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Monday, June 13, 2005
Defining Medical Marijuana: Is THC on the Wrong Drug List? Are you confused about the medical marijuana issue, thanks to last week's Supreme Court decision on this subject? Do you now have more questions about the scientific basis behind advocating the use of medical marijuana? If so, then I encourage you to read the article from Daniele Piomelli titled "Scientifically Speaking, This Drug's on the Wrong List." Dr. Piomelli is a Professor of Pharmacology and Director of the Center for Drug Discovery at UC Irvine. She summarizes much of the established and some recent science surrounding marijuana and its active ingredient, tetrahydrocannabinol (THC). First of all, she does not appear to be soft-pedaling the drawbacks of illegal, habitual marijuana use; far from it: Most importantly, perhaps, and contrary to common misconceptions, a growing number of studies show that prolonged exposure to marijuana or THC can cause addiction. This is best seen in lab experiments with monkeys, who learn to self-administer THC by pressing a lever that allows the drug to be delivered directly into a vein. The animals will work hard to get that fix -- though not as hard as they would for cocaine or other more addictive drugs. What's more, a marijuana withdrawal syndrome has been demonstrated in frequent long-term users of this drug: It is characterized by mild but distinctive symptoms, including loss of appetite, irritability and depression. But she also points out some of the safety considerations and medical benefits of THC: As drugs go, THC is a very safe compound: It would take about 70 pure grams of it -- about the weight of a chocolate bar -- to seriously harm a 150-pound adult. Indeed, it has satisfied the strict requirements of the Food and Drug Administration for approval as a human medicine and is currently used in the United States, under the trade name of Marinol (manufactured by Unimed), to reduce nausea and stimulate appetite in patients suffering from HIV/AIDS, or undergoing chemotherapy for cancer. Dr. Piomelli points out that, since the signing into law in 1970 of the Controlled Substances Act (CSA), marijuana and the purer derivative THC have been listed on what is called the "Schedule I" drug list: "those considered to have high potential for abuse, with no recognized medical use." Despite the data arguing in favor of valid medical applications of marijuana, it seems that ignorance and semantics have led to a bureaucratic train-wreck. There was a Drug Enforcement Agency (DEA) decision in 1999 to move Marinol -- but not THC -- to the CSA Schedule III list, which includes drugs "deemed to have less potential for abuse than Schedules I and II; recognized medical uses; and a moderate to low incidence of physical or psychological dependence" (such as codeine preparations with analgesics and the anti-hyperactivity drug Ritalin). Therefore: THC, the same drug as Marinol, is now listed on two completely different CSA schedules. Dr. Piomelli states firmly that "Marijuana, the smokable leaf, may well belong in Schedule I -- I am a neuroscientist and a pharmacologist, not a medical doctor or sociologist, and I am not going to address this issue. But THC, the chemical compound, does not belong there." My suspicion is that THC the term has become so identified in our culture with the still-illegal marijuana that it might seem counterproductive for the DEA to relegate THC to the less-restrictive Schedule III status. The second half of the article describes for the layperson some biochemical information regarding the modes of action of THC and heroin, the supreme villain of addictive drugs. Biologically and neurologically, the two drugs operate in such different ways, and have such completely different clinical effects, that it makes no logical sense to Dr. Piomelli that they are lumped together in the same category. Dr. Piomelli's summary of the science is interesting and readable. She even suggests ways to offset illegal marijuana's risks while still promoting the helpful applications of medicinal THC in the clinical setting. Because of THC's Schedule I status, that research sometimes faces extra bureaucratic hurdles. But preventing a few months of paperwork to a scientific project is not the main reason the drug and its derivatives should be reclassified to a schedule that is in accord with their medical utility. Far more important is the goal of having realistic drug laws in this country that penalize drug abuse but also encourage medical progress. Dr. Piomelli's argument seems balanced and logical -- especially in view of the bureaucratic snafu causing THC to be classified in two different ways under the Controlled Substances Act. In view of the recent Supreme Court decision affecting medical marijuana use and its implications for the rights of the 50 states to make their own laws covering the issue (about which I have recently written), the subject of medical marijuana/THC/Marinol seems much more complex. In the 13 June 2005 Houston Chronicle, reporter Robert Crowe gives a fairly balanced account of the potential implications of this ruling for both politicians and medical marijuana users in states with medical marijuana legislation on the books or under debate. There are physicians on both sides of the medical THC debate, which helps to confuse the issue for the public, legislators, and media. To some, there is a double standard when it comes to medical marijuana in comparison with other pharmaceuticals derived from harmful, illegal drugs. Comments Terry Keel (R-Austin), a Texas state representative and former sheriff and prosecutor who is co-sponsoring medical marijuana legislation: "You never hear the argument that [opium and heroin] are such serious drugs that their derivatives [such as morphine] would be too dangerous for medicine. So, it makes no sense with marijuana." In fact, contrast this with the observation, as reported by Blueworm of The Wide Awakes, that there seems to be a move by the medical community in Great Britain to offer addicts prescription heroin, with the ultimate goal a benefit to society through cost savings. One wonders whether similar proposals are afoot in the United States. There are many skeptics who find the whole medical marijuana argument a ruse. Steve at Pardon My English gives an argument for this position . It is certainly conspicuous (but not surprising) that some of the same activist groups cheerleading for medical THC also support decriminalization of marijuana generally. Steve also presents data from the pro-legalization group Common Sense for Drug Policy that seem to slant medical marijuana research results universally in favor of "toking up" for health. Their online resource, Drug War Facts.org, presents some additional data advocating medical marijuana. However, Steve seems to suggest that all these data are tainted because of the messenger's ulterior motives -- certainly a valid concern. From my brief survey of this site, it was not clear just how objective and scientific those otherwise well-referenced data were, or if they were largely taken out of the original context. Given our knowledge of marijuana addiction and the potential for negative long-term effects, plus the adverse effects on society vis à vis celebrating the drug culture, legalizing marijuana per se would seem a step in the wrong direction. However, perhaps the benefits outweigh the risks of making the derivative THC more available for medicinal purposes -- even though the pro-legalization forces could stand to benefit in the long run. There seems enough evidence of the potential benefits of medical THC to make further research of this drug seem reasonable, even prudent. At the same time, those who argue the "slippery slope" as regards possible inroads to legalization of marijuana leaf may be more right than they know. One thing seems certain: THC, through guilt-by-association with marijuana, is a Jekyl-and-Hyde as far as the DEA is concerned. This oversight simply confounds sensible arguments for criminal justice on the one side, and medical research on the other. The MaryHunter blogs at TMH's Bacon Bits. Blogger News Network is advertiser-supported, and your visits to our advertisers help BNN to meet its expenses. Help keep us afloat! posted by BNN Archive at 7:56 PM |
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