June 7, 2005—The push to make marijuana available for medical use was dealt a serious set back yesterday by the Supreme Court. In a 6-3 decision, the Court ruled that federal authorities could prosecute sick patients who took the controlled substance under a doctor's supervision, essentially overturning voter referendums that had made marijuana legal for "compassionate" use in 11 states.
Proponents claim that marijuana is often the only drug that helps for a variety of ailments, whether it's relieving pain or increasing appetites in those treated for cancer or AIDS. But yesterday's ruling adds further ammunition to those who have long contended that the drug is unsafe.
"Our national medical system relies on proven scientific research, not popular opinion," said John Walters, director of National Drug Control Policy, to reporters after the ruling was announced on Monday. "To date, science and research have not determined that smoking marijuana is safe or effective."
Illegal and Unknown
The effort to make marijuana available for medical purposes gained momentum after an Institute of Medicine (IOM) report suggested that the illegal drug held therapeutic potential. In the 1999 study, which was sponsored by the government's anti-drug office, the IOM stated that marijuana's active ingredients might prove effective for a range of conditions. These included countering nausea and lack of appetite from cancer treatment, to helping with painful conditions such as multiple sclerosis. The researchers called for rigorous testing in clinical trials.
Stanley Watson, the co-director of the Mental Health Research Institute at the University of Michigan and one of the authors of the IOM report, said there has been a lack of political interest in pursuing further studies. "There's not enough evidence to let us say that marijuana is a great treatment, nor is there enough evidence to let us say that marijuana is a bad treatment," he said. "The fact is we're stuck."
The Options
At the moment, the only legal marijuana option is Marinol, a prescription pill that contains THC, the active ingredient found in its illegal counterpart. The Food and Drug Administration approved Marinol to help relieve the nausea and vomiting associated with cancer chemotherapy. This past April, Canadian health authorities allowed for the use of a marijuana spray called Sativex. The new spray, which dissolves in the mouth and treats neurological pain associated with multiple sclerosis, contains THC and another marijuana ingredient, cannabidiol
For those who have tried marijuana to help with their medical conditions, are either of these an effective alternative? Margaret Haney of Columbia University said that a marijuana pill has not exactly caught on, but she contends that such drugs can help.
Health
"Marinol has gotten some bad press," said Haney, an associate professor of psychiatry at Columbia. After a rocky start, research is now showing that Marinol can help increase appetites, at least in those who are accustomed to smoking marijuana. "In these patients, Marinol is very well tolerated and effective," she said.
In a recent study, Haney and colleagues compared Marinol to smoking marijuana in 30 HIV-positive patients who smoked marijuana and who had lost significant amounts of weight. At doses four to eight times higher than what is usually prescribed, the pill led to a similar increase in appetite in former marijuana users compared to those who continued to smoke the drug.
Small studies also suggest some potential benefit with Marinol for those who have pain from multiple sclerosis. Dutch researchers evaluated 24 patients and found that the marijuana pill reduced pain intensity compared to those who took a placebo. The authors, who published their results in the British Medical Journal last June, concluded that Marinol should be offered to those whose pain is not severe enough to be treated with medications such as anticonvulsants, antidepressants or opioids.
Is a Pill Good Enough?
Donald Abrams, a prominent AIDS researcher at the University of California, San Francisco, said that the side effect of dizziness is a major detraction from Marinol. "Most don't like feeling that dopey," he said. The pill can keep people feeling groggy for 16 hours versus a couple of hours from smoking marijuana. Moreover, naturally grown marijuana contains upwards of 400 ingredients that can possibly help, whereas a pill version has only one.
As part of the Center for Medicinal Cannabis Research, Abrams said that he and others are studying the safety of alternative forms of administrating marijuana. He admitted that the research has been hard going. "Marijuana has been demonized by the government," he said.
Both Abrams and Watson expressed greater optimism for a marijuana spray, which appears safer than smoking and still provides immediate and quicker relief than a pill.
Watson said that the U.S. government should do more to study the potential benefits and downsides to marijuana as therapy. "We think marijuana can work," he said. "But we don't know what for."
