Making Sense of Bioethics: Column 156: The Smoke over Medical Marijuana

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A comprehensive 2015 scien­tific review found medical mariju­ana to be useful only for a small number of medical condi­tions. Writing in the Jour­nal of the American Medical Associa­tion, an in­ternational team of research­ers found scant evidence to sup­port broad claims for the drug's effec­tive­ness. Although clinical trials showed that chronic neuropathic pain and cancer-related pain could of­ten be treated, other forms of pain, such as those related to rheu­matoid arthri­tis, fibromyalgia, HIV and multi­ple sclerosis did not show statisti­cally significant im­provement. Research­ers also found inconclusive data for people with insomnia, anxi­ety disorders, depres­sion, Tourette syn­drome, psychosis, and sleep disor­ders. They registered concerns about medical marijuana’s signifi­cant side effects as well.

Yale University researchers, comment­ing on the review, noted how the approval process for medi­cal marijuana in U.S. states and ju­risdictions has often been based on "low-quality scientific evidence, an­ecdotal reports, individual testimo­nials, legislative initiatives, and pub­lic opinion." They raised concerns around the fact that medical mariju­ana seems to be receiving “special sta­tus” and is being “fast-tracked” for legalization, when it should in­stead be subject to the standard scien­tific verifications of the FDA ap­proval process to assure its ef­fi­cacy and safety. The Yale au­thors of­fered this corrective: 

"Imagine if other drugs were ap­proved through a similar ap­proach… If the goal is to make marijuana available for medi­cal purposes, then it is un­clear why the approval pro­cess should be different from that used for other medica­tions."

In his influential exposé Ma­riju­ana Debunked, Dr. Ed Gogek empha­sizes how the idea of medi­cal marijuana “didn’t come from doc­tors, or patient advocacy groups, or public health organi­za­tions, or the medical commu­nity. The ballot initiatives for medical mariju­ana laws were sponsored and promoted by pro-legalization groups.” These groups have used the medical ma­rijuana trump card to grease the skids for the ac­cep­tance of recre­ational mariju­ana. This pincer movement has ena­bled them to control and reap the windfall from an extensive sys­tem of dis­pensaries that supply and distrib­ute addictive sub­stances. Even if recreational mariju­ana does not ultimately be­come le­galized in a par­ticular jurisdic­tion, it is well docu­mented that medi­cal marijuana dis­pensaries often end up supplying the drug not for rare, valid medical uses, but for substance abuse, similar to the situation with opi­oid pain medi­cations. 

Yet the push for marijuana con­tin­ues unabated. In May 2018, the New York State Comptroller, Scott Stringer, issued a report declaring that legal­ized marijuana in the Empire State would be a potential $3 billion mar­ket, with taxes from its sale gen­erating a potential $436 million annu­ally statewide, and $336 million for New York City. With such sums at play, not only are investors coming out of the woodwork, but towns and municipali­ties are also issuing ordi­nances and changing zoning laws to bring in the dispensaries. Indeed, dol­lar signs beckon, much as they once did for tobacco companies and plan­ta­tion owners. 

Besides being addictive and profita­ble, tobacco and marijuana have other similarities. Marijuana smoke contains harmful chemicals, with ammonia, benzene, toluene, and naphtha­lene levels in marijuana ex­ceeding those found in tobacco smoke. These chemical components may contribute to emphysema, bron­chial irritation and inflammation. Pa­tients with medical conditions treata­ble by medical marijuana can avoid these toxic chemicals and other side ef­fects by using more purified prepa­rations containing only the active in­gredients.

In 2003, the Institute of Medi­cine, a nonprofit, nongovernmental organiza­tion that evaluates medical is­sues, acknowledged that compo­nents of marijuana may have medici­nal uses, and strongly recommended the develop­ment of prescription can­nabinoid medicines based on those compo­nents: 

“If there is any future for mari­ju­ana as a medicine, it lies in its iso­lated components, the canna­binoids and their synthetic de­riva­tives.” 

Several different cannabinoid medi­cations have been developed in re­cent years, and these medicines work as well as or better than marijuana, have fewer side effects, and are less likely to be abused. These drugs also tend to be effec­tive in the body for longer peri­ods.

Dr. Gogek notes the irony of the loud public outcry that would en­sue if the FDA were to approve “a drug that had no advantage over safer alterna­tives, went mostly to substance abuse, in­creased teenage drug use, and killed peo­ple on the highways.” He con­cludes, “We should not be sidestep­ping the FDA approval pro­cess that was designed to protect us.” 

In sum, the reality behind medi­cal marijuana is far from the rosy view painted by advocates.  Marijuana is not “just a plant.” It is an addictive drug abused in epidemic proportions, inflict­ing a serious individual and so­cietal toll. Its use as a medicine needs to be carefully regulated through stand­ard scientific oversight and the FDA approval process, not handed over to recreational enthusiasts and opportunis­tic businessmen. The cur­rent practice of encouraging states and municipali­ties to legalize medical, and then recreational, marijuana, is, in the fi­nal analysis, neither reasonable nor ethi­cal.

 Copyright © 2020, The National Catholic Bioethics Center, Philadelphia, PA. All rights reserved.

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