The clinical use of cannabis would be much farther along was is not for federal authorities blindly restricting research and prohibiting use. Federal bureaucratic intransigence is responsible for desperate patients and their families supporting state ballot initiatives and legislation across the country in defiance of the federal cannabis prohibition.
A debate was held about the Florida medical marihuana ballot initiative at the University of Tampa on February 25. The only physician debater was Eric Voss MD. He is a University of Kansas trained internist from Topeka, who lists his specialty as pain medicine. He has a long resume indicating he is a medical marijuana opponent.
Dr. Voss believes:
“The reality of it is that smoked pot is not medicine. There is no other medicine that is smoked out there. And one thing that the marijuana lobby has done is to blur in your mind is the issue of cannabinoids for medical uses and cannabis which is marijuana. Keep in mind we are talking about cannabinoids, which can be identified…which can be synthesized…that can be used as medicine, versus smoked pot.”
This stems from the propositions that:
- Isolated cannabinoids will provide more reliable effects than crude plant mixtures
- Oral administration is better that inhalation.
- Burning cannabis to volatilize the active components for inhalation produces toxicity
The first of these propositions are unproven. The fact is the FDA has approved many combination drugs because they are superior or more convenient. Sativex®, an oral spray which is an extract of the cannabis sativa plant, contains THC, CBD as well as other cannabinoids. It also contains other naturally occurring cannabis-derived terpenoids. They act synergistically, with the principal cannabinoids. Sativex® is approved in many countries. Natural mixtures of cannabinoids have been proven to have reliable pharmacological effects not reproduced by single agent such as dronabinol (THC). For example research shows CBD may mitigate some of the side-effects of THC. Quality control issues such as contaminated products or non-standardized doses can be remedied by standards and purity testing.
Inhalation is a route of administration that is approved for many drugs. It has advantages. For example when vomiting prevents oral administration it can provide rapid relief of symptoms. Unlike oral administration, inhalations of volatilized natural mixtures of cannabinoids have a rapid onset of action and may allow titration to the desired drug effect–whether it is pain, spasm or nausea relief. This is true whether or not the exact concentrations of the cannabinoids in the natural mixture are known. The correct dosage for an individual is based on symptom relief.
Burning cannabis produces multiple toxins similar to cigarette smoke. Generally the medical marijuana user will smoke less than a cigarette smoker. The increasing potency of cannabis today (decried by the prohibitionists as making cannabis more toxic) would be expected to result in less toxicity. Less smoking of more potent cannabis would produce the same therapeutic effect but less combustion by-products. Super potent cannabis wax would require still less burning. Better yet are vaporizers. Cannabinoids will vaporize at temperatures much lower than that required for combustion of plant matter. When heated air is drawn through the cannabis, the active components will aerosolize without the generation of smoke and toxins from combustion.
The smoking route of administration has advantages and disadvantages but does not disqualify cannabis as a medicine. Vaporizers provide a safer alternative to smoking. Medicinal plants have a long tradition in medicine. In the case of cannabis it may be superior to any single synthesized cannabiniod pharmaceutical. Numerous drugs fully approved by the FDA have caused deaths and injuries and many have been taken off the market within months. Medical cannabis has good safety record with centuries of use. An additional advantage of cannabis is that it has the capability of being produced locally and made available at low cost.