GREG PIKE: Medical Marijuana – a Dopey Idea?

Dr Gregory K Pike
Director, Adelaide Centre for Bioethics and Culture
May, 2013
…Is Marijuana Medicine?
If marijuana has medicinal value, the first question to be asked is, “In what form might it have medicinal value?”  Currently, many people claim that smoking marijuana treats a medical condition.  Research directed towards this question will be considered shortly, along with a series of related questions about abuse, harm, and other social and legal issues that are largely prudential in nature – but are nonetheless important and with far-reaching implications.
The modern scientific approach to medicines typically follows a path of inquiry directed towards obtaining the most beneficial form of a medicine to treat a specified condition.  For example, while opium has been recognised for its medicinal value for many centuries, the active ingredients codeine and morphine have now been extracted and subjected to extensive research and analysis over many years.  We now have both in various formulations with known dosage and purity, a body of information on side-effects, known indications and contraindications, knowledge of therapeutic targets, patient populations for whom treatment is appropriate, and knowledge of abuse potential.  No medical authority would ever prescribe or even recommend smoking opium, not only because of the availability of formulations of active ingredients which are superior, but also because of the harm of smoking as a delivery system.
Might not THC, CBD and other ingredients in marijuana likewise be useful medicines?
This is an important question in its own right regardless of the ‘recreational’ abuse of marijuana, and this area of research has gained considerable traction as discoveries about the endocannabinoid system in the brain have been made.
Currently there are 4 formulations of active ingredients, dronabinol (Marinol), nabilone, nabiximols (Sativex) and rimonabant.  The first two are THC lookalikes, whereas Nabiximols is a marijuana extract containing both THC and CBD.  Rimonabant is a cannabinoid receptor blocker which was initially marketed as an anti-obesity drug in Europe in 2006 before being withdrawn soon after when side effects including serious depression and suicidal ideation were found to be frequent.
Dronabinol was approved by the US Food and Drug Administration (FDA) in 1985 for treating chemotherapy-induced nausea and vomiting and AIDS-related wasting, and although proven effective, both dronabinol and nabilone have not become the mainstays of treatment mainly because of their side effects, which include sedation, anxiety, dizziness, euphoria/dysphoria and hypotension, as well as the presence of superior alternatives.
Dronabinol and nabilone have also been shown to produce symptomatic relief of neuropathic pain and the spasticity associated with multiple sclerosis.  However, whilst patients report alleviation of spasticity, measures of objective changes are mixed.  In a recent study by Kraft and co-workers, an orally administered extract of cannabis containing mainly THC was found to have no beneficial impact on acute pain and may possibly have enhanced pain sensation.   This study highlights not only the complex nature of pain itself, but also the importance of identifying specific therapeutic contexts in which THC may or may not be useful.

….The rationale is based upon the idea that the image of marijuana will be considerably softened by its use as a medicine. They would also likely be aware that medical marijuana constitutes such a regulatory mess that as more people use medical marijuana, policing of ‘recreational’ use becomes more difficult. To some in authority it may appear simpler to accede to pressure for full legalization.
Groups like the National Organisation for the Reform of Marijuana Laws (NORML) have been agitating for medical marijuana for a long time, as has the Drug Policy Alliance. However, particular individuals have also put in considerable funds. These include billionaire financier George Soros and insurance magnate Peter Lewis. It is estimated that Lewis alone has spent between $40 and $60 million on medical marijuana initiatives since the early 80s.
Soros-watcher Rachel Ehrenfeld has described the Soros strategy as set forth to pro-legalisation group Drug Policy Foundation in the early nineties:

… in 1993 Soros gave DPF a “set of suggestions to follow if they wanted his assistance: Come up with an approach that emphasizes `treatment and humanitarian endeavors,’ he said … target a few winnable issues, like medical marijuana and the repeal of mandatory minimums.” Apparently, they took his advice.

Medical marijuana is an example of a complex blurring of the lines between use and abuse, between potential medical utility and ‘recreational’ use. Concern about the use of smoked marijuana being made publically available has been vindicated by the spread of medical marijuana legislation throughout the US and the proliferation of dispensaries providing marijuana for dubious purposes including ‘recreational’ use.
Dr Greg Pike is a Bioethicist and the Director of the Adelaide Centre for Bioethics and Culture (ACBC). Dr Pike obtained his doctorate in Physiology from the University of Adelaide in 1984, then continued with postdoctoral studies in the USA supported by grants from the National Institutes of Health and the Muscular Dystrophy Association. In 1998 he joined the Southern Cross Bioethics Institute and was its director from 2004 to 2012 before becoming founding director of ACBC. He focuses on bioethics with a particular emphasis on the influence of bioethics on public policy development. He has participated extensively in public debates on stem cells, cloning, abortion, euthanasia and illicit drug policy. He has a broader interest in ethical issues related to new technologies in the health sciences, particularly reproductive technologies and genetics. He is the Chairman of the Board of the Australian Drug Treatment and Rehabilitation Programme, a member of The Institute on Global Drug Policy, and a Fellow of the Institute for the Study of Christianity in an Age of Science and Technology. He was also a member of the Australian Health Ethics Committee for the 2006-2009 triennium.

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