Medical Marijuana's Catch-22
April 21, 2006
The Editors, Scientific American
Yesterday the Food and Drug Administration issued a statement reaffirming its opposition to the medical use of marijuana, declaring that "no sound scientific studies supported medical use of marijuana for treatment in the United States, and no animal or human data supported the safety or efficacy of marijuana for general medical use. There are alternative FDA-approved medications in existence for treatment of many of the proposed uses of smoked marijuana." This, despite the existence of a 1999 report by the Institute of Medicine of the National Academy of Sciences, which concluded that marijuana was "moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting." As the New York Times notes in its front-page coverage:
Dr. John Benson, co-chairman of the Institute of Medicine committee that examined the research into marijuana's effects, said in an interview that the statement on Thursday and the combined review by other agencies were wrong.
The federal government "loves to ignore our report," said Dr. Benson, a professor of internal medicine at the University of Nebraska Medical Center. "They would rather it never happened."
Some scientists and legislators said the agency's statement about marijuana demonstrated that politics had trumped science.
(Forgive a digression: that last paragraph made me laugh. How many times in recent years have science reporters had to write some version of that sentence? "Some scientists and legislators said the [WHITE HOUSE/FEDERAL AGENCY]'s statement about [SUBJECT] demonstrated that politics had trumped science" ought to be a Word macro.)
I'm not going to pick a fight with the FDA's need to prevent anyone from circumventing its authority to test and regulate the availability of therapies. I'm also not going to argue about whether medical marijuana programs inevitably ease recreational access to pot, and whether that's a bad thing. (Attention, NORML: please spare me the missives about wondrous, wondrous hemp and its infinite uses.)
What is completely wrong about the FDA's position, however, is that in effect it continues to impede not just the medical use of marijuana but also medical research on marijuana, which could lead to superior therapies that don't involve smoking or getting high at all.
Back in December 2004, SciAm published "The Brain's Own Marijuana," by Roger A. Nicoll and Bradley N. Alger (you can read the entire text here). The article's deck tells the tale: "Research into natural chemicals that mimic marijuana's effects in the brain could help to explain--and suggest treatments for--pain, anxiety, eating disorders, phobias and other conditions." The SA Perspectives that month argued with the tight federal restrictions that limited the advance of that research:
Yet outdated regulations and attitudes thwart legitimate research with marijuana. Indeed, American biomedical researchers can more easily acquire and investigate cocaine. Marijuana is classified as a so-called Schedule 1 drug, alongside LSD and heroin. As such, it is defined as being potentially addictive and having no medical use, which under the circumstances becomes a self-fulfilling prophecy.
Any researcher attempting to study marijuana must obtain it through the National Institute on Drug Abuse (NIDA). The U.S. research crop, grown at a single facility, is regarded as less potent--and therefore less medicinally interesting--than the marijuana often easily available on the street. Thus, the legal supply is a poor vehicle for studying the approximately 60 cannabinoids that might have medical applications.
The reasonable course is to make it easier for American researchers to at least examine marijuana for possible medical benefits. Great Britain, no slacker in the war on drugs, takes this approach: the government has authorized a pharmaceutical firm to grow different strains of marijuana for clinical trials.
This call for marijuana research is not a closet campaign for drug legalization--easing research barriers would not require that marijuana be reclassified, nor would it have any bearing on individual states' decisions to approve limited use of medical marijuana. As a 1995 editorial in the Journal of the American Medical Association said, "We are not asking readers for immediate agreement with our affirmation that marijuana is medically useful, but we hope they will do more to encourage open and legal exploration of its potential." After almost a decade of little progress, we reiterate that sentiment.
And now we have to reiterate it again. Medical marijuana is caught in a classic Catch-22 situation: It is banned because the federal government dismisses the evidence of therapeutic benefit as insufficient. But because marijuana is banned, scientists can't easily gather more evidence to make the case. And new drugs based on marijuana are casualties of the same policies. Meanwhile, patients continue to suffer despite strong evidence that work in this area could lead to better medicines.
How does this seem like a good arrangement? Seriously, what are the feds smoking?
Update (4/24): Steve Mirsky reminds me that the second episode (Feb. 15) of Science Talk, the Scientific American podcast, features an interview with Bruce Mirken, director of communications for the Marijuana Policy Project.