IV. Synthetic Solutions
Rather than respond to public and political demands for marijuana's
medical availability, federal drug agencies are instead promoting bureaucratically
sanctioned alternatives which are synthetic, expensive and often ineffective. It is ironic
that after decades of pretending marijuana is medically useless, federal drug agencies are
now aggressively pushing synthetic Marinol, the so-called "pot pill," by arguing
it is as safe and effective as marijuana.(43)
Patients familiar with the synthetic "pot pill" have strongly condemned the
bureaucrats for "pushing" an inferior substitute. One AIDS patient recently told
a reporter,
"I tried [Marinol]. I went through five pills before I was able to keep one
down....When I did manage to keep one down it took a long while to take effect, and only
worked about half a day. Two or three tokes on a joint helps me immediately."(44)
Let'em Eat THC
Delta-9-tetrahydrocannabinol (THC) is the most powerful psycho-active chemical in
marijuana. Synthetic THC was developed for drug abuse research on rats and other animal
subjects. The synthetic "pot pill" was never intended for human use in a routine
of medical care. In the early 1980s, however, federal agencies were overwhelmed by demands
for legal access to government supplies of marijuana cigarettes for use in legislatively
authorized, state programs of patient care. FDA and DEA, unable to meet these state
requests for natural marijuana, began promoting synthetic THC pills as a therapeutic
substitute for marijuana.
In September 1980, federal agencies released THC through the National Cancer Institute's
Group C Treatment Program. Then federal agencies frantically searched for a private-sector
pharmaceutical company to sponsor a New Drug Application (NDA) for the federally-developed
THC pill. In exchange, federal agencies promised the company exclusive control over the
medical market for synthetic THC.
This promotion of synthetic THC was not designed to meet legitimate human needs. It had
only one objective: to maintain the medical prohibition against marijuana.
The public was told "Pot Pill Approved." Federal drug agencies assisted in a
misinformation campaign by saying marijuana was no longer medically needed because the
modern, synthetic "pot pill" had arrived. Federal agencies knew this was a
lie.
Marinol Isn't Marijuana
The problem with this synthetic strategy was most quickly evident to patients. Marinol
isn't marijuana. The synthetic solution failed because Marinol is only marginally
effective.
The difference between marijuana and THC was apparent from the outset. Cancer patients
quickly discovered smoking marijuana is far more effective than swallowing oral THC pills.(45) During the DEA hearings before Judge
Young, one researcher, Norman Zinberg, M.D., testified that during his 1974 research
nearly half the patients quit his legal, THC-based study in order to obtain illegal, but
more effective, marijuana.(46)
Zinberg's observations were amplified in an internal National Cancer Institute (NCI) memo
from mid-1978. Synthetic THC is described as "erratic,"
"unpredictable," and finally dismissed as "unfit" for human use.
Marijuana cigarettes, by contrast, are described as "reliable" and "highly
predictable." After reviewing the available evidence the cancer specialists at NCI
concluded, "All in all the [marijuana] cigarette may be the best means of delivering
the drug."(47)
After reviewing the available evidence DEA Judge Francis L. Young concluded Marinol is not
an adequate substitute for marijuana.(48)
Some will argue these are "old" conclusions. Yet as recently as 1992 , Dr.
Robert Gorter, a primary researcher of synthetic Marinol's use in AIDS therapy, echoed
Zinberg's testimony:
"Again and again patients have testified that they preferred marijuana above
dronabinol [Marinol] for its appetite stimulating effect. Therefore, it is hoped that
marijuana will stay an option for the medical treatment of [wasting syndrome] in AIDS
patients."(49)
Why is inhaled marijuana superior to synthetic THC?
Speed of delivery: When inhaled, marijuana reduces nausea and vomiting in five
to ten minutes.(50) Marinol, when
ingested, takes 1 to 4 hours to start working. This gives patients plenty of time to
throw-up the pill.
Control of Dose: Marijuana, when inhaled, works so quickly patients can exercise
very fine control over their dose. Once relief is achieved they simply stop smoking.
Inversely, a patient exercises NO control over an oral dose; once the pill is swallowed
all further control is lost. Moreover, because oral THC takes so long to work, and works
so erratically and unpredictably, patients may take a second oral dose. Little wonder
adverse psychological effects are far more common among people employing oral Marinol than
among those smoking marijuana.
Chemical Composition: Marijuana, like all naturally occurring substances, is
chemically complex. Marijuana has more than 400 chemical ingredients. Little is known
about which chemical ingredients -- or what combinations of ingredients -- are responsible
for the plant's multiple therapeutic actions.
Federal agencies did not approve Marinol because of evidence indicating
delta-9 THC is marijuana's most therapeutically-active ingredient. Delta-9 THC was
synthesized to facilitate drug abuse research on marijuana's psychoactive effects. Trapped
by their legal fixation on psychoactive effects, federal agencies simply assumed, despite
ample evidence to the contrary, that what gets you "high" makes you well.
The irony, of course, is that to avoid making marijuana medically available, federal
agencies are now aggressively promoting a synthetic alternative which contains pure THC
which is profoundly more psycho-active than marijuana in its natural form.(51)
Pills are medically familiar. Smoking is not. Opponents of marijuana's medical use often
argue inhalation is not compatible with modern medical practice. In the name of science
such opponents would deprive those who are now ill of care while researchers endeavor to
create a perfect "marijuana-like pill."
Advocates of marijuana's medical availability do not contend marijuana is
"perfect" or object to research into synthetic alternatives. Such research must
continue and, in some cases, begin.(52)But
it is medically unethical to use an elusive search for pharmaceutical perfection as an
excuse to deprive millions of currently ill Americans of therapeutic access to an
effective, albeit imperfect, treatment. This is particularly true when one considers the
long and distinguished history of marijuana's medical use.
To put it simply; how can the government criminalize seriously ill citizens who choose to
medically use a God-given plant?
The Great White Drug
When bureaucratic attempts to push synthetic Marinol as a substitute for marijuana fail,
federal drug agencies fall back on another old standard: there are "new" drugs
which make marijuana medically unnecessary.
In the early 1980s, for example, federal agencies promoted Torecan (Reglan) as an
antiemetic substitute for marijuana. Health care workers like Torecan because patients are
well-controlled. Indeed, Torecan renders patients nearly comatose. Many still vomit, but
they are not conscious enough to care.
Michigan tested the Torecan alternative in their state authorized marijuana program.
Researchers allowed patients to begin on Torecan or marijuana. Patients could, at any
time, elect to switch to the alternative drug. Significantly, 90% of the patients who
started on marijuana stayed on marijuana. Even more significantly, 90% of the patients who
received Torecan elected to switch to marijuana. (53)
The most recent "new" drug receiving bureaucratic praise as a marijuana
alternative is Zofran which costs $600 per dose and requires hospitalization at a
cost of $500 - 1,500 per day. Zofran is said to be effective 75% of the time in
helping patients vomit six times or less per chemotherapy treatment.
By contrast, marijuana costs a penny per dose, patients can safely use it at home, and
marijuana helps 90% of cancer patients unable to obtain relief using prescriptive
antiemetic agents.(54)
There is a final important difference. Zofran is not an appetite stimulant. Marijuana is.
A patient employing marijuana at home can sit down to eat dinner with the family. This is
not a matter of insignificant benefit.(55)
As Kenny Jenks, Chairman of the Marijuana/AIDS Research Service (MARS) has noted,
"To the unintentionally anorexic the munchies can be a life-saver."(56)
Let The Market Decide
No one is advocating that all patients with marijuana-responsive disorders be forced to
use marijuana. Ultimately the decision to employ any medication is a profoundly personal
decision which is best left to the patient and physician. In a more rationale world
natural marijuana and synthetic Marinol would both be medically available and patients and
physicians would determine which drug was most appropriate for a particular treatment
need. The market would decide.
For nearly two decades, federal agencies have used the medical prohibition to prevent such
a market-based determination. They have compounded this error by granting an exclusive
monopoly to the manufacturer of Marinol. In doing so FDA has ensured that the American
people will be forced to pay exorbitant prices to obtain a demonstrably inferior synthetic
substitute developed and researched almost exclusively at tax-payers' expense.
[ Up ] [ Introduction ] [ The Public Supports Medical Access ] [ Inheriting Bad Policy ] [ Synthetic Solutions ] [ What Can Be Done? ] [ Footnotes ]
