A CASE AGAINST SMOKING MARIJUANA

As a physician with more than 20 years of experience dealing with
patients addicted to drugs, I am often asked about a contentious
public health question: What is the medical basis for smoking
marijuana? The answer needs some context.

North Americans today have the world's safest, most effective system
of medical practice, built on a process of scientific research,
testing and oversight that is unequalled.

Before passage of the Pure Food and Drug Act in 1907, Americans were
exposed to a host of patent medicine "cure-alls," from vegetable "folk
remedies" to dangerous mixtures with morphine. The major component of
most "cures" was alcohol, which probably explained why people reported
they "felt better."

Claimed benefits were erratic and irreproducible.

Marijuana, whatever its value, is intoxicating, and it's not
surprising sincere people will report relief of their symptoms when
they smoke it. The important point is that there is a difference
between feeling better and actually getting better. It is the job of
modern medicine to establish this distinction.

The debate over drug use generates a great deal of media attention,
including focus on the administration's appeal this month to the U.S.
Supreme Court against medical marijuana, and frequent misinformation.
Some will have read, for instance, that the medicinal value of smoking
marijuana represents "mainstream medical opinion."

Simply put, there is no scientific evidence that qualifies smoked
marijuana to be called medicine. Further, there is no support in
medical literature that marijuana, or any medicine, should be smoked
as the preferred form of administration. The harms to health are
simply too great.

Marijuana advocates often cite the 1999 U.S. National Academy of
Science's Institute of Medicine report as justifying the drug's
medical use. But, in fact, its verdict was "marijuana is not a modern
medicine." The institute was particularly troubled by the notion that
crude marijuana might be smoked by patients.

These concerns are echoed by the U.S. Food and Drug Administration,
charged with approving all medicines. which noted: "While there are no
proven benefits to (smoked) marijuana use, there are many short- and
long-term risks associated with marijuana use."

Compounds in the marijuana plant do potentially have a medical value.
For instance, a synthetic version of an ingredient in marijuana has
been approved to treat nausea in chemotherapy patients, as well as for
treatment of anorexia in AIDS patients.

Admittedly, these medications have limitations, including the
relatively slow onset of relief. Researchers are exploring
drug-delivery systems that allow rapid relief, perhaps an oral
inhalator like those used by asthma patients, as a response to patient
needs.

But these medications are a far cry from burning the crude weed and
gulping down the smoke. Every American is familiar with Aspirin, and
some know that it was first found in willow bark, from which the
therapeutic agent acetylsalicylic acid was eventually synthesized.
Surely no one today would chew willow bark, much less smoke a piece of
tree, to cure a headache.

Medical science does not fear any compound, even those with a
potential for abuse. If a substance has the proven capacity to serve a
medical purpose, then it will be accepted. We have done so with
substances as dangerous as opium, allowing the medical use of many of
its derivatives, including morphine, Demerol and OxyContin. The key
term is "proven capacity." Only if compounds from marijuana pass the
same tests of research scrutiny that any other drug must undergo will
they become part of the modern medical arsenal.

Our investment in medical science is at risk if we do not defend the
proven process by which medicines are brought to the market.