Synthetic Solutions
Marijuana Rx ] Alliance for Cannabis Therapeutics ]

 

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Marijuana as Medicine:
A Recent History

SECTION I
People Are Suffering

SECTION II

Political Actions
Federal Legislation
Opinion Samplings
Polls & Surveys 
Public Elections 
A Remarkable Consensus 


SECTION III
Current Federal Policy
Demands for Change
Medical Prohibition Under Pressure
The Collapse of Compassion
Bush Blunders
Aftermath

SECTION IV
Let'em Eat THC

Marinol Isn't Marijuana
The Great White Drug
Let The Market Decide 

SECTION V
Presidents Come & Go
On The Other Hand
Beyond Cultural Warfare
Conclusion 

SECTION VI
Citations

 

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 ]