Dying to Get High: Marijuana as Medicine

5. Cannabis and Consciousness

115 5 Cannabis and Consciousness A Dangerous Drug with No Medicinal Value The consciousness-altering properties of cannabis are generally understood by policy makers as a critical impediment to the drug’s designation as a medicine. For many, the claim that cannabis is of any therapeutic value is a “ruse” employed not for the benefit of the dying, but rather for those dying to get high.1 In response, many medical marijuana advocates have downplayed the drug’s popular psychoactive effects, instead choosing to emphasize the role marijuana can play in managing pain, calming chemotherapy-related nausea, enhancing appetite in patients suffering from AIDS wasting, relieving muscle spasticity associated with MS, reducing intraocular pressure for glaucoma sufferers, or controlling seizure activity among epileptics . It is as if the “high” that makes the drug an attractive recreational substance either disappears with medical use or is nothing more than a trivial side effect unrelated to the plant’s therapeutic value. This reluctance to address the question of the therapeutic value of the high is easy to understand; it is hard to imagine that cannabis would have attracted any regulatory attention—much less placement in the most restrictive federal drug category—were it not for the herb’s psychoactive effects . For decades, the federal government has rationalized placing cannabis alongside such dangerous drugs as heroin as a Schedule 1 substance2 by arguing that marijuana not only has no accepted medical use but also carries extraordinary risks, including a high potential for abuse. In an effort to demonstrate these claims, the government has invested millions of dollars in research seeking to establish the dangers of the drug. In the 1980s alone, federal funding for research into risks associated with marijuana use increased nearly tenfold.3 But little evidence has emerged of clear harms associated with cannabis use beyond those related to the popular delivery system of smoking.4 The National Institute of Medicine (IOM) and the World Health Organization 116 Cannabis and Consciousness (WHO) both have concluded that the effects of marijuana are relatively benign and that there is “no convincing evidence of biological harm, psychological impairment, or social dysfunction” as a result of most cannabis consumption.5 This is not to say that cannabis is unequivocally safe. As with most medicines, some patients may experience rare but real harm from ingesting the drug. Recent research suggests, for example, that some middleaged users might face an elevated risk of heart attack, especially those with unrecognized coronary disease.6 Other research indicates that cannabis might be inappropriate as a medicine for a small subset of patients with a genetic predisposition to psychosis (including schizophrenia); for these patients, cannabis may serve as an environmental trigger for symptoms.7 But, for most patients, in the treatment of physiological and even some psychological symptoms,8 cannabis appears to be—in the words of the DEA’s own administrative law judge, Francis Young—“one of the safest therapeutically active drugs known.”9 And, unlike many approved prescription medications and over-the-counter drugs, it is impossible to ingest a fatal overdose of marijuana.10 In the face of growing evidence of the drug’s therapeutic potential, and in the absence of clear evidence of significant harm, continued federal prohibition on even physician-supervised medical use of marijuana increasingly depends on the claim that, because of the plant’s psychoactive properties, the drug carries a “high potential for abuse.”11 This claim, however, rests on unstable ground, undermined by the government’s own contradictory policies on synthetic versus natural THC. THC (delta-9tetrahydrocannabinol ) is the most psychoactive component of cannabis. A synthetic version of the substance, dronabinol (Marinol), has been available on prescription in the United States for more than twenty years. In 2004 synthetic THC was deemed so safe, with such a low risk of abuse, that dronabinol became the only drug ever moved from Schedule 2 to Schedule 3.12 Recently, the World Health Organization’s Expert Committee on Drug Dependence recommended a similar rescheduling of synthetic THC under international conventions to place it in the least stringently controlled category, Schedule 4.13 The Expert Committee acknowledged that THC is “a well known psychotropic substance” and that the synthetic form produces the same “perception-altering effects possessed by cannabis.”14 But the group concluded that all evidence indicates an “extremely low” risk of abuse.15 In other words, according to drug reg- Cannabis and Consciousness 117...