by Dr. Maurice Cary
I do have to say that I am somewhat confused by the recent excitement over the legalization of medical marijuana. I sincerely hope that many of the propounded benefits of Ms. Mary-Jane are proven. However, I do have to ask how marijuana can be “prescribed” when the FDA has not approved this for any indication (Sativex® is only registered outside of the US for the treatment of spasticity associated with Multiple Sclerosis). Due to the US system, it would appear that State Laws are on a collision course with Federal Policy. Physicians cannot prescribe marijuana, only recommend it for certain conditions. Separate, special licenses/marijuana cards and special dispensaries are required for procurement and neither the average Primary Care Physician nor the local Pharmacists are aware of how to (or, in several cases, willing to) assist patients via the newly introduced legislation. The eligible conditions vary tremendously from State to State with only severe, disabling or terminal illnesses being universally acceptable.
Currently, very few (primarily academic) controlled clinical studies are ongoing and “Big Pharma” has been excluded from assisting in this area of research, with one notable exception. In the US, the only current controlled studies are either being conducted under the NIH or via an agreement with GW Pharmaceuticals.
The DEA actually control the growth of any potential marijuana plants (a Class I controlled substance) which could theoretically be used in research and have been known to refuse to supply materials for investigational purposes (even when an IND has been approved). Amidst concern of the slippery slope argument regarding drug use (it goes without saying that all smokers of marijuana will undoubtedly become crack-whores!), a lot has been written about the isolation of the “active” cannabidiol (CBD) from the euphoria-enhancing tetra-hydrocannabinol (THC). However, it is questionable as to whether the psychological effects do not contribute significantly to any overall efficacy. (I suppose that this is a bit analogous to cough syrups only being effective because they taste terrible!) If alcoholism can be considered to be a disease because of abnormal mental functioning then neuro-stimulatory effects of marijuana are also likely to be a beneficial component for other conditions.
Amidst all of this, it has to be remembered that the first US President was a hemp-farmer and that the FDA actually own a patent on the methods of using certain CBDs for the purpose of treating a disease caused by oxidative stress or neurological disease. This patent will not expire until 2021 and is essentially why marijuana is not approved to treat neurological and oxidative diseases. The government knows that CBD can help in these chronic conditions – that’s why it patented cannabidiol in the first place – but is allowing these patients to suffer unnecessarily. Unfortunately, the US does not have a similar instrument such as the Traditional (Herbal) Medicines Directive in Europe, which could potentially help this situation. I am left, therefore, feeling that the wishes of the people who voted for legalizing medical marijuana are impotent against the over-riding conflicts imposed by Federal and governmental agencies.
And, just around the corner, we now have the potential that ecstasy may be a treatment for PTSD; maybe we can extend this to work-related stress. Happy times ahead dear friends – a Merry Christmas to all!