Pubdate: Thu, 07 Dec 2000
Source: Boston Globe (MA)
Copyright: 2000 Globe Newspaper Company.
Contact:  P.O. Box 2378, Boston, MA 02107-2378
Feedback: http://extranet.globe.com/LettersEditor/default.asp
Website: http://www.boston.com/globe/
Author: Dr. Lester Grinspoon
Note: Dr. Lester Grinspoon, professor emeritus at Harvard Medical 
School, is the author of "Marihuana Reconsidered" and "Marihuana, the 
Forbidden Medicine."

WHY WON'T GOVERNMENT LET US USE MARIJUANA AS MEDICINE?

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 ethnohistorical 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 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 
prohibition and its enormous costs, among which is the annual arrest 
of 700,000 people in the United States alone.

With 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 that 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, 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.

The 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 19th century until the passage of the first of 
the Draconian legislation aimed at marijuana in 1937 (the Marijuana 
Tax Act).

Under pressure from the Federal Bureau of Narcotics, the predecessor 
organization to the present Drug Enforcement Administration, the 
Journal of the American Medical Association published in 1945 a 
vehemently antimarijuana 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 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).

Today, 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 time. The costs of such 
studies are generally underwritten by pharmaceutical firms that stand 
to gain much if they can demonstrate a therapeutic usefulness in, and 
win Food and Drug Administration 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.

It 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 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 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 60 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 marshalled 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. Other reasons 
for doubting that marijuana would ever be officially approved are 
today's antismoking 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.
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MAP posted-by: Josh Sutcliffe