With the recent passage of a law permitting marijuana for medical purposes, New Jersey will become the fourteenth state to have legalized its use. Although the federal government still regards marijuana as an illegal narcotic, legalization and wider use of the drug for medicinal purposes at the state level is growing.
What most people don't realize is that one form of medical marijuana -- a synthetic version -- is already legal and available in all states. "Medical marijuana comes in two forms: Marijuana leaves or buds used for smoking, and as Marinol, a trade name for dronabinol, synthetic THC, the principal psychoactive ingredient in the drug," said Frank Lucido, M.D., a general family physician in Berekely, California, who has been prescribing Marinol since it was approved by the FDA in 1985. "It's available with a prescription at most drug stores," he said.
Among the conditions doctors like Dr. Lucido prescribe Marinol to treat are chronic pain, mood disorders, post-traumatic stress syndrome, anorexia, somegastrointestinal problems and for the nausea and vomiting associated with chemotherapy for cancer.
The drug is also used as an appetite stimulant, according to Stan Louie, Ph.D., an associate professor of pharmacology at the University of Southern California School of Pharmacy. "Users experience the same enhanced appetite with Marinol use as they do when smoking marijuana leaves," he said. The appetite enhancing effects are beneficial for patients with wasting diseases such as HIV/AIDS or cancer, said Dr. Lucido, who has some 13 years experience in these areas. "Medical marijuana also has sedative effects, and sometimes helps reduce the perception of pain in some patients," Louie said.
If Marinol is already legal and available, then why the push to legalize the smoking of the marijuana plant? "Although marijuana plants vary in potency, smoking it produces a stronger and more immediate effect than Marinol," said Louie. "That may be because a fungus also grows on marijuana plants that may enhance its effect. We just don't know." Also, the pill form takes much longer to take effect -- 60 minutes or more, as opposed to 15 for the inhaled version. That might not seem like a drastic time difference, but to someone in tremendous pain, it's certainly meaningful. Furthermore, "in patients with severe nausea and vomiting -- patients who can't keep a pill down -- marijuana [leaves] may be indicated," said Dr. Lucido.
People requesting Marinol or marijuana are screened carefully, said Dr. Lucido. "If they are not appropriate candidates for the drugs, they are denied usage," he said. If they are appropriate candidates, he would recommend the patient for the medical marijuana program. The legal aspects of this are complex and vary from state to state, and sometimes from city to city. Legally, a physician may not prescribe marijuana because it is not an FDA-approved drug. A physician may only recommend it or approve its use. The patient may then obtain it on his or her own. In California, there are state licensed dispensaries where it's available.
The strict federal and state regulations governing the prescription of medicinal marijuana may have prevented many doctors from prescribing it, in Dr. Lucido's opinion. "Many physicians won't recommend or approve it because they're not comfortable with it," he said. "They haven't been trained in its use. It's usually not approved for patients [even in California where it's legal] unless the patient asks for it. I would like to see more doctors use it," he continued. "It's very beneficial to patients."
Both Marinol and marijuana smoking are not without their downsides. Among the negative side effects are the impairment of cognitive abilities and visual and auditory hallucinations, Louie said. "In patients with diabetes, the enhancement of appetite makes them eat more, which worsens their condition. There are also potential lung problems for some patients who smoke it, including pulmonary infections and other effects, similar to those seen in people who smoke tobacco.
And, there's the issue of abuse -- a concern at the center of the debate over the legalization of the drug. "It's difficult to quit," said Louie. "Many patients experience euphoria [on the drug] and they don’t want to quit." While not all experts agree that marijuana is as addictive as other narcotics, Dr. Lucido says it is not: "Neither Marinol nor marijuana is addictive in the true sense. There are no withdrawal symptoms as there are with heroin use, for example. But the phenomenon of tolerance does occur -- meaning patients require more and more of the drug to experience the same effect," he said.
Louie believes more clinical studies are required before medicinal marijuana comes into widespread usage by physicians. "The question is, who will pay for the studies?" he asked.
But with the legalization of marijuana use in 14 states and ongoing lobbying efforts by pro-marijuana organizations, such as NORML (The National Organization for the Reform of Marijuana Laws), to have it legalized in others, the trend toward universal use in the U.S. is growing.
