Featured
Legitimizing Marijuana as “Medicine”
(Winter 2015) Twenty-three states plus the District of Columbia have legalized marijuana as “medicine.” But can a cannabis plant really be considered legitimate medication — especially in its whole and smokeable form? And in what other circumstances have citizens been given the authority to decide, simply by casting a vote, if a drug is appropriate to use in treating a medical condition?
At the same time, there are accounts of people experiencing genuine relief from their medical symptoms by ingesting marijuana — children suffering from epileptic seizures; cancer victims battling chemotherapy-induced nausea; and multiple sclerosis (MS) patients fighting pain, tremors and spasticity associated with their disease. But are these anecdotes — as heart-wrenching as they can be — enough to give marijuana the same credence as other substances that have officially been deemed safe and effective and legitimized as “medicine?”
Similar to the opium poppy plant, from which legitimate drugs like morphine and codeine are derived, it is likely that some of the over 400 natural components of the cannabis plant do have medicinal value in managing certain symptoms and conditions. But a legitimate (and potent) drug like morphine has not only gone through a rigorous approval process, it is also accompanied by specific directives and information to minimize user risk.
To credibly consider marijuana legalization, it seems the debate needs to move beyond “should marijuana be legalized as medicine?” to a more applicable discussion: “What needs to happen to legitimize specific components of marijuana as medicine?”
| TO BECOME A LEGITIMATE MEDICINE, MARIUANA MUST BE/BECOME … | ||
| 1. | LEGAL | Despite multiple challenges over the past decade, marijuana continues to be classified as a Schedule I drug, meaning it has “no currently accepted medical use and a high potential for abuse” according to the Drug Enforcement Administration (DEA). Drugs in this category are considered the “most dangerous of all the drug schedules with potentially severe psychological or physical dependence.”
Additionally, the Food and Drug Administration (FDA) has denied previous reclassification attempts citing the lack of sufficient research to prove marijuana’s effectiveness in treating medical conditions. |
| 2. | PROVEN EFFECTIVE | To date, there have been minimal large-scale clinical trials showing that the medicinal benefits from using the marijuana plant (as opposed to its cannabinoid ingredients) outweigh the risks.
A recently published article in the Journal of the American Medical Association did an independent review of 79 studies on the medical efficacy of marijuana in treating 10 different indications:
The report concluded that there was “moderate-quality evidence” to support the use of marijuana in treating only two of the 10 indications: chronic pain and spasticity. “Low-quality evidence” was found to support the use of the drug to treat four of the other issues (nausea and vomiting due to chemotherapy, sleep disorders, HIV-related weight loss and Tourette syndrome) and no evidence was found to support its use with the other four. The researchers only found one study, involving six patients, which examined the benefits of treating glaucoma with marijuana, a condition long associated with “medical” marijuana. |
| 3. | FDA-APPROVED | It is the FDA’s job to ensure that the benefits of a particular drug outweigh the potential risks, and that it is effective in treating a specific symptom, condition or disease.
Drug companies perform laboratory and human testing on the substance, submitting the research results, manufacturing information and proposed labeling information with their application for approval. The labeling information includes potential risks, side-effects and how it should best be administered. Though whole-plant marijuana has not been approved by the FDA, there are two synthetic (i.e., man-made) forms of cannabis that have FDA-approval and can be prescribed to treat severe nausea and vomiting caused by cancer chemotherapy:
|
| 4. | PRESCRIBED BY A HEALTHCARE PROFESSIONAL | Aside from the synthetic drugs mentioned above, there is NO SUCH THING AS A PRESCRIPTION FOR MARIJUANA. Nowhere in the U.S., not even in the 23 states where marijuana is legal for medicinal use, is it legal for a healthcare professional to write a prescription for marijuana like one would for a legitimate, FDA-approved medicine.
Instead, healthcare providers in these states can only (per state law) certify a patient’s condition for which the use of marijuana may be recommended, and issue a card or certificate to enable the patient to purchase the drug at a marijuana dispensary. And because marijuana is illegal at the federal level, a debate remains as to whether it is even ethical for medical professionals to recommend marijuana. |
| 5. | ACCOMPANIED BY PATIENT INFORMATION | Patients, just like healthcare professionals, need specific information about the medication they are prescribed to ensure they take the drug safely and responsibly:
This information does not exist with marijuana but needs to. When marijuana is used with alcohol, the effects of both are intensified. And drinkers are less likely to vomit when smoking weed, which increases the risk of alcohol poisoning or overdose if they drink large quantities. And how would a medical professional recommend an appropriate “dose” of marijuana when no standard measure of buds, joints or marijuana-infused candy bars or other edibles exists? This lack of dosing information is especially critical when considering children’s use of marijuana as “medicine.” Contrary to commonly held beliefs, marijuana is not a “soft” drug. Research indicates that one in 11 people who uses the drug becomes addicted to it, and the odds increase to one in six for those who began using during adolescence. |
| 6. | AVAILABLE AT A PHARMACY | Nowhere in the country can marijuana be purchased at a pharmacy or any other location that sells legitimate medicine. Nowhere. Never. Not even in states where it has been legalized for medical or personal use.
Instead, in legalized states it is sold in marijuana shops or dispensaries by bud tenders or store keepers with no required medical credentials or experience. |
The bottom line on legitimizing marijuana as medicine? More research is needed. Proponents for legalizing it outside the FDA process express concerns that it’s too difficult and time-consuming to research it within the constraints of the government. As a Schedule I drug, researchers are not allowed to grow plants themselves to study, but, instead, are required to purchase research-grade marijuana from the federal government. And to even conduct a clinical trial a researcher needs to obtain a license from the DEA.
In an effort to encourage more research, the Obama administration streamlined the research approval process in June 2015. Now, instead of requiring both the Public Service Health Board and FDA to approve research, only the FDA is involved in the process.
Despite these and other challenges, there has been movement to legitimize drugs containing components of marijuana. Sativex®, a cannabis-based nasal spray, has been approved in many countries (e.g., Canada, the UK, Spain and Germany) to treat spasticity due to multiple sclerosis and possibly cancer-related pain. Additionally, a cannabis-based drug called Epidiolex® is in clinical trials to treat seizures related to childhood epilepsy. This drug contains cannabidiol (CBD), a specific component in marijuana that does not produce a “high” like THC, the active ingredient in smokeable or edible marijuana.
So perhaps the debate about whether marijuana should be legalized marijuana as “medicine” should change focus. To determine if components of the plant can indeed provide safe and effective treatment or relief from specific conditions, experienced by carefully identified patients, citizens and healthcare professionals should insist that more research and drug development be done to fill the void. Legitimate patients deserve legitimate medication.
DISCLAIMER: This publication is designed to provide accurate information regarding the subject matter covered. It is provided with the understanding that those involved in the publication are not engaged in rendering legal counsel. If legal advice is required, the services of a competent professional should be sought.
