Pot Prohibitionists for Medical Marijuana
Obstacles to research are crumbling, with support from drug warriors.
Two reviews published in The Journal of the American Medical Association last week conclude there is substantial evidence that marijuana relieves the pain, nausea, and spasticity associated with certain illnesses. But the researchers found little evidence to support marijuana's use in treating most of the other conditions it is said to alleviate.
In an editorial accompanying the review articles, Yale psychiatrists Deepak Cyril D'Souza and Mohini Ranganathan express dismay at the proliferation of conditions that cannabis supposedly can be used to treat, which include glaucoma, anxiety, depression, sleep disorders, Tourette syndrome, epilepsy, hepatitis C, lupus, fibromyalgia, Crohn's disease, Alzheimer's disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, and post-traumatic stress disorder. "It has been argued that the lack of high-quality evidence reflects the difficulty in conducting marijuana research in the United States," D'Souza and Ranganathan write. "If so, the federal and state governments should support and encourage such research so that high-quality evidence can be generated to guide decisions about medical marijuana use for the conditions for which the existing evidence is either insufficient or of poor quality."
For decades approval of such research, let alone support and encouragement, has been hard to obtain. Federal officials argued that there was not enough evidence of marijuana's medical benefits to justify removing it from Schedule I, the most restrictive category of the Controlled Substances Act. At the same time, they made it difficult to do the research necessary to provide such evidence by erecting gratuitous bureaucratic obstacles. But those obstacles are beginning to crumble, reflecting a bipartisan consensus that the process for investigating cannabis-based medicine should be streamlined. These days even pot prohibitionists support medical marijuana research.
Last week Sens. Charles Grassley (R-Iowa) and Dianne Feinstein (D-Calif.), two of the most ardent drug warriors in Congress, convened a hearing of the Senate Caucus on International Narcotics Control to consider "barriers to research" on cannabidiol (CBD), a nonpsychoactive component of marijuana that shows promise in treating drug-resistant epilepsy. CBD has attracted champions across the ideological spectrum thanks to compelling stories about children with intractable epilepsy whose seizures were controlled by high-CBD, low-THC cannabis oil. Those stories explain conservative support for bills that have legalized the use of such extracts to treat epilepsy in a dozen states that otherwise do not recognize marijuana as a medicine, although the laws generally do not provide for a legal supply of CBD oil.
At last week's hearing, Tom Minahan, an emergency room physician and self-identified conservative from California, testified that his 12-year-old daughter, Mallory, who had her first seizure at 14 months, was eventually suffering 30 to 40 a month and as many as a dozen a night. "No prescribed medications kept her seizures under control and allowed her to have any quality of life," Minahan said. "Some medications had such toxic side effects that my wife and I often wondered if it was better for her to just try and live with constant seizures."
Then Minahan and his wife heard about the potential benefits of high-CBD cannabis oil for children like Mallory. "Reluctantly, cautiously, and knowing that we really didn't have too many options left, we started my daughter on it," he said. "She took the oil every eight hours. To our surprise, almost immediately my daughter demonstrated amazing results." The frequency of Mallory's seizures has been reduced by 90 percent. "She's more alert than ever before, and she's back in school for the first time in three years," Minahan reported. "We truly feel that thanks to cannabis oil, we have our daughter back."
Such accounts clearly have had an impact on Grassley and Feinstein. "Thousands of children throughout our country suffer from rare, extreme types of intractable epilepsy," Grassley noted in his opening statement. "Encouraging responsible research on CBD is a goal I think we all share."
Feinstein agreed. "I have not been a supporter of recreational marijuana use," she said, "but I do believe that we have a responsibility to determine if cannabidiol and other marijuana-derived medicines could have a positive long-term medical benefit, and we should also explore the ways to allow compassionate access while simultaneously pursuing a medically sound path forward. I've heard remarkable stories from parents in California and across the country…that cannabidiol has reduced seizures in children with intractable epilepsy and helped improve their quality of life."
Last October, Grassley and Feinstein sent letters to the Justice Department, which includes the Drug Enforcement Administration (DEA), and the Department of Health and Human Services, asking them to consider revising regulations that "may have the unintended consequence of inhibiting additional research on potential medical uses for marijuana." This week, as Grassley noted at the hearing, the Obama took a siginificant step in that direction by eliminating a requirement that medical marijuana studies undergo an additional layer of review by the U.S. Public Health Service. That requirement, instituted in 1999, applied to no other Schedule I drug.
"The Obama administration has actively supported scientific research on whether marijuana or its components can be safe and effective medicine," a spokesman for the Office of National Drug Control Policy told The Huffington Post. "Eliminating the Public Health Service review should help facilitate additional research to advance our understanding of both the adverse effects and potential therapeutic uses for marijuana or its components."
Another sign that the administration is serious about making medical marijuana research easier to do: The National Institute on Drug Abuse (NIDA), the only legal source of marijuana for research, recently expanded its menu of offerings to include high-CBD strains for the first time. "The change is part of the reduction in resistance to medical marijuana research due to the increasing number of medical marijuana and marijuana legalization states," says Rick Doblin, executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), which is sponsoring a study of marijuana as a treatment for posttraumatic stress disorder.
Researchers still would prefer the option of obtaining marijuana from other sources, which is permitted for other Schedule I drugs. They argue that eliminating NIDA's monopoly on marijuana, which is produced by a single contractor at the University of Mississippi, would improve variety and quality while making it possible to pursue approval of cannabis by prescription. Doblin notes that the Food and Drug Administration (FDA) requires that Phase 3 studies of a proposed medicine use exactly the same product that the sponsor plans to market, which is not feasible as long as NIDA has a lock on the supply. In 2009 the DEA rejected a MAPS-backed request to let University of Massachusetts at Amherst horticulturist Lyle Craker produce marijuana for research, despite an administrative law judge's recommendation that the petition be granted. But yesterday NIDA Director Nora Volkow said she thought it made sense for her agency to contract with additional cannabis producers.
"It's amazing," Doblin says. "Nora Volkow supports the end of the NIDA monopoly! The NIDA monopoly is the remaining barrier to research. We plan to work with Lyle Craker to submit a new application to the DEA for a license to grow marijuana exclusively for federally regulated research. We anticipate submitting the new application within a month. The end of the [Public Health Service] protocol review seems like a trial balloon for ending the NIDA monopoly, which today's hearing suggests the Obama Administration is ready to end."
Judging from what Joseph Rannazzisi, the DEA's deputy assistant administrator, said at the hearing, the agency (now under new management) may be more open to Craker's petition than it was in 2009. "The DEA supports research involving CBD and its potential capacity to treat multiple conditions," Rannazzisi said. "DEA understands the importance of supporting the efficient scientific assessment of marijuana and its constituents such as CBD in connection with new drug development. DOJ and DEA are fully committed to supporting lawful research involving marijuana and CBD."
Kevin Sabet, co-founder of the anti-pot group Project SAM, also voices support for facilitating medical marijuana research. Testifying last week, he recommended ending NIDA's marijuana monopoly, reducing or eliminating the DEA's registration requirements for researchers who handle CBD, and establishing research programs through which patients can obtain CBD before it is approved by the FDA. "It is important to separate the discussion of the recreational use of marijuana and the potential medical benefits of its components," Sabet said.
The desire for such a separation, along with the plight of children suffering from drug-resistant epilepsy, helps explain the sudden support for medical marijuana from prohibitionists like former drug czar Bill Bennett. In his recent book Going to Pot, Bennett recommends tightly controlled, federally regulated access to medical marijuana as an alternative to looser state programs. While prohibitionists portrayed state-regulated medical marijuana as a stalking horse for broader legalization, they see federally regulated medical marijuana as a defense against it.
This article originally appeared at Forbes.com.
