Medical Marijuana: A Budding Truth
At the highest level of law in the United States, marijuana is deemed as having no medical value. However, in the last two decades science has begun to reveal unbiased facts indicating the drug is an effective treatment of some illnesses. In light of new scientific evidence and public support some states have passed laws legalizing medical marijuana despite federal law. In 1997, due to some states blatantly passing laws that conflicted with federal law the White House Office of National Drug Control Policy commissioned the National Academy of Science's Institute of Medicine (IOM) to study the drug. In 1999, the IOM issued what is still to date regarded by the majority of the scientific community as the most conclusive report on marijuana. The report came to the conclusion that marijuana does have potential medical uses. Despite the IOM's finding, and without any further research or clinical studies in 2006, the FDA refused to reclassify the drug keeping it listed as a schedule I controlled substance. This meant marijuana would remain illegal and continue to have no acceptable medical uses under federal law. This paper explores the most prominent arguments from both sides of the debate while considering the subject from a scientific and ethical standpoint.
The political, legal, and ethical aspects concerning medical marijuana are vast and complex. At the highest level of law in the United States, the drug is deemed as having no medical value. However, in the last two decades science has begun to reveal unbiased facts about the drug leading to an increasingly intensified debate on medical marijuana between proponents and opponents in an effort to determine the legal fate of the drug. Proponents of the drug assert that the majority of the scientific community believes that marijuana does have some medical, and/or therapeutic value based on comprehensive scientific research. Opponents argue that marijuana is deemed as having no medical value, and its consumption is considered illegal, and immoral. Adding to the controversy surrounding whether the drug should be recognized for its medicinal properties some states have passed laws making medical marijuana legal despite federal law. This has become more common as increased availability of scientific facts, and public support of legislation grows. Still since federal law prohibits the usage and possession of marijuana; individuals prescribed marijuana in these states can still be arrested, and prosecuted by federal law enforcement agencies.
Even though the drug is considered illegal by federal law, sickened individuals should have the right to use marijuana because scientific research has provided overwhelming data proving marijuana to be an effective treatment for some individuals with certain illnesses. Therefore, it is ethically just and fair to allow one to alleviate their symptoms of discomfort and restore some measure of quality to their life if there is a way for them to do so effectively.
History of the use of marijuana
Marijuana, also known as cannabis, is an annual flowering plant that has three recognized subspecies; Cannabis Sativa, Cannabis Indica, and Cannabis Ruderalis. These three sub species of flora can be distinguished by growth patterns. Cannabis is a dioecious plant, meaning individual plants are either male or female. The female cannabis plant contains high levels of cannaboids, with delta 9-tetrahydrocannabinol (THC) being the primary active ingredient. The cannaboids are found in the mature female floral development. For medical or recreational applications the flower buds are dried and then consumed for the mental and physical effects. The male cannabis plant contains less cannaboids which is the sought after psychoactive chemical for medical purposes. Therefore, the male plant is more commonly used for industrial applications and the female for medical, recreational, and spiritual purposes.
Human beings use of the cannabis plant can be traced as far back as 8000 B.C. when the plant was recognized for its ability to produce high quality fiber. Cannabis fiber, or hemp, is one of the world's strongest naturally occurring fibers, and has been commonly used to make paper, rope, and clothing by mankind's ancient ancestors. These hemp products played an important role in ancient's life, and also in the development of more modern products. Mitch Earleywine (2002) emphasized in his book Understanding Marijuana of how valuable the cannabis plant is because “humans are able to use virtually every part of the plant. The stalks help produce fiber; the seeds provide food and oil, and the flowers and resins appear in medical and intoxicating preparations” (3).
Marijuana was first recorded being used as medicine around 2700 B.C by the Chinese emperor Shen Nung who is regarded as the father of Chinese medicine. Shen Nung recommended marijuana for a variety of ailments. He is also believed to be the first person to have brewed tea with marijuana. Earleywine (2002) discussed how from ancient Asia “cannabis's use as a treatment for a variety of illnesses helped it spread from ancient Asia throughout the world” (9).
Currently, marijuana is classified "as a Schedule I controlled substance by the U.S. government, meaning it has no approved medical use" (Foreman, 2009, p.1). The plant was made illegal in 1937 by the passage of the Marihuana tax act by the federal government. Despite this ruling 14 states have passed legislation legalizing the drug for medicinal use at the state level. This allows patients to obtain legally prescribed medical marijuana under state law. However, these patients can still be arrested and prosecuted by federal law enforcement agencies such as the DEA. But since most drug law enforcement is performed by individual states not the federal government; patients are provided a substantial amount of protection even though federal law prohibits the usage and possession of marijuana.
In 1997, due to some states blatantly passing laws that conflicted with federal law the White House Office of National Drug Control Policy commissioned a panel of highly regarded scientists at the National Academy of Science's Institute of Medicine (IOM) to study the drug. TheIOM’s main objective was to "conduct a review of the scientific evidence to assess the potential health benefits and risks of marijuana and its constituent cannabinoids" (Institute of Medicine, 1999, p.1). In 1999, theIOMissued what is still to date regarded by the majority of the scientific community as the most conclusive report on marijuana. The report came to the conclusion that "scientific data indicates the potential therapeutic value of cannabinoid drugs, primarilyTHC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crudeTHCdelivery system that also delivers harmful substances” (Institute of Medicine, 1999, p.4). TheIOMrecommended more clinical trials to be conducted on the drug that would focus on aspects that were yet to be studied.
Nevertheless, in order for a medical drug to be approved in the United States the drug must go through multiple phases of clinical and laboratory tests/studies conducted by the Food and Drug Administration (FDA). Despite the Institute of Medicine’s findings, and without any further research or clinical studies on April 2006, the FDA issued a statement announcing that in the United States marijuana has no proven or accepted medical use.
Major arguments against medical marijuana
There are many arguments employed by opponents of medical marijuana. A few of the more prominent include; marijuana has no medical use, smoked marijuana is harmful to the lungs, marijuana is addictive, and marijuana is a gateway drug.
The most prominent argument against medical marijuana is that it has no medical use. This argument is mostly supported by the FDA’s decision in 2006 to keep marijuana as a schedule I drug. What is interesting is that the FDA failed to provide any credible data to back up their decision which left many advocates for the legalization of marijuana in the medical community outraged. Even more contradictory to the FDA's decision is the FDA approval of synthetic THC in a prescription drug known as Dronabinol or by its brand name Marinol. Dronabinol is a synthetic chemical derivative of marijuana; it is taken orally in pill form and may cost the patient “$600 to over $1,000 dollars per month” (Earleywine, 2002, p.16). However, many patients using Dronabinol assert that marijuana is unsurpassed from a medicinal and economical standpoint. (Earleywine, 2002, p.16). “Patients prefer smoked marijuana to this medication. Anyone who is vomiting and nauseated may find swallowing a pill quite difficult. Because patients must digest the orally administered dronabinol, the effects do not appear as rapidly. Many claim that the dosage is much easier to modify with smoked marijuana” (Earleywine, 2002, p.16). Furthermore, supporters that marijuana has no medical use maintain that there are “legal drugs currently available that provide appropriate relief from relevant symptoms” (Earleywine, 2002, p.167). But it is common knowledge in pharmacology that individuals react differently to medications. Therefore, some individuals may not respond to standard treatments as well as they would respond to marijuana.
The most scientifically sound argument against medical marijuana is that smoked marijuana is harmful to the lungs. Medical studies have proven the inhalation of any kind of smoke is harmful to the lungs and respiratory system. And while it can't be argued that smoked marijuana delivers harmful carcinogens to the respiratory system, recent research has confirmed that other means of rapid delivery/consumption to be virtually harmless, such as vaporization, or in spray form administered by an inhaler. “Cannabis vaporizers are designed to let users inhale active cannabinoids while avoiding harmful smoke toxins. They do so by heating cannabis to a temperature of 180 – 200° C (356° – 392° F), just below the point of combustion where smoke is produced. At this point, THC and other medically active cannabinoids are emitted with little or none of the carcinogenic tars and noxious gases found in smoke” (California Norml). Sativex was “created by GW Pharmaceuticals and marketed in conjunction with Bayer, is a combination of plant-derived delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). It's administered via a spray pump which places Sativex spray under the tongue or on the inside of the cheek. Unpleasant effects are said to be extremely rare, and the mode of administration assists in micromanaging patient needs.” (Olson, 2005)
Advocates against medical marijuana also argue the drug is addictive, and has a high potential for abuse. In the Institute of Medicines 1999 report on marijuana they did in fact report that “a distinctive marijuana withdrawal syndrome has been identified, but it is mild and short-lived” (6). The report went on to state that “although few users develop dependence, some do, and risk factors for marijuana dependence are similar to those for other forms of substance abuse" (Institute of Medicine, 1999, p.6). Yet, the narcotic opiates most commonly prescribed in place of marijuana pose a greater risk of overdose, are more harmful and addicting to the human body, and withdrawal from such medications is much more severe and unpleasant.
Another argument against medical marijuana is that the use of marijuana leads to the use of harder drugs. Dubbed the gateway theory, the argument proposes that marijuana is a stepping-stone drug. However, after the Institute of Medicines extensive study on the drug they reported: "In the sense that marijuana use typically precedes rather than follows initiation of other illicit drug use, it is indeed a "gateway” drug. But because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, "gateway" to illicit drug use. There is no conclusive evidence that the drug effects of marijuana are casually linked to the subsequent abuse of other illicit drugs" (1999, p.6). In addition to the IOM report, more recent studies have gone on to disprove the gateway theory.
Major arguments in favor of medical marijuana
There are many arguments employed by advocates for the legalization of medical marijuana. The more prominent arguments include that marijuana; is proven to have legitimate medical uses, is less harmful than drugs it is used to substitute, is more beneficial than negative in cases when patient's would suffer a reduction in their quality of life, and that legalization would allow more regulation.
Legitimate medical research has proven marijuana to be effective for some individuals in treating; some forms of pain, glaucoma, nausea and weight loss due to chemotherapy or AIDS wasting (weight-loss), and muscle spasms (spasticity) due to multiple sclerosis, cerebral palsy, stroke, or brain damage (Earleywine, 2002, p.194). In addition, marijuana has shown some evidence for effectiveness in the treatment of; anxiety, arthritis, dystonia, insomnia, seizures, tumors, Tourette’s, Parkinson's disease, and Huntington's disease (Earleywine, 2002, p.194). There have been many research studies, and case studies, that have provided conclusive evidence showing positive results and potential uses of the drug.
As previously mentioned, in 1999 the Institute of Medicine issued what is still to date regarded by the majority of the scientific community as the most conclusive report on marijuana. The report came to the conclusion that "scientific data indicates the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances” (p.4). “Except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications” (p.5). “But because of the health risks associated with smoking, smoking marijuana should generally not be recommended for long-term medical use” (p.7). “However, it will likely be many years before a safe and effective cannabinoid delivery, system, such as an inhaler will be available for patients. In the meantime, there are patients with deliberating symptoms for whom smoked marijuana might provide relief. The use of smoked marijuana for those patients should weigh both the expected efficacy of marijuana and ethical issues in patient care, including providing information about the known and suspected risks of smoked marijuana use" (p.7).
Other substantial studies have concluded that the drug; is more easily absorbed by the body and users are more able to control the dosage in smoke or vapor form than orally ingested drugs, and that the economic cost of marijuana is far less than any of the drugs that are used to substitute it (Earleywine, 2002). In addition, controlled experiments have proven marijuana to be essentially nontoxic. Research data has shown that “A 160-pound person would require 9,125 mg of THC to receive a fatal dose. Most marijuana cigarettes weigh one gram and contain 20 mg of THC. Thus, this 160-pound person would require all the THC in over 450 marijuana cigarettes to reach a lethal dose” (Earleywine, 2002, p.144). This amount would be virtually impossible for one person to consume in such a short amount of time that would be available in order to be fatal. In contrast, that same 160 pound person would only have to consume around; 30 Tylenol, or 100 cups of coffee in a 24 hour period to have a fatal overdose.
Despite marijuana being a proven effective treatment for individuals with certain medical conditions, it could also be effective in treating other ailments but requires more research. However, research is largely prohibited due to marijuana’s listing as a schedule I drug. Other drugs for medicinal uses only have to be proven to have medical usage to be passed by the FDA. Yet, the FDA is requiring that marijuana must be proven to be superior to other drugs that are used for a particular treatment.
Proponents also argue marijuana is less harmful than drugs that it is used to substitute. Currently, for patients with cancer undergoing chemotherapy or AIDS wasting the drugs used to treat pain are narcotic opiates such as; Morphine, Vicodin, Oxycontin, Percocet. It is scientifically proven that these specific drugs are highly addictive and overdose deaths are a common occurrence. According to the Community Anti-Drug Coalitions of America (2008) these medications are fast becoming among the most abused illicit drugs in America (3). Narcotic opiates also come with certain side effects such as loss of appetite which proves rather severe for those already wasting from cancer or AIDS. Yet, there has never been a recorded overdose death caused by the use of marijuana, which is compelling evidence in support of marijuana and its safety.
Another argument from supporters of medical marijuana is that the immorality/morality of marijuana use is based on individual’s beliefs. These supporters argue that it is unjust to allow an individual to suffer just because of legal aspects if the use of marijuana could help them to avoid pain or misery. They assert that it just and fair to allow one to alleviate symptoms of discomfort and restore some measure of quality to their life, especially those facing terminal illnesses. Proponents of this argument go on to state that it should be one's own choice to be free to pursue relief of their ailments with the medicine that provides for them the most relief. And it is immoral to deny these patient's something that would help them ease or avoid suffering on a physical, and/or mental level.
In addition, advocates for the legalization of medical marijuana argue that current drug policies drive ill patients to participate in illegal activities to obtain the drug. They convey that legalization would result in a decrease in illegal drug activities while allowing better regulation over price, quality, and grade thereby increasing the safety of the ill. Advocates of this argument also point out that the government could create a new revenue stream through the taxation of medical marijuana which could essentially help the U.S. economy.
In conclusion, there are many substantial arguments employed by advocates on both sides of the debate. However, it seems hard to justify the denial of this medicine to those in need given the long history of the use of marijuana, and the vast knowledge that exist on the effects of the drug due to human interaction for thousands of years. Especially, when you consider that other drugs used in its place are synthetic man made creations that have only been around for less than a century, and many of the long term effects are unknown. In addition, in cases when marijuana is used in treating the symptoms of cancer and AIDS patients, the benefits of the drug far outweigh its harmfulness. To deny these ill patients' medicine is inhumane. From a human standpoint, it is our nature to be compassionate beings. Paper legislation shouldn't oppress a measure of relief, and I believe most people would concede when faced with actual human suffering. Therefore, individuals should have the right to use marijuana despite legal and ethical factors if the drug can help them ease or neutralize their suffering and/or pain. Ethically, it is just and fair to allow one to alleviate their symptoms of discomfort and restore some measure of quality to their life if there is a way for them to do so effectively.
California Norml. Why Cannabis Vaporization? Retrieved October 4, 2010, from http://www.canorml.org/healthfacts/vaporizers.html
Clark, PA. (2000). The ethics of medical marijuana: government restrictions vs. medical necessity. Journal of Public Health Policy. 21(1), 40-60.
Community Anti-Drug Coalitions of America. (2008). Teen Prescription Drug Use: An Emerging Threat. RetrievedOctober 10, 2010, from URL http://www.theantidrug.com/pdfs/resources/teen-rx/CADCA_Strategizer52.pdf
Earleywine, M. (2002). Understanding Marijuana: A new look at the scientific evidence. New York: Oxford University Press, Inc.
Foreman, J. (2009, July 20). Medical marijuana science, through the smoke [Electronic version]. Los Angeles Times. Retrieved October 4, 2010, from http://articles.latimes.com/2009/jul/20/health/he-marijuana20
Joy, J.E. (editor), Stanley W. J. (editor), and Benson J. A. (editor), Institute of Medicine (author). (1999). Marijuana and Medicine: Assessing the Science Base. Washington D.C.: National Academy Press.
Olson, N. (2005). Sativex: change of thinking? Cannabis Culture. Retrieved October 4, 2010, from http://www.cannabisculture.com/articles/4314.html
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