Medical Marijuana Hits a Speed Bump

After the almost continuous progress of medical marijuana toward legalization by states, the federal government is threatening to use the trump card of federal law to override state laws.

'marijuana joint' photo (c) 2008, Torben Hansen - license: http://creativecommons.org/licenses/by/2.0/
California medical marijuana dispensaries have been told to cease operations within weeks or face federal prosecution. This has always been a possibility and, while many are surprised and yell “unfair,” many more are surprised it has taken so long. Marijuana, for the record, remains an illegal federal schedule 1 drug.

Medical marijuana occupies a curious and singular position as a “quasi pharmaceutical.” Like prescription medications, it has uses in the treatment of certain diseases. Like prescription medications, it has the potential for abuse.

The federal government sees the potential harm from abuse overriding any benefit of medical marijuana. This is not to say there is no benefit, but the therapeutic ratio tilts toward more harm than good.

The unique position of medical marijuana is further demonstrated by the individual state laws that regulate the prescription and dispensing of marijuana. For the rest of the pharmacopoeia, the DEA regulates all aspects of the medication. The drug manufacturer must make the drug of a certain purity level, it must be free of other harmful chemicals, and must be of a certain strength that is measurable and virtually identical batch to batch. It also must be proven effective for the condition for which it is approved. Those prescribing are highly regulated (medical doctors) as are the pharmacists and pharmacies that dispense medications.

Medical marijuana is also unique in its “sig” (medical language for prescribing instructions). If you look at medication bottles you have had, they give specific directions (i.e., take 1 tablet 3 times per day with food). The instructions for medical marijuana are to essentially use as much as you need, as often as you need, for as long as you need. I can think of no other medication either over the counter or prescription that has that latitude of use.

That being said, marijuana does have some benefit as an appetite stimulant for people with diseases like cancer or HIV who can benefit from that stimulant. It also can benefit patients experiencing nausea from such things as chemotherapy. However, experience has shown us that 90% of patrons of medical marijuana dispensaries don’t have cancer, HIV or what the mainstream medical community sees as serious diseases that cannot be successfully treated with conventional medical treatments.

What it comes down to is the present patchwork solution to marijuana legislation is simply unworkable, requiring a resolution at the federal level. It needs to be either treated like a drug, a medication or classified like alcohol.

Treating marijuana like a medication would involve marijuana being produced by licensed drug companies, in a standardized fashion, with frequent inspection and quality assurance programs. Marijuana, the medication, needs to have standardized levels of THC (Tetrahydrocannabinol), ensuring patients get the same effective dose each time they use it. This would be sold and distributed by pharmacies, with licensed and trained pharmacists. This is unlikely for a number of reasons, not the least of which is that smoking anything causes lung cancer and large pharmaceutical companies or large pharmacies don’t want that liability or damage to their reputation.

Treating marijuana like alcohol at least on the surface appears workable.

This would involve some standardization of product, federal or state inspection and presumably paying state and federal taxes.

Restrictions could be placed on the sale or use of marijuana by underage people.

What we have now is not a solution, but an anti-solution. We should start with a clean slate and appoint a blue-ribbon panel of recognized experts to analyze the risk and benefits of marijuana use. These experts could examine or commission serious scientific research and make reasoned decisions based on fact, not opinion.

Take care,
Dr. B

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