Medical Marijuana
Legalization
Issues:
An Appeal for Reefer
Sanity
Kevin A. Sabet, Ph.D.
Director, Drug Policy Institute and Assistant Professor,
University of Florida
President, Policy Solutions Lab, Cambridge, MA
www.kevinsabet.com
All or nothing?
Legalization vs. Prohibition
Ultimately the Question is:
“Is the right to get high and buy legal
marijuana in a store worth the risk to kids,
society, and the economy in the form of:
•
•
•
•
greater addiction and learning deficits
a new, legal industry relying on addiction for
profits
increased safety and health costs (like car
crashes or the costs to health care and the costs
of a newly regulated system)
compromising our scientific system in the name
of politics and medicine a la public opinion”?
Is Marijuana Medicine?
NO: SMOKED OR INHALED RAW
MARIJUANA IS NOT MEDICINE
YES: THERE ARE MARIJUANA-BASED
PILLS AVAILABLE AND OTHER
MEDICATIONS COMING SOON
MAYBE: RESEARCH IS ONGOING IN
LOOKING AT MJ’s COMPONENTS
Bottom Line
We don’t smoke opium to get the effects of
morphine.
So why would we smoke marijuana
to get its potential medical effects?
Bypassing
the FDA Process
Before FDA approves a drug as medicine, testing is done to:
Determine the
benefits and risks
of the drug
Determine how it
may interact with
other drugs
Assure
standardization
of the drug
Determine the
appropriate
dosage levels
Identify and
monitor
side effects
Identify
safe drug
administration
FDA Determines Medicine
“No sound scientific studies supported
medical use of marijuana for treatment in
the United States, and no animal or
human data supported the safety or
efficacy of marijuana for general medical
use. There are alternative FDA-approved
medications in existence for treatment of
many of the proposed uses of smoked
marijuana.”
Distinction must be made
between raw, crude marijuana
and marijuana’s components
So we should research
marijuana’s components
Snapshot of Promising
Research: Sativex
• Sativex is a drug, approved in Canada, the
UK, and other parts of Europe for the
treatment of MS Spasticity and Cancer
Pain.
• It combines THC and
CBD to eliminate the
“high” from marijuana
Current Medical
Marijuana Laws
• 17 States and D.C.
• They vary in degree and implementation
– Started as “affirmative defense” for marijuana
use for medicinal purposes; or removal of
criminal penalties if “medical” use is claimed
– Evolved into state-based production and
distribution
• Rely not on the FDA, but unregulated
businesses
State Medical Marijuana
Programs Increase Drug Use
• Two independent, peer-reviewed studies
looking at medical marijuana states in the
2000s concluded that:
States with medical marijuana programs
had an increased in marijuana use not
seen in other states
Cerda, M. et al. (2011). Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana
and marijuana use, abuse and dependence. Drug and Alcohol Dependence. Found at
http://www.columbia.edu/~dsh2/pdf/MedicalMarijuana.pdf. Wall, M. et al (2011). Adolescent Marijuana Use from 2002 to 2008: Higher in
States with Medical Marijuana Laws, Cause Still Unclear, Annals of epidemiology, Vol 21 issue 9 Pages 714-716.
Increased access and availability
lead to decreased perceptions of
harm and increased use
Effects of “Medical” Marijuana
• California
• Oregon
• Colorado
Compassionate care
increased access to marijuana?
<5%
■ Less than 5% of card
holders have
cancer, HIV/AIDS,
or life-threatening diseases
■ 90% are registered
for ailments such
as general pain or headaches
Compassionate care or
increased access to marijuana?
>80%
■ Most card holders in
CA and CO are white
men between the
ages of 17 and 35
■ No history of chronic
illness
■ History of Alcohol
and Drug Use
California Profile
• Average user: 32 y/o WM
– No history of chronic illness
– History of cocaine and alcohol use
• Recent study by legalization
advocates report : 44% of users
received marijuana for “headaches”,
similar number for “exhaustion”
• Fridays at 2:00 PM – Sundays at
noon:
– Primary foot traffic
Oregon
• 2011: Currently 49,337 registered
individuals.
• 10 physicians made 46% of all recommendations.
• There are 40 Patients under age 18.
– 19 are age 17
– 12 are age 16
– 9 are under the age of 15
Colorado
Medical Marijuana Registry by Debilitating Conditions
Severe pain
Muscle spasms
Severe nausea
Seizures
Cancer
Total Conditions
Cachexia
HIV/AIDS
Severe pain
118,133
Muscle spasms
28,304
Severe nausea
15,972
Seizures
1,787
Cancer
2,646
Cachexia
1,653
Glaucoma
Typical Medical Marijuana
Legislation
• Listing conditions for which
marijuana can be obtained,
including “other conditions as
determined in writing...”
Typical Medical Marijuana
Legislation
• Two tier system:
• Marijuana Stores
• Home-Grown Cultivation
How Much Marijuana is Medicine?
• In MA: can possess a 60-day supply of
marijuana
• 60-day supply is not defined in proposed law
• 1 ounce = 60-120 joints
• At 3 joints/day, 1 oz. = 20 days
• So 60-day supply = 3 oz.
• 3 oz = 180-360 joints
• Three times more than what is currently
allowed in MA without arrest
But it could be more – as a day’s supply could
Typical Medical Marijuana
Legislation
• People could legally grow marijuana their
homes.
Typical Medical Marijuana
Legislation
• Pot based products such as foods,
oils, ointments, aerosols, may be
legally sold as “medicine”.
Other outstanding issues
• No expiration date or limit on renewals for
“recommendations”
• No age restrictions
• State Government would be charged to
regulate marijuana dispensaries, card
registration and statewide (users/growers
free to start before DPH steps in)
• Federally Illegal System (state employees at
risk of arrest)
That doesn’t mean
that components in
marijuana do not
have medical
properties.
These are being
scientifically developed.
Let’s do medical
marijuana the right way
• Determine all of the medicinal
compounds in the marijuana plant.
• Determine which compounds are
most effective for cancer patients,
which are more effective for pain
management, which are most
effective for treating other diseases.
• Make them available to doctors and
patients legitimately, at pharmacies.
The Government Is Doing Research
• Robust marijuana research program conducted
by the US Government
– Not much interest from Pharma
• 209 active researchers registered with DEA to
perform bona fide research with marijuana,
marijuana extracts, and THC.
– Every researcher who has put forth a valid research proposal
has received permission to study marijuana.
– Studies include evaluation of abuse potential,
physical/psychological effects, adverse effects, therapeutic
potential, and detection. 14 use smoked marijuana with
humans
Marijuana-Based Medications
• NIH is responsible for research into
marijuana-derived medications.
• 288 NIH-supported projects on
cannabinoids.
• Scheduling less relevant
– Cocaine is Schedule II, no “Dispensaries” allowed
– But it Would Be A Symbolic Victory for
Advocates
– Need an individual FDA-approved product for
medical use
A Compassionate
Access Proposal
• Before marijuana-based medications
become more widely available, offer
marijuana, regulated in strength,
purity, and composition, to:
• Cancer patients
• Terminally ill
• Those with MS, ALS, and AIDS
whose bona fide physicians have
recommended marijuana because
other medications have not worked
What is this really about?
• 1978: Keith Stroup “We are trying to get marijuana
reclassified medically. If we do that, (we'll do it in
at least 20 states this year for chemotherapy
patients) we'll be using the issue as a red herring to
give marijuana a good name.”
• 2012: MASSCANN/NORML spokesman: “Stepping
stone to legalization? I hope so. That’s the plan.
Decrim 2008, Medical 2012, Legal 2016. Yes we
want to legalize! We will completely legalize for
everybody in 2016.”
Marijuana is NOT approved as medicine
by:
• The FDA
• The American Medical Association
• The National Multiple Sclerosis Society
• The American Glaucoma Society
• The American Academy of Ophthalmology
• The American Cancer Society
• The American Pediatric Society
• The Massachusetts Medical Society
THANK YOU!
KEVINSABET@GMAIL.COM
WWW.KEVINSABET.COM