By William H. Foster, Ph.D.
Well, the debate continues apace. Fourteen states and the District of Columbia have already voted to legalize medical marijuana. And 8 states continue to consider the matter. If these considerations end up in the affirmative, we will have reached a point where the citizens in almost half of our states will have decided the medical merits and clinical value of a federally designated and controlled substance through the ballot box. No FDA review and approval required for this particular prescription medicine.
Through our nation's democratic political processes voters will have functionally certified the clinical effectiveness and "do no harm" character of a psychopharmacological treatment for both acute and chronic maladies, rather than through the use of our existing scientific review processes and well understood procedures of our FDA.
No carefully designed and implemented controlled clinical trials, no need for health-risk assessments, no encompassing epidemiological evidence required. We will have replaced them, in the case of medical marijuana, with some good doses of political rhetoric, numerous provocative "talking head" media debates, many formal legislative and public hearings and a final certification of medicinal safety and efficacy by majority vote.
I find this fascinating! It is certainly a legitimate question to ask as to whether marijuana has clinically therapeutic and/or curative characteristics. There is nothing wrong with a serious consideration as to whether this easily grown plant has merits as prescription medication for a select number of illnesses and health conditions, acute or chronic.
For many years now one of the plant's key ingredients, delta-9-tetrahydrocannabinol or THC, has been available to prescribers and patients in the form of the cannabinoid pills Marinol and Cesamet. A major complaint of patients, however, has been the inefficiency and ineffectiveness of the means of delivery of these medications. They are swallowed and as a result are slow to act and depress both the psychoactive and medicinal effects of the pill's THC.
In contrast when marijuana is smoked, as provided by voter authorized medical marijuana dispensaries, the active components of the plant are efficiently inhaled directly into the lungs and immediately into the blood stream -- purportedly providing both the psychoactive as well as the medicinal effects of the marijuana.
So, let's pretend for a moment that an efficient, clinically effective respiratory means of delivering only the medically beneficial components of marijuana were to be developed in some pharmaceutical laboratory. Wouldn't it be reasonable for us to expect that because of its therapeutic import, such a new medication, with its unique respiratory delivery system, would require FDA review and approval, subsequent prescriptive distribution and then clinical management through on-going medical supervision, as is currently the case with Marinol and Cesamet?
Then we could retreat from our peculiar practice of authorizing prescription medicines through the ballot box. And we could avoid the unintended consequences of our emerging medical marijuana distribution system -- a system vulnerable to concerns such as uncontrolled dose amounts; poorly monitored treatment protocols, on-going exposure to high levels of carcinogens, higher than any commercially sold cigarette; heightened probability of accidents due to intoxication; and almost certain diversion and subsequent increased availability for recreational rather than medicinal use. Prescribed, distributed, smoked medical marijuana may have its clinical value. But it does have its downsides -- some potentially serious ones.
Let's step back for a moment and look at what else could be going on here. Let's stipulate that as a carefully crafted tactical first step toward someone's ultimate objective of legalization that the medical marijuana political gambit is not a bad first act. For how many in the political arena can ultimately stand against the winds blowing in favor of helping the seriously sick and those with chronic pain?
If the end were truly better medications for patients perhaps it would be simpler and safer to just develop an efficient, effective delivery system for the clinically valuable components of this ubiquitous plant. Just like we have with medicinal derivatives from other plants such as those crafted from the poppy.
But, if legalization is in fact the ultimate intent of this current scripting of the American political psyche and landscape regarding medical marijuana, then let's be clear. Let us distinguish ends from means. Let's not be too naive regarding what this may actually be about.
If the end of this political gambit is legalization perhaps we should deal with the complex public health and medical matters associated with that proposition directly and thoughtfully. Not through the smoke screen of politically approved medical marijuana distraction, a distraction that is most likely just a means to another more problematic end.
Appeared on The Huffington Post on Dec. 11, 2010