But It’s Not a Pure Medicine
Messy plant, yes, but we need it
That’s what I hear from every medical colleague when the subject of medical use of cannabis comes up. “But it isn’t approved by the FDA,” “But it isn’t a pure medication,” “But it isn’t made in a pharmaceutical factory.” Yeah, I get it. Cannabis doesn’t fit our picture of a modern medicine. It’s a plant, and a messy one at that. It contains hundreds of active compounds that interact variably depending on the method of administration. Because it’s a plant (and illegal) it’s mostly grown by small producers who vary their technique so that even plants of the same strain might have differing amounts of active compounds. It’s just not what fits our idea of a medicine today.
Pure medicine
In 1905, Congress passed the Pure Food and Drug Act. That’s the one that got cocaine out of Coca-Cola and toothache pills, and cannabis and opioids out of patent medicines. It also solidified how we see medication and who can give it to us. It’s been over a century and it’s hard to imagine we lived a different way, but before the Pure Food and Drug Act, people had more choices.
Our great grandparents could walk down to the corner pharmacy and talk to the “druggist.” He knew them well and they knew him. Everyone in a four or five block radius went to his store when they needed something for their health, and he provided. Cannabis was a popular ingredient in many of his preparations. He didn’t try to separate the THC from the CBD or the hundreds of other compounds. He just used the plant.
The corner druggists’ tradition was older than our current 100 year history of purity. He practiced much the same way as the tribal shaman did for thousands of years. He knew everyone, and everyone knew him. His main enemy was nature, and it was also the source of his remedies. It would no sooner occur to him to cut some natural ingredients into their pure constituents as it would that someone would eliminate the rain from the weather. But for the shaman and his more technologically sophisticated progeny like the corner druggist, all that stopped in 1906.
Since that time, we don’t get our advice from a guy down the block. We go to the doctor. And not just any doctor. We go to an allopathic doctor. Back at the turn of the 20th Century, there was a good-sized conflict about what school of medicine would dominate. The allopaths and the American Medical Association won out. What also won out in that fight was the idea that a doctor would make a specific biological diagnosis and give a specific agent. At every point since then, the idea of purity of the chemical nature of a medication has been advanced. In fact, today, when pharmaceutical companies talk about a new medication, they refer to a “new molecule.” No more plants or plant extracts. We’d no more use cannabis than we’d tell a patient to make willow bark tea for a headache (that’s where aspirin came from originally).
So that’s all progress, right? And we’re all healthier and happier for it. We are, aren’t we? Well, I can think of one case where the purity idea didn’t work out so well. Cannabis.
Pure plant
It’s been known for a long time that THC is useful medically. In fact, when the AMA signed on to support the legislation making marijuana illegal in the 1930’s, they were surprised to find out afterwards that it was cannabis. They were pretty upset as they were still using it as a medicine. The G men told them this marijuana stuff was some new drug from Mexico and the AMA believed them.
Anyway, with cannabis illegal, and needing THC for medicine, of course we went to our friends at the pharmaceutical industry and asked for a “pure molecule.” And we got it. Marinol is a schedule II medication indicated for appetite stimulation in HIV and cancer patients. We used to use it at the HIV clinic I worked at. It was pure too. And powerful. There was only one problem. It was too pure.
See, in a cannabis plant, there’s a lot of stuff going on. THC is partially turning on our CB1 receptors and CBD is blocking that action a bit. So, my patients who were smoking pot were able to stimulate their appetites with mild euphoria. When I gave them Marinol so they could stop smoking that evil weed, there was no CBD to lower the effect. “Doc, it improves my appetite, but by the time I get my food I fall asleep with my face in the plate.” It didn’t help to improve the appetite if the patient didn’t actually eat the food.
Now we’ve learned. We seem to be asking as a people for the right to put in our bodies what we want including cannabis. I have a prediction to make. When cannabis becomes legal, we’re going to find a lot of medical applications across the spectrum of medical practice. We’ll also find that it’s more complicated than we thought, and specific individualization will be important in the prescribing of cannabis. We’ll probably find that the way the shaman did it will be best, try a little, see what works, and go from there. There are systems in nature and in our bodies that are too complex for one medication. A 100 years from now, we’ll all know that again.
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Dr Wetsman is an addiction psychiatrist and is currently studying data science. He has released his serial Ending Addiction. He also has something else in the fire — more to come. Nothing he writes is financial advice. Don’t do anything he suggests; look at other sources and make up your own mind.
