Health_Concerns: MEDICAL MARIHUANA - FACT FROM FICTION, A SCIENTIFIC MANNA?

In the early nineteenth century, medical journals published in Europe and America hailed the use of marihuana as a therapeutic drug. The drug was touted for its ability to stimulate lagging appetites and for its analgesic, relaxant and anticonvulsant properties. The Marihuana Tax Act of 1937, although designed to prevent recreational usage, actually had an unintended side effect: restricting the ability of physicians to obtain marihuana for scientific and medicinal purposes, thereby leading into a decline of its pharmacological use.

Although the federal government is vigorously opposed to the use of cannabis for medicinal purposes, some individuals are allowed to use the drug through the Individual Treatment program, which allows patients and their physicians to apply for special permission to use the drug where no other substitute will work. According to Dr. Lester Grinspoon's research, from 1976-1988, the federal government granted approximately six persons a year the right to use marihuana for medicinal purposes. In 1989, that number rose sharply, as AIDS patients flooded the Food and Drug Administration with applications, bringing the number of applications granted to 34. By 1991, the program was frozen due to policy concerns about the federal government approving the use of a Class I controlled substance. Currently, eight persons have the blessing of the Food and Drug Administration to use cannabis for their medical ailments.

The fact that the government allows select usage of marihuana for medicinal purposes tends to show that the controversy is one buried under a mountain of social policy rather than medical fact. Medical marihuana derives its name as a compassionate drug because it relieves the pain associated with the symptoms of a multitude of significant diseases and also increases appetite. More than a hallucinogenic drug for experimental teenagers, numerous scientific studies have proclaimed the benefits of marihuana use by patients suffering from migraines, epilepsy, nausea and vomiting associated with chemotherapy, glaucoma, anorexia, spasticity, arthritis, multiple sclerosis, paraplegia, quadriplegia, and the AIDS wasting syndrome.

Delta-9, tetrahydrocannabinol ([delta-9]-THC) is the "main" active substance found in marihuana. Ironically, since 1985, the synthetic form of tetrahydrocannabinol has been available for use by physicians for medicinal purposes due to its Schedule II classification. These derivatives, named Dronabinol and Marinol, are provided in the form of a capsule for oral consumption. Perhaps the federal government has given the Dronabinol and Marinol lower drug schedule classifications due to the government's ability to control dosage and duration through the oral capsules. Physicians and patients have been adamant that neither synthetic substance works as effectively as the ingestion of marihuana cigarettes.

The use of Dronabinol and Marinol also have significant drawbacks. Dronabinol is a difficult substance to titrate thus, few prescriptions are administered for the substance. Marinol is also problematic because of the difficulty that patients have in consuming the product, and because of its great expense. Marinol costs roughly $500 for 100 10-mg capsules. This price, juxtaposed against Dr. Lester Grinspoon's proximate estimation of thirty cents per marihuana cigarette if obtained in a legalized market up to a high of $5.00 in a criminal market, make the use of cannabis itself rather than substitutes very compelling.

According to the Report of the Lynn Pierson Therapeutic Research Program undertaken in conjunction with the New Mexico State Department of Health, both oral and inhaled cannabinoids were effective in reducing nausea and vomiting resulting from chemotherapy, however, inhaled marihuana was deemed far superior for those patients suffering from vomiting symptoms. While there has been no scientific finding demonstrating why marihuana is more effective if inhaled rather than orally ingested, many physicians believe that inhaling marihuana smoke allows it to enter the bloodstream immediately; patients receiving oral dosages of the synthetic substance must wait for the slow and steady absorption of the drug. Paul Consroe, a University of Arizona pharmacology professor states that "[w]ith smoked marijuana, patients get immediate relief, whereas with the oral drug they get a delayed, big rush of unpleasantness. When they take a smaller dose, it doesn't work." Physicians also speculate that the other components in marihuana combine to counteract some of the unpleasant side effects of the ingestion of pure THC.

Many scientists argue that marihuana is far from a manna, and is in fact, a medically dangerous substance. Most anti-marihuana advocates claim that diseases of the lung are the most dangerous aspect of marihuana ingestion. A 1995 study by the Lindesmith Center conducted by Lynn Zimmer and John Morgan report that marihuana smokers consume far fewer marihuana cigarettes than smokers who ingest tobacco, suggesting a ratio of as high as 10-1. More importantly, there is no epidemiological data to suggest that persons smoking only marihuana develop lung cancer.

In 1988, scientists researching the effect of THC on the brain found that biochemical responses to THC were associated largely in three areas where there was a high concentration of THC receptors. These areas consisted of parts of the brain that control memory, mood and the processing of visual stimuli. However, in a 1981 study, published in Volume 213 of Science, Jeffrey Schaeffer, Therese Andrysiak, and J. Thomas Ungerleider conducted a review of cognition and long-term use of cannabis. They discovered that none of their subjects suffered any cognitive impairment. The researchers chose subjects who self-reported smoking two to four ounces of marihuana a day over the course of a prolonged period of time, with the study mean being 7.4 years. The subjects were given marihuana with a concentration of 8% THC and subsequently subjected to standard psychological cognitive tests.

Researchers also discovered that there were very few THC receptors in the areas of the brain that control consciousness and respiration, thus making it impossible to ingest a fatal dose of marihuana.

GROUP ENDORSEMENTS OF MEDICAL MARIHUANA:

Even amongst the controversy, some groups have come forward to publicly urge the federal government to allow those in medical need to receive the treatment they need to lessen chronic pain. In a December 30, 1996 letter to Congress, Daniel H. Johnson, Jr., MD, President of the American Medical Association stated that, "[w]e urge federal funding of research to determine the validity of marijuana as an effective medical treatment." The American Nurses Association has also publicly stated that it supports researching the medicinal effectiveness of marihuana.

Closer still to the hearts of law students, is the endorsement of marihuana's use for medicinal purposes by the American Bar Association. In a recent letter to the Governmental Affairs Office, the ABA noted that its policy "recognizes that persons who suffer from serious illnesses for which marijuana has a medically recognized therapeutic value have a right to be treated with marijuana under the supervision of a physician..." The ABA went on to note that it "supports federal legislation to establish a program under which [seriously ill] patients can be treated with marijuana under the supervision of a physician and under such controls adequate to prevent any diversion or other improper use of medicinal marijuana"

A FINAL NOTE:

While the federal government may take an irresolute stand concerning medical marihuana, the general populace has not. Thirty-six states currently approve the use of marihuana for medicinal purposes, although it seems that Proposition 215 in the state of California has received the most media attention. Regardless of the popular will of the people, with federal law being the supreme law of this land, physicians and patients still remain subject to prosecution for violating our nation's drug laws. Ironically, cocaine and amphetamines, what most might consider truly illicit substances, are classified as Class II substances; this classification allows doctors to legally prescribe both substances for medicinal purposes.