The Truth About Prescription Pot

Just this past week, fresh off an event with President Obama, Drug Enforcement Administration Administrator Chuck Rosenberg surprised some by stating some frank words about “medical” marijuana.

“What really bothers me is the notion that marijuana is also medicinal — because it’s not,” he said. “There are pieces of marijuana — extracts, or constituents, or component parts — that have great promise” medicinally.

“But if you talk about smoking the leaf of marijuana, which is what people are talking about when they talk about medicinal marijuana, it has never been shown to be safe or effective as a medicine.”

Of course, the scientific and medical community almost universally agrees with the DEA chief – we don’t smoke any medicine (and dosing burned leaves isn’t easy), and there are scant studies proving anything safe or efficacious about inhaling the smoke of the marijuana plant.

But the American people don’t quite buy it. Almost 75 percent of Americans consistently say they are in favor of medical marijuana. Interestingly, though, most don’t want a pot shop in their community – medical or otherwise.

Why the disconnect then?

The answer can be found in both politics and muddled terminology.

Legalization advocates have long found it in their interest to confuse the issue of marijuana and its individual components, as well as the issue of medicine and legalization.

As the head of National Organization for the Reform of Marijuana Laws put it in 1979, “We will use medical marijuana as a red-herring to give marijuana a good name.” They will showcase poor, sick cancer or other patients to “prove” pot is medicine.

What we’re left with are heartbreaking anecdotes and confusing statements conflating the research done on “marijuana” and the plant’s components.

Thus most Americans, who aren’t up on the latest issue of the Journal of the American Medical Association, simply think if something helps someone, it should be legal.

But they’d probably be surprised if they learned that most studies looking at this issue have found that more than 95 percent of “medical” marijuana users don’t have cancer, HIV, or any other long-term illness. In fact, as one study found, the average user is a 32-year-old white male with a history of drug abuse and some self-diagnosed “back pain” or “insomnia.”

When I went into a “medical marijuana dispensary” once, I was immediately asked by a bikini-clad woman on roller blades if I had “been stressed in the last year” to see if I would qualify for some medicinal THC gummy bears.

A recent song by the comedienne-duet Garfunkel and Oats put it accurately:

Weed card, that’s what I need
Hardly ever. OK. Always.
But it’s not an addiction
‘Cause my doctor gave me a prescription
You can get your card for having headaches, bad dreams or anxiety
Propensity for drugs or alcohol, anorexia or obesity
Too fat, too thin, either way you win!
Carpal tunnel syndrome, color blindness
St-s, stuttering, tooth decay
Fatigue, depression, motion sickness, Impotence or TMJ
It’s a dream come true
There’s nothing pot can’t do

Pop culture aside, what does the science say?

A recent 2014 article in the Journal of the American Medical Association was damning to the “medical” marijuana movement. Authors argued that marijuana differs from other prescription medications because of the varying scientific evidence supporting its efficacy and its inability to meet the requirement for FDA approval. They cited a lack of evidence for the wide range of diseases proponents of marijuana legalization say it cures.

The authors noted that often-positive claims rely on testimonial and not rigorous science, and that for most of these conditions, medications that have been subjected to rigorous approval processes already exist. All of these warnings are coupled with the fact that no other medicine is smoked, since this may induce respiratory problems.

Scientists agree on the need to separate the marijuana plant from its constituent parts, similar to how we deal with opium. We would never ask someone to smoke opium to get the effects of morphine, an ingredient in the opium plant. A 2015 meta-analysis published in the Journal of the American Medical Association recently published an article reviewing the medicinal benefits and adverse effects of using different cannabinoid drugs (Whiting et al., 2015).

Indeed, there are a number of marijuana-based medicines available that do not require smoking or inhaling the raw plant, and the current research on the efficacy of cannabinoids is not focused on crude marijuana, but on the individual components of the plant that may have medical value.

For example, Sativex, an orally administered, 1:1 CBD-THC marijuana extract is currently in use in Canada and across Europe to treat neuropathic pain, spasticity, and other symptoms of multiple sclerosis. Epidiolex is a virtually THC-free, 98-percent pure CBD extract that is used to treat seizures – and early data look promising.

And dronabinol,  also known as Marinol, the only cannabis-based drug approved for distribution in the United States, is a laboratory-synthesized THC capsule approved in 1985 for treatment of nausea and vomiting associated with cancer chemotherapy. By 1992, the FDA also approved Marinol for appetite stimulation for AIDS patients.

Its most common adverse effects include anxiety, confusion, depersonalization, dizziness, euphoria, dysphoria, and somnolence, though clinical trials suggest that lowering its dosage can significantly alleviate these side effects (Joy, et al., 1999). While dronabinol is available in the United States, Sativex and Epidiolex are undergoing advanced-stages of research. None of the three drugs is smoked or inhaled in its raw form.

A JAMA study found that although cannabinoids were associated with certain improved benefits compared with placebos or comparators, few results were statistically significant.

The authors’ of the 2015 JAMA study looked at 79 randomized medical trials and found that although cannabinoids were associated with certain improved benefits compared with placebos or comparators, few results were statistically significant. Specifically, treatment of nausea-vomiting, appetite stimulation, treatment of chronic pain or spasticity, glaucoma, or psychosis all yielded no improvements, or statistically insignificant ones. A use of marijuana for glaucoma would involve smoking every three hours, something not practical, and highly dangerous when the user neglected this regiment.

The meta-analysis finds that cannabidiol, a component of marijuana, is associated with a greater improvement in anxiety as well as sleep disorders than a placebo. However, the researchers judged that many of the trials included in the analysis are at high risk of bias and thus should be interpreted with caution.

Regarding adverse effects of marijuana use in these therapeutic studies, an analysis of 62 trials finds that there is a statistically significant increased risk of short-term adverse effects such as balance problems, confusion, disorientation, euphoria, and hallucination associated with the drug’s use. And, of course, let’s not forget the long-term established problems connecting marijuana and mental illness, which is why the American Psychiatric Association says that treating PTSD with marijuana is a no-no.

Clearly, there is medical promise among medications based on the parts of marijuana. They should be studied and researched further. My organization put out a responsible plan to study marijuana’s components here.

But, if we’re honest, let’s stop pretending that smoking a joint or eating some THC chocolate bars are “medicinal.” It’s not only a dangerous and irresponsible assertion to make — it is plain wrong.

Kevin Sabet served in the Obama administration as senior advisor at the White House Office of National Drug Control Policy from 2009 to 2011 and is president of Smart Approaches to Marijuana. SAM has issued a report providing recommendations on addressing medical marijuana.