The Problem with Medical Marijuana

[tongodeon]

A few thousand years ago the Greeks invented the Pill. At the time pills were simple balls of paste, but the invention of the pill was a breakthrough because it enabled a measured dosage of medication to be reliably administered. Greek patients no longer had to fumble with scales or guess how much to consume, they knew exactly how much to take

Comments

[sploof]

I did quite a bit of research on marinol when my mom was on chemo, even though it turned out she couldn't take it for other reasons. What I was told was:
a) marinol is only available as a pill, which is problematic if your nausea is so bad you can't keep pills down (not uncommon for chemo),
b) quite a few people think that pot contains other active beneficial substances not in marinol, making it less effective,
c) marinol gets you higher than a comperable amount of pot,
d) marinol's only available for a small subset of the things pot is supposedly good for, and
e) a lot of doctors won't prescribe marinol because doing so attracts the bad kind of attention from the FDA and the DEA.

[tongodeon]

Sativex is a metered THC spray for patients with ingestion issues, but I'm not even saying that a legitimate medical marijuana campaign should be limited to those two commercial drugs. I just want MCD "pharmacists" to be operating at medieval technology levels. Test batches of medical marijuana for potency and sell it in metered "per-dose" bags so that patients know how much medication they're getting.

I suspect that this doesn't happen because the real goal of medical cannabis is to provide cover for recreational users who couldn't be able to say "this is medical" if their stash isn't in legitimately tested and individually packaged bags.

[sploof]

Sativex isn't generally available yet outside of the UK. Also, things have probably progressed, but last I looked into it, sativex was primarily intended for MS, and it wasn't clear how well the spray method would work for people dealing with chemo and other issues.

the real goal of medical cannabis

"Medical cannabis" doesn't have a real goal; each of the people advocating it have their own goals. Some people advocating it want it to be available for medical use. Some people advocating it want to mainstream pot and reduce the popular and political stigma in order to clear the way for eventual legalization. Some people, who may or may not actually advocate it, want to use it as cover for their own illegal use or business.

I think it's a real mistake to paint everyone involved with the same brush.

[ikkyu2]

I'm also baffled that Marinol (dronabinol), which is pretty much pure Δ-9-THC, doesn't come up more often in medical marijuana discussions. Both sides pretend it doesn't exist, the anti-marijuana side because anything euphorigenic is evil, the pro-marijuana side because they want to be free to smoke grass, not take a pill.

It turns out that dihydrocannibinols and other compounds in marijuana have pharmaceutical activity - some of them are responsible for part of the anti-glaucoma effect, others possibly for some of the antiepileptogenic effect - and to my mind this is worse, not better, for the medical marijuana advocates. Not only aren't they giving a standard dose, but they're giving a mixture of active compounds with uncertainty about the dose of each one.

If you have no need for therapy and are consuming marijuana for pure recreational enjoyment there is far less reason to require careful measurementThis is the only statement you made I'd really take issue with. I don't see how standardization and measurement of recreational

[tongodeon]

This is the only statement you made I'd really take issue with.

I'm being *really* generous with what I've written above, because you're right. The active ingredient in recreational products are metered and this is a good thing. The alcohol content in wine, the cocoa content in chocolate, the fat content of cheese, the nudity and violence content of film, the framerate and complexity of 3D games, the difficulty rating of climbing faces or ski slopes - all these things help the consumer decide what to select and how much of it they need to get high.

[swingland]

I liked this comment the best in terms of explaining what is needed and what should be provided.

[ikkyu2]

Thanks.

I have other ideas, too. What if, instead of a "psych E/R," we modeled psychiatric care on the model of the ICU (intensive care unit)? What if the idea was that someone who was seriously mentally deranged, instead of being sequestered from humanity in a locked room and sedated so he stopped thinking and moving, was put in a place with high tech monitoring, hugely skilled nurses, and a pharmacopoeia designed to be able to speedily and powerfully alter their state of mind for the better, so they could then participate in the talk therapy they needed to effect permanent gains? We do it for people having heart attack or aneurysm rupture or kidney failure. Why not for people undergoing mind failure?

As long as I am proposing these things, I would also like to propose that I receive a pony.

[mskala]

I've been told, though I don't know to what extent this may be propaganda, that smoking can be a better delivery system than pills, even for purely medical non-recreational THC use. The right dose is variable, from day to day as well as from patient to patient, and because smoked THC gets into the bloodstream much faster, it's easier for the patient to know how much is the right amount and control their dose. "Smoke until you feel better" is easy to get right, as opposed to "Take pills until two hours later you WILL feel better, and hope that you can predict how many that will be based on the number you took yesterday, even though it's probably not the right number today." On the other hand, you have to balance the advantages of smoking with the issue that smoking anything isn't going to make your lungs happy, and smoking is also preferred by the recreational users (so making any distinction between the two kinds of users that much harder), and (because of faster reward) likely to amplify any addiction potential that might exist

[tongodeon]

See above comment. "Pills" isn't the only option. Inhalers, vaporizers, patches, suppositories, IV injections, medicated gum - we've come a long way in the last 2000 years, but these people seem to be intentionally choosing to live in the dark ages for suspect reasons.

[ikkyu2]

I think what you say has merit.

Drug delivery in 2007 is certainly a serious science, there are thousands of Ph.D.'s worldwide who study and research it as their primary career goal. Not to mention the tobacco companies - their body of knowledge on drug delivery in smoked systems is probably one of the most comprehensive, scientific body of knowledge in any field.

In addition to considering the technologies available, it makes sense to consider the patient. If someone's dying of terminal cancer, with a life expectancy of three months, and they want to be able to enjoy their last few meals with the aid of marijuana, do I really have to consider that smoking unfiltered marijuana daily raises their lifetime risk of subsequent lung cancer by X% over the next 20 years? No, I don't, and it's silly to say otherwise.

The idea that we as a society have all this knowledge and we're forbidden by law to apply it usefully to a substance that many people choose to use strikes me as a black-and-white ethical violation.

[mmcirvin]

My impression of the whole issue is more or less the same as yours--I feel conflicted about it because the whole push for medical marijuana seems so obviously a cover for quasi-legalization of recreational marijuana, and that seems dishonest to me, but... I'm for legalization of recreational marijuana, so should I quibble over methods?

There are obvious dangers in believing that ends always justify the means, but on the other hand, the past few years of American politics have me feeling a lot more results-oriented--the opposition on most issues I care about doesn't seem to have any inhibitions about using any procedural means necessary, so taking the high road and insisting on the cleanest victories possible usually means you lose.

On the other hand, the weird situation as it stands seems to be affecting the quality of life in your neighborhood, if I'm reading your posts correctly.

[sploof]

I think there are MCDs that are focused on medical usage and do their best to screen out recreational users, and there are dealers who set up MCDs to cover their business. It's likely that there are more of the latter because there are a lot of pot dealers around, but that shouldn't discredit the former, it just means that SF set up a system that's easy to abuse.

The problem with standardizing dosage is that it's expensive and requires production facilities that would be an easy target for federal law enforcement. It would be particularly difficult to do while keeping inhalation as a consumption method, which is a major benefit for a significant chunk of genuine medical users.