Pubdate: Sun, 17 Aug 2003
Source: Boston Globe (MA)
Copyright: 2003 Globe Newspaper Company
Contact:  http://www.boston.com/globe/
Details: http://www.mapinc.org/media/52
Author: Lester Grinspoon
Note: Dr. Lester Grinspoon, an emeritus professor of psychiatry at Harvard
Medical School, is author of "Marihuana Reconsidered" coauthor of
"Marijuana, the Forbidden Medicine."

THE SHIFTING MEDICAL VIEW ON MARIJUANA

IN A RECENT poll conducted by Medscape, a website directed at health care 
providers, 76 percent of physicians and 89 percent of nurses said they 
thought marijuana should be available as a medicine. That's a big change 
from the attitude in the medical community a decade ago, when few health 
providers believed (or would acknowledge) that cannabis had any medical 
utility. That was not surprising; physicians receive most of their new drug 
education from journal articles or from drug company advertisements and 
promotions, and neither of these sources provides information about medical 
marijuana.

The dramatic change of view is the result of clinical experience. Doctors 
and nurses have seen that for many patients cannabis is more useful, less 
toxic, and less expensive than the conventional medicines prescribed for 
diverse syndromes and symptoms, including multiple sclerosis, Crohn's 
disease, migraine headaches, severe nausea and vomiting, convulsive 
disorders, the AIDS wasting syndrome, chronic pain, and many others.

A mountain of anecdotal evidence speaks to marijuana's medical versatility 
and striking lack of toxicity. Even the federally sponsored Institute of 
Medicine has grudgingly acknowledged that marijuana has medical uses.

However, the government itself refuses to learn. Its official position, as 
stated recently by the new DEA administrator, is that "marijuana is not a 
medicine."

When it is at last obliged to acknowledge the medical value of marijuana, 
the government will be faced with the problem its present attitude has 
allowed it to avoid. How can it grant access to marijuana for medical 
purposes while prohibiting its use for other, disapproved purposes? One 
solution is what I would call "pharmaceuticalization": the development of 
prescription medicines derived from the therapeutically active components 
of cannabis and synthetic variants of these molecules.

This process has already begun in a small way. The Food and Drug 
Administration, under pressure from a growing number of physicians and 
patients, approved Marinol for the treatment of the nausea and vomiting of 
cancer chemotherapy. Marinol is synthetic tetrahydrocannabinol, the primary 
active cannabinoid in marijuana, packed in a capsule with sesame oil so 
that it cannot be smoked.

But relatively few patients have found Marinol useful. It is less effective 
than marijuana for several reasons. Because it must be taken orally, the 
effect appears only after an hour or more. That eliminates one of the main 
advantages of smoked or vaporized inhaled cannabis, which works so quickly 
that the patient can adjust the dose with remarkable precision. 
Furthermore, Marinol is more expensive than marijuana, even with the 
prohibition tariff that raises the price of illicit cannabis.

Several other products, including extracts of marijuana, are in the 
pipeline, but they are unlikely to be any more useful or less expensive 
than plant marijuana. Even if pharmaceutical companies invest the many 
millions of dollars it will take to develop useful cannabinoid products, 
they will not displace natural marijuana for most purposes. And because the 
primary, and for many the only, advantage of these drugs will be legality, 
their manufacturers will have an interest in vigorously enforced 
prohibition that raises the price of the competitive product, street marijuana.

The realities of human need are incompatible with the demand for a legally 
enforceable distinction between medicine and all other uses of cannabis. 
Marijuana not only has many potential medical uses, but can also safely 
enhance many pleasures and ease many discomforts of everyday life. In many 
cases what lay people do in prescribing marijuana for themselves is not 
very different from what physicians do when they provide prescriptions for 
psychoactive or other drugs.

The only workable way of realizing the full potential of this remarkable 
substance, including its full medical potential, is to free it from a dual 
set of regulations -- the laws that control prescription drugs, and the 
often cruel and self-defeating criminal laws that control psychoactive 
substances used to for nonmedical purposes. These mutually reinforcing laws 
strangle marijuana's uniquely multifaceted potential. The only way to 
liberate the potential is to give marijuana the same legal status as 
alcohol, a far more dangerous substance.

Marijuana should be removed from the medical and criminal control systems. 
It should be legalized for adults for all uses.
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MAP posted-by: Keith Brilhart