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One Drug, Two Takes
Scientists and patients scoff at an FDA announcement that smoking marijuana has no medical benefits.
Mary Beckman | Los Angeles Times | 05/01/2006

As assistant district attorney in San Francisco, Keith Vines prosecuted one of the largest illicit drug busts the city had ever seen. Then he came down with AIDS wasting syndrome and lost 60 pounds over three years.

To stimulate his appetite, he started taking marinol, an FDA-approved drug containing THC, one of the active ingredients in marijuana. He says he couldn't control the dose of the drug, which must be swallowed. "I would be out of it for four or five hours," he says.

And so, instead of continuing with marinol, he started smoking medical marijuana, keeping his head clear by puffing only as much as he needed to get hungry. He gained back all his weight, he says.

Like many in his condition, Vines flatly disagrees with an April 20 announcement by the Food and Drug Administration and several other federal agencies that smoking marijuana confers no medical benefits.

So do physicians who write prescriptions for medical marijuana. (Doctors can't prescribe the plant.) They say the government hasn't done its homework — and cite a 1999 report by the Institute of Medicine, a prestigious organization that advises the government, that found otherwise.

That 1999 report concluded that smoked marijuana could stimulate appetite in some patients with AIDS wasting disease; lessen nausea and vomiting caused by chemotherapy for cancer; and alleviate pain.

"I'm disappointed that they haven't really read the research or spoken with people in the field," says Los Angeles internist Dr. Eve H. Elting, who recommends medical marijuana to treat patients with chronic pain due to cancer and injuries; nausea and vomiting caused by chemotherapy; and migraines.

"The FDA statement directly opposes what the [Institute of Medicine] said," says Dr. Jean Talleyrand of Ukiah, who also recommends medical marijuana. "My first question is, how did they come to that conclusion?"

Some scientists involved in crafting the 1999 report were more circumspect.

"I thought there was pretty good agreement among the panel that THC has good benefit, and it's in marijuana," says Billy R. Martin, a professor of pharmacology and toxicology at Virginia Commonwealth University.

But, he adds, "when you turn to the FDA, they require well-controlled studies showing efficacy."

(BuzzNote: The FDA and the DEA have categorically denied permission to scientists to perform studies looking for anything other than marijuana's possible negative effects. No legitimate research can be done without a legal marijuana supply. The DEA has total control over that supply.)

Martin says in many ways the tussle between federal agencies such as the FDA and medical marijuana proponents boils down to politics — on both sides.

"I'm sad, but I don't think science is a factor," he says.

Dr. Howard Fields, a professor of neurology and psychology at UC San Francisco and another panel member, agrees. "There is so much distortion of the research on both ends of the spectrum," he says.

FDA's statement

According to FDA spokeswoman Kathleen Quinn, the agency's decision to issue a statement about marijuana was prompted by inquiries from individuals and members of Congress who were curious about "recent reports [that] have suggested that smoked marijuana may offer pain relief for [some] conditions," she wrote in an e-mail.

The FDA, she added, drew upon "the latest formal scientific evaluation of the government" of marijuana — a 2001 Drug Enforcement Agency report.

Some doctors and scientists say they trust science over drug laws. (BuzzNote: The ones who don't are neither doctors nor are they scientists, they're prohibitionist toadies, "government-owned scientists", and political hacks.) Scientists outside of law enforcement crafted the Institute of Medicine report. To write it, Martin, Fields and nine other clinical and basic researchers perused hundreds of studies on marijuana, consulted biomedical and social researchers in the field, held workshops with medical marijuana patients, and visited HIV/AIDS clinics.

The result was neither a blanket endorsement nor an utter dismissal of medical marijuana use — but something in-between.

Some of the studies, the scientists found, lend support for Vines' experience with marinol and marijuana. Marinol pills release their contents slowly, taking 2.5 hours to maximize their levels in blood. Smoking delivers the chemicals in 2.5 minutes.

In addition, studies show that the chemicals delivered to the body differ, depending on whether marijuana's active compounds travel through the stomach (as they do when swallowed) or the liver (as they do when smoked).

"There's less of a psychoactive chemical when you inhale it," says Dr. Donald I. Abrams, a professor of hematology and oncology at UC San Francisco, who was not a member of the panel.

The report also points out that some chemotherapy patients would not be able to keep down pills long enough for the drugs to take effect.

"No doubt about it. Marijuana smoke is a great way to deliver drugs," says Martin. (BuzzNote: And vaporizers are much better.)

The scientists also looked at few studies that tested the ability of THC-related compounds to quell chronic pain due to cancer or nerve damage.

For example, in one 1975 study, researchers gave either placebos or THC pills in a range of doses to 10 cancer pain patients averaging 51 years of age. They found that higher doses quelled the pain significantly.

Glaucoma patients have long valued marijuana's medicinal properties of reducing internal pressure of the eye. Such pressure can eventually cause blindness.

But Martin says the panel didn't recommend marijuana for glaucoma because the connection between eye pressure and nerve damage is not clear, and studies hadn't addressed whether marijuana is safe for the optic nerve.

Although eight studies which gauged eye measurements in people taking marijuana or THC support the idea that marijuana can reduce eyeball pressure, clinical studies are only now underway to test the effects of the drug more closely.

For nausea, the panel examined about a dozen studies that looked at THC or marijuana's ability to quell nausea during chemotherapy. For example, in one study, 56 cancer patients who did not respond to other anti-nausea and vomiting drugs were given marijuana. More than one-third rated the plant as moderately or highly effective.

The report pointed out, however, that these studies weren't well controlled — and controls, Martin says, are especially important in studying smoked marijuana. "There are a fair number of learned behaviors with marijuana — such as expecting to feel good," he says. (BuzzNote: And the marijuana gives the mind the power to get what it expects, i.e. it increases your suggestibility. Self-hypnosis does the rest.)

The report also stated that the benefits of smoking the plant must be weighed against the potential harm in the smoke. Marijuana smoke contains some of the same hazardous chemicals found in cigarette smoke.

Scientists say that there is no conclusive evidence that smoking marijuana causes cancer in people. Still, because of the potential carcinogenicity, the American Cancer Society does not advocate the use of inhaled marijuana or the legalization of marijuana, while agreeing that THC and cannabinoids in marijuana will help alleviate some symptoms, says ACS spokesman David Sampson.

Nonsmoking options

There could be ways to mitigate that risk. Both the Institute of Medicine report and the Drug Enforcement Agency report used by the FDA recommended that alternatives to smoking marijuana cigarettes be developed.

They cited vaporizers, available to medical marijuana users these days, that "toast" marijuana rather than burn it.

This lets the volatile THC and other active compounds escape the plant for inhalation, leaving behind some of the toxic chemicals, such as benzene and toluene. The appliances, however, can cost 20 times that of a conventional marijuana pipe. (BuzzNote: The toxic chemicals are all by-products of incomplete combustion. No combustion = no chemicals. A $120 vape stretches your stash considerably and will pay for itself in saved stash in the first ounce or two vaped, depending on how much the weed costs.)

In the midst of the impassioned debate, a lot of people overlook the fact that THC (although not marijuana's other active ingredients) is available in pill form, Fields says. The pain relief offered by marinol is comparable to that of aspirin, he says, "so why would anyone want to use cannabis?"

(BuzzNote: Why would anyone want to be able to control their dosage for optimum effect and get instant relief rather than waiting for an hour or two?)

Fields does think that there are some people who could benefit from smoking marijuana. And Vines, for whom marinol did not work, says the government could erase many of the problems associated with medical marijuana use by altering its legal status so the drug can be obtained — but by prescription only.

"You can't help but scratch your head and wonder what the government is doing," he says.

(BuzzNote: If the government wanted to sever the connection between medical marijuana and recreational marijuana, all it would have to do is allow medical marijuana to be supplied by prescription, like Vicodin. No one says that painkillers should be banned because they can be used for non-medical purposes.)

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Sec

I wonder if Mj could alleviate the Chronic Wasting Disease suffered by White Tail Deer, Mule Deer and Elk? It's probably not the same type of disease, it was just a thought I had while reading the article.

Just think, If it did help the animals, the Forest Service could plant fields of pot all over the Plains and Rockies and the deer and elk could eat themselves healthy again. Then, the DEA could arrest the Forest Service, and we could all laugh about it.

(sorry, my monday humor is not what it used to be.)

Seriously:
I really think there are many people who have no pre-conceived expectation of the effects of marijuana. Especially in the 51 year old range. At least there are enough to conduct a valid study.

Are the effects of smoking, vaping, eating, etc., marijuana different (a more effective painkiller) than taking a marinol tablet? Maybe that is why patients prefer to use marijuana to taking a marinol tablet if marinol can be compared to aspirin.

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LibertyLover

Aspirin also kills thousands of people every year and causes many terrible side affects... as opposed to pot where the person immediately starts smoking crack, raping white women, and murdering children.

818-Kush

Is this a sad attempt at sarcasm or what?

I've smoked "pot" recreationally for 6 years. I have never used LSD, Peyote, Cocaine, Mescaline, Heroin, MDMA, or any other drug previously for recreational use. Once I was in the hospital and was administered Codeine. That about sums up my drug usage in total.

I have taken less than 100 asprin in my entire life. In fact, the only pain relivier I like/I think works for ME, is Advil.

I've never snorted a line, nor smoked crack. I've never raped a white woman, or any other woman or man for that matter. I've also never even thought about ever raping somebody. That is disgusting. I've never thought about murdering children, but I've thought about murdering plenty of adults. This was before I ever touched any psychoactive (MJ) in my life. In fact, if it wasn't for MJ (my personal outlet), I would have killed someone.

Your logic is pathetic, and wrong. If you are trying to be humorous or sarcastic, try to do a better job of it. If you are trying to be slanderous, again, try to do a better job of it. So far, all you did was confuse me. I wonder if you yourself were all here when you wrote it.

MrIMStoned

I thought it was sarcasm and I thought it was funny.

Maybe you should stop thinking about killing people and relax.

__________________
"In the end the Party would announce that two and two made five, and you would have to believe it. It was inevitable that they should make that claim sooner or later: the logic of their position demanded it. Not merely the validity of experience, but the very existence of external reality, was tacitly denied by their philosophy. The heresy of heresies was common sense. And what was terrifying was not that they would kill you for thinking otherwise, but that they might be right. For, after all, how do we know that two and two make four? Or that the force of gravity works? Or that the past is unchangeable? If both the past and the external world exist only in the mind, and if the mind itself is controllable what then?"

 

Sec

I also at first thought it must be a joke, but then I wasn't sure. Whatever it is, it is in poor taste.

dedbr

don't we all want herb to just be legalized?

I mean, sure, let the sick who can benefit from it have all they want, but folks, going to the doctor for pain felief is like asking another person to tell you how bad your tooth hurts. They can't do it.

A doctor has no way to tell how bad you hurt, or how much medication it's going to take to relieve that pain.

I'm sorry, and of course this is just my opinion, but we're going to be sorry if and when herb is legalized but only for medical use.

I thought the whole idea was to get them out of our business? How can we do that if the bottle says how much we can smoke and when? And you better pray the doctor gives you a script for kind bud instead of the schwag or you'll be back on the street lookin' for the "black market."

Seems like a contradiction to me. Medical herb will maybe keep the law off some of our backs, but what about those "recreators" out there? Are they supposed to just quit?


I don't think we've figured this out all the way, but we're jumping in with both feet. There's rock's under the water that we can't see, and we're just going to get hurt.....


Somewhere in Ded Land....

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Tolerance4all

I understood it to be sarcasm! I have seen Liberty Lovers previous posts.

JofD

its total bullshit. This is all about money, or so i think. We're talking about multi million dollar companies who supply us with official "medications". They slip a couple blank checks into the big boys pockets, send him a couple hookers, and bang! they're pulling sorry excuses out of their asses to keep the weed out of our hands, and their thousands of "law enforcers" keep their jobs/pensions/etc. Its just sad. I NEVER smoked marijuana before i was 23. I have crohns disease, and well generally im in a sour mood almost all the time. Well i gave in to peer pressure to smoke it and It has changed my life. It takes away the pain and frustration, and it helps me eat the bland diet my doctors reccomend. I could and would take a polygraph to back up my legitimate decisions to smoke marijuana, and let me tell you, its sad that Mr. emery and fellows like him are a bad position right now. If it was possible I would take up and keep going with what he was doing, and i know there are many like me out there who would stick up for the cause here. STICK IT TO THE MAN! this has been my TWO cents.