REEFER MADNESS

Medical Marijuana

Marijuana Is Medically Useful, Whether Politicians Like It Or Not

IF CANNABIS were unknown, and bioprospectors were suddenly to find it
in some remote mountain crevice, its discovery would no doubt be
hailed as a medical breakthrough. Scientists would praise its
potential for treating everything from pain to cancer, and marvel at
its rich pharmacopoeia--many of whose chemicals mimic vital molecules
in the human body. In reality, cannabis has been with humanity for
thousands of years and is considered by many governments (notably
America's) to be a dangerous drug without utility. Any suggestion
that the plant might be medically useful is politically
controversial, whatever the science says. It is in this context that,
on April 20th, America's Food and Drug Administration (FDA) issued a
statement saying that smoked marijuana has no accepted medical use in
treatment in the United States.

The statement is curious in a number of ways. For one thing, it
overlooks a report made in 1999 by the Institute of Medicine (IOM),
part of the National Academy of Sciences, which came to a different
conclusion. John Benson, a professor of medicine at the University of
Nebraska who co-chaired the committee that drew up the report, found
some sound scientific information that supports the medical use of
marijuana for certain patients for short periods--even for smoked marijuana.

This is important, because one of the objections to marijuana is
that, when burned, its smoke contains many of the harmful things
found in tobacco smoke, such as carcinogenic tar, cyanide and carbon
monoxide. Yet the IOM report supports what some patients suffering
from multiple sclerosis, AIDS and cancer--and their doctors--have
known for a long time. This is that the drug gives them medicinal
benefits over and above the medications they are already receiving,
and despite the fact that the smoke has risks. That is probably why
several studies show that many doctors recommend smoking cannabis to
their patients, even though they are unable to prescribe it. Patients
then turn to the black market for their supply.

Another reason the FDA statement is odd is that it seems to lack
common sense. Cannabis has been used as a medicinal plant for
millennia. In fact, the American government actually supplied
cannabis as a medicine for some time, before the scheme was shut down
in the early 1990s. Today, cannabis is used all over the world,
despite its illegality, to relieve pain and anxiety, to aid sleep,
and to prevent seizures and muscle spasms. For example, two of its
long-advocated benefits are that it suppresses vomiting and enhances
appetite--qualities that AIDS patients and those on anti-cancer
chemotherapy find useful. So useful, in fact, that the FDA has
licensed a drug called Marinol, a synthetic version of one of the
active ingredients of marijuana--delta-9-tetrahydrocannabinol (THC).
Unfortunately, many users of Marinol complain that it gets them high
(which isn't what they actually want) and is not nearly as effective,
nor cheap, as the real weed itself.

This may be because Marinol is ingested into the stomach, meaning
that it is metabolised before being absorbed. Or it may be because
the medicinal benefits of cannabis come from the synergistic effect
of the multiplicity of chemicals it contains. Just what have you been smoking?

THC is the best known active ingredient of cannabis, but by no means
the only one. At the last count, marijuana was known to contain
nearly 70 different cannabinoids, as THC and its cousins are
collectively known. These chemicals activate receptor molecules in
the human body, particularly the cannabinoid receptors on the
surfaces of some nerve cells in the brain, and stimulate changes in
biochemical activity. But the details often remain vague--in
particular, the details of which molecules are having which clinical effects.

More clinical research would help. In particular, the breeding of
different varieties of cannabis, with different mixtures of
cannabinoids, would enable researchers to find out whether one
variety works better for, say, multiple sclerosis-related spasticity
while another works for AIDS-related nerve pain. However, in the
United States, this kind of work has been inhibited by marijuana's
illegality and the unwillingness of the Drug Enforcement
Administration (DEA) to license researchers to grow it for research.

Since 2001, for example, Lyle Craker, a researcher at the University
of Massachusetts, has been trying to obtain a licence from the DEA to
grow cannabis for use in clinical research. After years of
prevarication, and pressure on the DEA to make a decision, Dr
Craker's application was turned down in 2004. Today, the saga
continues and a DEA judge (who presides over a quasi-judicial process
within the agency) is hearing an appeal, which could come to a close
this summer. Dr Craker says that his situation is like that described
in Joseph Heller's novel, "Catch 22". "We can say that this has no
medical benefit because no tests have been done, and then we refuse
to let you do any tests. The US has gotten into a bind, it has made
cannabis out to be such a villain that people blindly say 'no'."

Anjuli Verma, the advocacy director of the American Civil Liberties
Union (ACLU), a group helping Dr Craker fight his appeal, says that
even if the DEA judge rules in their favour, the agency's chief
administrator can still decide whether to allow the application. And,
as she points out, the DEA is a political organisation charged with
enforcing the drug laws. So, she says, the ACLU is in this for the
long haul, and is already prepared for another appeal--one that would
be heard in a federal court in the normal judicial system.

Ms Verma's view of the FDA's statement is that other arms of
government are putting pressure on the agency to make a public
pronouncement that conforms with drug ideology as promulgated by the
White House, the DEA and a number of vocal anti-cannabis congressmen.
In particular, the federal government has been rattled in recent
years by the fact that eleven states have passed laws allowing the
medical use of marijuana. In this context it is notable that the
FDA's statement emphasises that it is smoked marijuana which has not
gone through the process necessary to make it a prescription drug.
(Nor would it be likely to, with all of the harmful things in the
smoke.) The statement's emphasis on smoked marijuana is important
because it leaves the door open for the agency to approve other
methods of delivery. High hopes

Donald Abrams, a professor of clinical medicine at the University of
California, San Francisco, has been working on one such option. He is
allowed by the National Institute on Drug Abuse (the only legal
supplier of cannabis in the United States) to do research on a German
nebuliser that heats cannabis to the point of vaporisation, where it
releases its cannabinoids without any of the smoke of a spliff, and
with fewer carcinogens.

That is encouraging. But it does not address the wider question of
which cannabinoids are doing what. For that, researchers need to be
able to do their own plant-breeding programmes.

In America, this is impossible. But it is happening in other
countries. In 1997, for example, the British government asked
Geoffrey Guy, the executive chairman and founder of GW
Pharmaceuticals, to come up with a programme to develop cannabis into
a pharmaceutical product.

In the intervening years, GW has assembled a "library" of more than
300 varieties of cannabis, and obtained plant-breeder's rights on
between 30 and 40 of these. It has found the genes that control
cannabinoid production and can specify within strict limits the seven
or eight cannabinoids it is most interested in. And it knows how to
crossbreed its strains to get the mixtures it wants.

Nor is this knowledge merely academic. Last year, GW gained approval
in Canada for the use of its first drug, Sativex, which is an extract
of cannabis sprayed under the tongue that is designed for the relief
of neuropathic pain in multiple sclerosis. Sativex is also available
to a more limited degree in Spain and Britain, and is in clinical
trials for other uses, such as relieving the pain of rheumatoid arthritis.

At the start of this year, the company made the first step towards
gaining regulatory approval for Sativex in America when the FDA
accepted it as a legitimate candidate for clinical trials. But there
is still a long way to go.

And that delay raises an important point. Once available, a
well-formulated and scientifically tested drug should knock a herbal
medicine into a cocked hat. No one would argue for chewing willow
bark when aspirin is available. But, in the meantime, there is unmet
medical need that, as the IOM report pointed out, could easily and
cheaply be met--if the American government cared more about suffering
and less about posturing.