The Medical Marijuana Problem by Lester Grinspoon MD

*The medical marijuana problem is a Janus-like conundrum; one view of the problem is seen through the eyes of patients and another through those of their government.

*that of an obdurate government as it defensively and inconsistently insists that "marijuana is not a medicine", and backs up this ill-informed, arrogant position with the full force of its vast legal power as it is presently doing in the state of California.


 
*There are many thousands of patients who currently use cannabis as a medicine. Only seven are allowed to use it legally.
 
*This program was actually discontinued because of the exponentially growing number of Compassionate IND applications; the official reason was provided by James O. Mason, then chief of the Public Health Service: "It gives a bad signal. I don't mind doing that if there is no other way of helping these people... But there is not a shred of evidence that smoking marijuana assists a person with AIDS ".
 
*Each of the surviving IND recipients receives monthly a tin containing enough rolled marijuana joints to treat his or her symptoms for that month.
 
*Because the quality of the cannabis is poor, it requires more inhalation than a superior quality medicinal cannabis would. In fact, some of the recipients have been known to supplement this Government Issue with better quality street marijuana.
 
*Dronabinol is a solution of synthetic tetrahydrocannabinol in sesame oil (the sesame oil is meant to protect against the possibility that the contents of the capsule could be smoked).
 
*Dronabinol was developed by Unimed Pharmaceuticals Inc. with a great deal of financial support from the United States government.
 
*This was the first hint that the "pharmaceuticalization" of cannabis might be what the government hoped would solve its problem with marijuana as medicine, the problem of how to make the medicinal properties of cannabis (in so far as the government believes such properties exist) widely available while at the same time prohibiting its use for any other purpose.
 
*Marinol did not displace marijuana as "the treatment of choice"; most patients found the herb itself much more useful than dronabinol in the treatment of the nausea and vomiting of cancer chemotherapy.
 
*Because it was thought that it would sell better if it were placed in a less restrictive Drug Control Schedule, it was moved from Schedule 2 to Schedule 3 in the year 2000.
 
***Marinol has not solved the marijuana-as-a-medicine problem because so few of the patients who have discovered the therapeutic usefulness of marijuana use dronabinol.***
 
**they find it less effective than smoked marijuana, it cannot be titrated because it has to be taken orally, it takes at least an hour for the therapeutic effect to manifest itself and even with the prohibition tariff on street marijuana, Marinol is more expensive. **
 
*for many patients who use marijuana as a medicine the doctor-prescribed Marinol serves primarily as a cover from the threat of the growing ubiquity of urine tests.



*If the doctor and the pharmacist behave ethically, only those who have a medical need for marijuana can receive it. In turn, patients have a reliable source for the drug, relieving them of the stress of buying it on the street or secretly growing their own.

*Two distribution models have evolved. One is based on the conventional delivery system for medicine: a patient visits a buyers' club (read: pharmacy), where he or she presents a note from a physician, certifying that the patient has a condition for which the physician recommends cannabis (read: prescription).

*The second distribution model resembles a social club more than it does a pharmacy. The dispensing area is plastered with menus offering types, grades and prices. Large rooms are filled with brightly colored posters, lounge chairs and sofas, tables, magazines and newspapers. While some patients remain only long enough to buy their medicine, most stay to smoke and talk. There are animated conversations, laughter, music and the pervasive, pungent odor of cannabis. The atmosphere is informal, welcoming and warm, providing support for patients who may be socially isolated and have little opportunity to share concerns and feelings about their illnesses. This type of club is a blend of Amsterdam-style coffeehouse, American bar and medical support group. The model was epitomized by the San Francisco Cannabis Cultivators' Club.


*Until some kind of legal accommodation makes it possible for patients to obtain marijuana without violating the law, buyers' clubs are the best approach to the problem. Yet the federal government, including the White House, the Drug Enforcement Administration and federal law enforcement at all levels, remains opposed to the idea.

**Yet the importance of the social aspect of buyers' clubs cannot be underestimated and, in my view, offers a medically significant new model for future conventional use of cannabis as a medicine. It is becoming increasingly clear that emotional support -- contacts with and help from fellow-patients, friends, family, co-workers and others -- plays a salutary role in battling many illnesses.**

**This kind of support improves the quality of life, and there is growing evidence that it may even prolong life

*Researchers have consistently found that support groups are effective for patients with a variety of cancers. Participants become less anxious and depressed, make better use of their time and are more likely to return to work than patients who are given only standard care, regardless of whether they have serious psychiatric symptoms.