Medical Judgment


Polls consistently find that most Americans think patients who can benefit from marijuana should be able to obtain it legally. Yet the House of Representatives, on a vote of 310 to 93, recently approved a resolution saying it is "unequivocally opposed to legalizing marijuana for medicinal use."

Representative Bill McCollum, the Florida Republican who sponsored the resolution, told the Associated Press that "science cannot be based on opinion polls." Apparently, though, it can be based on demagogic declarations by legislators terrified of seeming soft on drugs two months before an election.

The resolution implies that marijuana cannot be a medicine because it is "dangerous and addictive." Yet the Drug Enforcement Administration's chief administrative law judge has described marijuana as "one of the safest therapeutically active substances known to man." Doctors prescribe a host of pharmaceuticals with side effects far more serious than marijuana's.

They also prescribe a wide variety of narcotics, stimulants, and sedatives that people have been known to use for nonmedical reasons. Since the federal government recognizes legitimate uses for powerful psychoactive substances such as morphine, cocaine, and barbiturates, it's hard to see why marijuana should be excluded because of its potential for abuse.

The House resolution does not dispute marijuana's effectiveness at relieving nausea and restoring appetite in patients undergoing cancer chemotherapy or suffering from AIDS wasting syndrome. Marijuana's antiemetic properties have been demonstrated in studies of both the plant and THC, its main active ingredient.

But the resolution insists that "the use of crude marijuana for medicinal purposes is unnecessary" because adequate alternatives are available. Many patients disagree. They say they tried other nausea medications without success before finding relief by smoking marijuana.

Patients often prefer marijuana even to synthetic THC capsules because it's easier to absorb, it takes effect more quickly, the dose can be calibrated more readily, and the psychoactive effects are less disturbing. In a 1990 survey of oncologists, 44 percent said they had recommended marijuana to at least one patient.

Marijuana's relative advantages as an antiemetic nevertheless remain controversial. So does its utility in treating other conditions, such as glaucoma, muscle spasms, and chronic pain.

But instead of calling for more research to help resolve these issues, the House of Representatives has simply declared that "marijuana is not a medicine." Such a position is anything but scientific.

The Clinton administration, by contrast, officially favors gathering more data. After the 1996 elections, drug czar Barry McCaffrey and Secretary of Health and Human Services Donna Shalala condemned voters in Arizona and California for legalizing medical marijuana through ballot initiatives, thereby circumventing the scientific process.

McCaffrey and Shalala say marijuana's legal status should be determined by the government's experts. But since those experts still maintain that it's appropriate to classify marijuana as a Schedule I substance–meaning that it has a high potential for abuse, lacks any accepted medical use, and cannot be safely used even under a doctor's supervision–their commitment to empiricism is open to question.

There are other reasons to doubt that science is the administration's main concern. For U.S. research, the National Institute on Drug Abuse, part of the National Institutes of Health, is the only legal source of marijuana. But NIDA is not eager to share its stash with scientists investigating marijuana's medical utility.

A researcher whose study has passed muster with his institutional review board, the Food and Drug Administration, and the DEA cannot obtain marijuana unless his protocol is also approved by the NIH. In August 1997, recognizing that the additional requirement was discouraging research, an NIH panel of scientists recommended that NIDA supply marijuana to any "bona fide clinical research study" that had received FDA and DEA approval.

More than a year later, NIDA's policy has not changed. Deputy Director Richard Millstein concedes that NIDA has plenty of marijuana but says, "We still have to assure that this is bona fide clinical research."

It's doubtful that bureaucrats are more reliable as arbiters of science than voters or legislators. In any case, the issue of who may use marijuana and under what circumstances will not be resolved on scientific grounds, because it is fundamentally a political question.

The fact that the question has been raised may be encouraging, but the need to raise it is depressing. We long ago surrendered to the government the authority to determine what chemicals we may put into our bodies. Now we're just quibbling over the details.