A Haze of Misinformation Clouds Issue of Medical Marijuana

As a physician with more than 20 years of experience dealing with patients who are addicted to drugs, I am often asked my professional opinion about a contentious public health question: What is the medical basis for smoking marijuana? The answer needs some context.

Americans today have the world’s safest, most effective system of medical practice, built on a process of scientific research, testing and oversight that is unequaled.

Before the passage of the Pure Food and Drug Act in 1907, Americans were exposed to a host of patent medicine “cure-alls,” everything from vegetable “folk remedies” to dangerous mixtures with morphine. The major component of most “cures” was alcohol, which probably explained why people reported that they “felt better.”

Needless to say, claimed benefits were erratic and irreproducible.

Marijuana, whatever its value, is intoxicating, and it’s not surprising that sincere people will report relief of their symptoms when they smoke it. The important point is that there is a difference between feeling better and actually getting better. It is the job of modern medicine to establish this distinction.

The debate over drug use generates a great deal of media attention -- including the focus on the administration’s appeal this month to the U.S. Supreme Court against medical marijuana -- and frequent misinformation. Some will have read, for instance, that the medicinal value of smoking marijuana represents “mainstream medical opinion.” It is time to set the record straight.

Simply put, there is no scientific evidence that qualifies smoked marijuana to be called medicine. Further, there is no support in the medical literature that marijuana, or indeed any medicine, should be smoked as the preferred form of administration. The harms to health are simply too great.

Marijuana advocates often cite the 1999 National Academy of Science’s Institute of Medicine report as justifying the drug’s medical use. But, in fact, the verdict of that report was “marijuana is not a modern medicine.” The institute was particularly troubled by the notion that crude marijuana might be smoked by patients, which it termed “a harmful drug-delivery system.”

These concerns are echoed by the Food and Drug Administration, the agency charged with approving all medicines. As the FDA recently noted: “While there are no proven benefits to [smoked] marijuana use, there are many short- and long-term risks associated with marijuana use.”

Compounds in the marijuana plant do potentially have a medical value. For instance, a synthetic version of an ingredient in marijuana has been approved for treating nausea for chemotherapy patients, as well as for treatment of anorexia associated with weight loss in patients with AIDS.

Admittedly, these medications have limitations, including the relatively slow onset of relief. Researchers are exploring drug-delivery systems that allow rapid relief -- perhaps an oral inhalator like those used by asthma patients -- as a response to patient needs.

But these medications are a far cry from burning the crude weed and gulping down the smoke. Every American is familiar with aspirin, and some know that it was first found in willow bark, from which the therapeutic agent acetylsalicylic acid was eventually synthesized. Surely no one today would chew willow bark, much less smoke a piece of tree, to cure a headache.

Medical science does not fear any compound, even those with a potential for abuse. If a substance has the proven capacity to serve a medical purpose, then it will be accepted. We have done so with substances as dangerous as opium, allowing the medical use of many of its derivatives, including morphine, Demerol and OxyContin. The key term is “proven capacity.” Only if compounds from marijuana pass the same tests of research scrutiny that any other drug must undergo will they become part of the modern medical arsenal.

Our investment in medical science is at risk if we do not defend the proven process by which medicines are brought to the market. All drugs must undergo rigorous clinical trials before a drug can be released for public use.

The overarching charge to any physician is: “First, do no harm.” That is the test smoked marijuana cannot pass.