Today’s Boston Globe has an op-ed [*] by Lester Grinspoon, a fervent advocate of the medical use of cannabis. He reports enthusiastically that professional opinion is swinging his way:
IN A RECENT poll conducted by Medscape, a website directed at health care providers, 76 percent of physicians and 89 percent of nurses said they thought marijuana should be available as a medicine. That’s a big change from the attitude in the medical community a decade ago, when few health providers believed (or would acknowledge) that cannabis had any medical utility. [snip] The dramatic change of view is the result of clinical experience
The numbers sound impressive, though you have to wonder how Dr. Grinspoon knows that the change in attitudes he believes he sees came from “clinical experience” rather than from reading the newspapers. Surely it can’t be the case that three-quarters of American physicians have personally recommended what remains, after all, an illegal remedy.
As it turns out, though, the question of what caused medical opinion on this topic to change doesn’t even arise, because Dr. Grinspoon provides no evidence whatever that opinion has, in fact, changed.
It turns out that the “poll” Dr. Grinspoon cites [*] is one of those on-line surveys websites use to build their traffic. The “sample” consists merely of whoever heard about the poll and bothered to answer. So all we really know is that of the 6500 people who found the site and decided to vote, 5500 voted “yes.” About the opinion of physicians or health-care providers overall, the Medscape pseudo-survey tells us exactly nothing.
In any case, clinical opinion, even when it is carefully gathered [*], is no substitute for clinical research.
Advocates of the medical use of cannabis insist that the almost complete absence experimental data on their pet remedy results entirely from the unwillingness of the federal government to allow research to go forward, but that doesn’t explain why there’s also no published research from any of the many countries (The Netherlands, Switzerland, Canada, the UK, Germany, Spain) with active medical-research traditions and governments far less caught up in “Reefer Madness” ideology than ours.
Politically, “medical marijuana” is a great issue for the anti-drug-war forces, one of the very few questions on which the public sympathizes with the legalizers rather than the drug warriors. That helps explain why so much of the effort of the medical marijuana advocates has gone into litigation, legislation, and referenda, and so little into the medical research that quite probably would result in making cannabis a legal medicine again in the space of a few years for an expenditure of a few million dollars.
And in fact Dr. Grinspoon concludes his article by saying that making marijuana available as a medicine is not his preferred outcome: he argues that to take full advantage of its medical benefits, one would have to legalize the drug completely, for “recreational” as well as medical purposes.
My non-specialist view, based on reading the literature, is that inhaling the vapor of crude cannabis is probably useful for a substantial number of patients and highly useful for a smaller number, and that oral administration of pure delta-9 THC, which is currently legal, is on average less useful and carries with it more severe side-effects, in particular anxiety and dysphoric intoxication. My better-informed view as a student of drug policy is that making whole cannabis a legal medicine again would have roughly no impact on the number of people who wind up suffering from cannabis abuse or dependency disorder.
As to non-medical use, cannabis is a much bigger problem than most of my boomer age-mates think it is, with about one in eleven of all those who use it more than experimentally spending some months as heavy daily users. That makes me afraid of the sort of commercialized legalization that would turn cannabis into another drug like alcohol or tobacco, with highly-paid marketing executives doing their level best to create and maintain as many addicts as possible. So my own preference would be for a “grow your own” policy, making cannabis legal to possess or produce, but not to sell. That wouldn’t prevent sale, but it would prevent commercial marketing.
But whether you’re for or against legalizing cannabis as a medicine, and whether you’re for or against legalizing it in some form as a recreational drug, you should be against misrepresentation, which both the drug warriors [*] and the drug law reformers [*]practice with dismaying frequency.
Any claim about what American physicians think based on an on-line “poll” is an insult to the intelligence of the reader, and I for one resent it. Dr. Grinspoon and the editors of the Globe should know better.