While it has long been clear that chemical compounds found in the marijuana plant offer potential for medical use, smoking the raw plant is a method of delivery supported neither by law nor recent scientific evidence.
Nonetheless, a number of recent ballot initiatives have advocated marijuana as a treatment for various ailments. The net effect of these initiatives has been to favor political activism over objective science in advancing what would be the only smoked drug in America.
Advocates for smoking marijuana make a well-financed, emotional appeal to the voting public, claiming that what they demand is humane, useful and safe. While relying on anecdote to document their claims, they seize upon partial statements to validate their assertions. But in so doing they avoid the main conclusion of medical science: That there is little future in smoked marijuana as a medically approved drug.
A report by the prestigious Institute of Medicine (IOM) concluded that cannabinoid drugs have potential for therapeutic use. It specifically named pain, nausea, vomiting, and lack of appetite as symptoms that might be alleviated. According to the report, cannabinoids are “moderately well suited” to combat AIDS wasting and chemotherapy-induced nausea and “probably have a natural role in pain modulation, control of movement, and memory.”
Another report, by the National Institutes of Health (NIH), recognized the potential benefit of marijuana to help with appetite stimulation and AIDS wasting.
These studies present a consistent theme: Cannabinoids in marijuana do show potential for symptom management of several conditions. But the finding most important to the debate is that the studies did not advocate smoked marijuana as medicine. To the contrary, the NIH report called for a non-smoked alternative as a focus of further research. The IOM report recommended smoking marijuana as medicine only in the most extreme cases.
The conclusions of the NIH and IOM reports are supported by commentary published in the nation’s medical journals. Much of this literature focuses on the problematic aspect of smoke as a delivery system when using cannabinoids for medical purposes.
There is strong evidence that smoking marijuana has detrimental health effects to the degree that it is unlikely ever to be approved by the Food and Drug Administration as a medicine. Unrefined marijuana contains approximately 400 chemicals that become combustible when smoked, producing in turn more than 2,000 impure chemicals. The IOM report states that, when used chronically, “marijuana smoking is associated with abnormalities of cells lining the human respiratory tract. Marijuana smoke, like tobacco smoke, is associated with increased risk of cancer, lung damage, and poor pregnancy outcomes.”
A subsequent study by Dr. Zuo-Feng Zhary of the Jonsson Cancer Center at the University of California-Los Angeles determined that carcinogens in marijuana are much stronger than those in tobacco.
Chronic bronchitis and increased incidence of pulmonary disease are associated with frequent use of smoked marijuana, as are reduced sperm mobility and testosterone levels in males. Decreased immune system response, which is likely to increase vulnerability to infection and tumors, is also associated with frequent use. Even a slight decrease in immune response can have a major public health ramifications.
Irrespective of such risks and the fact that the demonstrated beneficial components in marijuana are already available in the approved prescription drug Dronabinol, ballot initiatives have proceeded with tumultuous consequences. All such initiatives create a conflict between state and federal drug laws. California’s problematic experience is instructive: The “buyers’ clubs” for marijuana became notorious for facetious interpretations of the definitions of “prescription,” “doctor’s recommendation,” and “medical.” One “patient” obtained a prescription for marijuana to treat hot flashes. Another, arrested for possession, claimed he was medically entitled to his stash to treat a condition exacerbated by an ingrown toenail. Undercover police in several buyers clubs reported flagrant sales to minors. Eventually, 10 of the 13 clubs in California were closed.
Further exacerbating the confusion over smoked marijuana as medicine are doctor concerns over medical liability. Some of those purported to need smoked marijuana have serious illnesses such as cancer and AIDS, making them vulnerable to toxic substances in the plant. As a result, doctors are loath to risk their patients’ health and their own financial well-being by prescribing it.
Advocacy for smoked marijuana has been cast in terms of relief from suffering. The Hippocratic oath doctors take specifies that they must “first, do not harm.” Clearly some people supporting medicinal marijuana are genuinely concerned about the sick. Others partisan in their quest for the legalization of marijuana are cynically manipulative in pursuing their objectives under the pretense of compassion for the ill. Either way, violating established medical procedure does harm, and it confounds the political, medical and legal processes that best serve American society.
In the single-minded pursuit of an extreme position that harkens back to the era of home medicine and herbal remedies, advocates for smoked marijuana not only retard legitimate scientific progress but become easy prey for less noble-minded zealots who seek to promote the acceptance of use of marijuana a dangerous and illegal drug.
James McDonough is director of the Florida Office of Drug Control. This article was adapted from a longer article in the journal Policy Review, published by the Heritage Foundation.