Last weekend, the Board of Trustees of the California Medical Association (CMA) voted to adopt a white paper calling for marijuana legalization. Though they are still contemplating their decision, the California Society of Addiction Medicine is considering following suit. The CMA reasoned that existing "medical marijuana" laws have thrust physicians in an impossible position -- one they never wanted or asked for. They are forced to be the legal gatekeepers, whose "recommendation" allows an individual to use, cultivate or otherwise obtain marijuana for medical purposes. They correctly point out that doctors need to know the composition of a medication and how much of it is in each dose; otherwise, they cannot ethically advise a patient whether (and how) to use it. Marijuana from dispensaries is usually not standardized or quality-controlled, varies widely in potency, and can contain dangerous pesticides and microorganisms. So doctors are in dangerous and unknown territory.
The CMA has decided that the solution is completely to legalize marijuana for all purposes, both medical and recreational, and then study it. But this is backwards. With no other modern medication have we taken this approach. Can you imagine if we made some new psychoactive substance -- say Spice, K-2, or "bath salts"-- fully legal before researching it? A great deal of harm would be caused before we had the data. This is why products go first through the FDA process -- to collect information on risks and benefits, to ensure batch-to-batch consistency, to identify an effective dose, etc.
Furthermore, the raw marijuana plant material -- itself containing hundreds of unknown components -- has not met FDA's standards of safety and efficacy. But that does not mean marijuana has no medicinal value. Indeed, the FDA has determined that some constituents of marijuana do, and they are available today in pill form. Should we stop there? Of course not. Research is also investigating other safe delivery methods for these types of medications and the Drug Enforcement Administration has granted hundreds of licenses to researchers investigating the possible medical value of components within marijuana.
The National Institutes of Health funds a number of these studies. Research into how components of marijuana may affect our brains and bodies is an exciting area of science. But we don't smoke opium to reap the benefits of morphine, nor do we chew willow bark to receive the effects of aspirin. Similarly, we should not have to smoke marijuana to get potential therapeutic effects from its components. Could the feds speed up the approval process for safe, marijuana-based medications and ensure that our scientific resources are adequately allocated as such? Of course they could, and I hope they will.
Similarly, could our current marijuana laws be updated so that people who use it are not denied social benefits for their whole life and rammed through a criminal justice system that may not always have their best interests in mind? Yes, but that is a far cry from advocating for legalization.
But medical marijuana as it stands today, in California and many other states, has turned into a sad joke. A recent study found that the average "patient" was a 32-year-old white male with a history of drug and alcohol abuse and no history of a life-threatening disease. Further studies have shown that very few of those who sought a recommendation had cancer, HIV/AIDS, glaucoma, or multiple sclerosis. We are also beginning to see a link between medical marijuana and increased drug use in states, according to a few recent, exhaustive studies.
No country in the world has fully legalized marijuana, though many have experimented with reducing or eliminating criminal penalties for mere possession. In the Netherlands, high-potency marijuana has been reclassified as hard drug, and its sale will be prohibited in "coffee houses." So what is the solution to getting the doctors out of their dilemma? Stick to the rules. Real medications must be fully studied, then approved by the FDA, then made available to patients by prescription.
Medical groups -- themselves understandably increasingly impatient with both the current scientific process for medication approval and the political process that puts them in a tough bind -- should focus their angst on speeding up that effort. Legalizing marijuana, however, and risking large increases in use and addiction, represents a hasty solution sure to compromise both the public health and safety.
Dr. Sabet served from 2009-2011 as the senior policy advisor to President Obama's drug czar, Gil Kerlikowske. He can be reached through www.kevinsabet.com.
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