Cannabis, the Gateway Herb: A Doctor Responds
Dr. Sack’s anti-marijuana platform is built on the foundation of addiction psychiatry, practiced through the lens of pharmaceutical medicine, resting primarily on a characterization of the FDA approval process as a gold standard of medical evaluation. This same contention, that without FDA approval marijuana cannot have medical value, has been repeated as medical cannabis laws are decided by voters. However, the FDA process is not an infallible one, and it is important to point out about half of FDA approved drugs have been subject to recall or black box warnings. There is no need to belabor this point, but just bear in mind: Accutane, Serzone, Clozapine Pradaxa, Reglan, Yasmin, Chantix, Celebrex and Rosiglitozone, to name a few. The FDA process is not perfect, and the "gold standard" randomized controlled clinical trial is not a one-size-fits-all process: it was particularly designed for single molecule synthetic compounds. As a clinical study tool, it has its limitations, especially where integrative medicine and herbal supplements are concerned.
As Dr. Sack and other cannabis opponents point out, it is truly unfortunate that there is a dearth of clinical trials assessing the efficacy of a variety of cannabis products for a wide array of diagnoses. We can thank our Federal government for this, because research is strictly limited. However, what little research has been conducted demonstrates an utter lack of detrimental health impacts, including no mechanism for an “overdose” bodily response, which can be triggered by virtually all other drugs. In the last decade or so, the American Medical Association, the National Nurses Association, the National College of Physicians, and even the federally-run National Health Institute have all recommended that cannabis be removed from Schedule I and become available as part of treatment regimes.
Despite Dr. Sack’s firmly-worded assertions, we have much to learn about what predisposes individuals to addictive behavior. In the mean time, there is a massive uncontrolled clinical trial being conducted by millions of Americans who are using Cannabis to treat quite a wide range of symptoms and diagnoses. With an explosiong of marijuana use both recreational and medical since the Controlled Substances Act was passed in 1969, mental illness and other supposed ills of marijuana use have not materialized in the general population.
Regardless of what status cannabis has with the FDA, it behooves us as physicians to be interested in and informed about what our patients are using as medicine. As for meeting FDA criteria, a recent study proposed by the Multidisciplinary Association for Psychedelic Studies on smoked and/or vaporized marijuana for symptoms of PTSD in veterans of war, was approved by the FDA in April of 2001, but hindered by the National Institute on Drugs of Abuse. The National Cancer Institute has published a comprehensive Physician Data Query (PDQ) and The Institute of Medicine both have publications where the science base of Cannabis has been assessed. And unlike drugs that go through the FDA approval process, cannabis had been part of the American pharmacopoeia long before the Pure Food and Drug Act was passed. Federal hindering of new scientific studies of marijuana does not erase millenia of human cultural experience with the medical value of this plant.
Though some physicians are uncomfortable with this fact, we are in an era of a revival of natural approaches to health. The National Center for Complementary and Alternative Medicine in 2008 estimated that 40% of adults in the US are using some form of complementary alternative care, spending 33.9 billion out-of-pocket dollars. Many of the tools and herbs they access have been practiced and used literally for centuries (ten centuries for cannabis), and what Dr. Sacks characterizes as "anecdotal" evidence is the safety data.
There are some in the medical community who question the reliability of the current FDA approval system (especially where complex plant mixtures are concerned), work with their patients toward optimal whole health, and are not threatened by new paradigms of healthcare. The ultimate yardstick under federal law is whether or not a substance has "accepted medical use in the United States." ASA will be challenging the DEA's assertion that marijuana has not medical value in court on October 16th, and we've created a sign-on letter for prescribing medical professionals to express their agreement. Cannabis seems to be opening the door to what some may consider a "Pandora's Box", and other simply see as Robert Frost saw, the gate to a road "less traveled by".
Michelle Sexton, N.D., is an Assistant Research Scientist at Bastyr University Research Institute, and a member of the ASA Foundation Board.
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