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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

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

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

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

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

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

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

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.

Pubdate: Thu, 07 Dec 2000
Source: Boston Globe (MA)
Copyright: 2000 Globe Newspaper Company.
Contact: letter@globe.com
Address: P.O. Box 2378, Boston, MA 02107-2378
Feedback: http://extranet.globe.com/LettersEditor/default.asp
Website: http://www.boston.com/globe/
Author: Lester Grinspoon, MD