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[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 (http://www.ksdk.com/news/article/267091/9/Using-medical-marijuana-to-treat-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.]