THE SHIFTING MEDICAL VIEW ON MARIJUANA

IN A RECENT poll conducted by Medscape, a website directed at health care
providers, 76 percent of physicians and 89 percent of nurses said they
thought marijuana should be available as a medicine. That's a big change
from the attitude in the medical community a decade ago, when few health
providers believed (or would acknowledge) that cannabis had any medical
utility. That was not surprising; physicians receive most of their new drug
education from journal articles or from drug company advertisements and
promotions, and neither of these sources provides information about medical
marijuana.

The dramatic change of view is the result of clinical experience. Doctors
and nurses have seen that for many patients cannabis is more useful, less
toxic, and less expensive than the conventional medicines prescribed for
diverse syndromes and symptoms, including multiple sclerosis, Crohn's
disease, migraine headaches, severe nausea and vomiting, convulsive
disorders, the AIDS wasting syndrome, chronic pain, and many others.

A mountain of anecdotal evidence speaks to marijuana's medical versatility
and striking lack of toxicity. Even the federally sponsored Institute of
Medicine has grudgingly acknowledged that marijuana has medical uses.

However, the government itself refuses to learn. Its official position, as
stated recently by the new DEA administrator, is that "marijuana is not a
medicine."

When it is at last obliged to acknowledge the medical value of marijuana,
the government will be faced with the problem its present attitude has
allowed it to avoid. How can it grant access to marijuana for medical
purposes while prohibiting its use for other, disapproved purposes? One
solution is what I would call "pharmaceuticalization": the development of
prescription medicines derived from the therapeutically active components
of cannabis and synthetic variants of these molecules.

This process has already begun in a small way. The Food and Drug
Administration, under pressure from a growing number of physicians and
patients, approved Marinol for the treatment of the nausea and vomiting of
cancer chemotherapy. Marinol is synthetic tetrahydrocannabinol, the primary
active cannabinoid in marijuana, packed in a capsule with sesame oil so
that it cannot be smoked.

But relatively few patients have found Marinol useful. It is less effective
than marijuana for several reasons. Because it must be taken orally, the
effect appears only after an hour or more. That eliminates one of the main
advantages of smoked or vaporized inhaled cannabis, which works so quickly
that the patient can adjust the dose with remarkable precision.
Furthermore, Marinol is more expensive than marijuana, even with the
prohibition tariff that raises the price of illicit cannabis.

Several other products, including extracts of marijuana, are in the
pipeline, but they are unlikely to be any more useful or less expensive
than plant marijuana. Even if pharmaceutical companies invest the many
millions of dollars it will take to develop useful cannabinoid products,
they will not displace natural marijuana for most purposes. And because the
primary, and for many the only, advantage of these drugs will be legality,
their manufacturers will have an interest in vigorously enforced
prohibition that raises the price of the competitive product, street marijuana.

The realities of human need are incompatible with the demand for a legally
enforceable distinction between medicine and all other uses of cannabis.
Marijuana not only has many potential medical uses, but can also safely
enhance many pleasures and ease many discomforts of everyday life. In many
cases what lay people do in prescribing marijuana for themselves is not
very different from what physicians do when they provide prescriptions for
psychoactive or other drugs.

The only workable way of realizing the full potential of this remarkable
substance, including its full medical potential, is to free it from a dual
set of regulations -- the laws that control prescription drugs, and the
often cruel and self-defeating criminal laws that control psychoactive
substances used to for nonmedical purposes. These mutually reinforcing laws
strangle marijuana's uniquely multifaceted potential. The only way to
liberate the potential is to give marijuana the same legal status as
alcohol, a far more dangerous substance.

Marijuana should be removed from the medical and criminal control systems.
It should be legalized for adults for all uses.