Reading the article entitled Canada Inches Towards Decriminalizing
Marijuana, which was featured on Join Together
Online, June 5, 2001 caused me to think about the implications of the
medical marijuana issue to management both in Canada and in the United
States. Here are some of my thoughts on the issue.
Although we have entered a new millennium many old controversies are still raging. One of these issues is the use of marijuana as a legitimate medication. There are two polarized camps fueling this debate. One side preaches the evils of using this herb and the other side extols the virtues.
We may be able to learn from a more enlightened government in Canada if proposed decriminalization of marijuana legislation succeeds there. The Canadian government has proposed expanding medicinal use of marijuana, while the Canadian Medical Association Journal recently came out in support of full decriminalization.
Over the past 17 years I have listened to both sides of this issue and have seen the impact of this controversy on my clients. Unfortunately, there is an important piece missing; reliable double-blind studies in the United States designed to test how effective marijuana really is as a legitimate medication. There is also the issue of how the Drug Enforcement Agency (DEA) rates or "Schedules" drugs.
What has been available for several years as a legitimate medication is Marinol, a synthetic THC (the active psychoactive chemical in marijuana). While marijuana is still listed as a Schedule I drug by the DEA and illegal for medical use, Marinol the synthetic form of THC has finally been reduced from Schedule II to a Schedule III Drug.
For Schedule I substances, the criteria that need to be considered are whether the substance has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision. While Schedule I drugs cannot be used medically, the law does allow supervised research.
For substances in Schedule II, the criteria that need to be considered are its high potential for abuse, whether it has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions and whether abuse of the substances may lead to severe psychological or physical dependence. While legal for medical use, doctors need to go through additional legal steps when prescribing these drugs.
A substance is placed on Schedule III based on its potential for abuse relative to substances in other schedules, whether it has a currently accepted medical use in treatment in the United States, and its relative potential to produce physical or psychological dependence is less.
Marinol has been used in treating Glaucoma, people undergoing chemotherapy, and for AIDS patients. Again sides are split on the effectiveness of this medication. One side says Marinol works great therefore there is no need to legalize the medical use of marijuana. The other side states that Marinol is not nearly as effective as smoked marijuana.
After working with many individuals who have used Marinol and also smoked marijuana, I see that both sides have some good points. For example, after helping some of my clients work through denial issues surrounding marijuana abuse, they become honest and share that the Marinol did work as well for controlling nausea or increasing appetite, but they didn't get high. On the other hand, several clients who needed help for nausea caused by chemotherapy treatment were not able to ingest the Marinol tablets and found smoking marijuana to be a much better option.
The major problems I have with smoking marijuana as a medicine is the inability to regulate the dosage and, even more important the delivery system. The level of THC varies so greatly in the marijuana that is currently available that coming up with a therapeutic dose is extremely difficult. In addition, the marijuana has other ingredients that may have unfortunate side effects. Then there is the dangerous delivery system-the issue of smoking it. No other medication we have is administered that way because of the potential dangers.
Because of the lack of research there has been no exploration of a safer delivery system for the active ingredient of marijuana (THC). There have been suggestions that an aerosol delivery system for the THC or Marinol would eliminate the dosage and the unsafe smoking problems. Why is this not being given due consideration?
One of the reasons may be that there is not enough profit for drug companies, but I believe the main reason is the stigma that has historically surrounded marijuana. I do believe that marijuana is a serious drug of abuse that leads to dependency (addiction) but this is also true of many legal prescription medications. For example Vicoden and OxyContin have both been increasingly abused in the past several years and Valium and Xanax have been a serious abuse problem for at least the past decade.
Another problem with medical marijuana is that often times it is being prescribed for conditions that may not be medially indicated. In fact, several of my clients received prescriptions for stress management and pain management.
I am not aware of any legitimate research that indicates marijuana is a medically sound treatment for either of those conditions. That is why quality research needs to be undertaken to prove once and for all the legitimacy of using marijuana-or at least its active ingredient THC-to treat specific medical conditions.
I do understand this is a controversial issue. While I am not in favor of legalizing "street drugs" I do advocate legalizing the medical use of marijuana and utilizing this potentially effective medication after it has undergone the same level of testing as the other medications we currently use. However, I believe that in addition to verifying the effectiveness, the delivery system and dosage problems also need to be resolved before I would feel comfortable fully endorsing the use of medicinal marijuana.