Medical Marijuana – Debate Rumbles
Cannabis is also known as pot, grass and weed but its official name is actually marijuana. It comes from the leaves and flowers of the Cannabis sativa plant. 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, a substance that has a very high potential for abuse and has no proven medical use. Over the years several studies have claimed that some of the substances found in marijuana have medicinal uses, especially in terminal illnesses such as cancer and AIDS. This started a heated debate about the pros and cons of using 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 is comprehensive but does not provide a clear yes or no answer. Opponents of the issue of medical marijuana often cite parts of the report in their advocacy arguments. However, although the report clarified many things, it never resolved the controversy once and for all.
Let’s look at the issues that support why medical marijuana should be legalized.
(1) Cannabis is a natural herb and has been used from South America to Asia as a medicinal herb for thousands of years. In this day and age when all natural and organic are important health buzzwords, natural ingredients like marijuana may be more attractive and safer to consumers than synthetic drugs.
(2) Cannabis has strong therapeutic potential. Several studies, as summarized in the IOM report, have observed that cannabis can be used as an analgesic, for example to treat pain. Several studies have shown that THC, a component of marijuana, is effective in treating chronic pain experienced by cancer patients. However, studies of acute pain as experienced during surgery and trauma have inconclusive reports. Several studies, also summarized in the IOM report, have shown that some components of cannabis have antiemetic properties and, therefore, are effective against nausea and vomiting, which are common side effects of cancer chemotherapy and radiation therapy. Some researchers believe that marijuana has some therapeutic potential against neurological diseases such as multiple sclerosis. The specific compounds extracted from cannabis have strong therapeutic potential. Cannobidiol (CBD), the main component of cannabis, 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 the active ingredients present in marijuana but have been synthetically produced in a laboratory are approved by the US FDA. One example is Marinol, an antiemetic agent indicated for nausea and vomiting associated with cancer chemotherapy. The active ingredient is dronabinol, a synthetic delta-9-tetrahydrocannabinol (THC). Other cannabinoids have been shown to prevent high intraocular pressure (IOP), a major risk factor for glaucoma. Drugs that contain the active ingredient present in marijuana but have been synthetically produced in a laboratory are approved by the US FDA. One example is Marinol, an antiemetic agent indicated for nausea and vomiting associated with cancer chemotherapy. The active ingredient is dronabinol, a synthetic delta-9-tetrahydrocannabinol (THC). Other cannabinoids have been shown to prevent high intraocular pressure (IOP), a major risk factor for glaucoma. Drugs that contain the active ingredients present in marijuana but have been synthetically produced in a laboratory are approved by the US FDA. One example is Marinol, an antiemetic agent indicated for nausea and vomiting associated with cancer chemotherapy. The active ingredient is dronabinol, a synthetic delta-9-tetrahydrocannabinol (THC).
(3) One of the main proponents of medical marijuana is the Marijuana Policy Project (MPP), a US-based organization. Many medical professional societies and organizations have expressed their support. For example, The American College of Physicians, recommended a re-evaluation of the Schedule I cannabis classification in their 2008 position paper. The ACP also expressed strong support for research into cannabis’ therapeutic role as well as acquittal from federal criminal prosecution; civil liability; or professional sanctions for doctors prescribing or dispensing medical marijuana in accordance with state law. Likewise, protection from criminal or civil penalties for patients using medical marijuana as permitted by state law.
(4) Medical marijuana is used legally in many developed countries The argument if they can do it, why can’t we? is another strong point. Several countries, including Canada, Belgium, Austria, the Netherlands, the UK, Spain, Israel, and Finland have legalized the therapeutic use of cannabis under strict prescription controls. Some states in the US also allow exceptions.
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 remains to be established. Benefits only come second. Even if marijuana has some beneficial health effects, the benefits must outweigh the risks to be considered for medical use. Unless marijuana proves to be better (safer and more effective) than the drugs currently available on the market, its approval for medical use may still be a long way off. 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, benefits no one. Just having access, without having adequate safety, efficacy, and usage information does not help the patient.
(2) Unknown chemical component. Medical marijuana is only easily accessible and affordable in herbal form. Like other herbs, cannabis belongs to the category of botanical products. Unrefined 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 a future for cannabis as a drug, it lies in its isolated components, the cannabinoids and their synthetic derivatives. To fully characterize the various components of cannabis would cost so much time and money that the cost of the drugs that would come out of it would be too high. At present, it appears that no pharmaceutical company is interested in investing money to isolate more therapeutic components of cannabis beyond those already available on the market.
(3) Potential for abuse. Cannabis or marijuana is addictive. It may not be as addictive as hard drugs like cocaine; however there is no denying that there is a potential for substance abuse associated with marijuana. This has been demonstrated by several studies as summarized in the IOM report.
(4) Lack of a safe delivery system. The most common form of cannabis delivery is through smoking. Considering the current trend in anti-smoking laws, this form of delivery will never be approved by health authorities. A reliable and safe delivery system in the form of a vaporizer, nebulizer or inhaler is still in the testing phase.
(5) Relieves symptoms, not cures. Even if marijuana has a therapeutic effect, it only addresses the symptoms of certain diseases. It does not treat or cure this disease. Given that it is effective against these symptoms, there are already drugs available that work as well or even better, without the side effects and risks of abuse associated with marijuana.
The 1999 IOM report could not settle the debate about medical marijuana with the scientific evidence available at the time. The report clearly discourages the use of smoked marijuana but provides a nod to the use of marijuana via inhalers or medical vaporizers. In addition, the report also recommends the compassionate use of marijuana under strict medical supervision. In addition, it is pressing for more funding in research into the safety and efficacy of cannabinoids that are being used in area 52 delta 8 items.
So what stands in the way of clarifying the questions raised by the IOM report? Health authorities don’t seem interested in a review. There is limited data available and whatever is available is biased towards safety concerns about the adverse effects of smoked marijuana. The available data on efficacy come mainly from studies on synthetic cannabinoids (eg THC). This disparity in data makes an objective risk-benefit assessment difficult.
Clinical studies on cannabis are few and far between due to limited funds and strict regulations. Because of the complicated legalities involved, very few pharmaceutical companies invest 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 botanical product cannabis or does it include synthetic cannabinoid components (e.g. THC and its derivatives) as well? Synthetic cannabinoids (eg Marinol) available in the market are very expensive, pushing people towards more affordable cannabinoids in the form of marijuana. Of course, the matter is increasingly shrouded in conspiracy theories involving the pharmaceutical industry and drug regulators.
In conclusion, the future of medical marijuana and the resolution of the debate will depend on more comprehensive and comparable scientific research. An update of the IOM report in the near future is urgently needed.