Maybe someday governments will base policy on facts and data. It sure would be nice.

While we’re not used to factual accuracy from ONDCP, in this case they’re wrong not once, but twice.

First, there is absolutely no reason that plant medicines can’t be standardized and controlled for purity and potency. Indeed, the Netherlands has been doing just that for years, with medical marijuana distributed in Dutch pharmacies that is “of pharmaceutical quality and complies with the strictest requirements,” according to the Dutch government.

Second, the FDA has never said that a natural plant product can’t be a medicine. Indeed the agency has a lengthy “Guidance for Industry: Botanical Drug Products,” specifically designed to aid developers of plant medicines. The document not only doesn’t rule out plants as medicines, it even states, “In the initial stage of clinical studies of a botanical drug, it is generally not necessary to identify the active constituents or other biological markers or to have a chemical identification and assay for a particular constituent or marker.” Given that the active components of marijuana are already well-known and extensively researched, marijuana is well ahead of where the FDA says plant products need to be to start the process of seeking FDA licensing.

Yes, the FDA did put out a press release in 2006 saying that “smoked marijuana” had not been shown to be a safe and effective medicine. That statement was utterly unscientific, as we pointed out at the time, but it was absolutely not a declaration that the plant could never be a medicine.

First, for reasons that aren’t clear, before performing the tests of smoking and vaporization, the researchers put the marijuana through a drying procedure that ordinary marijuana consumers don’t do. This might have eliminated some plant compounds, such as terpenoids, that are actually of interest.

A second possible flaw is that the researchers considered all “byproducts” – defined as substances other than cannabinoids –  together. They didn’t analyze precisely what they were, lumping bad stuff like the toxic combustion products contained in smoke with potentially beneficial plant compounds like those terpenoids mentioned above. That puts the finding that fewer byproducts were produced at 230 degrees Celsius than were produced at lower temperatures in a somewhat different perspective: We don’t know if the same byproducts were produced at 230 degrees as were produced at lower temperatures – and what’s in that mixture could be just as important as how much of it there is.

Opponents of medical marijuana love to condemn smoking, but a new study adds more data to the growing pile of research confirming that vaporization provides the benefits of inhalation without the unwanted combustion products in smoke.  In a study comparing vaporization to smoking in the journal Inhalation Toxicology, researchers from Leiden University report, “Based on the results, we can conclude that with the use of the vaporizer a much ‘cleaner’ and therefore a more healthy cannabis vapor can be produced for the medicinal use of C. sativa, in comparison to the administration of THC via cigarettes.”

The article also provides some new practical information on vaporization, suggesting that a temperature of 230 degrees Celsius is ideal, and that using smaller amounts of marijuana in the vaporizer produces more vapor, but does not extract THC more efficiently, so there is no apparent gain in using an amount less than about half a gram at a time.

Setting the Record Straight on Medical Marijuana
by
Bruce Mirken and Mike Meno

Charles Lane’s column, “Medical marijuana is an insult to our intelligence,” (Oct. 20) was riddled with inaccuracies. Had Mr. Lane bothered to review the medical literature, he would have found not “hokum” and “snake oil,” as he calls it, but a small mountain of published, peer-reviewed research documenting that medical marijuana is a safe, effective, and sometimes even life-saving medication for many seriously ill Americans.

That’s not our opinion, it’s the opinion of a huge array of respected medical and public health organizations, including the American College of Physicians, American Nurses Association, American Public Health Association, American Academy of HIV Medicine, Leukemia and Lymphoma Society and many others. In 1999, for instance, the National Academy of Sciences’ Institute of Medicine reported that “nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana.”

In a brief filed with the U.S. Supreme Court, the Lymphoma Foundation of America, HIV Medicine Association of the Infectious Diseases Society of America and other top experts stated, “For certain persons the medical use of marijuana can literally mean the difference between life and death. At a minimum, marijuana provides some seriously ill patients the gift of relative health and the ability to function as productive members of society.”

And last year, the American College of Physicians – 124,000 doctors of internal medicine – stated, “Evidence not only supports the use of medical marijuana in certain conditions
but also suggests numerous indications for cannabinoids,” marijuana’s unique, active components.

A series of recent clinical trials has documented marijuana’s ability to relieve what is known as neuropathic pain – pain stemming from damage to the nerves. This type of pain plagues millions of Americans suffering from HIV/AIDS, multiple sclerosis, diabetes and other ailments, and is notoriously resistant to conventional pain drugs. Marijuana has been unequivocally shown to safely relieve this type of pain, even in many cases where conventional painkillers have failed.

While it is true that the Food and Drug Administration has not approved marijuana as a prescription medicine, the reason for that is political, not scientific. The federal government has maintained a stranglehold on medical marijuana research, preventing the types of studies that would be needed for FDA approval. Researchers at the University of Massachusetts are still fighting the federal government for the right to set up a research facility designed to move medical marijuana through the FDA approval process.

Finally, a word must be said about Mr. Lane’s reprehensible attack on Supreme Court plaintiff Angel Raich, who, he says, “might consider a consultation for hypochondria, or perhaps marijuana dependency” – apparently because anyone with multiple medical problems must surely be making them up. Actually, the Court’s majority opinion noted that Raich and fellow plaintiff Diane Monson had made “strong arguments that they will suffer irreparable harm, because, despite a congressional finding to the contrary, marijuana does have valid therapeutic purposes.” Raich is having highly risky surgery October 28 – surgery that her doctors had originally ruled out because it is too dangerous — because her brain tumor has now become life-threatening.

There is indeed much hokum in the medical marijuana debate, but it is coming from the opponents of medical marijuana, not the supporters.

Anyone who wants to learn about these other cannabinoids should check out this recent review published in the journal Trends in Pharmacological Sciences.

The article devotes a lot of space to cannabidiol (CBD), the most studied of these compounds, noting that “CBD exerts several positive pharmacological effects that make it a highly attractive therapeutic entity in inflammation, diabetes, cancer and affective or neurodegenerative diseases.” Notably, CBD has antipsychotic actions, but fewer side effects than “typical antipsychotics.” Lots of other cannabinoids have potentially useful properties as well. For example, cannabichromene has antimicrobial and anti-inflammatory activity, plus “modest” analgesic effect.

The article tends to be a bit dismissive of THC because of its psychoactivity, and focuses mainly on cannabinoids as individual chemicals rather than as components of an herbal medicine that has proven extraordinarily useful in its natural form (biases that are pretty much typical in the medical literature), but even with these limitations, it’s an important read.

Canadian researcher Mark Ware presented results of a yearlong safety study known as the COMPASS study, which compared 215 patients who used marijuana to manage chronic pain with comparable control patients who did not use marijuana. Ware and colleagues report “no difference in serious adverse events” between the two groups, concluding, “Cannabis use for chronic pain over one year is not associated with major changes in lung, endocrine, cognitive function or serious adverse events.”

A much-awaited study came from the University of California, San Francisco, where Donald Abrams and colleagues tested the effects of adding marijuana to the therapeutic regimen of chronic pain patients on long-term morphine or oxycodone therapy. Unfortunately, because the researchers were crunching numbers right up until the conference, the abstract doesn’t include a lot of details. But the study shows that marijuana did indeed add significant pain relief on top of that already provided by the narcotic painkillers. The scientists conclude, “Cannabinoids may augment the analgesic effects of opioids, allowing longer treatment at lower doses with fewer side effects.”

Meanwhile, British researchers added to the body of evidence indicating that marijuana can aid the treatment of multiple sclerosis. Two-hundred and seventy-nine patients received either a standardized cannabis extract, given orally, or a placebo. Patients receiving the extract were twice as likely to experience relief of muscle stiffness, and also reported relief of body pain, spasms, and sleep problems.