In one sense, marijuana is under-tested. Its status as a Schedule I controlled substance with no medical value has long discouraged efforts to study its clinical effects.
But in another sense, marijuana may be the most-tested drug in history. Used since ancient times, tried by every hippie worth his salt during the ’60s, sampled by an estimated 94 million Americans over the age of 12 today, the cannabis plant is hardly a mystery substance.
Yet debate continues to rage about its use, especially for medical purposes. Is marijuana genuinely good for the body, or do its side effects outweigh its purported benefits?
“Medicine (n.): any drug or other substance used in treating disease, healing, or relieving pain…” —Webster’s Unabridged Dictionary
Marijuana (cannabis) is a complex plant containing hundreds of substances, but its most active ingredients are THC and cannabidiol. In the 1980s it was discovered that many animals, including fish, reptiles, birds and mammals, have receptors in their brains for cannabinoids such as THC, receptors that don’t seem to bind with any other type of chemical.
In 1997, the White House’s Office of National Drug Control Policy commissioned a review of the scientific literature by the National Academy of Sciences’ Institute of Medicine to assess the risks and potential benefits of marijuana.
The resulting landmark 1999 report, “Marijuana and Medicine: Embracing the Science Base,” reached a number of conclusions, many of which are already widely accepted by the public:
• Cannabinoid drugs do show promise for relieving pain, quelling nausea, and stimulating appetite. The effects are generally modest but vary from person to person, so some people will respond better to marijuana than to other, more traditional drugs.
• Marijuana’s psychological effects can be disturbing to patients who aren’t familiar with the euphoria and spaciness. However, pot’s anti-anxiety effects can also enhance its medical benefits in certain patients.
• Because marijuana relaxes muscles, people shouldn’t drive cars or operate machinery while under its influence.
• Long-term users may suffer withdrawal symptoms if they quit, but those symptoms will be much milder than those resulting from withdrawal from opiates (morphine-related drugs) or benzodiazepines such as Valium.
A number of other studies have found that pot may or does help glaucoma sufferers, ease symptoms of Parkinson’s, reduce pain, and relax spastic muscles.
In 2000, the California state legislature created the Center for Medicinal Cannabis Research at the University of California to study the therapeutic value of marijuana. A February 2010 report from the cannabis center said that it had commissioned four completed clinical trials into marijuana’s analgesic effects on nerve pain, all of which found that cannabis did help patients. “This result is particularly important because three of these CMCR studies utilized cannabis as an add-on treatment for patients who were not receiving adequate benefit from a wide range of standard pain-relieving medications,” the report states.
The center also commissioned a study on muscle spasticity in multiple sclerosis. The study found that “cannabis reduces MS spasticity, at least in the short term, beyond the benefit available from usual medical care.”
“Now when your throat get dry
And you know you’re high
Everything is dandy.”
— Hancock Wayne, “When You’re a Viper”
Pot’s recreational effects are wellknown: mild euphoria, a pleasant dreamy state, an enhancement of the senses (especially hearing and taste).
As one Cortez police officer wrote in a recent incident report, “[The subject] appeared to be under the influence of marijuana in that he had the odor of marijuana on his person, his pupils were dilated and he appeared to be very relaxed and calm.”
But ganja’s steady march toward legitimate medical status has raised a host of new questions about its use. If it is medicine, how should it be regulated and dispensed? Should it be standardized and sold through pharmaceutical companies?
On the other hand, is it possible to completely control access to a plant that can be easily cultivated? Should pot simply be legalized altogether?
“To send me to prison for leaves of dried grass
While the real crooks are doubling the price of our gas
Seems to say something of this government’s laws
And its failure to cure society’s flaws. — anonymous
At the moment, medical marijuana exists in a jurisdictional limbo in the 14 states where it is legal, (including Colorado and New Mexico). It is neither standard medicine — approved and tested by the FDA — nor over-the-counter nutritional supplement. Instead, it is sold at specialized dispensaries to patients who receive a state-issued card after first getting a physician’s approval.
Travis Pollock, owner of Nature’s Own Wellness medical-marijuana dispensaries in Durango and Cortez, said there would be an upside and a downside to having marijuana’s medical uses recognized and regulated by the federal government.
“Any time you can get federal recognition, especially from an FDA or something like that, for this industry, it’s going to be beneficial,” he said. “But it’s also not beneficial, because if we allow large companies like Wal-Mart and Walgreens to be a part of this industry, it will hurt the small companies that are providing a quality product and can be more handson and more of a caregiver.
“It’s kind of a toss-up. You want acceptance from the federal government that this is a viable medical substance, but you don’t want to open up doors to companies that have a tremendous amount of capital but have a disconnect from the patient.”
In Colorado, medical marijuana was originally approved for use for eight conditions: cancer, glaucoma, HIV, cachexia (wasting), severe pain, severe nausea, seizures, and persistent muscle spasms such as those in multiple sclerosis. There is now a proposal to add Tourette’s syndrome to the list.
Medical-marijuana proponents tout the product’s use for many other conditions, including anxiety, post-traumatic stress disorder, Huntington’s disease, asthma, rheumatoid arthritis and fibromyalgia. More than 100,000 patients have applied to the state of Colorado for medical-marijuana cards, though because of a backlog, most applications have not been processed (a fact that has led critics to accuse the state health department of deliberately trying to undermine the industry).
Skeptics wonder whether a lot of these applicants aren’t simply finding a legal way to smoke pot recreationally. They wonder particularly about prescribing marijuana for pain, a condition that is highly subjective.
“Last dance with Mary Jane
One more time to kill the pain. — Tom Petty
Russell Wasley, Republican candidate for district attorney in the 22nd Judicial District, is among the doubters.
“There are problems with the way it is quote-unquote prescribed,” he said. “A lot of these prescriptions are not legitimate at all, or barely legitimate. If someone is a cancer sufferer in their last days trying to remediate pain, fine, but I find it suspect that a large number of 19- to 25-year-olds who should be the most healthy have some sort of back pain that causes them to get a quick and not very thorough examination for medical marijuana.”
Critics also say a raw, un-distilled plant doesn’t qualify as modern medicine. They say if it has any healing properties, it should be processed, standardized and dispensed as pills or ointments – not rolled into cigarettes and smoked.
Marijuana does exist in pill form as Marinol, a synthetic form of THC. However, some patients complain that swallowing Marinol, which takes about an hour to take effect, is less beneficial than smoking pot, which produces almostinstant results. They say they can easily regulate their own dosage by puffing on a joint, whereas Marinol delivers a sudden dose of THC. There have also been complaints that Marinol’s psychedelic effects are stronger than those of pot, possibly because the THC has been isolated from the rest of the plant’s compounds.
The fact that marijuana is smoked certainly makes it unusual among medicines, and there are efforts to find better ways to deliver it. If eating it isn’t desirable, it can be applied to the skin, and vaporizers are being studied as an alternative to smoking.
The 1999 NAS reviewers agreed there is concern about the long-term effects of inhaling pot. Marijuana contains many of the same carcinogens and irritants as tobacco, and experts say it could be even more dangerous because people inhale it more deeply. “Smoked marijuana . . . is a crude THC delivery system that also delivers harmful substances. . .,” the NAS researchers wrote. “Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects.”
However, pot’s proponents point out that people generally smoke far more cigarettes daily than marijuana users. And the 1999 reviewers found that pot’s other side effects are generally minor.
“. . . except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications,” they wrote.
“Serotonin syndrome. This is a condition that may be life-threatening… Severe allergic reactions. Abnormal bleeding…. Mania. . . Seizures. Loss of appetite. Low salt (sodium) levels in the blood…. abnormal dreams, orgasm problems, decreased appetite, anxiety, weakness, diarrhea, dry mouth, indigestion, flu, trouble sleeping, decreased sex drive, feeling sick to your stomach, nervousness, sore throat, rash, watery nasal discharge, sleepiness, sweating, tremor, hot flashes, and yawn.” — from the list of warnings about the widely prescribed antidepressant Prozac
The medical literature says there has never been a documented case of a human dying of an overdose of THC or marijuana.
However, there may be drawbacks to marijuana beyond potential lung damage. The drug may lower testosterone levels in men, though the effects seem to be temporary. It can increase heart rate and blood pressure. There are concerns about its effects on short-term memory, though hard data is lacking. Some researchers believe it may cause psychosis in some users, especially teens and children; other studies found no link to brain damage, schizophrenia, or psychosis.
There are doctors and researchers who believe pot causes “amotivational syndrome,” meaning a lack of motivation to become a productive citizen. However, other experts say there is no proof that marijuana users are less motivated than anyone else, or that marijuana causes ordinary people to become unmotivated.
The NAS reviewers called for more studies into the use of cannabis’s components to help patients who have no other recourse for intractable conditions. “If there is any future for marijuana as a medicine, it lies in its isolated components,” they wrote.
If marijuana were to be prescribed as a regular drug, it would spell the end of the current system of patients, caregivers, and dispensaries. Some patients would welcome that; many other people, including recreational users, would rather see marijuana legalized altogether.
Why fret about whether patients are getting “high” while easing their pain? say the legalization proponents. Let marijuana be grown, harvested, sold to adults, and taxed and regulated like alcohol. After all, society tolerates the enormous adverse consequences of alcohol use in order to gain its benefits — and avoid the drawbacks of Prohibition.
Well, I ain’t seen my baby since I don’t know when,
I’ve been drinking bourbon, whiskey, scotch and gin.
— Rudy Toombs/John Lee Hooker
But many law-enforcement officers and other citizens are concerned that marijuana is a “gateway” drug that entices people to use stronger, more dangerous substances.
The NAS reviewers addressed that issue in their 1999 report, saying that, because marijuana is the most widely used illicit drug, it’s usually the first one people try, but most users try alcohol and nicotine before smoking pot.
“Because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, ‘gateway’ to illicit drug use,” they wrote. “There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs.”
Marijuana’s image as the symbol of a hedonistic counter-culture may be behind much of the distaste with which it is viewed by a portion of the public. But other people have serious concerns about seeing it become widely available, whether through legalization or through a laissez-faire, quasi-medical system. They worry, among other things, about an increase in traffic accidents caused by stoned drivers, a surge in marijuana dependency, and a rise in under-age experimentation.
All that, researchers have noted, is beyond the purview of medical science.
“. . . there is a broad social concern that sanctioning the medical use of marijuana might increase its use among the general population,” stated the 1999 report. “. . . . this question is beyond the issues normally considered for medical uses of drugs and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids.”
So far, that potential appears to be promising.