'Much Confusion' About Medical Marijuana

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Yesterday, in anticipation of the Supreme Court's imminent decision in Ashcroft v. Raich, the medical marijuana case, The New York Times ran a bizarre story that suggests cannabis is more likely to drive a patient insane than relieve his symptoms. "There remains much confusion over whether marijuana in fact has any significant medical effect," declares Times reporter Dan Hurley. The confusion, it turns out, is mostly in his own mind.

It is beyond serious dispute that marijuana relieves nausea and enhances appetite. Hurley seems unaware of the fact that the FDA has approved Marinol, a capsule containing a synthetic version of THC, marijuana's main active ingredient, for treating AIDS wasting syndrome and the side effects of cancer chemotherapy. When it comes to these and similar uses, the medical question is not whether marijuana works but whether its advantages over Marinol–which include easier absorption, faster action, and better patient control over dose–outweigh the potential respiratory hazards of smoking.

Despite THC's well-established use an anti-emetic, Hurley's story focuses on marijuana's effectiveness in controlling seizures associated with epilepsy and multiple sclerosis, where the evidence is much more limited. He conflates research results in this area, which are promising but preliminary, with the overall case for medicinal use of cannabis. In the third paragraph, for example, Hurley quotes Joseph I. Sirven, an associate professor of neurology at the Mayo Clinic College of Medicine, as saying: "People subjectively report benefits….There's a whole Internet literature suggesting what a wonderful thing [marijuana] is. But the reality is, we don't know." It only gradually becomes clear that Sirven is talking specifically about cannabis in the treatment of epilepsy, not about its overall medical utility.

Hurley tries to minimize the evidence concerning marijuana's effectiveness in relieving nausea and pain by saying it involves "subjective measures"–i.e., patients' reports of nausea and pain. How else would you measure these symptoms? If a randomized trial finds that people who get marijuana are more likely to report decreased nausea or pain than people given a placebo, that's evidence of effectiveness, even though we do not have machines that objectively measure nausea and pain.

Perhaps strangest of all, Hurley early on raises the specter of reefer madness, saying in the fourth paragraph that "a growing body of research indicates that, at least in teenagers, heavy marijuana use over a period of years significantly increases the risk of developing psychosis and schizophrenia." He devotes several more paragraphs to this research before conceding, in the 28th paragraph, that the correlation between heavy pot smoking and psychosis in teenagers is not really relevant to the medical use of marijuana by adult patients. So what is this discussion doing in the article?

While devoting substantial space to a putative hazard that turns out to be a red herring, Hurley does not even mention the government-commissioned report on medical marijuana that the National Academy of Sciences issued in 1999. The report was by no means a ringing endorsement of marijuana as a miracle drug. But after carefully weighing the scientific evidence, it concluded that "the accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation." It also noted that, with the exception of the potential respiratory effects of smoking, "the adverse effects of marijuana use are within the range of effects tolerated for other medications."

A careful reporter who was honestly trying to get a handle on marijuana's medical utility would have started with the NAS's thorough assessment and asked experts (including the report's authors) whether and how the evidence has changed in the last five years. For some reason, Hurley went a different way.

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  1. Marijuana is a miracle drug. i recommend it for everyone at least twice a day.

  2. Jacob, can you check and see if Hurley is on the White House payroll a la William Armstrong? A reporter, who should be up on current events or at least, well researched for an article, should have known better unless they were employed to spread propaganda.

  3. JSM wins this week’s Oxymoron Award for using “reporter” and “well researched” in the same sentence.

  4. Imagine the Church Lady of Saturday Nite Live saying this:

    Could Hurley be…
    ????
    SATAN!?

  5. Chuck, you nailed me, my bad!

    So what’s my reward? Hopefully becoming a guinea pig for medical pot research while being a roommate to Hurley!

  6. Yes, and Hurley will be our first test subject for the effects of second-hand pot smoke. And you get a free one-month supply of pizza and Cheetos, delivered to your door!!

  7. I’m curious about this schizophrenia/pot link in light of what’s known about the propensity of schizophrenics to be heavy tobacco smokers. Nobody there supposes that the tobacco causes the schizophrenia. Just the opposite: schizophrenics report that smoking cigarettes helps to mitigate some of the symptoms of the condition. Why wouldn’t we expect that something similar may be true of teens beginning to feel early symptoms of as-yet-undiagnosed schizophrenia?

  8. Julian–

    As far as I know, this bit of information is based on the New Zealand study. The sample size for the group in question (people who smoked pot heavily in their teens AND who had a family history of psychosis) in that study was ridiculously small (less than 10 IIRC), so even if the study were designed to determine a causal link–which it wasn’t–the sample size makes any broader conclusions very premature.

    Nevertheless, it would be prudent to tell all the 12-year-olds you know who come from certified psychotic families not to smoke five joints a day. 🙂 And as Jacob said, what this has to do with medicinal pot smoking by adults is pretty unclear.

  9. Could someone explain how you get better dosage control by smoking, as opposed to taking a pill?

  10. Aaron-
    Simple. In a pill, your dose is the whole pill’s worth; with smoking, you can choose how much to smoke, how deeply you inhale, what potency you wish to smoke, et cetera.

  11. Aaron,

    You consume slower, more steadily, and bit by bit, in response to how you feel. As opposed to a pill, which gives you 100% of some pre-determined dose all at once.

  12. aaron,

    Because smoking reaches your brain right away in samll doses with each puff so you can tell when it has had an effect right away. A pill takes time to break down and then releases the entire pill over time. A very precise dose needed at a particular time is easier to achieve with smoking because of the instant feedback.

  13. Aaron – because the time from inhaling the smoke and feeling the effect is a matter of seconds, so it’s easy to gauge when you’ve had enough, which is necessarily a subjective matter. Ingesting the drug is a much slower delivery method and there is more risk of taking too much because you don’t when a dose has fully kicked in.

  14. Re: The NYT article:
    Fuckity fuck fuck.
    There’s only one way I’m going to make it through the day… Ahhh there’s my bowl

  15. Another ridiculous article. How fucked up as a society are we can’t even have an honest discussion about something like medical marijuana.

    Most mainstream articles tend to advance similar lines about no proof or any medical good and whatnot. They also tend to ignore how little funding/access for any research the government provides. Many researchers have been scared off from even trying to study the effects of it.

    How do you guage if something is effective for nausia or pain?? Oh I dunno maybe see if the patient reports less nausea or pain? Is there some kind of quantitative test that proves how effective Doan’s pills are for back pain? Or how effective Alleve is for minor aches and pains?
    One that doesn’t rely on such flawed subjective measures like the patients reporting how something effected them?
    When it comes to things like that it’s all subjective.

    Hey at least they didn’t talk about how mediacal-Marijuana is just a backdoor way of legalizing it.(even though I wouldnt be against legalizing it, I think its an unfair characterization of the medical marijuana lobby)

    Just another example of how mainstream publications refuse to honestly discuss “taboo” subjects. (Not to mention a lack of discussion of the validity of the state prohibiting what they consider to be “self-destructive” behavior.)

  16. To get a rough idea of the medical potential of psychoactive cannabinoids, refer to this chart by the British GW Pharmaceutical.

  17. Another descriptive resource from the same company is here.

  18. A pill for nausea is likely to be puked back up. Smoking weed trumps marinol for this reason if not others.

  19. Rack up another one for not letting the facts get in the way of a good story.

  20. It’s all no different than the raking over the coals that steroids are getting right now, and that other performance enhancing supplements (creatine, anyone?) will be getting in the near future.

    Perhaps the US gov should just put a big fence around the US, declare the whole place a prison and declare martial law on our asses? That’ll surely protect the children from themselves…

  21. dumbass – like they don’t already have that plan drawn up.

    I just can’t believe that this reporter was even allowed to publish this story. His editor should have shredded it and fired his ass.

    But why should I think that even the editor was educated, informed, or impartial?

  22. Has anybody tried giving Terri Schiavo medical marijuana?

    And how is her first name spelled? I’ve seen Terry, Terri, Teri, and probably other variants.

  23. Aaron, it appears that others have forgot about the “creeper” weed which takes a bit longer to come on, but when it does…look out!

    NoStar, got a good story here, sort of. Had a dear friend from Jamaica, rasta guy, struck with leukymia and laid up in Virgin Mason Hospital in Seattle, dying. He asked the doctor if he could get a joint to smoke why praying to Jah. The doctor told him no chance but could look into getting a Marinol suppository. You could not imagine the look on my friends face when the doctor explained how the suppository worked. When my friend explained this to me, he said in Jamaica, no one would have ever thought of trying to smoke some pot through their ass. Because my friend was denied pot while lying on his death bed, I spent a lot of time and energy being an activist on the medical pot movement.

  24. The doctor told him no chance but could look into getting a Marinol suppository.

    Pot combined with anal stimulation?

    The world is coming to an end!

  25. JSM,
    That maybe just the cure for anal-retentiveness.

  26. Does anybody else find it amusing that a guy named Hurley has trouble recognizing the anti-emetic properties of pot? If I wasn’t laughing, the irony might make me wanna Ralph…

  27. I’m just disoriented from having a Dan Hurley thread right next to a Don Henley thread.

  28. First of all, Marinol isn’t pot in a pill. It’s one type of the many psychoactive cannabinoid compounds that provide marijuana’s “active ingredient.”

    I can tell you from first hand experience. Marinol is roughly as fun and effective as ibuprofen.

    As far as the schizophrenia link. There may be a small addition risk in users predisposed to psychosis. Unfortunately it’s hard to study this sort of thing when people with imbalanced brain chemistries will naturally seek out chemicals to alter them, for better or worse.

    If you’re a little crazy. Psychoactives are going to make you crazier. I think we’ve known this for quite some time now.

  29. See, This is why “liberals” have such a sad rep these days.
    One EXPECTS “conservatives” to have their heads jammed firmly up inside their anal cavities when it comes to drugs. They make up for their slavering idiocy on THAT subject by taking a hard line on killing terrorists.
    “Liberals,” on the other hand, don’t seem to really believe in the existence of “terrorists.” But of course, if indeed such deplorable creatures as terrorists really exist, then the ‘New York Times,’ bastion of liberal cant, evidently believes these ‘terrorists’ will surely respond reasonably to reason, so long as neither they nor their victims smoke any of that DEVIL WEED.
    That’s the part that really sticks in my craw.
    I mean…what?!
    You don’t have any problem excoriating Bush for trying to clean up, by main force, that ancient cesspool of tyranny and zealotry which we charitably refer to as middle-eastern culture, yet you HAVE a problem with some poor old hippie smokin’ a joint?!
    What the hell is wrong with you, “New York Times?” Where is the sense of proportion? The application of logic to ethics?
    Was it missing all along, and I just didn’t notice until now?
    Ugh….

  30. Uh…yeah, the NYT has been a piece of s**t for decades. Does the name Judith Miller ring any bells?

    When you compare NYT reporting with the facts on the ground, the paper is always revealed for what it is- a rah-rah cheerleader for the worst fascistic tendencies of Amerika.

    Get thyself to some alternate news sources.

  31. Ridiculous, that pot causes schizophrenia. I’d love to write a nasty letter to the NYT editor, but first I gotta do what the voices are telling me to do and kill my mother.

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