The End of the Medical Marijuana Debate?
Last month, Canada approved a new treatment for Multiple Sclerosis which is derived from the cannabis plant. Sativex is an extract of the whole plant, as opposed to the synthetic THC provided by Marinol. It is administered “sublingually”–as a spray under the tongue or inside the cheek.
People like me who have been generally suspicious of medical marijuana advocates–because the same folks tend to advocate complete legalization of marijuana–have long pointed to Marinol as a reason why smoking pot is not a legitimate medicinal activity. The cannabis advocates replied (and not without merit) that THC without the other components of marijuana is not as effective as the whole plant. But now all the evidence suggests that Sativex is just as effective as whole cannabis (marijuana advocate Rob Kampia says “Make no mistake: Sativex is liquid marijuana”), but without the insult to the throat and lungs caused by smoking. Sativex also contains a consistent ratio of active cannabinoids, which the raw plant material lacks.
Kampia argues that because Sativex has been found safe and effective, patients should be allowed to grow their own marijuana rather than pay for prescription Sativex. He also clearly implies that the prohibition on recreational marijuana use has been undercut by Sativex. However, the medical legitimacy of Sativex no more logically justifies allowing people to grow marijuana in their back yards than the medical legitimacy of morphine justifies allowing people to grow a patch of opium poppies. In short, Sativex may take the “medical marijuana” argument out of the debate over the legality of smoking pot.
14 Responses to “The End of the Medical Marijuana Debate?”
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Irslattery provides some instruction regarding miracles. Questions with answers: What are miracles? Can men work miracles? Can miracles be worked by the relics of saints, pictures, etc.? Why are there not so many miracles in our times as there were …
The main reason the medical marijuana argument continues to be powerful against prohibition is because it clearly illustrated the irrationality of the prohibition itself (and the prohibitionists, as well).
Just a couple days ago you were concerned about evil trial lawyers denying sick patients the right to experimental drugs. Marijuana prohibition has denied sick patients the right to an experimental drug for decades; are the prohibitionists as evil as trial lawyers?
Clearly, clinical trials involving forms of medical marijuana *have* been going on for years, and drugs like Marinol and Sativex are the result.
Eric, plain ‘ol smokeable marijuana did virtually everything these synthetics do, 40 years ago. They’ve spent 40 years denying patients the right to this stuff, so they can eliminate the “harmful effects of the smoke.” Which the patients weren’t complaining about anyway.
How is that different from trial lawyers forcing the drug companies to be liable for harmful effects of Tysabri that the patients aren’t complaining about anyway? Yes, in 40 years, maybe they’ll have figured out a way to eliminate all the risk factors from Tysabri. In the meantime, the trial lawyers will have denied patients the right to this drug for decades.
How is this not parallel? How are the prohibitionists better than the trial lawyers?
Why is it necessary to have an intermediary, in the form of a pharmaceutical company, deliver the drug instead of allowing people to produce it on their own at a much cheaper cost? Why does medical marijuana become acceptable when it has a profit margin and remain unacceptable when it doesn’t?
I’m sympathetic to the discomfort of those who believe that many medical marijuana advocates are really just fronting for full legalization. I actually support full legalization of all drugs, but I also get really angry at people in San Francisco and Santa Cruz (to name two places I’ve lived) who turn the marijuana dispensaries into dope dens: it’s stupid to allow the perfect to be the enemy of the good, as in, “It should all be legal, man!” That attitude provides a convenient excuse for anti-drug crusaders who fight against medical marijuana regardless of the human cost, precisely to prevent the door opening to full legalization of personal use.
That said, just as pro-legalization advocates need to separate those issues, so do anti-legalization partisans. Pot works as a medicine. As the National Academy of Science concluded: “Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation…” As such, it should be legal for those who need it. To argue, as Eric Seymour did, in favor of access to experimental drugs but against access to medical marijuana on the basis of the attitudes of a portion of the pro-medical marijuana crowd is both hypocritical and imposes a high human cost because of the actions of a few, most of whom aren’t those who are really negatively affected, that is, the sick.
For a little more perspective, check out this L.A. Times article and some of the responding Letters to the Editor.
Rick, read what I wrote. I am very much in favor of the therapeutic value of cannabinoid drugs. What I’m against is “smoke two of these and call me in the morning” quackery.
Allowing people to grow their own pot and “medicate” themselves would provide clear enforcement problems. How are you going to make sure folks are growing it only for their own medical use, and not turning it into a cash crop?
That said, I’m rather agnostic about marijuana prohibition. I find some of the arguments in favor of legalization to be compelling, though I’m not yet convinced it’s better than the status quo.
I agree that permitting “grow-your-own” medical marijuana does present massive enforcement problems. If you want to try and prevent people from using marijuana recreationally, allowing patients to self-medicate is pretty much opening the floodgates.
But I think drug prohibition generally is moral authoritarianism, so while I agree with the logic at the enforcement stage, I find the whole operation to be poisonous underneath.
It all comes down to how you feel about whether the government is better positioned than the individual to decide what’s right for the individual. Which is why it makes total sense that maintaining drug prohibition is generally a conservative position. Right?
I think this is great news for the legalization of recreational marijuana, too. When it is realized that whole-plant marijuana extracts are safe and effective medicines, that dangerous overdoses are impossible, and that addictions are on the whole quite rare, the rationale behind prohibition won’t survive very long.
Another problem with “grow your own” pharmaceuticals is that patients by and large aren’t qualified to determine the proper dosage.
If consumers aren’t qualified to determine proper dosage, can’t they just grow their own, and then ask their doctor what he thinks is the proper dosage?
Patients self-treat at home all the time. When I was in college, I used to help this sick one-armed-one-legged old man who was at home, without health insurance, slowly rotting away from various infections in and out of bed every night. I used a hydraulic lift and a bunch of chains and canvas. I was completely unqualified to do this; I could have dropped him on his head and killed him at any time.
However, because it was a miserable, agonizing task that nobody would ever actually want to do, nobody wanted to regulate it. Now, giving him PAINKILLERS to help him relieve his physical agony would have been illegal. Not because I wasn’t qualified to do it — I wasn’t qualified to do any of the dangerous things I did. But because that was a DRUG and for some reason (moral authoritarianism) drugs are scary things individuals can’t handle. Unlike the other complex, dangerous tasks I did for him to help him survive …
Unlike, say, cars — massive multi-ton steel boxes we hurl past each other in at 60 miles per hour every day — drugs are TOO DANGEROUS for the average individual to be trusted using on his or her own.
Drugs and cars don’t make for a good comparison. The root of good driving skills is common sense and alertness. The average citizen cannot competently diagnose illness in most cases, and in those cases is thus in no position to self-prescribe any medication.
In retrospect, grow-your-own could work under the rules of drug prescriptions – with one exception. The doc gives us the prescription and not the drug, after all. But the doc determines not only the individual dose but the number of doses.
Grow-your-own would technically be over-the-counter, since the supply is set by patient and not physician. Plants don’t come with dosage labels, so there would have to be an information market on how to prepare and dose the plants properly.
Whether marijuana is properly an OTC drug is another issue.
when the FDA authorizes grow-your-own Oxycontin, count me in.
Eric,
In what way is smoking naturally grown marijuana quackery while taking it from a medicine dropper sound medicine? Is there some magical realism imparted along with the pharmaceutical manufacturing process that makes administering the same medicine less quackery? The point about dosage is really a red herring. Along with the argument made that “today’s marijuana is up to 40 times stronger than what you may have smoked in the 60s,” this completely misunderstands how patients and recreational users dose themselves with the drug. Basically, smoking provides effectively instantaneous feedback on the current dosage. This allows the user to take as much as desired or needed at a particular time and then stop. In the parlance of medical marijuana, smoked marijuana is “self-titrating,” allowing the user direct control over the amount of the drug consumed at each dosing. A report from the NIH in 1997 claimed that aerosol THC “is absorbed within seconds and delivered to the brain very rapidly and efficiently… Oral ingestion is slower and maximum THC plasma levels are reached 1-3 hours after dose.” I can’t find any information on the absorption time of Sativex, so I can’t compare the two. But this is simply to show that smoking is not “quackery.”
On the other hand, “controlled” pharmaceutical doses provide more an illusion of control than any real safety measure over the amount of medication that’s appropriate for the user. Consider the fact that most medicines provide dosage information for “adults”, even though what it means to be an adult varies wildly in size, gender, body chemistry, tolerance of or sensitivity to a particular drug, and so on. A standardized dosing system might make you feel that that the dosages would then be more controlled: the fact is that self-titration is controlled directly by the user, with the dose escalating with each puff and allowing the user to stop once the appropriate amount has been consumed. Putting a few drops under the tongue provides the dosage in one shot: this may be enough or it can easily be too much (especially in the case of someone who is in the midst of an attack of nausea).
Regarding the negative health effects of smoking, there are two main counterpoints to that:
Again, although I’m in favor of both medicinal marijuana and recreational use, I’m in favor of them on two different grounds and am careful to separate the issues. The fact that sick and dying people are denied marijuana when there are clear health benefits is inhumane (and, as an aside, I find it interesting that most of those who wanted to keep Terri Schiavo alive are also hard-core drug warriors).
I see no rational or consistent justification for approving a “medicine” that is basically “pot in a can” while not allowing free usage of the natural plant. This is not because I’m a homeopathic, mystical blatherer who believes that “Mother Earth provides better, man.” Instead, it’s a matter of dollars and cents: marijuana and the accessories for its use can be provided cheaply to those who need it. Given the surging profits of the pharmaceutical manufacturers and the surging growth in the costs of health care in America, it’s stupid to try to find yet another way to give money to pharmaceutical companies when a cheap, reliable, and cost-effective means of providing exactly the same medication (reading GW’s FAQ shows that they’re really just providing distilled cannabis plants) to patients exists.
In my WHO ought to the stress the government & policy maker if they are serious about the health care of the nation they will immediately take some steps to bring revutionary changes into our health care systems.