"Some dismiss medical marijuana as a hoax that exploits our natural compassion for the sick.," notes a new report from the Institute of Medicine that details the therapeutic potential of cannabis. The IOM's experts discreetly refrain from adding that it's an opinion shared by the man who commissioned the report.
"There is not a shred of scientific evidence that shows that smoked marijuana is useful or needed," Barry McCaffrey, director of the Office of National Drug Control Policy, told the San Francisco Chronicle in August 1996. "This is not medicine. This is a cruel hoax."
McCaffrey was campaigning against ballot initiatives aimed at allowing patients to use marijuana without fear of prosecution. After voters in California and Arizona approved these measures, he and other federal officials threatened to punish physicians who recommended marijuana to their patients.
At a December 1996 press conference, McCaffrey was asked whether there was "any evidence…that marijuana is useful in a medical situation." His reply was unequivocal: "No, none at all."
A week later, however, McCaffrey asked the IOM, a branch of the National Academy of Sciences, to review the evidence of marijuana's medical utility–evidence he had repeatedly claimed did not exist. The result was this month's report, which confirms that McCaffrey is guilty either of appalling ignorance or of bald-faced mendacity.
"The accumulated data indicate a potential therapeutic value for cannabinoid drugs [marijuana's active ingredients], particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation," says the report (available at www.nap.edu). "Cannabinoids would be moderately well suited for certain conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting."
The authors add that marijuana's tendency to reduce anxiety would probably be welcomed by many seriously ill patients. They also note evidence that marijuana helps control the muscle spasms associated with multiple sclerosis.
Looking at the drug's risks, the report says "few marijuana users develop dependence," while any withdrawal syndrome is "mild and short-lived." The authors find "there is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other drugs"–a theory favored by prohibitionists such as McCaffrey. As for the idea that "sanctioning the medical use of marijuana might increase its use in the general population"–another of McCaffrey's favorite bugaboos–"there are no convincing data to support this concern."
The report finds that "the adverse effects of marijuana use are within the range of effects tolerated for other medications," with one exception: Smoking it introduces toxins that may lead to respiratory illness over the long term. For this reason, the authors conclude that the future of medical marijuana lies not in smoking the whole plant but in absorbing its active components through inhalers or other clean delivery systems.
The report concedes that developing and marketing such products will take years, and it acknowledges that some patients get better relief from marijuana than they do from the currently available alternatives. It recommends that such patients be permitted to use marijuana under strict rules and close supervision while research continues.
Harvard psychiatrist Lester Grinspoon, co-author of Marihuana, Forbidden Medicine and one of 13 experts who reviewed the IOM report before publication, said it should have discussed marijuana vaporizers, which release cannabinoids from the plant without burning it. He said these devices, which address the IOM's main concern about marijuana's side effects, are already available.
Given the needless suffering of patients who could get relief with marijuana, the attempt to make the drug more acceptable to the medical establishment is understandable. But leaving aside the cultural baggage this particular drug carries, most doctors view the medicinal use of raw plant matter as hopelessly primitive in an age of purified pharmaceuticals.
Furthermore, as Grinspoon has observed, a prescription system for marijuana would have to filter out the people seeking simply to get high, and "the doctors are not going to want to be gatekeepers." Indeed, Grinspoon has argued that full legalization is the only way to make marijuana available to every patient who could benefit from it.
It is this prospect, of course, that scares the drug warriors who decry medical marijuana as a "hoax." But if, as the IOM report indicates, marijuana's benefits are genuine and its hazards have been greatly exaggerated, the real hoax is the one that men like Barry McCaffrey have perpetrated on the American public for more than half a century.