PUFFING IS THE BEST MEDICINE

THE FOOD AND Drug Administration is contradicting itself. It recently
reiterated its position that cannabis has no medical utility, but it
also approved advanced clinical trials for a marijuana-derived drug
called Sativex, a liquid preparation of two of the most
therapeutically useful compounds of cannabis. This is the same agency
that in 1985 approved Marinol, another oral cannabis-derived medicine.

Both Sativex and Marinol represent the "pharmaceuticalization" of
marijuana. They are attempts to make available its quite obvious
medicinal properties -- to treat pain, appetite loss and many other
ailments -- while at the same time prohibiting it for any other use.
Clinicians know that the herb -- because it can be smoked or inhaled
via a vaporizer -- is a much more useful and reliable medicine than
oral preparations. So it might be wise to consider exactly what
Sativex can and can't do before it's marketed here.

A few years ago, the British firm GW Pharmaceuticals convinced
Britain's Home Office that it should be allowed to develop Sativex
because the drug could provide all of the medical benefits of
cannabis without burdening patients with its "dangerous" effects --
those of smoking and getting high.

But there is very little evidence that smoking marijuana as a means
of taking it represents a significant health risk. Although cannabis
has been smoked widely in Western countries for more than four
decades, there have been no reported cases of lung cancer or
emphysema attributed to marijuana. I suspect that a day's breathing
in any city with poor air quality poses more of a threat than
inhaling a day's dose -- which for many ailments is just a portion of
a joint -- of marijuana.

Further, those who are concerned about the toxic effects of smoking
can now use a vaporizer, which frees the cannabinoid molecules from
the plant material without burning it and producing smoke.

As for getting high, I am not convinced that the therapeutic benefits
of cannabis can always be separated from its psychoactive effects.
For example, many patients with multiple sclerosis who use marijuana
speak of "feeling better" as well as of the relief from muscle spasms
and other symptoms. If cannabis contributes to this mood elevation,
should patients be deprived of it?

The statement that Sativex, "when taken properly," won't cause
intoxication hinges on the phrase "when taken properly." "Properly"
here merely means taking a dose -- by holding a few drops of liquid
under the tongue -- that is under the level required for the
psychoactive effect. As with Marinol, people who want to use Sativex
to get high will certainly be able to do so.

One of the most important characteristics of cannabis is how fast it
acts when it is inhaled, which allows patients to easily determine
the right dose for symptom relief. Sativex's sublingual absorption is
more efficient than orally administered Marinol (which requires 1 1/2
to two hours to take effect), but it's still not nearly as fast as
smoking or inhaling the herb.

That means "self-titration," or self-dosage, is difficult if not
impossible. Further, many patients cannot hold Sativex, which has an
unpleasant taste, under the tongue long enough for it to be absorbed.
As a consequence, varying amounts trickle down the esophagus. It then
behaves like orally administered cannabis, with the consequent delay
in the therapeutic effect.

Cannabis will one day be seen as a wonder drug, as was penicillin in
the 1940s. Like penicillin, herbal marijuana is remarkably nontoxic,
has a wide range of therapeutic applications and would be quite
inexpensive if it were legal. Even now, good-quality illicit or
homegrown marijuana, which is, at the very least, no less useful a
medicine than Sativex, is less expensive than Sativex or Marinol.

The "pharmaceuticalization" of marijuana has promise. No doubt the
industry could produce unique analogs of the naturally occurring
cannabinoids that would be useful in ways smoked cannabis is not. But
for now, medicines such as Sativex provide only one advantage over
the herb: They're legal.

I have yet to see a patient who preferred Marinol to smoked
marijuana. Similarly, the commercial success of Sativex will largely
depend on how vigorously the marijuana laws are enforced. It is not
unreasonable to believe that drug companies have an interest in
sustaining the prohibition against the herb.

Geoffrey Guy, who founded GW Pharmaceuticals, claims his aim was to
keep people who find marijuana useful out of court. There is, of
course, a way to do this that would be much less expensive -- both
economically and in terms of human suffering.