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8 Dec
Lester Grinspoon OP ED in Boston Globe

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BOSTON GLOBE
Dec 7, 2000

Editorials / OPEDs

Why won't government let us use marijuana as medicine?

By Lester Grinspoon

HIGH-RANKING government officials in the United States have referred to
the concept of medical marijuana as a hoax, a subterfuge by which proponents
of a more liberal policy toward this drug will succeed in undoing the
long-standing, harsh prohibition.

Ignorant of the role cannabis played in Western medicine from mid-19th into
the early 20th century, they and their many supporters view the notion that
cannabis has medicinal properties as a new intrusion into allopathic
medicine. The parochialism of this view is highlighted by ethnohistorical
studies which document not only how ancient is the use of this substance
as a medicine but, as well, the multiplicity of cultures that have used it
in so many different ways for the treatment of a large variety of human
ailments and discomforts.

Its use as a medicine is so widespread and reports of its toxicity so rare,
the contemporary judgment of Western medicine seems deviant. One might ask
why the government of the United States, the leading oppositional force,
clings so tenaciously to this insular and harmful policy?

The answer, of course, is the fear that as people gain more experience with
cannabis as a medicine they will discover that its toxicity has been greatly
exaggerated, its usefulness undervalued, and that it can be used for
purposes the government disapproves of. Having made these discoveries, they
will be less supportive of the prohibition and its enormous costs, among
which is the annual arrest of 700,000 people in the United States alone.

With the publication of its report in March 1999, the Institute of Medicine
of the National Academy of Sciences grudgingly acknowledged that cannabis
has some medical utility but averred that because smoking it was too
dangerous to their health, patients would have to await the development of
pharmaceutical products that would eliminate this hazard.

While the report greatly exaggerates the danger of smoking cannabis, it
fails to provide a discussion of vaporization, a technique that allows
patients who wish to avoid the smoke to inhale the cannabinoids largely
free of particulate matter.

Another reason the authorities would have patients wait for the
''pharmaceuticalization'' of marijuana is to allow for the development of
cannabinoid analogs that will be free of any psychoactive effects.

This goal is based on the assumption that the psychoactive effects are both
unhealthy and bad for the patient in the vague way in which the ''high''
is thought by the prohibitionists to be deleterious.

It is an assumption that is not supported by the mountain of anecdotal
evidence that supports marijuana's usefulness as a medicine. While there
are some patients who do not like the psychoactive effects, they are
relatively rare; the vast majority, patients suffering from serious
illnesses, finds that smoking cannabis not only relieves a particular
symptom, but also makes them ''feel better.''

Helping patients, particularly those with chronic diseases, feel better is
an important goal of the humane practice of medicine. And there is a growing
understanding in medicine that patients who feel better do better.

The resistance of government authorities to allowing the availability of
cannabis as a medicine is generally supported by the Western medical
establishment. This has not always been so. Physicians in the United States
were enthusiastic about the medicinal uses of cannabis from the middle of
the 19th century until the passage of the first of the Draconian legislation
aimed at marijuana in 1937 (the Marijuana Tax Act).

Under pressure from the Federal Bureau of Narcotics, the predecessor
organization to the present Drug Enforcement Administration, the Journal
of the American Medical Association published in 1945 a vehemently
antimarijuana editorial, which signaled a sea change in the attitude of
doctors toward this drug. They became both victims and agents of the
marijuana disinformation campaign launched by Harry Anslinger, the first
chief of the Federal Bureau of Narcotics.

Many physicians still suffer from both this legacy and fear of the DEA, so
much so that they are afraid to prescribe Marinol (a legally available
synthetic THC, both more expensive and less effective than marijuana).

Today, the medical establishment takes the position that there is no
scientific evidence demonstrating that cannabis has medical usefulness.
This stance is based on the fact that there is a paucity of double-blind
controlled studies of the clinical usefulness of marijuana.

This scarcity is likely to persist for some time. The costs of such studies
are generally underwritten by pharmaceutical firms that stand to gain much
if they can demonstrate a therapeutic usefulness in, and win Food and Drug
Administration approval of, a drug whose patent they hold. Because this
naturally occurring herb can not be patented, these firms will not invest
the more than $200 million needed to do the studies required for official
approval of a pharmaceutical. Consequently, the medical utility of marijuana
will continue to rest on anecdotal evidence.

It would not be the first medicine to be admitted to the pharmacopoeia on
the strength of anecdotal evidence. Anecdotal evidence commands much less
attention then it once did, yet it is the source of much of our knowledge
of synthetic medicines as well as plant derivatives. Controlled experiments
were not needed to recognize the therapeutic potential of chloral hydrate,
barbiturates, aspirin, curare, insulin, or penicillin.

It is unlikely that marijuana will ever be developed as an officially
recognized medicine via the FDA approval process, which is ultimately a
risk/benefit analysis. Thousands of years of widespread use have
demonstrated its medical value; the extensive multi-million dollar
government-supported effort (through the National Institute of Drug Abuse)
of the last three decades to establish a sufficient level of toxicity to
support prohibition has instead provided a record of safety that is more
compelling than that of most approved medicines.

The modern FDA protocol is not necessary to establish a risk-benefit
estimate for a drug with such a history. To impose this protocol on cannabis
would be like making the same demand of aspirin, which was accepted as a
medicine more than 60 years before the advent of the double-blind controlled
study.

Many years of experience have shown us that aspirin has many uses and
limited toxicity, yet today it could not be marshalled through the FDA
approval process. The patent has long since expired, and with it the
incentive to underwrite the enormous cost of this modern seal of approval.

Cannabis too is unpatentable, so the only source of funding for a
''start-from-scratch'' approval would be the government. Other reasons for
doubting that marijuana would ever be officially approved are today's
antismoking climate and, most important, the widespread use of cannabis
for purposes disapproved of by the US government. As a result, we are going
to have two distribution systems for medical cannabis.

One will be the conventional model of pharmacy-filled prescriptions for
FDA-approved medicines derived from cannabis as isolated or synthetic
cannabinoids and cannabinoid analogs. The other will have more in common
with some of the means of distribution and use of alternative and herbal
medicines. The only difference, an enormous one, will be the continued
illegality of whole smoked or ingested cannabis.

In any case, increasing medical use by either distribution pathway will
inevitably make growing numbers of people familiar with cannabis and its
derivatives.

As they learn that its harmfulness has been greatly exaggerated and its
usefulness underestimated, the pressure will increase for drastic change
in the way we as a society deal with this drug.


Dr. Lester Grinspoon, professor emeritus at Harvard Medical School, is the
author of ''Marihuana Reconsidered'' and ''Marihuana, the Forbidden
Medicine.''

This story ran on page A23 of the Boston Globe on 12/7/2000. Copyright 2000
Globe Newspaper Company.

© 2000 Peter Langston