Medical Marijuana

THE REPORT by the Institute of Medicine on medical uses of marijuana
provides guidance on a subject that has been politicized beyond both
its actual medical promise and its actual law enforcement
implications. The report has been spun as a victory by all sides, but
its contents are neither a ringing endorsement nor an outright
rejection of marijuana's therapeutic qualities.

Its authors conclude that while marijuana-derived chemicals such as
THC and other cannabinoids may be useful for a variety of symptoms,
smoked marijuana is "a crude THC delivery system that also delivers
harmful substances." The goal in studying "smoked marijuana would not
be to develop marijuana as a licensed drug," they write, but "as a
first step towards . . . nonsmoked, rapid-onset cannabinoid delivery
systems."

There are good reasons to be skeptical of the movement for medical
marijuana. The issue has become a kind of stalking horse for marijuana
legalization generally, one that avoids the serious public policy
questions legalization presents.

Moreover, THC is already available commercially in oral form with a
prescription, and the FDA has approved other drugs to treat many
symptoms marijuana is said to relieve.

Something is wrongheaded about the notion of drug availability as a
subject for referenda, rather than for a regulatory process in which
data from rigorous clinical trials are evaluated.

The flip side, as the institute's report suggests, is that the class
of patients seems to be limited, generally, to terminally ill people
suffering from chronic pain, nausea from chemotherapy, or appetite
suppression from AIDS or advanced cancers who don't respond to
standard therapies but do respond to marijuana.

It seems wrong, in the name of fighting the war on drugs, to withhold
from these patients a drug, however imperfect, that offers relief.

And it should be possible to arrange for access to marijuana by people
who may benefit from it -- as compassionate-use programs have allowed
access to many unapproved therapies -- without a general relaxation of
drug laws.

The institute's report recommends that marijuana and its constituent
compounds be studied further, with trials of smoked marijuana
examining only short-term use to avoid the health consequences of
longer-term marijuana smoking.

No reasonable objection can be made to this idea, particularly insofar
as further studies could lead to cannabinoid delivery systems that
lack the unhealthful qualities of smoking.

The report also recommends that access to marijuana be permitted for
patients who have failed to respond to standard treatments and whose
doctors approve their use of it. This too seems reasonable. Key,
however, is that such expanded access not become a system -- such as
the buyers' clubs that followed the referendum in California -- under
which marijuana is made openly available even to those with no medical
need for it. If marijuana is to be medicine, it should be under tight
controls and used only by those who cannot avail themselves of other
drugs.