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Medical Marijuana: The IOM Report

What Policy Changes Can We Expect?

 By Dr. Tom O'Connell, MD


Although the Institute Of Medicine report on medical marijuana was predictably pusillanimous and deferential toward the irrational federal policy which has prohibited Cannabis for 62 years, the good news is that it acknowledged that cannabinoids have legitimate and important therapeutic applications-essentially the same (predictable) conclusions the IOM reached in 1982.

The difference is that both the political climate and the research background have changed significantly since 1982, so their recommendation for "more research" won't be as easy for the government sweep under the rug and ignore now as it was then.

Our madcap drug czar, who has mastered the dubious skill of embracing opposite poles of the same controversy in a single sentence; even while speaking on national television, was at it again. While there wasn't time for an exhaustive review of all the news articles, I believe important clues to the direction of future policy can be found in a relatively brief Reuters wire item which originated in LA on March 17.

Wire: Medical Marijuana Smoking To Remain Illegal

In part: "Smokable marijuana is not the answer," McCaffrey said, adding the federal government would continue to arrest those smoking marijuana for medical reasons, including people in the seven states where voter initiatives have made its medical use legal.

But he welcomed the report, which he said took the discussion over the medical use of marijuana away from politicians and put it "firmly in the context of science, where it belongs."

McCaffrey said while cannabinoids held no promise of cure, they could be useful in pain management, which he said was a much neglected field in modern medicine.

"Everyone is looking for a cure these days and pain is seen as a sort of blurry background. There needs to be more pain management," he said.

McCaffrey said the government would continue to support bona fide research into medical uses for marijuana, and he called for more research into delivering THC, one of the medically beneficial ingredients of marijuana that has been isolated by scientists.

"In particular, I would support deep-lung delivery vehicles such as aerosols," he said. He also supported controlled delivery by patches similar to those used to deliver nicotine.

On a cautionary note, McCaffrey highlighted the report's finding that developing pain killing drugs from marijuana could cost between $200 million and $300 million and said he did not think there was "any commercial interest in the (pharmaceutical) market for the development of such drugs."

Quick translation: The federal government will continue to discourage, or even block, human cannabinoid research in the US.

If Geoffrey Guy, or some other (non-US) commercial interest comes up with a patentable aerosol delivery system (as now seems likely) the US will grudgingly accord it the same (Schedule 2) status as Marinol. The feds will never legalize smoked marijuana, but will continue to treat it as the demon variant, just as heroin is the designated demon variant of morphine and other therapeutically allowed opioids.

Any patients discomfited by this policy, even if it denies life-preserving therapy between now and development of a scientifically acceptable cannabinoid delivery system are out of luck. They'd certainly better not break the law: they will be thrown in jail.

Tom O'Connell, M.D. is a practicing surgeon in San Francisco. A member of the Board of Directors of Drug Sense, he is commentator for the Drug Sense Weekly - an electronic newsletter.

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