The Case Against Medical Marijuana
On Wednesday, two leading governors called on the Feds to reclassify marijuana for medical use. The Fix's newest columnist, a former drug policy adviser to the Obama administration, thinks that's a very bad idea.
On Wednesday, the governors of Washington and Rhode Island convened a press conference calling on the federal government to reclassify marijuana so as to acknowledge its medical value and allow its use, in their words, “for treatment—prescribed by doctors and filled by pharmacists.”
Houston, we have a problem. Call it bad staff work or just an easy way for Governors Lincoln Chafee (D-RI) and Chris Gregoire (I-WA) to pass the buck to the Feds and dodge a highly volatile issue, but federal rescheduling will not do any of the things they are calling for. A few facts to consider: First, rescheduling marijuana would not allow doctors to prescribe the drug, nor would it make it okay for pharmacists to dispense the drug. The Food and Drug Administration (FDA) requires drugs to go through a rigorous safety and efficacy approval process before allowing any prescriptions to be written. Second—and this is a big one—marijuana-derived medications have already been rescheduled. Finally, it’s worth noting that medical associations around the world agree that any medicine should be determined in the lab by the scientific process, not the ballot box.
Medical marijuana is a sticky subject, to be sure. No one wants to see their loved ones suffer needlessly, and there is a good case to be made that federal law enforcement should focus its limited resources on major drug producers and distributors.
We all know that smoked marijuana is not medicine, and it is not based on science. In fact, anyone living with smoked medical marijuana in their state knows that it has turned into a sad joke.
But as recently as this past summer, the FDA ruled that raw marijuana—which contains hundreds of unknown components—did not meet its general standards of safety and efficacy. And the drug failed an exhaustive eight-factor scientific analysis that examined hundreds of studies on the plant's health effects. The FDA's position has also been affirmed by independent scientific bodies like the National Academies of Sciences’ Institute of Medicine (IOM), which famously determined that “there is little future in smoked marijuana as a medically approved medication.”
This does not mean that marijuana has no medicinal value. Indeed, the FDA has determined that some elements found in marijuana are helpful to seriously ill patients, and the IOM also concluded that “if there is any future for marijuana as a medicine, it lies in its isolated components…” Some of those components—like Marinol and Cesamet—are available to be prescribed today (though they aren’t as popular as you might think—doctors generally find non-marijuana medications more effective for many conditions). But we don't smoke opium to reap the benefits of morphine, nor do we chew willow bark to receive the effects of aspirin. Similarly, we should not have to smoke marijuana to get potential therapeutic effects from its components.
Does that mean that our work investigating marijuana’s components as a medicine is done? Of course not. Researchers are investigating other safe delivery methods for these types of medications, as well as the possible medical value of other elements within marijuana that we are just learning about. The National Institutes of Health funds a number of these studies. Research into how components of marijuana may affect our brains and bodies is an exciting area of science. Does marijuana’s status as a Schedule I drug stop this research from happening? No. Could the Feds speed up the approval process for safe, marijuana-based medications and ensure that our scientific resources are adequately allocated? Of course, and I hope they will. Many of us who follow this area of science are excited about these drugs coming down the FDA pipeline. One such product is called Sativex, a mouth-spray containing two active components of the marijuana plant and already approved in several countries around the world.
But smoked marijuana is not medicine, and it is not based on science. Anyone living with smoked medical marijuana in their state knows that it has turned into a sad joke. A recent study found that the average "patient" was a 32-year-old white male with a history of drug and alcohol abuse and no history of a life-threatening disease. Further studies have shown that very few of those who sought a recommendation for the drug had cancer, HIV/AIDS, glaucoma, or multiple sclerosis. We are also beginning to see a link between medical marijuana and increased drug use, according to a few recent, exhaustive studies.
So what explains this rather bizarre (and factually inaccurate) appeal by these two otherwise sensible governors? Politics. These officials, and many others, find themselves in a difficult spot—caught between laws that were intended to allow the limited use of marijuana for (ostensible) medical purposes and the reality of what that means when these laws are actually implemented—the headache of “dispensaries”, increased drug use that results from rampant distribution of the drug, and a federal government determined to uphold existing law. It’s not an envious position to be in, but it would make a whole lot of sense if these governors were taking their cues from the science and advocating for, say, expedited approval of a marijuana-derived drug like Sativex, which is not smoked and has a standard dose. Advocating for a policy that is impossible to implement and, more importantly, does not solve their conundrum in the first place diverts away from the real, complicated issues at hand. And it helps no one in the end.
Kevin A. Sabet is the former senior policy advisor to President Obama's drug czar, Gil Kerlikowske. He also advised the Bush and Clinton Administrations on drug policy and holds a doctorate in public policy from Oxford University. He currently is a fellow at the Center for Substance Abuse Solutions at Penn and a policy consultant for the United Nations and NGOs through www.kevinsabet.com. Follow him @kevinsabet