How marijuana promoters bypass the law - and the public good

When I graduated from pharmacy school, I voluntarily pledged to use my knowledge, experience, and skills to the best of my ability to ensure optimal drug therapy outcomes for the patients I serve, and to consider the welfare of humanity with the full realization of the responsibility entrusted by the public.

To me this means that we, as pharmacists, must step up and speak the truth when it comes to claims about “medical” marijuana.

In California in 1996, with the introduction of Proposition 215, the “Compassionate Use Act,” too many of us remained quiet about the claims being made by people attempting to promote marijuana for their own agendas.

The public approved the use of marijuana for seriously ill Californians to obtain and use marijuana for medical purposes, when recommended by a physician who has determined that the person’s health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, glaucoma, arthritis, migraine, or any illness for which marijuana provides relief.

There was no need for any placebo-controlled, randomized, FDA–approved study to be conducted - just the physician’s recommendation.

See also: Should you establish a medical marijuana dispensary?

The decriminalization of marijuana countered the Controlled Substance Act of 1970, which categorized marijuana as a Controlled Substance I, a category encompassing all drugs characterized by the highest abuse and addiction potential, withdrawal symptoms (both physical and psychological), and no accepted medical use. 

Available alternatives

In 1996, the United States already had dronabinol (Marinol), approved by FDA since May of 1985. Dronabinol is a synthetic psychoactive delta-9 tetrahydrocannbinol (THC) product, free of molds, fungi, pesticides and other harmful chemicals. FDA approved doses of 2.5 mg, 5 mg, and 10 mg of THC (dronabinol) to increase appetite, reduce nausea and vomiting associated with chemotherapy for patients who have failed other drugs, and to reduce weight loss due to AIDS wasting. Dronabinol has been around so long, it is available as a generic product.  

Another synthetic cannabinoid, nabilone (Cessamet) was approved by FDA in December of 1985 for the treatment of nausea and vomiting induced by cancer chemotherapy. These agents are also very rarely used. 

See also: Smoked marijuana is not good medicine

Several have attributed miraculous benefits to marijuana. One of the many cannabinols in the plant is a non-psychoactive component known as cannabidiol (CBD) (aka “Charlotte’s Web”). As of September 26, 2015, the U.S. National Institute of Health has approved 15 free studies investigating CBD activity in connection with its use in childhood epilepsy syndromes.

In a recent JAMA article (2015; 313(24): 2456-2473), a systematic review and meta-analysis of the use of cannabinoids for medical purposes, derived from 28 databases, revealed 79 acceptable studies involving 6,462 participants. Potential use of cannabinoids may include benefits seen in chronic pain (smoked THC and nabiximols) and spasticity studies (nabiximols, nabilone, THC/CBD capsules, and dronabinol).

There is evidence of low quality seen in connection with chemotherapy nausea and vomiting (dronabinol, nabiximols), weight gain in HIV infection (dronabinol), sleep disorders (nabilone, nabiximols), and Tourette syndrome (THC capsules).

Adverse effects were common and include balance problems, confusion, dizziness, disorientation, dry mouth, euphoria, drowsiness, fatigue, hallucination, nausea, somnolence, and vomiting.

Clearly better randomized controlled studies are needed to determine which cannabinoids work the best and in which doses.

Newer agents

In 1991, with the release on ondansetron (Zofran), a new class of drugs, the serotonin (5-HT3) receptor antagonists, helped revolutionize the treatment of nausea and vomiting caused by cancer chemotherapy, radiation therapy, surgery, and gastroenteritis. 

In 1995, FDA approved the protease inhibitor antiretrovirals [saquinavir (Invirase) and ritonavir (Norvir)], and the dire treatment of AIDS patients changed forever. 

Subsequently FDA has approved other drug classes, including the attachment and entry inhibitors, and integrase inhibitors.

Duped

The public has been duped by individuals whose main goal is to promote the legalization of marijuana. 

In an interview provided to the Emory Wheel in February 1979, Keith Stoup, legal counsel for the National Organization for the Reform of Marijuana Laws (NORML), was quoted as saying, “We will use [medical marijuana] as a red herring, to give marijuana a good name.” 

In 2009, Allen St Pierre, NORML Director, stated to CNN that “in California, marijuana has been de facto legalized under the guise of medical marijuana.”

The numbers speak

Since 1996, more than 23 states has approved marijuana for “medical” purposes, and four states (Colorado, Washington, Oregon, and Alaska) and Washington, D.C., have allowed its recreational use, with taxation. To date, this social experiment has met with devastating consequences.

The following is what has occurred in Colorado since legalization:

• Increased hospitalizations related to marijuana (11,439 in 2014 compared to 2,539 in 2000).

• Increased homelessness and crime (property and violent crime in Denver up 5% over past 5 years since commercialization).

• 32 butane hash-oil home explosions in 2014 (12 explosions in 2013).

• Suicides and homicides involved with edible products (containing upwards of 420 mg THC in a single product).

• An increase in ingestions by children 0-5 years old (from 27 cases in 2005-2009 to 106 cases in 2010-2014) and ingestions by children 6-14 years old (23 cases in 2005-2009 to 57 cases in 2010-2014). 

• Drivers who test positive for marijuana or self-report using marijuana are more than twice as likely as sober drivers to be involved in motor vehicle crashes. When marijuana is combined with alcohol, the risk increases 8-fold. 

• Colorado automobile fatalities in cases involving a driver using marijuana have risen from 47 cases in 2009 (commercialization) to 94 in 2014, with 77% of those driving under the influence of drugs involving marijuana.

In 2014, the state of Washington reported an increase in fatalities connected with drivers affected by active THC, a rise from 65% (38 of 60 drivers) in 2013 to 85% (75 of 89 drivers) in 2014, the year Washington implemented legal marijuana.

Depending on when you graduated from pharmacy school, you pledged an oath. Whether you will abide by that oath to stay educated about pharmaceuticals and be a voice for appropriate drug use is up to you, but the public is relying on you to hold up your end of your oath.

Phillip Drumis an inpatient pharmacy consultant in northern California. Contact him at phillipdrum@comcast.net.