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139 6 Mother’s Milk and the Muffin Man Smoking Is Hazardous to Your Health The most common and best-established risks of sustained marijuana use in botanical form are associated not with the plant, but with the effects of one of the most popular delivery systems: smoking. For this reason, drug prohibitionists tend to focus on the dangers of inhaling smoke as a way to avoid a discussion of the relative safety of cannabis itself. They can point to research on the effects of chronic marijuana smoking that concludes that lung function is impaired in much the same way as with heavy tobacco smoking; indeed, “Marijuana smoke and tobacco smoke are rather similar. Many of the toxic compounds, such as tar, carbon monoxide, and cyanide, are found in comparable levels in both types of smoke.”1 The 1999 Institute of Medicine (IOM) report on marijuana also makes the point that “numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease.”2 But the report is clear that it is smoking—not the use of the plant itself—that is a safety concern: “Except for the harms associated with smoking, the adverse effects of marijuana use are within the range tolerated for other medicines.”3 Because of the dangers of smoking, the report strongly recommends research into alternative delivery systems: “The argument against the future of smoked marijuana for treating any condition is not that there is no reason to predict efficacy, but that there is risk. That risk could be overcome by the development of a non-smoked, rapid-onset delivery system for cannabinoid drugs.”4 But because smoking is well established as hazardous, while marijuana itself is not, opponents of the legalization of even the medicinal uses of cannabis frequently focus on the dangers of the popular delivery system as a stand-in for missing or weak arguments about the dangers of the botanical drug itself. At an April 2004 congressional hearing on medical marijuana, the chair of the subcommittee—and an outspoken opponent of marijuana use—Representative Mark Souder (R-IN), used the IOM 140 Mother’s Milk and the Muffin Man report to dismiss the possibility that the botanical form of the drug might have any medicinal value. To establish this point, he noted that the IOM report “stressed that smoking marijuana is not safe, not a safe medical delivery device, and exposes patients to a significant number of harmful substances.”5 Repeatedly during the hearings, risks of smoking are raised as the reason why whole plant, botanical cannabis should not be considered an appropriate medicinal substance. Dr. Robert Meyer, director of the FDA’s Office of Drug Evaluation, in his testimony before the committee, for example, observed that while some components within cannabis appear to be therapeutically active, “Marijuana, botanical marijuana, is not an approved drug.”6 Souder immediately followed this observation with the suggestion that any cannabinoid medication would be distinct from the botanical plant: “And it wouldn’t be marijuana? It would be some component inside the marijuana.” Meyer’s response is telling: “Well, again, I think there are inherent toxicities to smoking anything.”7 The substance in its botanical form becomes synonymous with the delivery system of smoking. At the end of his testimony, Meyer returned to the question of herbal or botanical medicine, arguing that the “FDA does not have an inherent bias against botanical products. If botanical products are developed correctly and shown to be safe and effective . . . we would approve of a botanical product.”8 Souder immediately interjected, “Do you have any smoked products you’ve approved?” Meyer replied, “I don’t believe so. No.”9 Once again, the botanical form of the drug is reduced to a “smoked product.” This rhetorical strategy has been deployed in more-popular venues as well. During an interview on the television program the O’Reilly Factor, Dr. Andrea Barthwell, the U.S. deputy “drug czar,” dismissed the possibility that marijuana might have medical value by saying, “There is nothing that tells us from the science now that smoked, crude botanical should be a medication.”10 One notable exception to this approach among prominent public health officials has been articulated by former U.S. Surgeon General Joycelyn Elders . In a published editorial in 2004, Dr. Elders observed that “marijuana does not need to be smoked. Some patients prefer to eat it, while those who need the fast action and dose control provided by inhalation can avoid...

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