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For other articles and previous issues click here. February 28, 2005 Is
There Hope for Legalized Dope? Is marijuana a viable treatment option for patients with glaucoma and other serious health conditions? If so, does it stand a chance of being approved for medical purposes? Controversial and emotionally charged, the debate over medical marijuana has heated up once again, fueled in part by the recent Supreme Court hearing Ashcroft v Raich. It has become a classic battle of federal rights vs. state rights, and it is one with no resolution in sight. The issue is far more complex than it may seem, and getting to the heart of it means first cutting through its myriad layers (eg, medical, political, legal) and identifying all the potential ramifications. Medical marijuana is a double-edged sword. A vote against legalizing it in effect denies patients legal access to a substance that may provide pain relief and other health benefits. On the other hand, some experts argue that sanctioning the illegal herb for even limited medical purposes flies in the face of the U.S. government’s war on drugs and that it would be difficult, if not impossible, to control distribution. What, according to experts, does the future hold for this powerful herb, and do its potential benefits outweigh the risks of legalizing it? Marijuana: A Viable Medicine? DeOrio, himself torn on the issue of medical marijuana, also sees potential for the drug in treating glaucoma patients. He says the American Academy of Ophthalmology believes marijuana, when taken orally or inhaled, may help lower intraocular pressure in glaucoma patients but cites inconclusive evidence that marijuana produces this effect safely and as well as conventional drugs. Drawing on this, DeOrio says marijuana may be more effectively used as a complementary glaucoma medicine. “There’s a lot of controversy around it, so I think that the use of marijuana maybe as an adjunct to other, more traditional forms of treating glaucoma may be a better approach as opposed to trying to rely solely on marijuana to induce the effect of intraocular pressure reduction. A lot of my [glaucoma] patients are on two or three different drugs, and maybe marijuana could show some benefit where you may not have to use a drug in as high a dose if it’s combined with a small amount of marijuana.” DeOrio adds that incorporating marijuana into glaucoma patients’ treatment regimens may help prevent the drug resistance that often develops—many patients build up a tolerance to traditional glaucoma medicines over time, rendering them all but ineffective—but he is quick to point out that the drug needs to be studied further to determine its medical safety profile over the long term. According to John W. Huffman, PhD, professor of chemistry at Clemson University in South Carolina, tetrahydrocannabinol (THC), marijuana’s principal active component, is an excellent drug for relieving pain, stimulating appetite and repressing nausea in cancer patients who have had chemotherapy, and reducing spasticity associated with multiple sclerosis. A synthetic form of THC, sold under the name Marinol, is currently licensed for treatment of select conditions. But even though Marinol is a legal medicinal product, “it’s very tough to get a prescription for it,” says Huffman. “A doctor can write a prescription, but they [pharmacists] won’t fill it unless it’s cancer, chemotherapy, or AIDS… It’s licensed as an appetite stimulant in AIDS patients and for nausea in cancer/chemotherapy patients. Marinol is not licensed for treatment of glaucoma.” In addition to Marinol’s strict usage criteria, experts debate the drug’s effectiveness when compared with pure marijuana. “It [Marinol] certainly should be [just as effective as smoking marijuana],” says Huffman, a synthetic chemist. “Our pharmacology collaborators at Virginia Commonwealth [University] have tried to duplicate the makeup of active compounds in marijuana in a synthetic mixture or against just THC—this was done in animals. And the animals can’t tell the difference.” Paul Doering, MS, University of Florida (UF) pharmacy professor, offers a counterpoint: “You could call Marinol basically medical marijuana. But it’s not the same because it doesn’t go racing to the brain like marijuana does or racing to the brain like nicotine does if you’re a cigarette smoker. THC is the active ingredient that’s in marijuana, but it’s in a capsule instead, so it’s less intense in terms of its onset and the levels that are achieved in the body are less than if you were to smoke a drug. That’s why people have turned a blind eye to Marinol and instead would rather use the smoked drug.” According to DeOrio, Marinol is a great drug for stimulating appetite in cancer/chemotherapy patients. Many of his patients have benefitted from its use and have been pleased with the results. But like Doering, he questions Marinol’s efficacy when compared with marijuana. “I don’t think that it [Marinol] has the same level of effect as the actual herb does. There are other components within marijuana that I think are exerting the effects. It’s not just purely the THC. So therefore, synthetic THC … doesn’t have the same level of efficacy as smoking it or taking it orally.” Regardless of Marinol’s effectiveness, the drug remains a highly controlled substance with little leeway for use under the law. It is currently classified as a Schedule II drug, meaning that although it has approved medical uses, it is considered to have a high potential for abuse. So what allowances are made for people, such as multiple sclerosis and glaucoma patients, who are denied legal access to Marinol and medical marijuana? The Need for Weed “If you look at these two individuals, their lives are absolutely not worth living unless they’re firing up with a bowl of marijuana,” Doering says. “It’s almost the analogy of someone dying from cancer or dying from [another] disease, and if the only thing that gives them a little relief and a little pleasure from the constant pain that they have is smoking marijuana, then there’s a humanistic side of me that’s saying, ‘Give them the marijuana, for heaven’s sake.’” According to the report, Raich and Monson, both residents of California, cited the state’s Compassionate Use Act of 1996 as justification for their marijuana use. (The law permits physician-approved use of marijuana.) Both women experience allergic reactions to traditional medications, and they argue that marijuana “treats” the painful effects of their illnesses. In this case, the heart of the issue is whether state government or federal government has the right to determine and control drug laws. Doering sees the classic federal vs. state battle taking place today over medical marijuana. “It argues the rights of states to make laws that may be contrary to that of the federal government,” he says. “And it harks back to me to the days of the Civil War where the states said, ‘You can’t tell us what to do!’ and the federal government said, ‘You watch!’” So far, only a handful of states, including California and Massachusetts, have proposed legislation that would make it legal for patients with certain health conditions to possess and use marijuana. It remains to be seen, however, whether the federal government will ultimately override the will of states. The petitioners’ pleas before the court were enough to tug on Doering’s heartstrings, but did they have the same effect on some of the Supreme Court’s staunch conservatives? Only time will tell, but Doering offers a prediction: “If I had a crystal ball and I could determine what they were going to do on this issue, it would be pretty clear to me that the Supreme Court is once again going to affirm its federal ban on marijuana—period, end of discussion.” The Obstacles “I think marijuana being a Schedule I drug, like morphine … is a bit extreme,” says DeOrio. “I don’t think that it’s as addictive or as potentially lethal as morphine. You can get overdoses on morphine relatively easily, whereas marijuana requires large amounts, probably beyond the capacity for anyone to at least inhale—you probably couldn’t inhale enough marijuana to actually kill yourself… So what’s the purpose of making it a Schedule I drug, except to protect the public—to prevent people from overdosing or to make it more difficult for physicians to prescribe it?” Huffman’s work, which is funded by the National Institute on Drug Abuse, is more or less unaffected by marijuana’s current Schedule I drug classification. Doering and DeOrio, however, believe marijuana’s scheduling severely restricts funding allocated for research and testing. Backed by inadequate funding, it therefore appears unlikely that marijuana will be legalized for medical purposes—that is, unless it were to be reclassified to a lower drug class. “Two things would have to happen in order to approve medical marijuana,” says Doering. “One would be figuring out how to schedule it in terms of controlled substance category. No. 2 might be: How do you standardize it so that it’s not a pot plant in Mary’s back yard that’s not nearly as potent as somebody growing ‘krypie,’ or high-potency marijuana? Who would manufacture it? What standards would be set and what dosage forms? [For marijuana to be] recognized as a drug, there has to be answers to those questions.” Other unanswered questions include the following: Is marijuana safe enough for medical purposes? “I understand what people are saying—that it’s helped them with certain symptomatology,” DeOrio explains. “But at the same time, I also know that marijuana, when smoked, can also cause a lot of brain damage… There might be some benefit in terms of marijuana’s use in glaucoma: reducing or lowering intraocular pressure and preventing optic nerve damage. [But] there could also be other effects in the long term that could be more deleterious than the benefits of the drug itself.” How would marijuana’s medical distribution be monitored? What would be the criteria for its distribution—ie, would its use be designated for only certain conditions, excluding others? In addition to those obstacles, Doering cites the U.S. government as a major roadblock in and of itself. One of the Bush administration’s biggest initiatives is its war on drugs, and Doering, for one, questions whether a government that places so much emphasis on drug prosecution would ever stand behind legalizing marijuana, a historically “dangerous” substance. “With a very strong administration in the White House and the huge problem in our country with recreational drug use, I think our federal government would see this [legalizing medical marijuana] as a giant step in the wrong direction,” he says. The Bottom Line: Alternatives “I think that the bottom line here is the federal government has got to find a way to promote and support research in the use of either marijuana or the components of marijuana as drugs … yet at the same time protect the public from an unbridled use of a drug that has negative consequences. That’s a challenge,” he says. Doering favors seeking a better delivery method than inhaling marijuana, which he sees as a highly inappropriate way of managing an illness. Referring to glaucoma, he says, “A drug could be developed—let’s say an eye drop, for crying out loud—so [patients] wouldn’t have to expose their lungs to burning plant material.” He believes in treatment that spares the body as much as possible and instead narrows the focus of treatment to the specific ailing organs. Like Doering, Huffman believes a resolution lies in finding more suitable methods of medicating patients, whether that means developing a synthetic THC compound or alternative delivery mechanism. “There’s more tar and junk in marijuana than there is in a cigarette. Basically, that’s my objection to medical marijuana—it’s not a very good delivery system,” says Huffman. “Also, unless the plant is grown under controlled conditions and assayed, you have extreme variability in terms of the concentration of THC in the plant… Ideally, there are folks working on inhalers, like an asthma inhaler, or a patch, and both of those would be much better delivery systems.” DeOrio has developed a unique alternative to medical marijuana—one that precludes drugs. He says the staff at the DeOrio Wellness Medical Center attempts to use as much of an integrative approach to health as possible, promoting the benefits of acupuncture, proper nutrition, and herbs. “We do what’s called sound therapy. We actually have the marijuana frequencies, and we’ve developed CDs that have all the different forms of marijuana frequencies on them. We have patients who … get a little buzzed and euphoric listening to the CD. It actually can create the same type of effect [as smoking marijuana] in the body through the brain by using frequencies.” DeOrio concludes, “Bottom line: We’ve got CDs that we give our patients, so we don’t even have to deal with the whole concept of smoking it or taking it orally. We just give them the frequency of marijuana. That’s how we get around all this federal stuff.” — Heather Gurk is production editor at For The Record. |
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