MARIJUANA IS THE WRONG MEDICINE

The debate over using marijuana as medicine has been distorted by a
basic confusion: the assumption that smoking marijuana is a better
therapy than ingesting its active therapeutic agent. THC, in Pill form
or taking other approved medications. This assumption is wrong. THC
(known in pill form as Marinol) is an approved remedy that may be
prescribed by physicians for nausea and AIDS wasting syndrome. It is
safer than marijuana smoke.

The prestigious New England Journal of Medicine added to the
confusion with its Jan. 30 editorial, signed by Editor Jerome P. Kassirer
entitled "Federal Foolishness and Marijuana. Among it's errors:

It underestimates the toxic properties of marijuana smoke. This
smoke contains carbon monoxide, acetaldehyde, napthalene and
carcinogen. Inhalation of THC decreases lung defense mechanisms that
are already compromised in AIDS patients. who a extremely
vulnerable to pulmonary infections and tumors like Kaposi's sarcoma.
Thus marijuana smoke is a questionable choice to treat the symptoms
of AIDS or cancer. Safer and more effective medications are available.

It implies that marijuana smoking relieves pain. THC does not
interfere directly with the endorphin system; indeed, it *increases* the
perception of pain. Dr. Kassirer declares it "hypocritical" to forbid a
physician to prescribe marijuana yet allow him to prescribe morphine
for the relief of pain. If he means to imply that marijuana is analgesic,
he is simply wrong. If the implication Is that it is hypocritical to
prescribe one dependenceproducing drug and not another, Dr. Kassirer
is relying on a spurious analogy that clouds the relevant
pharmacological question: What is the effectiveness of a therapeutic
substance prescribed by physician?

It makes implausible claimes about the advantages of smoking
marijuana over Marinol. "Since smoking marijuana produces a rapid
increase in the blood level of active Ingredients. it is more likely to be
therapeutic." Dr. Kassirer claims. But based on pharmacology. the
opposite should be the case: Plasma THC concentration following pill
administration reaches a more sustained steady level, lasting three to
four hours, twice as long as after smoking marijuana. Such prolonged
concentration should be more effective than a rapid rise and fall of
THC concentration after smoking.

It claims the efficacy of new drugs to treat nausea has not been
tested. Dr. Kassirer ignores that experimental and clinical studies have
clearly established the superiority of substituted benzamide and
ondansetron over Marinol, though acknowledges that these drugs
*may* be more beneficial than marijuana.

It dismisses as "specious" the argument that approving marijuana for
medical use would send the wrong signal to the young. Epidemiological
surveys, however, indicate that the greater the perception of harm
associated with marijuana, the lower the frequency of its use among
children and adolescents.

It condemns as "misguided, heavy handed and inhumane" the Drug
Enforcement Administration's refusal to reclassify marijuana from
Schedule I (addictive and illegal) to Schedule II (addictive but legal for
some medical uses). Yet this refusal was based on a thorough analysis
of reports from medical specialists in ophthamology, oncology and
neurology. None re ported evidence that smoking marijuana was more
effective than approved remedies. The DEA's decision was supported
by both the Food and Drug Administration and the Public Health
Service. A doctor prescribing marijuana to a patient may be
"courageous" in Dr. Kassirer's mindbut he is also scientifically
misinformed and in violation of federal law.

Dr. Kassirer recommends that the federal government get into the
marijuana business, by "declar[ing] itself the only agency sanctioned to
provide the marijuana." Thus the government would "ensure its proper
distribution and use." In effect, Dr. Kassirer is opening the door to the
"controlled" legitimization of marijuana as it exists in the Netherlands
but even the Dutch have not approved marijuana for medical use.

Finally, Dr. Kassirer makes the obligatory appeal to "compassion" for
the suffering. He considers the prohibition of marijuana smoking to
infringe on the rights of patients at "death's door." In this instance, the
use of marijuana can no longer be considered a therapeutic intervention
but one of several procedures used to ease the ebbing of life of the
terminally ill. But for this purpose doctors should prescribe antiemetic
and analgesic therapies of proven efficacy, rather than marijuana. This
therapeutic course is not based on bureaucratic absolutism, political
correctness or reflexive ideologybut on scientific knowledge and the
humane practice of medicine.

Dr. Nahas, Dr. Sutin and Dr. Manger are professors at New York
University's Department of Anesthesiology and Medicine. Dr. Hyman
is a professor emeritus of medicine at Colombia University's College of
Physicians and Surgeons.