Western medicine has relied upon plants as the basis formuch of its work, taking extracts and making synthetic versions of what is found in nature, John Morgan, MD, a pharmacologist at the CUNY medical school, explained to those attending the National Organization for the Reform of Marijuana Laws (NORML) annual convention in Washington, D.C., April 20.
The principle active ingredient in marijuana appears to be the cannabinoid known by the chemical shorthand of THC, though many argue that some of the other cannabinoid molecules found in the plant may also play a medicinal role. Marinol is the trade name of the synthetic version of THC approved for sale in the U.S. under strict regulation.
Morgan said, and many who have used it agree, Marinol is a heavy-handed approach. Only one dosing strength is available and it takes a long time to be absorbed and metabolized by the body. Other methods of administration, such as a vaporizer/inhaler, a liquid suspension held under the tongue, or perhaps a skin patch similar to one used to stop smoking, might offer more immediate and better-calibrated delivery of cannabinoids. But government restrictions haveinhibited such research.
He concluded, “The government’s decision to prosecute marijuana smokers [while licensing the sale of Marinol] is akin to encouragingthe taking of synthetic vitamin C by outlawing orange juice.”
California researcher Dale Gieringer is working on ways tomake inhaled marijuana safer by reducing or eliminating the cancer causing byproducts associated with all smoked materials. He said they first tried waterpipes but found that water filtered out the THC as well as the carcinogens. People simply smoked more to get the required effect of THC and there was no net gain in safety.
He held up a “M-1 volatizer,” calling it “basically a high-tech cigarette lighter.” The prototype heats marijuana to a temperature sufficient to turn cannabinoids into a gas but not hot enough to do the same to benzene and other carcinogenic byproducts that come from burning materials.
They have found cannabinoids volatilize, or separate and become airborne, at temperatures of about 180 degrees centigrade. The cancer causing chemicals require the higher temperature associated with combustion (230 degrees centigrade) in order to form and become airborne, so none were present at the lower level. At the end of the experiment, most of the cannabinoids seem to have been drawn from the marijuana, while the sample maintained its form and was still green, Gieringer said.
He showed how many medical marijuana users in California are now jerry-rigging their own volatizer. They use a paint stripper heat gun and a bong, “let it run for a few seconds [to heat the marijuana] and then inhale.”He said a paint gun with a rechargeable battery “is good for 30-50 tokes.”
Oakland physician Tod Mikuriya said that he has smoked marijuana since 1964, but two months ago switched to the paint gun option, “and I can moralistically say, I don’t smoke marijuana.”
Ethan Russo, whose research at the University of Montana focuses on herbs and natural products, said that 80 percent of migraine sufferers get systematic relief from smoking cannabis. He called Marinol “the caviar of prescription medicines” because the pills look like fish eggs and are expensive. “If you are lucky enough to have a doctor that will write you a prescription, go ahead, bankrupt your HMO.”
The Journal of Cannabis Therapeutics debuted at the conference, published by the medical association Cannabis Medicille in cooperation with Haworth Press. It is a fascinating compendium of historic data on medical use of the herb, as well as contemporary research in clinical and molecular biology.
Marijuana and the Supremes
The issue before the U.S. Supreme Court March 28 ostensibly was medical marijuana, but things are seldom so simple with the Court. U.S. v. Oakland Cannabis Buyers’ Cooperative also grappled with underlying principles concerning the roles of the national and state governments in the federated structured of governance, as well as with questions of popular will and the appropriate route for prosecution.
A majority of the Justices pursued lines of questioning that left most observers believing that they were not favorably disposed to pot. Yet most also believe that the Court will end up issuing a narrow ruling, as is their preference, that will not completely resolve all questions surrounding medical marijuana.
In 1996, California voters overwhelmingly passed Proposition 215 that allowed seriously ill patients to use marijuana for medical purposes without fear of legal prosecution under the law. The Oakland Cannabis Buyers’ Cooperative was among those created to provide a safe and affordable supply of marijuana for sick people, and was so recognized by the city government.
Federal prosecutors moved to close all such organizations in the state as being in violation of the Federal Controlled Substances Act (1970), which declares marijuana to be of no medical value and prohibits its use.
The feds decided not to criminally prosecute sick people using marijuana, but rather chose to file civil suits against organizations such as the Cooperative that supplied them the marijuana. The approach seemed to be crafted to avoid a direct legal challenge of Proposition 215 and to avoid putting the matter before a jury, most of whom likely voted for the proposition.
The matter went back and forth between U.S. District Judge Charles Breyer and the 9th U.S. Circuit Court of Appeals. The narrow issue that ended up before the Supreme Court was whether organizations and individuals can raise a medical necessity defense in justifying violation of the federal law. Medical necessity says an individual’s right to save their own life trumps the law.
Cooperative attorney Gerald Uelmen said that lower courts had recognized “a limited exception” to the law under the medical necessity argument.
Justice Anthony Kennedy responded that the scope of the case before them “doesn’t sound limited at all,” while Justice Sandra Day O’Connor said the argument “appeared to create a blanket exception to the Controlled Substances Act.” Justice Antonin Scalia seemed to differentiate between use of a medical necessity defense for an individual and for those prescribing and dispensing marijuana. He called the later “a vast expansion beyond any necessity defense I’ve ever heard.”
Uelmen admitted to Chief Justice William Rehnquist that while lower courts had recognized the medical necessity defense, the Supreme Court had not.
Justice Ruth Bader Ginsburg, who underwent treatment for colon cancer a year ago, pressed questions on the extent of use of marijuana by patients. Kennedy noted there were no patients as plaintiffs in the case before them.
Further clouding the matter was the procedural question raised by Justice David Souter. He suggested that federal officials pursued civil rather than traditional criminal prosecution as a tactic by which they could avoid a jury, where if would be difficult to obtain a conviction in light of the public vote for Proposition 215. He suggested this may be a misuse of prosecutorial authority.
An added wrinkle is that only eight Justices will decide the issues. Justice Stephen Breyer withdrew from the case because of a possible conflict of interest. His younger brother Charles was the district judge who heard the original case.
Most observers anticipate a fairly narrow ruling that will not take on the legitimacy of medical marijuana initiatives passed by voters in nine states. Language on the medical necessity defense likely will be limited to organizations, leaving the question of its use by individuals for another day.