Special articleBlurred Boundaries: The Therapeutics and Politics of Medical Marijuana
Section snippets
What is Medical Marijuana?
For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally, and spiritually.6 As a folk medicine marijuana has been “used to treat an endless variety of human miseries,” although typically under the aegis of strict cultural controls, according to DuPont.7 The first medical use probably occurred in Central Asia and later spread to China and India. The Chinese emperor Shen-Nung is known to have prescribed it nearly 5 millennia ago. Between 2000 and 1400 bc, it
Recreational Use Blends Into Medical Use
For recreational users, access to marijuana has always been about getting intoxicated. In the 21st century, cannabis is the most widely used illicit drug in the world,22 with the United Nations estimating that up to 190 million people consumed cannabis in 2007.23, 24, 25 Alice B. Toklas's legendary brownies notwithstanding, smoke inhalation is the preferred method of ingestion.20 Unlike eaten botanical cannabis, smoked botanical cannabis affords high bioavailability, rapid and predictable
The Relationship Between Psychosis and Marijuana
Marijuana continues to have the reputation among the general public as being benign, non–habit-forming, and incapable of inducing true addiction.39, 48 For most users this may be so. Experimentation with marijuana has become an adolescent rite of passage, with the prevalence of use peaking in the late teens and early 20s, then decreasing significantly as youths settle into the adult business of establishing careers and families. With a lifetime dependence risk of 9% in marijuana users vs 32%
Dangers of Early Use
Whereas adult users appear comparatively immune to cannabis-induced behavioral and brain morphologic changes, the same cannot be said of individuals initiating use during their early teens, when effects are both more severe and more long-lasting than in adults.66 During puberty, a period characterized by significant cerebral reorganization, particularly of the frontal lobes implicated in behavior, the brain is especially vulnerable to adverse effects from exogenous cannabinoids.58, 67 How they
Dangers of Medical Marijuana
Those skeptical of botanical cannabis do not argue that it is necessarily bad. Rather they contend that the benefits of cannabis—particularly when smoked—remain scientifically unproven, not only on its own merits but also compared with other available treatments. They contend that the usual standards for evaluating pharmacotherapies have been largely side-stepped.17 They want legitimate research. In a 2008 position paper, the American College of Physicians trod a middle ground between praising
The Endocannabinoid System
Although cannabis has been part of the world's herbal pharmacopoeia for millennia, next to nothing about its mechanisms of action was known until the last half century. As with all folk medicines, practitioners established the therapeutic benefits and risks of their plant-derived remedies through careful observation. In this respect, the cannabis story mirrors that of the Oriental poppy, Papaver somniferum, the source of opium, which was appreciated both as a renowned painkiller and a
Promising Pharmaceutical Applications
In the rapidly growing field of endocannabinoid pharmacology, the potential for designing pharmacologic interventions is as broad as the endocannabinoid system's bodily distribution.91 “Perhaps no other signaling system discovered during the past 15 years is raising as many expectations for the development of new therapeutic drugs, encompassing such a wide range of potential strategies for treatments,” Di Marzo92 writes. Describing the endocannabinoid system as “having pleiotropic homeostatic
Currently Available Pharmaceuticals
To date, only 4 pharmaceutical cannabinoids have been marketed. The first and second (dronabinol and nabilone) have been available in the United States since 1985 and a third one (nabiximols) in Canada since 2005.36 A fourth (rimonabant) has shown promise treating nicotine dependence and reducing appetite in obese individuals. Available in Europe since 2006, the FDA failed to approve its release in the United States over concerns it can induce depression and suicidal behavior.56, 84, 90
The 2 US
Federal Barriers to Cannabis Research
For nearly a century, cannabis was a part of the American pharmacopeia,83 but by the 1930s, its days as a legitimate treatment were numbered. The flames of popular fear had been fanned for decades by the popular press102 and by the likes of such high-camp films as the 1936 Reefer Madness, which hysterically portrayed “marihuana” as a threat to Western civilization through its purported capacity to induce user insanity and incite societal mayhem. In a standoff foreshadowing the current
States' Defiance of Federal Law
Meanwhile, in the legal arena, the federal government pits itself against increasing numbers of states—16 plus the District of Columbia—with regulations permitting botanical cannabis use for certain chronically or critically ill patients that contradict federal law.10 A consequence of the discrepancies between federal and state statutes is that users and purveyors of botanical cannabis for any purpose can be arrested and charged with federal crimes, even in states where possessing small
Conclusions
Given cannabis' worldwide use for thousands of years for medical and spiritual purposes, the contemporary American tumult over medical marijuana seems peculiar and misguided. Despite cannabis being part of the US pharmacopeia through much of the 19th and early 20th centuries, a federal government deeply suspicious of mind-altering substances began imposing restrictions on its prescription in the late 1930s, culminating in 1970 when the US Congress classified it as a Schedule I substance,
Acknowledgments
For Gabe, whose ongoing recovery from chemical dependence inspired me to write this article.
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