There is a long history of negative propaganda associated with the use of marijuana dating back ~80 years to the film Reefer Madness (1936): A movie which was so comical in its representation of pot-smokers as murderers, rapists and generally depraved individuals, that it enjoyed a re-branding as an exploitation film in the 1970s and was even remade into a musical satire in the 1990s. Not so comical is the continued reticence of federal governing bodies to objectively (and fairly) examine both the negative and positive effects of the drug.
The use of marijuana as a psychoactive drug and for medical purposes is hardly new; evidence shows cannabis use dates back at least as far as 2727 BCE. in ancient China, as well as historically in ancient Rome, Greece, the Middle East and Northern Africa. In fact, cannabis’ history of cultivation both as medicine and for pyschoactive effect closely mirrors that of two other crops: the coca plant (cocaine) and the opium poppy (morphine, codeine, heroin and oxycodone). Unlike those other crops, there has been a persistent stigma associated with marijuana use and cannabis research that has stood in the way of extensive unbiased research.
This is curious, considering that the potential negative effects (addiction and withdrawal properties specifically) of cannabinoids compared to cocaine and opioids/narcotics are significantly lower.
Research into the coca and poppy plants has been thorough and extensive (in spite of the higher risks associated with their derivatives) and the results have yielded numerous medical advances, with applications in multiple areas of medicine including pain management, eye and nasal surgery and anaesthesia.
Objective research of cannabis efficacy is harder to find. This is not to say that there has not been any research performed, or that those studies in themselves are unreliable. The issue is moreso that studies are forced in large part to make use of anecdotal evidence and patient self-reports, due to limited availability and access to medical marijuana for research.
The National Institute on Drug Abuse (NIDA) currently holds a federally-granted monopoly on the U.S.’s medical marijuana supply, with a laboratory at the University of Mississippi being the only facility permitted to grow medical marijuana. They also oversee an estimated 85% of the world’s research on controlled substances. The effects of this on the research of marijuana both domestically and abroad are complicated: NIDA exerts control both over what studies are approved for research, as well as what types of studies are approved.
In a January 19, 2010 article in the New York Times, NIDA spokeswoman Shirley Simson stated,
“As the National Institute on Drug Abuse, our focus is primarily on the negative consequences of marijuana use. We generally do not fund research focused on the potential beneficial medical effects of marijuana.”
This represents a major conflict of interest: With the only controlling body of medical marijuana distribution steering all research towards only examining the negative effects of the drug, obtaining objective and unbiased information about potential medical uses for the drug is virtually impossible.
In the same article, Dr. Rick Doblin, Founder and Executive Director of MAPS (Multidisciplinary Association for Psychedelic Studies), a researcher who has spent his career writing papers on the medical uses of marijuana and other psychedelics, expresses his frustration over the limited access to research materials:
Researchers investigating LSD, Ecstasy and other illegal drugs can use any of a number of suppliers licensed by the Drug Enforcement Administration. And if a researcher wants to use a variety of marijuana that the University of Mississippi does not grow — and there are many with differing medicinal properties — they are out of luck.
In spite of the resistance from NIDA and the DEA, acceptance of medical marijuana as a potentially effective treatment for a multitude of ailments (including pain, nausea, muscle spasms from multiple sclerosis, appetite/weight loss, seizures and Crohn’s disease) is on the rise, spurred on by anecdotal reports from patients and users. In a recent survey performed on the website WebMD, 69% of doctors and 52% of patients reported that they believed marijuana delivers benefits. However, the results of the same survey showed mixed results in terms of legalizing the drug, with 53% of doctors and 51% of consumers opposed.
Both NIDA and NIH (National Institute of Health) continue to stress the anecdotal nature of these purported benefits and steer the conversation back towards concerns of addiction and the potential for negative effects: “We don’t know a lot about the things we wish we did,” Francis Collins, NIH Director was quoted as saying in a recent National Geographic article.
It’s a circular argument: To cite concerns over the limited existence of substantial research into the long-term effects of marijuana as a reason against its legalization; while simultaneously being the largest impediment to the gathering and dissemination of such research is disingenuous:
The DEA wants to have it both ways, denying that marijuana is a medicine because the FDA has not approved it, while simultaneously blocking the appropriate administrative channels which would facilitate FDA clinical trials.
In spite of the philosophical resistance of NIDA (Director Nora Volkow insists they are not in the business of policy-making), the legalization of medical marijuana continues to spread across the U.S. While on the surface this represents a significant victory for medical marijuana users, it is also worrisome.
My prediction is that state legalization will expose more people to marijuana. As a result you’re going to have many more adverse consequences, just as we have with nicotine and alcohol—simply because so many more people will become exposed to it.
Dr. Volkow’s prediction may possibly be correct; but she fails to acknowledge that the reason we do not have those answers is in no small part due to decades of obfuscation by NIDA and other bureaucratic bodies. The end result is an unstoppable push towards policy-making by frustrated patients and doctors who have had access blocked to medication that should reasonably have been extensively researched ~50 years ago.
Medical marijuana is being unleashed upon society without a safety net. This is not reassuring. Doctors and patients have limited information about marijuana and drug interactions, what the appropriate dosage is, or if there are comorbid conditions that would prove it to be contraindicated. For example, recent studies into the effects of marijuana on patients with bipolar disorder and schizophrenia indicate that while it can exacerbate these underlying conditions, patients also show improved neurocognitive function. Obviously further testing and monitoring is required to determine if the drug will prove beneficial — and that’s the problem: as a Schedule 1 classified substance currently all medical marijuana prescriptions are off-label.
All drugs carry risks, however. Treatment decisions involve weighing possible risks against possible benefits. Sometimes the risks outweigh the benefits. When it comes to off-label drugs, sometimes there isn’t enough reliable evidence to make informed decisions.
Moving forward then — since wide-scale legalization would seem to be an inevitability at this point — an acceleration and intensification of research into the effects and uses of marijuana is paramount. But how do you solve a problem like NIDA?
There have been several past attempts to challenge this monopoly. In April 2013 after a 12-year battle, the United States Court of Appeals rejected a lawsuit by Prof. Lyle Craker against the Drug Enforcement Agency (DEA), which he had filed after being denied a license to grow marijuana for medical research.
In its decision, the Court uncritically accepted the DEA’s arguments that NIDA’s monopoly provided “an adequate supply produced under adequately competitive conditions” and that U.S. obligations under the United Nations Single Convention prohibited the DEA from licensing Prof. Craker.
Ultimately, until NIDA’s monopoly is loosened or their policies for granting licenses and access to their medical marijuana supply change, the ability of scientists and drug companies to develop medicines that can be FDA-approved and tested will continue to be seriously hampered, since in order to obtain such approval, privately-funded sponsors must conduct clinical trials. In the meantime, many patients may not get the relief they crave over fears concerning the legitimacy of marijuana treatment, and proposals for valuable research on the subject may be discarded due to frustrating bureaucracy.