of doctors toward this drug.
They became both victims and agents of the marijuana disinformation
campaign launched by Harry Anslinger, the first Chief of the Federal
Bureau of Narcotics. Many
physicians today still suffer from both this legacy and fear of the DEA,
so much so that they are afraid to prescribe Marinol (a legally available
synthetic THC, both more expensive and less effective than marijuana).
the medical establishment takes the position that there is no scientific
evidence demonstrating that cannabis has medical usefulness.
This stance is based on the fact that there is a paucity of
double-blind controlled studies of the clinical usefulness of marijuana.
This scarcity is likely to persist for some considerable time. The
costs of such studies are generally underwritten by pharmaceutical firms
who stand to gain much if they can demonstrate a therapeutic usefulness
in, and win Food and Drug Administration (FDA) approval of, a drug whose
patent they hold. Because this naturally occurring herb can not be patented,
these firms will not invest the more than $200 million needed to do the
studies required for official approval of a pharmaceutical. Consequently, the medical utility of marijuana will continue
to rest on anecdotal evidence of which a great deal has accumulated here
in the West and all around the world.
would not be the first medicine to be admitted to the pharmacopoeia on the
strength of anecdotal evidence. Anecdotal evidence commands much less attention then it once
did, yet it is the source of much of our knowledge of synthetic medicines
as well as plant derivatives. Controlled
experiments were not needed to recognize the therapeutic potential of
chloral hydrate, barbiturates, aspirin, curare, insulin, or penicillin.
It is unlikely that marijuana should or will ever be developed as
an officially recognized medicine via the FDA approval process, which is
ultimately a risk/benefit analysis. Thousands of years of widespread use have demonstrated its
medical value; the extensive multi-million dollar government-supported
effort (through the National Institute of Drug Abuse) of the last three
decades to establish a sufficient level of toxicity to support the harsh
prohibition has instead provided a record of safety that is more
compelling than that of most approved medicines.
The modern FDA protocol is not necessary to establish a
risk-benefit estimate for a drug with such a history.
To impose this protocol on cannabis would be like making the same
demand of aspirin, which was accepted as a medicine more than sixty years
before the advent of the double-blind controlled study.
Many years of experience have shown us that aspirin has many uses
and limited toxicity, yet today it could not be marshaled through the FDA
approval process. The patent
has long since expired, and with it the incentive to underwrite the
enormous cost of this modern seal of approval. Cannabis too is
unpatentable, so the only source of funding for a
"start-from-scratch" approval would be the government, which is,
to put it mildly, unlikely to be helpful.
Other reasons for doubting that marijuana would ever be officially
approved are today's anti-smoking climate and, most important, the
widespread use of cannabis for purposes disapproved of by the US
government. As a result, we
are going to have two distribution systems for medical cannabis. One will
be the conventional model of pharmacy-filled prescriptions for
FDA-approved medicines derived from cannabis as isolated or synthetic
cannabinoids and cannabinoid analogs.
The other will have more in common with some of the means of
distribution and use of alternative and herbal medicines.
The only difference, an enormous one, will be the continued
illegality of whole smoked or ingested cannabis.
In any case, increasing medical use by either distribution pathway
will inevitably make growing numbers of people familiar with cannabis and
its derivatives. As they learn that its harmfulness has been greatly
exaggerated and its usefulness underestimated, the pressure will increase
for drastic change in the way we as a society deal with this drug.