Paul Armentano tipped me off to this article on Forbes.com entitled “Medical Marijuana: An Over-Hyped Drug” by Dr. Peter Lipson that I felt deserved a little radical commentary.
Of course it should come as no surprise that ingesting marijuana makes people feel good. The real question is whether it safely and effectively mitigates the course or symptoms of any medical condition.
There is no doubt about the “safely” part; cannabis is remarkably non-toxic and in the words of DEA Administrative Law Judge Francis L. Young, “the safest therapeutically-active substance known to man”. It cannot cause overdose and its most common side effects are red eyes, dry mouth, and euphoria.
When I prescribe a pharmacologic intervention, I usually have some data to back up my decision. My most commonly prescribed medications, such as metformin, ACE inhibitors, beta blockers, statins, and aspirin, have clear dosing options and have clear outcome data that support their use.
Sure, there are many amazing substances out there that the government does not prohibit, allowing researchers to develop incredible medications from them. However, many of these medications have side effects far worse than red eyes and dry mouth:
So for just one of Dr. Lipson’s magic remedies, I have a coin-flip chance of diarrhea and 1-in-4 chance of nausea. Even the seemingly benign aspirins and NSAIDs (Tylenol, etc.) that some pop like candy for every little ache and pain lead to over 16,000 deaths per year.
Marijuana is not a clearly science-based treatment. Marijuana does not come in easily measured doses, and products that do contain set amounts of cannabanoids, such as Marinol (Solvay/Abbott), are often derided by weed mavens as being “not as good as the real thing”.
Because they aren’t as good as the real thing. Inhaled cannabis vapor is superior to a Marinol pill because (a) Marinol has only THC and lacks CBD, CBG, CBN, CBL, flavinods, and terpenes and (b) inhaled vapor is felt instantaneously and therefore dosage can be titrated by the user when desired effect is reached.
You know why we have specific dosages on a bottle of aspirin? Because if you take too many of them too quickly, you will die. Swallowed pills don’t take effect until digested, usually after 45 minutes. You can’t pop an aspirin, still have a headache a minute later, pop another, still have a headache a minute later, pop another, and so forth. You have to pop an aspirin and wait 45 minutes to see if that worked, then if it didn’t, you can pop another and wait another 45 minutes.
But with cannabis, if you have a headache you can take a puff off a vapor bag and know immediately if it helped. If it didn’t, you can take another puff, and another, and another without any worry of overdose.
Now transfer the headache analogy to a cancer-ridden chemotherapy patient who’s weak and vomiting from intense nausea. Are you going to offer her a puff from a vapor bag that will ease her nausea immediately, or are you going to ask her to swallow – and keep down – a Marinol pill and wait 45 minutes to see if it works?
Whether or not cannabis is a useful drug is not a moral question. It is also not one that can be answered by individuals—science doesn’t work that way. The use of individual anecdotes can be a useful stepping stone to real science, but it can also lead to ethical disasters. The data so far on medical cannabis has been disappointing. It doesn’t seem to help with weight loss in cancer, with agitation from dementia, or with nausea and appetite loss. But cannabis is clearly an active drug and might plausibly have some medical use.
Translation: we can’t believe the hundreds of thousands of cancer patients who smoked a joint for the nausea of chemo and we can’t believe the tens of thousands of AIDS patients who smoked a joint and were finally able to have an appetite and keep their weight at healthy levels, because they didn’t take something that was a standardized dose-measured synthesized extract that fits neatly into the Western pharmaceutical concept of medicine.
All drugs have effects, both good and bad. Marijuana has many negative effects, such as addiction and withdrawal, and it is not yet clear what benefits, if any, the drug may provide. Those who advocate for its use should focus their efforts on improving the study of marijuana rather than the premature use of it as a drug.
22 million Americans will use cannabis this year, but only 3.5 million or so will use frequently (twice a week or more) and of those frequent users about 9% develop any sort of dependence on cannabis, the withdrawal from which is characterized by symptoms like irritability, sleep disturbance, and anxiety. Clearly the greatest negative effect of cannabis use is arrest and incarceration if one is caught.
Which all brings me to the question of this post: If other medications work better than marijuana, so what? Suppose medical science succeeds in creating an inhaler that delivers all the medicinal benefits of cannabis without the side effects of dry mouth, red eyes, and that pesky “high”. Suppose the inhaler is even proven to be superior to natural vaporized cannabis. So what? If my choices between two safe and effective medications are the $50 / month inhaler I get at CVS or the pot plant I grow in my closet, what justification is there for arresting me for the latter, aside from protecting the sales of the former? It would be like arresting people for planting willow trees because aspirin in pill form is superior to chewing willow bark for the acetylsalicylic acid.