Smoked Marijuana

Fiction:  Smoked marijuana is best for instant relief

“Medical” marijuana advocates claim that smoking marijuana is the best way to use marijuana because smoking takes effect almost instantaneously and the patients can self-regulate the dose. Advocates claim that patients cannot swallow pills and that smoking is the best way. Patients should be allowed to smoke.

Fact:   Smoking is a very poor way to deliver medicine.

NO FDA-APPROVED MEDICATIONS ARE SMOKED. It is difficult to administer safe, regulated dosages of medicines in smoked form. Furthermore, the harmful chemicals and carcinogens that are byproducts of smoking create entirely new health problems.

The respiratory difficulties associated with marijuana use preclude the inhaled route of administration as a medicine. Smoked marijuana is associated with higher concentrations of tar, carbon monoxide, and carcinogens than even cigarette smoke.

Marijuana adversely impairs some aspects of lung function, causes abnormalities in the cells lining the airways of the upper and lower respiratory tract and the airspaces deep within the lung. Marijuana has been associated with the development of cancer.

In addition to these cellular abnormalities and consequences, contaminants of marijuana smoke include certain forms of bacteria and fungi. Those at particular risk for the development of disease and infection when these substances are inhaled are users with impaired immunity such as AIDS.

Research for a Safe Delivery Process

Fiction:   It is unfair to make people wait for the results of research.

“Medical” marijuana advocates claim that it may be years before a safe and effective cannabinoid delivery system might be available, and that we do not have the time to do the thorough research to isolate which of the sixty cannabinoids found in marijuana are the most effective.  

Fact:   We must study cannabinoids to isolate them for safe use

According to John A. Benson, Jr. M.D., of the Institute of Medicine, research on other cannabinoids is underway and some of these chemicals may one day prove to be useful medicines. However, he states: “While we see a future in the development of chemically defined cannabinoid drugs, we see little future in smoked marijuana as a medicine.”

The fact that one chemical in marijuana is an FDA-approved medicine does not make crude marijuana an approved medicine. Crude marijuana from the leaves and flowering tops of the Cannabis plant contains some 400 chemicals, most of which have not been studied by scientists. Some 60 of these chemicals, called cannabinoids, are unique to the Cannabis plant. One cannabinoid, Delta-9-tetrahydrocannabinol (THC), was synthesized, tested, and approved by FDA in 1985 for treating nausea in cancer patients and wasting in AIDS patients. The drug's generic name is dronabinol and its trade name is Marinol. It is produced by Unimed Pharmaceuticals and it can be obtained by prescription.

The fact that crude marijuana contains a chemical that has been synthesized, tested, and approved for medical use does not make marijuana itself a safe or effective medicine. Modern pharmaceutical science would require all the 400 or more chemicals in marijuana to pass the safety and efficacy tests in research, and this has not happened. Any consideration of this issue must take into account the substantial toxicity and morbidity associated with marijuana use. Efforts to gain legal status of marijuana through passing state laws or ballot initiatives seriously threaten the Food and Drug Administration process of proving safety and efficacy.  They create an atmosphere of medicine by popular vote, rather than the rigorous scientific and medical process that all medicines must undergo.

Marinol (synthetic THC in sesame oil) has been available by prescription for over 20 years. Cesamet (nabilone--a THC analogue) was recently approved. Many other cannabinoid and cannabis-derived products are in the pharmaceutical development pipeline. For example, Sativex --a cannabis-derived extract comprising a defined ratio of cannabinoids (CBD:THC) and administered as a precisely-metered spray inside the patient's mouth--has begun late-stage clinical trials in the U.S. Sativex is already available by prescription in Canada for neuropathic pain in multiple sclerosis (MS) and cancer pain. It appears that the pharmaceutical companies developing these products are conducting serious, legitimate research. 

Marinol  vs. Smoked Crude Marijuana

Fiction:   Marinol is not effective

“Medical” marijuana advocates claim that Marinol is too slow to work and that it is not effective for all the conditions they claim smoking marijuana is effective for. They claim that since Marinol is in a pill form some patients cannot swallow it. 64 Fed. Reg. 35, 928 (1999).

Fact:   Marinol and other drugs are more effective and safe
There already exists a legalized form of “medical marijuana” (i.e., Marinol) which can deliver controlled doses of THC to a patient in the form of a pill (and other approved drugs exist as well to treat these diseases).  

Marinol, which can be controlled for its strength and which delivers none of the harmful side effects of smoking marijuana already exists for use through a doctor’s prescription.  Many other FDA approved medications also exist to treat the debilitating diseases for which the use of “medical marijuana” is being sought. 

Marinol is better for many patients because it is often cheaper and more convenient to use than smoked marijuana. Marinol as an FDA approved drug is covered by medical insurance plans and can be obtained at local drug stores. In addition, Marinol can be ingested more privately than smoked “medical” marijuana.