The Institute of Medicine is an authoritative voice in the nation’s medical community.
In 1997, the non-profit institute launched a review that resulted in the book “Marijuana and medicine: Assessing the science base,” which explores the effects of cannabis as well as testimony from supporters and opponents.
The institute’s review followed California’s passage of a medical marijuana law the previous year. Washington state voters approved their own law in 1998, alongside Arizona, Alaska, Nevada and Oregon (Arizona’s law was soon nullified because it called for “prescriptions”).
Amid its conclusions, the book acknowledges the therapeutic aspects of cannabis for pain, appetite and sleep. The book also frequently cites a need for further research.
“Ultimately, the complex moral and social judgments that underlie drug control must be made by the American people and their elected officials,” according to the book’s introduction.
Likewise, pharmaceutical companies are limited in their cannabis research and development of cannabis-based medications due to federal restrictions.
Federal law classifies cannabis as a Schedule I substance, considered to have no accepted medical use in treatment, no accepted standard of safety for use under medical supervision, and a high potential for abuse. Other Schedule I drugs include heroin and LSD.
Like 12 other states in the nation, Washington state’s medical marijuana laws conflict with the federal government.
As such, doctors are prohibited from writing prescriptions for marijuana. Instead, doctors may only authorize the drug with a written recommendation.
The reclassification of cannabis to a Schedule II or Schedule III substance would immediately open doors for medical research.
“That legal classification has basically produced all these state medical marijuana laws,” said Sunil Aggarwal, a medical student at the University of Washington. “I don’t need a clinical anecdote to convince me of cannabis’s medical utility.”
Aggarwal finished his Ph.D. last year, studying the medical geography of cannabinoid botanicals in Washington state. “Cannabinoid botanicals,” another way of saying medical marijuana, refers to the chemical compounds of cannabis.
“Pharmaceutical companies could benefit from doing more work in the field of cannabinoid research,” he said. “There are a lot of medicines that could come out of this.”
Turning tides on federal and state levels
There is no way to officially track the number of medical marijuana patients in Washington state. Estimates hover around 25,000 when compared to states such as Oregon, which requires registration of patients.
In 2007, Washington state established guidelines on a 60-day supply for patients: 24 dry ounces and 15 plants at a time. This amount has become another point of contention. Aggarwal and some medical professionals determined that 71 dry ounces was a more appropriate amount for 60 days.
This conclusion was based on accounting for delivery differences of the psychoactive chemical THC in consumption (smoking vs. ingestion). It also took into account the average amount supplied to patients in a three-decade old federal marijuana clinical research study, Aggarwal said.
California is generally regarded as the leader, for better or worse, in shaping state laws and attitudes on medical marijuana. California boasts hundreds of dispensaries along with more qualifying conditions for patients seeking a doctor’s recommendation.
Marijuana’s medical legitimacy is undermined in California mainly due to low-standard physicians, said Aggarwal, noting the state’s market potential for cannabis.
Cannabis dispensaries in the Golden State have storefronts sporting neon signs and advertisements in newspapers. They’re also big businesses that could bolster government coffers. Gov. Arnold Schwarzenegger, a Republican, has suggested his state explore options regarding tax revenue from marijuana.
Elsewhere, Rhode Island just joined New Mexico to feature state-licensed dispensaries for patients (California’s dispensaries are not regulated by law).
On the federal level, President Barack Obama has promised to end federal raids on medical marijuana patients, and Attorney General Eric Holder vowed not to prosecute them.
Earlier this month, U.S. Rep. Barney Frank (D-MA) introduced a bill that would strengthen legal protections for state-authorized patients as well as reclassify marijuana to Schedule II.
“It will definitely open up a larger discussion on whether non-medical use is accepted in our society,” Aggarwal said of the escalating debate over cannabis. “There will always be a need for a medical market, a medical channel.”
Academic cannabis
Topics in the dissertation include:
• The emerging field of cannabinoid medicine as well as the increase in related medical and scientific literature.
• Survey results from medical marijuana patients in Washington state.
• “In its 4,000-plus years of documented use, there is no report of death from overdose with cannabis. In contrast, as little as 2 grams of dried opium poppy sap can be a lethal dose in humans as a result of severe respiratory depression.”
• The study of 139 medical marijuana patients accessing cannabis treatment for chronic pain at a clinic in rural Washington state. The patients were severely ill or injured. “Due to the non-reimbursable cost and general unavailability of delivery systems, medical-grade cannabis is frequently difficult for patients with documented medical needs to obtain.”
• “Seven randomized, placebo-controlled or dronabinol (Marinol)-controlled clinical trials of cannabis published in 2005-2008 and conducted in patient populations in the United States, which investigated indications such as HIV- and other forms of painful neuropathy, spasticity in multiple sclerosis, and appetite stimulation in HIV patients, have consistently shown statistically significant improvements in pain relief, spasticity, and appetite in the cannabis-using groups compared to controls.”
• A breakdown of delivery costs involved in a four-month cycle of medical marijuana for one clinic in Washington state. Costs included labor, growing equipment, facility rental and transportation. “An important point that I was trying to make about the medical value of the cannabis plant: That access to a single sample of cannabis germplasm (plant genetic resource) allows for the growth of four monoclonal, large cannabis plants whose yield was able to serve the needs of 71 patients,” Aggarwal said about this study.
• “Political ecology” and its effects on interpretations of medical marijuana, from the political to the social. The dissertation also weighs the dilemmas involved in policies and definitions of drug abuse and controlled substances.
• “Only 19 researchers in the U.S. have the necessary licenses to conduct research with cannabis supplied by federal agencies.”
Coming up: Part 4 of the series
• Stay tuned for part 4 of The Mirror’s series on medical marijuana in Washington state. Part 4 is slated to run Saturday, June 27.
