MEDICAL MARIJUANA IN WA: ACADEMICS AND THE TURNING TIDE

Part 3 of Series

The Institute of Medicine is an authoritative voice in the nation's
medical community.

In 1997, the non-profit institute launched a review that resulted in
the book "Marijuana and medicine: Assessing the science base," which
explores the effects of cannabis as well as testimony from supporters
and opponents.

The institute's review followed California's passage of a medical
marijuana law the previous year. Washington state voters approved
their own law in 1998, alongside Arizona, Alaska, Nevada and Oregon
(Arizona's law was soon nullified because it called for "prescriptions").

Amid its conclusions, the book acknowledges the therapeutic aspects
of cannabis for pain, appetite and sleep. The book also frequently
cites a need for further research.

"Ultimately, the complex moral and social judgments that underlie
drug control must be made by the American people and their elected
officials," according to the book's introduction.

Likewise, pharmaceutical companies are limited in their cannabis
research and development of cannabis-based medications due to federal
restrictions.

Federal law classifies cannabis as a Schedule I substance, considered
to have no accepted medical use in treatment, no accepted standard of
safety for use under medical supervision, and a high potential for
abuse. Other Schedule I drugs include heroin and LSD.

Like 12 other states in the nation, Washington state's medical
marijuana laws conflict with the federal government.

As such, doctors are prohibited from writing prescriptions for
marijuana. Instead, doctors may only authorize the drug with a
written recommendation.

The reclassification of cannabis to a Schedule II or Schedule III
substance would immediately open doors for medical research.

"That legal classification has basically produced all these state
medical marijuana laws," said Sunil Aggarwal, a medical student at
the University of Washington. "I don't need a clinical anecdote to
convince me of cannabis's medical utility."

Aggarwal finished his Ph.D. last year, studying the medical geography
of cannabinoid botanicals in Washington state. "Cannabinoid
botanicals," another way of saying medical marijuana, refers to the
chemical compounds of cannabis.

"Pharmaceutical companies could benefit from doing more work in the
field of cannabinoid research," he said. "There are a lot of
medicines that could come out of this."

Turning Tides on Federal and State Levels

There is no way to officially track the number of medical marijuana
patients in Washington state. Estimates hover around 25,000 when
compared to states such as Oregon, which requires registration of patients.

In 2007, Washington state established guidelines on a 60-day supply
for patients: 24 dry ounces and 15 plants at a time. This amount has
become another point of contention. Aggarwal and some medical
professionals determined that 71 dry ounces was a more appropriate
amount for 60 days.

This conclusion was based on accounting for delivery differences of
the psychoactive chemical THC in consumption (smoking vs. ingestion).
It also took into account the average amount supplied to patients in
a three-decade old federal marijuana clinical research study, Aggarwal said.

California is generally regarded as the leader, for better or worse,
in shaping state laws and attitudes on medical marijuana. California
boasts hundreds of dispensaries along with more qualifying conditions
for patients seeking a doctor's recommendation.

Marijuana's medical legitimacy is undermined in California mainly due
to low-standard physicians, said Aggarwal, noting the state's market
potential for cannabis.

Cannabis dispensaries in the Golden State have storefronts sporting
neon signs and advertisements in newspapers. They're also big
businesses that could bolster government coffers. Gov. Arnold
Schwarzenegger, a Republican, has suggested his state explore options
regarding tax revenue from marijuana.

Elsewhere, Rhode Island just joined New Mexico to feature
state-licensed dispensaries for patients (California's dispensaries
are not regulated by law).

On the federal level, President Barack Obama has promised to end
federal raids on medical marijuana patients, and Attorney General
Eric Holder vowed not to prosecute them.

Earlier this month, U.S. Rep. Barney Frank (D-MA) introduced a bill
that would strengthen legal protections for state-authorized patients
as well as reclassify marijuana to Schedule II.

"It will definitely open up a larger discussion on whether
non-medical use is accepted in our society," Aggarwal said of the
escalating debate over cannabis. "There will always be a need for a
medical market, a medical channel."

Academic Cannabis

Aggarwal's 395-page Ph.D. dissertation is titled "The Medical
Geography of Cannabinoid Botanicals in Washington State: Access,
Delivery and Distress."

Topics in the dissertation include:

The emerging field of cannabinoid medicine as well as the increase in
related medical and scientific literature.

Survey results from medical marijuana patients in Washington state.

"In its 4,000-plus years of documented use, there is no report of
death from overdose with cannabis. In contrast, as little as 2 grams
of dried opium poppy sap can be a lethal dose in humans as a result
of severe respiratory depression."

The study of 139 medical marijuana patients accessing cannabis
treatment for chronic pain at a clinic in rural Washington state. The
patients were severely ill or injured. "Due to the non-reimbursable
cost and general unavailability of delivery systems, medical-grade
cannabis is frequently difficult for patients with documented medical
needs to obtain."

"Seven randomized, placebo-controlled or dronabinol
(Marinol)-controlled clinical trials of cannabis published in
2005-2008 and conducted in patient populations in the United States,
which investigated indications such as HIV- and other forms of
painful neuropathy, spasticity in multiple sclerosis, and appetite
stimulation in HIV patients, have consistently shown statistically
significant improvements in pain relief, spasticity, and appetite in
the cannabis-using groups compared to controls."

A breakdown of delivery costs involved in a four-month cycle of
medical marijuana for one clinic in Washington state. Costs included
labor, growing equipment, facility rental and transportation. "An
important point that I was trying to make about the medical value of
the cannabis plant: That access to a single sample of cannabis
germplasm (plant genetic resource) allows for the growth of four
monoclonal, large cannabis plants whose yield was able to serve the
needs of 71 patients," Aggarwal said about this study.

"Political ecology" and its effects on interpretations of medical
marijuana, from the political to the social. The dissertation also
weighs the dilemmas involved in policies and definitions of drug
abuse and controlled substances.

"Only 19 researchers in the U.S. have the necessary licenses to
conduct research with cannabis supplied by federal agencies."