Science and politics in medical marijuana

Time for the Administration to back its “science over ideology” slogan with action.

The California “medical marijuana” system is a bad joke. But it’s hard to blame it on the pot activists when the Federal government continues to obstruct real research into the medical utility of cannabis. One of the barriers to approving whole cannabis as a medicine is that it’s generally smoked, and smoking is generally a bad idea. But a study of vaporization as an alternative to smoking – a study not even involving giving the drug to any patients – has been blocked for three years by the inability of the research team to get a few grams of cannabis from the monopoly supplier.

On the one hand, there’s no particular reason not to do the research abroad, where the authorities are less obstructionist; that’s been the strategy of GW Pharma with its Sativex whole-cannabis extract. But on the other, there’s also no reason why it should be impossible to do that work here. And the demand that cannabis be shown to be better than something else, rather than merely safe and effective, before it’s approved strikes me as wrong-headed. People vary in their reactions to drugs, so giving doctors and patients more options is generally better.

This issue tests the commitment of the Obama Administration to science-based policy. I have my fingers crossed.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

16 thoughts on “Science and politics in medical marijuana”

  1. I am thoroughly confused. What is preventing researchers from using the pot available on the locally legal market in California? Certainly I can see that if it's federally funded research, researchers would be required to obtain their material from the University of Mississippi. However, there must be adequate private funding to allow at least some studies of medical benefit using the (far superior) privately grown plants. Is it that the FDA won't accept the research as valid unless it used U of M supplied cannabis? Even if that's so, it seems as if it would be worth it to get well-conducted research into the peer-reviewed literature regardless of the FDA's requirements.

  2. I'm just guessing, Confused, but I assume the reason is that pot is still a *federally* scheduled drug, and so the researchers and their subjects would be committing federal crimes (even if the administration has signaled that it will no longer try to enforce this against CA). That would be a bit of a hurdle for research ethics approval panels, etc.

  3. Funny, the FDA is required to approve Big Pharma's drugs if they are "safe and effective" — even if they're the fifth or sixth "me-too" drug in a class, no showing of superiority to other drugs already on the market needed.

  4. It's worth noting, as well, that even if smoking is generally unsafe, the way to handle that is by giving warnings. If smoking the pot is less safe but also more pleasurable for the person taking the medicine, there's no reason other than pure purtanism not to allow the patient to smoke it if he or she wants to.

    Part of the problem with this whole issue is there seems to be wholesale resistance to the idea that taking your medicine could also be fun. Allowing a patient to smoke therapeutic marijuana shouldn't be seen as any different than packaging a child's medication in a candy form.

  5. JMG, I'm not well informed on these issues, so I ask this sincerely: are you sure that "the fifth or sixth 'me-too' drug in a class" doesn't also need to be shown to be more effective than existing drugs, in order to qualify as "effective"? Because I thought I heard something similar about other drugs, not just pot …

    (Also, the definition of "effective" could be interesting. Is a drug that's exactly as medically functional as another more effective because it's cheaper? If so, is a much cheaper drug that is slightly less medically functional actually more "effective"? There can also be issues of compliance – I know at least one doctor who insists that given two versions of the same medication, one that needs to be taken several times a day and another much more expensive one that need only be taken once per day, the latter is much more effective because the patient is much more likely to use their prescription correctly.)

  6. See Doctor Jerry Avorn's outstanding book, "Powerful Medicines: The benefits, risks, and costs of prescription drugs" for a terrific introduction to the mad, mad, mad, mad, mad world of Big Pharma. And, no, the latecomers need not be superior to prior market entries — only to a placebo, which is the standard that the first-mover needs to meet as well.

    Given the capture of the entire regulatory apparatus by corporations, this is hardly surprising.

  7. the latecomers need not be superior to prior market entries — only to a placebo, which is the standard that the first-mover needs to meet as well.

    I thought this presented an ethical problem: if there are existing medications available, then denying those medications to patients in order to give the ma placebo instead is unethical – and therefore new medications must be compared to existing ones, not to placebos.

  8. It's actually quite sensible to approve me-two drugs that aren't any more effective than existing drugs. We're not an army of clones, after all, the drug that works well for one person isn't necessarily the drug that will work well for another. Being able to predict which in advance is one of the huge benefits we should expect soon from the declining cost of gene sequencing.

    "there’s no reason other than pure purtanism not to allow the patient to smoke it if he or she wants to."

    Alas, "pure puritanism" IS the motive behind our drug laws.

  9. My first thought is that even if Obama has deeper leftward leanings on this than he might admit to, it would still be a waste of political capital. Same w/DADT. But it seems he might shore up some socially progressive-minded independent (don't they slant that way?) dimwits that appear to be leaving him in droves.

  10. If you're Big Pharma, you can find a sub-population or a particular set of conditions (or failing that, just a particular set of studies) for which your drug outperforms the current standard therapy. A couple hundred million dollars buys a lot of research. (And then you can promote off-label uses.)

    Given the number of compounds in marijuana and the range of conditions it might apply to, a couple billion dollars in studies sounds about right. A hundred million or so would be good for a start. Instead, pretty close to nothing.

  11. Eli, that's the Democrats in a nutshell. They're always so afraid to waste political capital that they never actually use any of it. And since the ABC Washington Post Poll released Monday showed 81% support for medical marijuana nationally, it's getting really hard to figure how Democrats lose political capital by supporting it.

  12. On the other hand, Democrats can surely continue to alienate this particular dimwitted socially minded registered Democrats such as myself by continuing to view marijuana reform as some kind of political "third rail".

    Take some obscure state officeholder named Martha Coakley as an example, Exhibit "A". Last year, Martha took it upon herself as AG to fight a marijuana decriminalization referendum in Massachusetts. She first formed an illegal campaign committee against the proposition which didn't file the required reports. Then, when the measure passed in a landslide (2,000,000 out of the 3,000,000 votes, or 65%), Martha tried to obstruct the measure by gratuitously offering a draft local municipal ordinance that would reinstate the arrest penalties for small amounts eliminated by the successful citizen referendum.

    Of course, in the billions of words and gallons of ink spilled yesterday about the Democrats' travails, no mention of the mainstream media or blogosphere about Martha and marijuana. Although most people are not well informed about political minutiae, I'm sure that at least SOME of the 2,000,000 people that voted for this noticed some arrogant obstructionist pol trying to defeat it, unsuccessfully. And by "noticed", I mean, not in a good way that would lead to that candidate's future success at the polls.

  13. Democrats are stuck so far up Republican asses (sounds completely absurd but 100% true) that I really doubt you are going to see party-wide movement on this issue, until national legalization is an absolute foregone conclusion.

    If there is a mistake to be made, you can be assured that the Democrats will make it. They represent no one but their own power hungry, greedy asses! If they don't make money from illegality, they are scared sh*tless about what a legalized marijuana market would look like. They are still deathly afraid of a black male reefer addict robbing them at gunpoint!

    Democrats are just as blame hungry as Republicans, but with a lot more overt elitism thrown in.

  14. Both major parties have repeatedly supported the drug war; both NIDA and the DEA are fully committed to its absurd (and never studied) precepts. The press has tacitly supported a lunatic policy for reasons of their own. In any event, the idea that herbal cannabinoids can't be medicine is absurd on its face, but remains a critical element of both federal policy and rhetoric. The best hope for sanity in the future is that the first baby boomers will start reaching Medicare age in 2011, which should produce a big jump in demand MMJ from people of retirement age because many are illegally self-medicating with it right now.

    The only body that can "legalize" pot is Congress; they will have to ingest an enormous helping of crow before that can happen.

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