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Thursday, July 28, 2011

Medical Marijuana [Full link to blog for email clients.][FT:C44]

[I have reprinted a response to a recent article and online debate.]

It happens every six months or so, a news article picks up on a new miraculous cure involving marijuana and I start this argument all over again. On one side is usually a group advocating legalization using medical marijuana as justification. On the other side are strict traditionalists claiming that there are no medicinal benefits, and the legalizers just want an excuse to smoke pot. So where does that leave the scientists and doctors who are actually doing research into the medicinal applications of cannabinoids (the chemical ingredients of the cannabis sativa marijuana plant)?

Well, usually in the middle. And as is true in so many cases, the efforts to identify and bring to practice real medicinal uses are hurt by both sides.

First and foremost, I am not arguing for or against legalization. I really don't care that much what substances you put into your body. Legalization is a question to be decided by a society that debates and votes for their respective stand on the issue. As a researcher of cannabinoids I have a stake only in potential medicinal applications – but also in the use and mis-use of the concept of medical marijuana.

I do not find marijuana to be harmless. There are side-effects. Cannabinoids alter memory, they alter the ability to make critical decisions, in some cases they can affect reaction time, and smoking the unprocessed, unfiltered leaf exposes the lungs to more chemicals than tobacco. It can reveal latent tendency to anxiety, depression or schizophrenia. It is up to society to decide if those side-effects are less than, say, ethanol. This is why I stay out of the legalization argument.

Where I do argue is against the use of "marijuana" as a medicinal agent. There are very few medical applications where smoking marijuana is an appropriate means of delivering appropriate cannabinoids to the body. One of those is cancer pain – by all means, if the marijuana alleviates pain and allows the patient to escape for a few hours, do it.

But there are many other medicinal applications: glaucoma, nausea, loss of appetite due to chemotherapy, bone pain, convulsions, stress, cancer, and now… autism ( The recent autism reports are disturbing because there is no research supporting the results, and the probable mechanisms would likely be from compounds other than the widely known ingredients of marijuana. The problem is that so many of these medicinal applications do not rely on the same chemical compounds of marijuana smoke. Smoking marijuana bought from a street vendor – whether a medicinal storefront in Berkeley or a street pusher in Detroit – provides no control over the chemical constituents of marijuana.

Does that matter? In a word – yes. The chemical compounds mean everything with respect to effects. You've probably heard of Tetrahydrocannabinol – THC – the main ingredient of marijuana. But did you know that there is more than one type of THC? There's Delta-9-THC. That's the one usually referred to with marijuana, but there's also Delta-8-THC and 11-hydroxy-THC. Those are slightly different chemical compounds, and have slightly different potencies. How about Cannabidiol? Ever hear of it? Cannabidiol is responsible for some of the anticonvulsive and anti-anxiety effects of marijuana. How about Cannabigerol, Cannabidivarin or Tetrahydrocannabivarin? These are all trace ingredients on the average in the cannabis sativa plant. New research shows that these compounds have some very important medicinal effects – as well as potential side effects depending on what is being treated.

And here's the dirty little secret of medical marijuana – when buying street pot, you don't know how much of these other chemicals are in the plant. Pot is grown – even bred like roses and show dogs – for a particular characteristic, the euphoric feeling or "high." Cannabindiol for one, and some of the other cannabinoids block or reduce that high. About one third of all pot available in the U.S. has negligible Cannabidiol. Now if you were counting on that "medicinal" effect, you're out of luck!

The concept of buying pot from any source and self-medicating is not medicine – it's smoking pot. Pot smoking is not medicinal. If you go to the doctor with severe pain, he doesn't prescribe chewing tree bark (for salicylate, the main ingredient in aspirin), boiling poppies (for opium and its primary product, morphine) or eating mushrooms (for muscarine, and it's derivative acetylcholine). No, the doctor prescribes a controlled dose of a drug that is a purified chemical derived from or synthesized to resemble a single ingredient in those substances. Again, medical marijuana, as practiced in this manner is not medicinal.

I once had this argument online in a discussion group and my opponent started listing research studies that proved the medicinal benefits of marijuana. Yes, there are studies that support medicinal applications. However, my favorite was an article that showed suppression of lymphoma growth: Marijuana Cures Cancer! Unfortunately not true. The discussion stopped cold when I pointed out that the substance used in the test was a synthetic chemical (first identified in Israel where they do a lot of medicinal cannabinoids research) and was not present in the cannabis plant and therefore could never be obtained by medical pot smoking!

At the recent meeting of the International Cannabinoid Research Society – a group of about 400 scientists and physicians that study cannabis and cannabinoids from drug abuse to medicinal potential – less than 10% of the scientific presentations used smoked marijuana – and most of those were abuse studies. The truly medicinal studies used purified extracts and synthetic compounds. Here's a hint: if an article refers to THC it is probably talking about marijuana leaf or at least a purified extract; if it mentions cannabidiol (CBD) is definitely a purified extract; if it mentions chemical designations such as WIN 55212-2, CP55940, HU-210, anandamide, 2-AG, it is talking about synthetic compounds not found in marijuana.

In summary, I really don't have much of a stand on marijuana legalization, but I oppose medical marijuana use as it is currently practiced in this country. Why? Because it is not medicinal. It is becoming more obvious that there are many medicinal benefits to be had from a better study of the cannabinoid chemicals in cannabis. Those benefits are all too easily confused by those who promote use of a drug in the absence of controlled dosing, known chemical composition and physician monitoring. To argue otherwise is contrary to decades of scientific research attempting to understand those medical applications.

Smoke pot, or not. Just leave so-called "medical" pot smoking out of the debate.

[Dr. Tedd "Speaker to Lab Animals" Roberts is a neuroscientist with 29 years research experience studying effects of drugs on learning, memory and cognitive decision making in animals and humans.]


  1. Do the medicinally useful canabaliods cause the mental impairment from smoking, or do they go along with the THC high?

  2. Very good article Speaker. Much of that I did not know, but I'm not surprised. Even before I read this, I had my suspicions that the whole "medicinal" applications of smoked pot were blown way out of proportion, and mostly used as an excuse to legalize it so California could help get itself out of debt.

    Also, as I am a bit allergic (or maybe just hyper-sensitive) to smoke, I really am happy to hear that they are working on reducing the plant down to the chemical compounds that can be put into a simple pill or doctor applied shot. That would mean that if-heaven forbid-I get cancer or any other medical issue that might require that type of medicine, I can actually benefit from the medicinal properties without putting all that trash in my lungs or suffering the high side effects.

    I may be an artist, but I never was the stereotypical drugged out creative who needed her brain to buzz before she got any good ideas. I've always found that I do my best work when my mind is clear. I have no problem with others smoking it though and I think they should probably just legalize it and regulate it along with other accepted drugs like alcohol and nicotine. Just don't blow smoke in my face (or up my butt to coin a phrase) please.

  3. First - sorry about the delay in answering - Dan - it varies per chemical. Delta-9-THC is very useful, and it *is* psychoactive. Many of the other compounds, most notably cannabidiol, or CBD, is not psychoactive. In fact, CBD reduces the high when it is present at high concentrations in the plant. This is one reason why I rant against the use of smoked marijuana from "street" sources for medicinal use.

  4. Emily:

    Thanks for your support. One of the disturbing trends in medicine is acceptance of "self-treatment" without a doctor monitoring. That's essentially where medical marijuana (MMJ) is today. The extracts have variable effects, but that is being researched. Of course, if it doesn't cause a "high" it has trouble being understood and accepted by those who currently support "MMJ."

    After all - if you can "take your medicine" and get high at the same time, isn't that better than just taking medicine? Yes, that's sarcasm. Sorry about that. But your points are well taken - MJ smoke is worse than tobacco because the leaf has not been subject to the commercial breeding, composition and filtering process. Legalizing MJ may bring some... interesting... side effects.

  5. Thanks. Since the answer's yes and no I'd be interested in knowing a bit about which types of problems are/not treatable without having getting high as a side effect.

  6. Sorry, but you don't get to make up your own definition of "medicinal". According to law, a "medicine" is anything that is recognized as an effective medicine by a respectable minority of doctors. You can read about that in the ruling of the DEA Chief Administrative Law Judge on medical marijuana at

    He studied the issue for two years and accumulated 15 volumes of research from both the DEA and the opposition. According to him, marijuana most definitely is legally a "medicine." That was in 1988 - before even most of the research you probably read.

    You will note that the legal definition of "medicine" does not require that the "med" be pure, or in pill form, or approved by the FDA or any other regulatory body. Neither does it say anything about the method in which it is administered.

    Furthermore, it seems pretty obvious - since you admit that cannabinoids have medicinal uses - that the plant that contains them would also have medicinal uses.

    You might also want to explain why the US Federal Government sends a big tin can full of medical marijuana joints to a number of patients each month.

    Furthermore, you may want to explain why the Insitute of Medicine (1999) disagreed with you.

  7. "And here's the dirty little secret of medical marijuana – when buying street pot, you don't know how much of these other chemicals are in the plant."

    Yeah, that's a problem, for sure. Of course, the only real reason for that is that pot is illegal - which you might want to put into your computations on your feelings about legalization.

    But the good news is that experienced pot smokers can usually tell whether their bag of pot meets their desired chemical profile. Within a puff or two (about one minute), most of them can tell you whether it meets their medical requirements. They may not be able to tell you that it is X% this or Y% that, but as long as those numbers are in a widely expected range, then they can adjust the dosage on their own.

    As for "what is the recommended dosage?" It is the same as the dosage printed on many other medicines - "as needed". Smoked marijuana is very easy to titrate and there is negligible risk of an overdose. According to which Federal govt. authority you want to believe, the lethal dose of mj is somewhere between one-third your body weight and 1,500 pounds, consumed in 15 minutes. The lethal dose of water is lower than the lethal dose of marijuana.

  8. But all this "medical" stuff is really a moot point if we go to the heart of the issue - legalization. You said you are not decided on legalization.

    So let's review the medical evidence for the laws in the first place. If you aren't comfortable with the idea of "medical" marijuana, then surely you will be more comfortable with the medical ideas behind the laws.

    Marijuana was originally outlawed for two major reasons. The first was because "All Mexicans are crazy and marijuana is what makes them crazy." The second was the fear that heroin addiction would lead to the use of marijuana - exactly the opposite of the modern "gateway" idea.

    Only two doctors testified at the hearings for the Marihuana Tax Act of 1937. The representative of the American Medical Association said that there was no evidence that mj was a dangerous drug and no reason for the law. He pointed out that it was used in hundreds of common medicines with no major issues. In response, the committee told him that, if he wasn't going to cooperate, he should shut up and leave.

    The only other doctor to testify was James C. Munch. His sole claim to fame was that he had injected some extract of mj directly into the brains of 300 dogs, and two of them died. When they asked him what he concluded from this, he said he didn't know what to conclude because he wasn't a dog psychologist.

    He also testified in court, under oath, that mj would make your fangs grow six inches long and drip with blood. He also said that, when he tried it, it turned him into a bat. He then described how he flew around the room for two hours and found himself at the bottom of a 200 foot high inkwell.

    Dr. Munch was the only doctor in the US who thought mj should be illegal, so he was appointed US Official Expert on marijuana, where he served for 25 years.

    You can start your reading on this topic with the short history of the mj laws at

    You can find the best overall review of the drug problem ever written at

    You can find the full text of the congressional hearings for the Marihuana Tax Act at

    You can find the full text of the largest government commission ever to study the marijuana issue at

    You can find another excellent history of the subject, written by a former president of the American Bar Association at

    You can find the full text of other histories by different authors, as well as hundreds of original historical documents at

    So, any time you want to do another article on which side of this argument is closer to the truth, you just let me know.

  9. And just so you know, Speaker, I know a number of the people who receive Federal medical marijuana every month. They - and others - have tried the pills and they don't find the pills nearly as good for a number of specific reasons.

    1) There are apparently other compounds besides THC in marijuana which enhance the effects. They report that the pills don't relieve the symptoms as well.
    2) The pills are horrendously expensive.
    3) The pills don't work very well for nausea and it is pretty discouraging to see expensive pills in your puke. Inhaled medicines work better.
    4) It is too hard to adjust dosage with the pills. There are only two dosages which gives them the choice between too little and too much.
    5) The pills take a half hour to take effect, so they suffer longer and have more trouble adjusting their dosage. With smoked marijuana, they can take a small puff and know whether it is enough within about one minute.
    6) The pills often give them what they describe as a "debilitating stone". It hits them so hard they can't function. Smoked marijuana is much easier to properly titrate to their needs.

    Just FYI - that's the reason the Feds didn't switch these people to the Marinol pills -- because their doctors all agreed that the pills were not adequate for many reasons..

    As for the possible lung damage - Google Donald Tashkin, for starters. As it turns out, it doesn't cause lung cancer (something the epidemiologists surely would have picked up on by now.)

    As for other side effects - go get your copy of the Physician's Desk Reference and point out anything in there that does not have warnings about side effects and contraindications. You would have trouble locating one where the side effects are as mild as they are for marijuana.

    The moral of that story is that every medicine, herb, or anything else has the potential to cause problems. Water overdoses kill about 100 people per year, so even water isn't safe to drink.

    When people take a medicine, they have to make their own decisions about the benefits versus the drawbacks. No medicine works equally well for everyone, and no medicine has the same side effects in everyone. Therefore, it is up to the individual to make that choice.

    If they think they get better relief from chewing willow bark than swallowing an aspirin then what is the real problem? You can advise thme that you think the aspirin should be preferred, but it is still their choice - and ultimately none of your business.

    Moreover, we can only hope that you would be sensible enough that you would not recommend that they be punished if they chose willow bark.

    Let me point out one simple truth that ought to be recognized up front by all doctors -- It is morally wrong to punish anyone who has done nothing more than try to relieve their own suffering -- even if you disagree with their choice of medicine.

    Can we agree on that last point, doc?

  10. You don't think pot smoking can be "medical". We already covered the legal meaning of the word, and you are clearly wrong there.

    So let's go with a more general definition. How do you tell when someone is using a drug "medically" as opposed to "recreationally"?

    Like morphine, for instance. It has legitimate medical uses and is prescribed routinely. So, if you see someone taking some morphine, how do you tell whether they are "medical" or "recreational"?

    I have been asking this question for years and - so far - only one doctor has provided a sensible answer. You ought to think over the answer pretty seriously before you try this column again.

    This doctor gave a lot of recommendations for medical marijuana and he perceived a pattern in his patients but he couldn't make out what the pattern was. So he started taking life histories of his patients and began to notice certain patterns.

    His clients were mostly male, and divided evenly between under 30 and over 30. Demographically, they matched the US "averages" very closely. There was a wide range of income, profession, etc.

    They had a high frequency of things like absent fathers during early childhood, early diagnoses with things like ADD, ADHD, PTSD, etc. They tended to have used drugs at an early age, usually beginning with alcohol and tobacco. They reported drug abuse, of multiple drugs, at an early age with periods of blackouts, and addiction.

    Most interesting, while they all had legitimate physical injuries for which mj might provide relief, most of them were veteran pot smokers before they came down with the injury.

    So what is really going on here? This doctor's conclusion is that much of drug abuse is driven by anxiety-related disorders. People are attempting to self-medicate anxiety problems, the same way other people might go to a doctor and get a prescription for Valium.

    So, according to your reasoning, if they go to a doctor to get a Valium then that is "medical" while if they get one from a friend, it isn't? That definition of "medical" obviously doesn't work very well.

    The doctor concluded (from the largest research done to date on why people use medical marijuana) that marijuana use becomes "medical" the first time someone buys it for themselves - as opposed to accepting it from friends.

    What's the basis for that? The reports of his patients and an interesting set of stats.

    Many of his patients had been abusers of hard core drugs like alcohol, cocaine, heroin, etc. Ninety percent of them greatly reduced their use of harder drugs and ten percent quit completely when they took up the regular use of medical marijuana.

    So, if they are using it to mediate their addiction, doesn't that mean it is "medical" to them? Or would you still think that they have to buy it from the pharmacy before it would qualify?

  11. Well, I am going to leave this up for a while to respond to it - but frankly, if you are going to go off on setting up straw men and knocking them down...

    Get your own blog.

    Don't use mine to advance your agenda.

    I can some up my counter to your argument very simply...

    Pot smoking is uncontrolled medication.

    Notice that I accept that there is a legitimate use for medical pot - in the case where the euphoria is an important part of the treatment, i.e. for intractable pain such as cancer.

    For every other use, there is no control of dosing or constituents. "Use as needed" is not "treatment" it is palliative. It is not a cure, it is not a medication, it is not targeted to a particular disease process. It is relief of symptoms only.

    Yes, relief of symptoms is important. But it does not address the underlying condition - to do so would require a more precise dosing and blend of ingredients.

    You lecture on about definition of "medication" - are you really so naive as to think I don't know that? You spout anecdotes about how persons get relief from smoking weed but not from pills. Did you miss the part where I said that there are 63 individual cannabinoid compounds in cannabis sativa leaf? And that the proportions are important? The "pills" are pure THC, and no, they don't work well. That's one of the reasons why Sativex is taking so long to be approved - it is leaf bred for a particular ratio, then testes, extracted, compounded and packaged as a spray.

    Again, did you think you were trying to pull one over on me? Did you read my blog about students who ask The Impossible Question to make themselves look good at the expense of the teacher?

    You state that if pot were legalized there would be more consistency in the product for medicinal purposes. I'm afraid I have to call b#llsh!t on that point. Look at any convenience store that sells cigarettes, any store that sells beer, wine or liquor. Where is the standardization?

    No, I stand by my original statement. Smoking pot for the sake of a medical treatment without bother to control dose or constituents - and particularly without divorcing the psychoactive effects from the drug - is smoking pot.

    As for your "agenda" - keep it off of my blog.

  12. >Pot smoking is uncontrolled medication.

    It has all the control it needs to be safe for the vast majority of people who use it.

    >Notice that I accept that there is a legitimate
    >use for medical pot - in the case where the euphoria
    >is an important part of the treatment, i.e. for
    >intractable pain such as cancer.

    >For every other use, there is no control of dosing
    >or constituents. "Use as needed" is not "treatment"
    >it is palliative. It is not a cure, it is not a
    >medication, it is not targeted to a particular
    >disease process. It is relief of symptoms only.

    It is the same as seen on numerous other prescriptions.

    >Yes, relief of symptoms is important. But it does
    > not address the underlying condition - to do so
    >would require a more precise dosing and blend of ingredients.

    Do me a favor. Check the PDR and tell me how many of those drugs cure something, as opposed to those that only relieve symptoms.

    If the patient says it works for them, then the dosing and blend is apparently good enough to do the job.

    >You lecture on about definition of "medication" -
    >are you really so naive as to think I don't know that?

    Your own words showed that you apparently understood some other definition. You didn't define it yourself.

    >You spout anecdotes about how persons get relief from
    >smoking weed but not from pills. Did you miss the part
    >where I said that there are 63 individual cannabinoid
    >compounds in cannabis sativa leaf? And that the
    >proportions are important? The "pills" are pure THC,
    >and no, they don't work well. That's one of the reasons
    >why Sativex is taking so long to be approved - it is
    >leaf bred for a particular ratio, then testes, extracted,
    >compounded and packaged as a spray.

    So the pills don't work, but the use of marijuana in their place to achieve the same result would not be "medical"?

    >Again, did you think you were trying to pull one over
    >on me? Did you read my blog about students who ask The Impossible Question to make themselves look good at the expense of the teacher?

    >You state that if pot were legalized there would be
    >more consistency in the product for medicinal purposes.
    >I'm afraid I have to call b#llsh!t on that point. Look
    >at any convenience store that sells cigarettes, any
    >store that sells beer, wine or liquor. Where is the standardization?

    You mean, as opposed to the standardization of alcohol during alcohol prohibition?

    >No, I stand by my original statement. Smoking pot for
    >the sake of a medical treatment without bother to control
    >dose or constituents - and particularly without divorcing
    >the psychoactive effects from the drug - is smoking pot.

    If you think there is no regard for dose or constituents then you obviously are not familiar with the habits of medical marijuana users.

    As for divorcing the psychoactive effects then that would mean that morphine is not "medical" either because the psychoactive effects have not been "divorced." Let me gently suggest that your argument has a fundamental problem. Defining "medical" that way poses some obvious problems. (That's why I thought you had not read the legal definition.)

    >As for your "agenda" - keep it off of my blog.

    This is the Internet, friend. If you don't want people to comment on your statements, then don't put them on the Internet. If you decide to put it on the net, then have the balls to face up to honest critiques.

    You see, one of the problems is that other people are quoting you as gospel. They didn't stop to think that you aren't using the legal definition of "medical" but just kinda making it up as you go along to suit you.

    but if you aren't man enough to take honest criticism, then so be it. You wouldn't be the first.

  13. And just FYI, the California courts have already ruled on this issue. According to them, the decision of what is "medical" is solely the province of the patient's doctor. If the doctor decides, then that is the end of the story. Nobody else's opinion -- including the police, the prosecutor, or yours -- is worth even two cents in the argument.

    So whatever definition of "medical" you may be using -- including one that you made up yourself based on your own arbitrary standards -- isn't worth a hill of beans. Your opinion has no standing anywhere and makes no difference at all -- even if your arbitrary standards happened to be right.

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