Marinol vs. Marijuana: Politics, Science, and Popular Culture

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07-12-2004, 08:01 PM

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Marinol vs. Marijuana: Politics, Science, and Popular Culture

 

Marijuana has been used as a medicine for millennia by cultures

spanning the globe. Ever since 1937, that medical necessity has fallen

in America to political pressure, and the cannabis plant remains

illegal regardless of intended use. Since then, patients have

continued demanding marijuana's therapeutic effects, thus prompting

the pharmaceutical industry to find a legitimate means of meeting

their needs without violating federal law. This quest for " legal weed "

resulted in the introduction of dronabinol (a synthetic drug commonly

referred to by its trade name Marinol), into contemporary American

pharmacopoeia. However, this " solution " to the medical marijuana

question now poses a double standard: whereas, medical marijuana users

still face severe penalties, including loss of property and mandatory

incarceration, for therapeutically using an illegal substance, Marinol

users enjoy the benefits of marijuana's active ingredient,

tetrahydracannibidol (THC), without the criminal penalties or the

social stigma. With this paradox in mind, I intend to examine the

vastly different public perceptions of these two essentially similar

substances, marijuana and Marinol, while framing this complex analysis

within a broader historical and theoretical structure. This

examination will focus first on each of these two drugs individually,

and will then illustrate the disparate public discourse in American

pop culture surrounding natural and synthetic THC, respectively.

Without taking a definite position on this hotly debated issue, this

analysis will reveal how politics influence science, how marijuana has

garnered such a distinctively negative reputation, and how Marinol has

successfully appeased the anti-marijuana American public.

 

MARIJUANA

 

Marijuana boasts a long and pertinent history of medicinal use, based

in the earliest known civilizations. The first recorded use of medical

cannabis dates back to 2800 B.C., when the Chinese Emperor Shen-nung

used it as a muscle relaxant and painkiller. The ancient Egyptians

also found medical benefits in cannabis, as evidenced by their usage

of it to quell the pangs of childbirth. Numerous other civilizations,

including the Assyrians, Persians, Zulu, Spaniards, and countless

others, have since established traditional medical applications of

cannabis. Underlying this historical trend is the simple fact that the

medical benefits of marijuana have and continue to serve numerous

cultures.

 

Certainly, the medical use of marijuana was once commonplace in

America, as well. Over one hundred articles recommending cannabis were

published between 1840 and 1900 alone. In fact, marijuana was a

prominent part of the pharmacopoeia from 1870 up until 1937, when the

Marijuana Tax Act effectively banned the plant from public consumption

regardless of intended use. Employed primarily as a painkiller during

childbirth, as a treatment for asthma and gonorrhea symptoms, and as a

relaxant for anxiety-prone patients, marijuana was formerly a

well-documented drug in standard texts on pharmacology and

therapeutics. When Congress first considered banning the cannabis

plant, the respected American Medical Association (AMA) testified

before federal committees in defense of marijuana's medical

applicability. Despite the AMA's efforts, the political motivations

behind outlawing the plant far outweighed any medical considerations,

and in 1937, cannabis became illegal. The sudden and severe public

reaction to this " new " drug was surprising, considering that no one in

America had even hear the word " marijuana " until the late 1920s. A

closer examination of marijuana's entry into the American public

reveals the source of its stigmatization..

 

The term " marihuana " (later spelled " marijuana " ) was invented in the

early 1930s to confuse Americans who had positive associations with

hemp, a major cash crop, and cannabis, a well-known medicine and mild

intoxicant. By ascribing various social ills to the heavily maligned

drug " marihuana, " politicians used this term, with which the public

was unfamiliar, to pass legislation banning an otherwise commonly

known substance. Numerous theories exist about the motives behind the

sudden vilification of cannabis; however, I will limit my analysis to

those aspects of vilification which underscore the strange

relationship between politics and medicine. For example, many

newspapers reported that " degenerate Mexicans " smuggled the evil

" marihuana " into America, raping Anglo women, or murdering innocent

citizens while under its influence. These newspapers, ranging from

well-known national journals like the Christian Science Monitor and

the Washington Herald to little-known local papers like the Rocky

Mountain Times, contributed heavily to the growing anti-marijuana

hysteria, by identifying marijuana-crazed ethnic minorities as the

root cause of crime in America. The Federal Bureau of Narcotics

offered this statement to corroborate these claims:

 

Police officials in cities of those states where it [marihuana] is

most widely used estimate that fifty per cent of the violent crimes

committed in districts occupied by Mexicans, Spaniards,

Latin-Americans, Greeks, or Negroes may be traced to this evil.

 

Evidently, the medical necessity of cannabis could not withstand the

onslaught of such negative associations with marijuana, and political

motives ultimately swallowed medical concerns entirely.

 

Marijuana remained illegal in America for several years, although

medical and recreational use did not disappear whatsoever. Retaining

popularity among American subcultures, such as Black musicians in the

1940s, Beatniks in the 1950s, and Hippies in the 1960s (just to name a

few), marijuana remained a prominent aspect of social life despite its

prohibition. In fact, cannabis consumption reached well beyond the

subcultures of these eras and into the American mainstream. Many

people from varying social backgrounds and ideologies used marijuana

at some point, solely for recreation, including current President Bill

Clinton, Vice-President Al Gore, Speaker of the House Newt Gingrich,

and countless doctors, lawyers, professors, and engineers, among

others. While recreational use remained popular, new medical uses for

marijuana were also discovered, prompting many suffering people to

illegally medicate themselves. The treatments of glaucoma,

chemotherapy induced nausea, spastic disorders, AIDS wasting away

syndrome, and other less severe illnesses were significantly aided

with the therapeutic use of marijuana. Those same officials who tried

the drug recreationally now subject people with an obvious medical

need for marijuana to the constant threat of arrest for violating U.S.

federal law.

 

Although authorities have perpetuated the vilification of marijuana

since its prohibition in 1937, they nonetheless responded partially to

growing demands for medical marijuana in 1969 by supplying researchers

with government-grown marijuana for scientific experimentation. The

" pot farm " at the University of Mississippi in Oxford raised thousands

of cannabis plants (and still grows them today) behind a 12 foot tall

barbed wire fence for the National Institute of Drug Abuse (NIDA), the

federal agency which retains sole rights to supply marijuana to

researchers. Barrels of the low-grade marijuana get shipped to the

Research Triangle Institute in Raleigh, North Carolina where the dried

leaves are rolled at a cost of $2 per joint for patients participating

in experimental programs. This system of farming has resulted in a

" highly standardized …reliable and reproducible method of

administering the drug. " according to Dr. Monroe Wall of the Research

Triangle Institute. Thanks to research conducted with government pot

acknowledging marijuana's medical benefits, New Mexico boldly strayed

from federal drug policy in 1978 and passed the first state law

recognizing the medical value of marijuana. Comparable medical needs

around the country prompted over 30 states to enact similar

legislation within the next few years. Glaucoma patient and medical

marijuana user, Robert Randall, remembers, " By the summer of 1980,

there was building pressure on the federal government to provide

marijuana through an experimental program. " The most remarkable

example of this growing trend for medical marijuana consumption

involved California's request for one million joints from NIDA. Rather

than accept the obvious solution to increase production at the " pot

farm " in order to meet the growing demand (a remedy deemed

" imponderable " by anti-marijuana government officials), bureaucrats

decided to pursue a pharmaceutical alternative. They hoped to

encourage the giant pharmaceutical industry to create a synthetic drug

with properties similar to cannabis.

 

The first attempt to synthetically reproduce the medical effects of

marijuana failed miserably. The Eli Lilly pharmaceutical company had

responded quickly to the federal challenge by manufacturing nabilone,

otherwise known as Cesamet, which soon became hailed as the " great

white drug " that would replace marijuana. In 1978, they began

double-track testing on cancer patients as well as animals in order to

gain FDA approval quicker; however, their lofty aspirations came

crashing down tragically, when dogs on nabilone suffered convulsions

and dropped dead. The door remained open, anticipating another

pharmaceutical product to fill the marijuana demand.

 

 

 

 

 

MARINOL

 

In pertinence to the history of medical marijuana, Congress' passing

of the Controlled Substances Act of 1970 added a new dimension to the

cannabis as medicine controversy. Upon ranking the various drugs

according to levels of danger, the Act placed marijuana in Schedule I,

the most dangerous category. In order to attain Schedule I

classification, a drug must meet three requirements: 1) high potential

for abuse; 2) no accepted safety even under supervision; and most

significantly, 3) no medical use. In placing marijuana in Schedule I,

the government not only ignored cannabis' previous medical use in this

country, but also overlooked the numerous experiments proving the

drug's therapeutic efficacy. Still, bureaucrats needed to help

severely ill patients without acknowledging marijuana as a potential

therapeutic agent. The government prayed for a pharmaceutical

alternative to marijuana, and with Marinol's entrance into the medical

arena, their prayers were adequately answered.

 

In 1980, the National Cancer Institute (NCI) began experimental

distribution of a new drug called Marinol, an oral form of THC (the

primary active ingredient in marijuana), to cancer patients in San

Francisco. Simultaneously, six states conducted studies comparing

smoked marijuana to oral THC in cancer patients who had not responded

to traditional antivomiting medication. These state-sponsored studies

revealed that thousands of patients found marijuana safer and more

effective than synthetic THC. Meanwhile, the NCI experiments showed

that some patients responded well to Marinol, although one patient

reportedly stormed into her doctor's office and accused him of trying

to poison her with the drug (the doctor later dropped out of NCI's

experimental program). Confronted with two different medical

recommendations, the government chose to dismiss the state studies and

give Marinol the green light. In 1981, the government sold the Marinol

patent to a small pharmaceutical company named Unimed based in

Somerville, New Jersey. By 1985, after one unsuccessful attempt at FDA

approval, Marinol was finally approved as a Schedule II drug (a

relatively quick approval by FDA standards). Thus, Unimed, with

government backing, began targeting terminal cancer patients in order

to accumulate profit.

 

With Marinol's acceptance behind them, executives at Unimed launched a

massive sales enterprise in conjunction with their distributor Roxanne

Laboratories, a subsidiary of pharmaceutical giant

Boehringer-Ingelheim. A combined sales force of about 60 people roamed

the country promoting Marinol to oncologists and AIDS doctors.

Building from early profits, Unimed invested money into testing new

uses for Marinol. In 1992, the drug received approval as an appetite

stimulant for patients with AIDS cachexia, otherwise known as wasting

away syndrome. This new use coupled with Marinol's recent approvals in

various international markets, like South Africa (where it is marketed

under the trade name Elevat) with its incredibly high AIDS rate, along

with Canada, Puerto Rico, Israel, and Australia, significantly boosted

Unimed's profits and prestige. Furthermore, the FDA granted Marinol

the highly prized Orphan Drug Status, a privilege that allowed Unimed

exclusive manufacturing rights to Marinol, as well as protocol

assistance, and tax breaks for its investors. As a business, Unimed

still specializes primarily in niche pharmaceutical markets, namely

AIDS drugs. However, among the few drugs manufactured by Unimed,

Marinol easily garners the highest profits, drawing in over 90% of

total revenues. Unimed has reported greater sales nearly every year

since 1985, reaching a high of $9.7 million in 1995. President and CEO

Stephen Simes predicted that sales will reach between $50-100 million

by the year 2000. Based on their growth rate, this figure seems

unlikely; however, the company clearly has high hopes.

 

Despite enormous financial backing and rapid FDA approval, few

proponents of Marinol are aware of the intricate, physical processes

involved in manufacturing synthetic THC. Unlike marijuana which

requires only light, water, and some nutrients to grow, Marinol

manufacture involves numerous time-consuming steps, the efforts of

several companies, and multiple complex chemical processes. Unimed

contracts Norac Industries in Azusa, California to manufacture the

synthetic THC which is then shipped to Roxanne Laboratories in

Columbus, Ohio where it is encapsulated and sent to pharmacies around

the country. Intrigued by the process of synthetically reproducing a

natural psychoactive product, I interviewed an informant at Norac

extensively. Apparently, the basic elements of delta 9

tetra-hydra-cannibidol, marijuana's primary—though by no means

only—active ingredient, are derived from the compounds tempere

olivitol and paramenthide (PMD). Norac used to purchase olivitol from

Aldrich Labs, but opted to manufacture it themselves in order to save

money. Norac also used to acquire its other raw material, PMD, from

the German lab Ferminic until frequent explosions caused the company

to halt its PMD production. As of 1993, Norac was forced to produce

its own PMD as well. My informant at Norac explained that they too

have experienced explosions due to the highly unstable characteristics

of PMD, but that the volatile compound currently remains largely in

check. The final synthetic THC solution is approximately 98% pure—a

very high concentration compared to that of the cannabis plant, where

THC amounts normally range between 2% and 10%. Since the Orphan Drug

Status for chemotherapy related nausea expired in 1992, I assumed that

other pharmaceutical companies would attempt to infiltrate Marinol's

markets by producing their own versions of synthetic THC. However, my

source at Norac explained that manufacturing THC is a very expensive,

and thus cost-prohibitive, process. The encapsulation procedure also

requires elaborate and expensive chemical processes that use fairly

common preservatives like methylparaben and propylparaben, as well the

whitening agent titanium dioxide, in a sesame oil capsule. The once

unstable synthetic THC compound now has a long shelf-life in the

sesame oil capsules, although all Marinol products are marked with 6

month expiration dates for added safety. Obviously, reproducing

marijuana's therapeutic effects is no easy task, even with today's

most cutting-edge technologies.

 

Since marijuana and Marinol derived from two entirely different

processes (arguably polar opposites), it seems ironic that Marinol

functions as the only legal alternative to marijuana. Considering

their vastly disparate backgrounds, one can logically conclude that

the therapeutic effects must also differ, but according to many

researchers, the results are essentially the same. In fact, the two

drugs' reported side effects are quite similar, although advocates of

medical marijuana claim that Marinol produces more damaging side

effects. Marinol proponents argue, in turn, that marijuana possesses

more undocumented side effects. Upon analyzing a 1995 product brochure

explaining the benefits and possible effects of using Marinol, I

discovered new information that completely undermined my original

assumptions about Marinol.

 

Considering that Marinol is legal while marijuana is not, I assumed

that Marinol would have far fewer side effects than those attributed

to marijuana; however, this assumption and numerous others proved

quite inaccurate. According to the 1995 product insert, Marinol may be

habit forming, a condition commonly linked with cannabis. In addition,

Marinol may cause the following side effects: feeling " high " (i.e.

easy laughing, elation, and heightened awareness), abdominal pain,

dizziness, confusion, depression, nightmares, speech difficulties,

chills, sweating, and even psychological and physiological dependence.

Some of these potential side effects seem quite serious for any legal

pharmaceutical. Even less comforting, the 1992 product insert explains

what to do in case of accidental overdose:

 

A potentially serious oral ingestion, if recent, should be managed

with gut decontamination. In unconscious patients with a secure

airway, instill activated charcoal via a nosagastric tube. A saline

cathartic or sorbitol may be added to the first dose of activated

charcoal. Patients experiencing depressive, hallucinatory or psychotic

reactions should be placed in a quiet area and offered reassurance.

 

Considering the enormous sales of Marinol, patients must desperately

need medication to risk such potentially severe reactions. While

marijuana may produce such side effects as: euphoria, laughter,

anxiety, dry mouth, red eyes, sleepiness, clumsiness, increased

appetite; these conditions pale in comparison to those attributed to

Marinol. A 1985 edition of The Medical Letter listed the side effects

of Marinol as " disorientation, depression, paranoia, hallucinations,

and manic psychosis. " A 1986 Marinol product insert explains that even

patients on low doses of the drug may experience " a full-blown picture

of psychosis; " this reference was conspicuously dropped from their

later product inserts. Given the intensity of Marinol's side effects,

marijuana appears less dangerous than its synthetic Schedule II

counterpart.

 

Many patients believe that the much higher THC content in Marinol

produces these more extreme side effects. Robert Randall, a glaucoma

patient who currently receives a legal supply of marijuana from the

government, describes his experiences with Marinol, " It was way too

psychoactive. When I took Marinol, I found it anxiety-provoking and

intense, like I had wandered into a short story by Flannery O'Connor. "

He further explains, " I talked to hundreds of AIDS patients, and only

one preferred Marinol to marijuana. It's not just that marijuana helps

them gain weight—it's that Marinol is so scary. " Dr. Robert Gorter, a

San Francisco AIDS expert, corroborated Randall's anecdotal

conclusions in the Journal of the Physicians Association for AIDS

where he stated, " Again and again patients have testified that they

preferred marijuana above dronabinol [the scientific term for

Marinol]… " Further evidence citing the potential dangers of Marinol

exists in the 1995 Marinol product insert itself, which warns against

giving dronabinol to children and to the elderly (although Unimed is

currently in Phase III testing for approval of Marinol in the

treatment of Alzheimer's patients) because of the drug's " psychoactive

effects. " It seems odd that Marinol supposedly functions better as a

medicine than marijuana, a substance casually consumed by millions of

Americans without such debilitating side effects.

 

Hoping to discover specific patient complaints against Marinol, and

not just potential side effects or anecdotal information, I contacted

the Food and Drug Administration (FDA) for more information on adverse

effects caused by Marinol. I was told that this information was

confidential, and that only by using the Freedom of Information Act

(and enclosing a check for $70) could I attain limited access to this

knowledge, and even then, certain details would remain censored. By

contrast, if I needed information on marijuana's adverse effects, I

could contact hundreds of sources (including elected officials,

rehabilitation centers, law enforcement, internet sites, parent

groups, local libraries, pharmacies, etc.) from whom I could receive a

deluge of free information. Another medical paradox exposing the sharp

contrast between the popular conception of marijuana and Marinol

involves carcinogenic studies. Anti-marijuana government studies had

very tentatively linked marijuana smoke (and not ingested marijuana)

with lung cancer in an unpublished report (although a recent panel of

scientists re-examined that report and found that marijuana was

actually found to prevent malignancies not cause them). Despite the

presence of THC, common to both marijuana and Marinol, no carcinogenic

studies have been performed on Marinol. Culturally, marijuana

continues to face vilification while Marinol enjoys legitimacy and

government backing. Sick people face harsh criminal penalties for

self-medicating with natural THC, while patients using synthetic THC

get insurance coverage and freedom from persecution and prosecution.

The influential role that politics plays in science and medicine can

explain the enormous rift in the cultural perception of these two

essentially similar substances. Only a close examination of political

influence in medicine can explain popular culture's polarity regarding

marijuana and Marinol perception.

 

POLITICS AND MEDICINE

 

Medicine may seem like a domain completely outside of political

debate, but the information garnered in this examination thus far

suggests otherwise. Scientists and medical researchers compete for

funding from government agencies and private business. If the

government has strong anti-marijuana policies, then logically, the

studies which they fund will attempt to further indict marijuana. John

Falk, a researcher from Rutgers University, explains,

 

Policy can be a closed, self-validating system, almost impervious to

scientific facts: While science considers new facts and alternative

explanations and rejects them on logical or empirical grounds, policy

can be dismissive of facts and alternatives simply on the grounds that

they are distasteful.

 

Governments regularly accept or reject scientific studies based on

their relation to desired policies. For example, President Richard

Nixon hand-picked a federal commission to determine an improved

marijuana policy. After several years of research, the commission

concluded that decriminalization of marijuana was the best drug policy

option. Since this result was intolerable to the drug warrior Nixon,

he ignored the recommendations of his own counsel. Another example of

government ignoring science involves the Compassionate Investigative

New Drug (IND) program which supplied government grown medical

marijuana to a handful of patients from 1978 until 1992. Due to a

rising number of applications from AIDS patients, President George

Bush terminated the program, not because it harmed people or led to

increased drug abuse, but because he wanted a " zero-tolerance " stance

towards all illegal substances in his War on Drugs, and because the

legal pot might " send the wrong message " to children. Only eight

patients (known as the Acapulco Eight) continue to receive medication

under that program thanks to a hard-fought grandfather clause; the

rest have already died.

 

The terminology spouted by politicians in the War on Drugs further

illuminates the often subtle (or not so subtle) relationship between

politics and medicine. From the popular phrase of the 1930s referring

to marijuana as the " assassin of youth, " to contemporary use of such

militaristic phrases as " war on drugs " or " combating the drug menace, "

such highly dramatic linguistic manipulation reveals an underlying

attempt to influence the uncritical American public. In the 1930s,

marijuana intoxication was popularly referred to as " reefer madness, "

implying insanity, unpredictability, and hyperactivity. Today, the

terminology for that same state of intoxication has shifted 180

degrees to " amotivational syndrome, " implying indolence and

slovenliness. The complete inversion of negative accusations maligning

marijuana only reveal how arbitrary and unfounded the indictments

really are. Continuing the semantic war after the passage of

Proposition 215 in California and Proposition 200 in Arizona, federal

bureaucrats, including " Drug Czar " Barry McCaffrey, quickly claimed

that voters were " duped " by wealthy " potheads " promoting " Cheech and

Chong medicine. " Anti-marijuana rhetoric continued streaming from the

lips of politicians and from newspaper presses despite the majority

approval of both propositions. Like medical authority, Stanton Peele,

remarked, " To put it simply, saying bad things about drugs is never

questioned, and disconfirming information never requires revision of

original claims. " Medical issues lay dormant under the political cloud

raised by vociferous opponents of marijuana, while advocates only

prayed that a strong grassroots effort would influence public opinion

to the extent of changing policy. Even though voters approved both

propositions, the Clinton administration announced that physicians

prescribing marijuana were still subject to criminal punishment,

proving that neither medical arguments, nor voter approval, can change

an entrenched government policy.

 

During these medical marijuana debates, Marinol remained elusive, yet

ever-present. Newspapers and magazines loosely referred to dronabinol

as a legal alternative to smoked marijuana, although very few

reporters commented on Marinol's numerous side effects, or on patient

claims that marijuana worked much better than synthetic THC. Unimed's

National Sales Director, Brian Jennings, explained to me in a

telephone interview that Unimed knew about the propositions before

hand but chose not to officially participate, because they felt

medicine should remain outside of the political sphere. Jennings

stated, " It is not for us to determine what should be medicine and

what shouldn't. " When asked if Unimed had received thank you mail from

recovering patients, Jennings exuberantly responded, " Yes! But you

won't hear that on the media, " meaning positive representations of

Marinol allegedly pale in comparison to those of marijuana, a favorite

topic of journalists. Based on this telephone interview, it seemed as

if Unimed was sincerely interested in helping sick people, and not in

fanning the flames of marijuana hysteria, or simply in making larger

and larger profits. However, after carefully reading their roughly 200

page investor portfolio, only one mention was made of assisting sick

people in need. The bulk of their literature focused on profits,

plans, and bottom lines.

 

To guarantee that they lost no precious profits to decriminalized

marijuana, Unimed hired a top public relations firm during the West

Coast medical marijuana debates. This publicity company sent news

releases to every major newspaper in America explaining the existence

of Marinol and its benefits over marijuana. Although Unimed's National

Sales Director informed me that his company preferred not to

participate in the debates, he neglected to mention that they had

hired someone to participate for them. In these press releases, much

of the information was exactly accurate; however, several statements

were simply untrue. Unimed claimed that " patients using Marinol do not

experience a `high' and are thus able to work and perform normal daily

functions unimpaired. " This claim directly contradicts Marinol's 1995

product insert which explains that " dose-related `high' has been

reported by patients receiving Marinol… " Evidently, Unimed hoped to

draw a clear distinction between Marinol and marijuana, and although

numerous differences already exist, they chose to create false ones,

hoping to capitalize on the further maligning of cannabis. Other

examples of Unimed's attempt to infiltrate mainstream media with

marijuana lies include the blatantly false claim that Marinol pills

are taken only once per day, while marijuana must be smoked several

times per day, thereby causing inconvenience, lung damage, and other

more serious complications. The user directions on Marinol's product

insert specifically state that two capsules per day are required as a

starting dosage, after which more daily capsules are suggested. In

addition, medical marijuana consumers self-medicate as needed; which,

for patients using cannabis to prevent the nausea associated with

chemotherapy, equals about one cigarette every few weeks.

 

Although the Unimed press release cites the absence of controlled

clinical studies proving marijuana's safety and effectiveness, such

studies remain impossible to conduct because of NIDA's refusal to

grant cannabis to researchers who support medical marijuana. Dr.

Donald Abrams of the San Francisco Community Consortium gained

authorization from the FDA and the National Institute of Health (NIH)

to study marijuana and Marinol's effects in AIDS cachexia.

Unfortunately, NIDA denied him access to their pot supplies. They

claimed that if they granted marijuana to Dr. Abrams then they might

become deluged by other research proposals requiring marijuana. This

bureaucratic entanglement represents one aspect of drug policy in

popular culture; however, to fully explore the scope of this issue,

one must examine the debate through more mainstream media sources.

 

Americans consistently support medical marijuana in polls, but that

majority seems to disappear in the public sphere. While Rolling Stone

magazine contends that the war on marijuana exists for political

purposes completely outside of medical considerations, the New

Republic argues that Proposition 215 serves as a front for drug

legalization advocates and that medical cannabis clubs are populated

by a " sorry lot of smokers who are not sick. " This disparity in public

opinion mirrors itself regularly throughout popular American culture.

For example, a Los Angeles Times Column Right author, Charles

Krauthammer, angrily exclaimed, " The cannabis clubs are a sham, an

invitation to every teenager with a hangnail to come in and zone out. "

In contrast, the Los Angeles gay magazine 4Front ran a cover article

titled, " Clinton/McCaffery Declare War on People With AIDS!!!, "

wherein they vehemently declare, " This two bit General [McCaffery] has

declared war on people with AIDS. It's outrageous that the President

who `didn't inhale' is denying sick and dying people the relief that

medical marijuana provides. "

 

Further examples of the public polarizing around this issue abound

throughout American pop culture. For instance, Newsweek magazine

claimed that, " The problem with Marinol is that is doesn't always work

as well as smoking marijuana. " , while my local newspaper, The Daily

Breeze, printed an article claiming that, " With smoked pot, the dosage

varies substantially, so it is usually a lot easier to prescribe a

pill. " Gary Trudeau, creator and cartoonist of Doonesbury, also joined

the cultural melee by creating a Sunday comic strip about Proposition

215. When the main character, Zonker Harris, learns about California

Attorney General Dan Lungren's massive raid on the San Francisco

Cannabis Buyer's Club, he incredulously asks, " What country are we

living in? Germany? Russia? Idaho? " Lungren must have realized that a

major act of aggression against a medical supplier to severely ill

patients would not earn him much popularity; however, Trudeau's biting

comic strip angered him so much that he demanded Doonesbury's

distributor, Universal Press Syndicate, to promptly remove the comic.

Much to his chagrin, they refused.

 

Even advice columnist Ann Landers joined in the cannabis debate by

stating, " I do believe that medical marijuana should be available for

medical needs, since this serves a humane purpose. " Although other

contributors to her column challenged her position, citing marijuana's

alleged " gateway " effect leading to harder drugs. One respondent from

La Grange, Illinois, sarcastically commented, " [the] idea of releasing

marijuana prisoners is great, but…doesn't go far enough. Let's release

all of the murderers too…Free the rapists. Then, put all the child

molesters back on the streets. " Clearly, passion underlines all

opinions, but consensus seems hopeless.

 

The medical marijuana versus Marinol debate rages among medical

practitioners as well. After DEA Associate Chief Counsel Steven Stone

suggested that only a fringe group of oncologists accepted marijuana

as an antiemetic, two Harvard scholars conducted a poll to verify that

statement, and discovered a vastly different reality. They sent

detailed questionnaires to over 2,000 registered oncologists, and

found that 44% of respondents think that marijuana is safe and

efficacious, and would prescribe it regardless of legality. Nearly 90%

of respondents accepted the medical use of Marinol, thereby leaving

dozens of doctors who reject its use. Interestingly, respondents who

graduated from medical school during the " Just Say No " Reagan era were

significantly less likely to favor medical marijuana, while those who

graduated in the 50s, 60s, and 70s had higher rates of approval. Based

on these findings, the study's authors concluded that smoked marijuana

remains superior to oral THC because:

 

The bioavailability of THC absorbed through the lungs has been shown

to be more reliable than that of THC absorbed through the

gastrointestinal tract, smoking offers patients the opportunity to

self-titrate dosages to realize therapeutic levels with a minimum of

side effects, and there are active agents in the crude marijuana that

are absent from pure synthetic THC.

 

The two essential points that greater bodily absorption and greater

self-medicating control are possible with medical marijuana use (and

not Marinol use) cannot even be denied by much hyped anti-marijuana

studies, like those of the notorious Dr. Gabriel Nahas. The argument

that marijuana contains more than one active ingredient, thereby

implying that Marinol cannot possibly replicate all of marijuana's

medical effects, finds favor among many physicians and physicians'

groups. Arthur Leccese of Gambier College further explains this

sentiment, " Consideration of the basic pharmacology of marijuana

reveals the error of public policy that denied therapeutic benefit to

those who might profit from inhalation, or oral consumption of more

than one psychoactive component of the crude marijuana plant. " Since

marijuana is composed of hundreds of compounds, it seems arbitrary for

U.S. medical policy to only accept one of those compounds as medically

valid. Many other respected organizations share this disapproval of

current U.S. drug policy. For example, the following medical groups

and journals favor medical marijuana over Marinol: National Academy of

Sciences, American Public Health Association, California Academy of

Family Physicians, San Francisco Medical Society, Federation of

American Scientists, Psychopharmacology, and most recently, the New

England Journal of Medicine. Although these organizations normally

carry tremendous influence, the current government drug policy

disfavors medical marijuana to such an extent, that even these

organizations lose their voice.

 

With prominent medical organizations and journals being ignored by

federal policy makers, and with many mainstream magazines and

newspapers creating a general uproar over the medical marijuana issue,

the recent furor in America sparked by the passage of Propositions 200

and 215 truly highlights the relationship between science and

politics. Dennis Peron, the driving force behind Proposition 215,

wonders, " What in the world is a retired Army general doing telling

doctors what to do? " Regardless of their position on synthetic vs.

natural THC, most doctors agree that government does not belong in

their medical affairs. Some oncologists find it extremely hypocritical

that someone can acquire terminal cancer by smoking cigarettes, yet

they cannot medicate themselves with marijuana. Cancer specialist,

Elizabeth Lowenthal, writes about this paradox in the Journal of the

American Medical Association,

 

It is ironic to inform cancer patients that they cannot partake of

marijuana to relieve their metastatic lung cancer associated anorexia

and cachexia acquired from years of partaking in `the only consumer

product sold legally in the United States that is unequivocally

carcinogenic when used as directed.'

 

Prominent medical marijuana expert Lester Grinspoon, author of

Marihuana: The Forbidden Medicine, illuminates another paradox in U.S.

drug policy, stating that, " Cocaine and morphine, for example, have

always been available as prescription drugs, but no one believes that

availability is a significant cause of illicit use. " Both cocaine and

morphine have maintained Schedule II classification since the

Controlled Substances Act began in 1970. Marinol also rests in

Schedule II, although Brian Jennings, National Sales Director for

Unimed, informed me, " I think it is well known that we are trying to

place Marinol in Schedule III. " By dropping down to Schedule III,

Unimed can sell Marinol without completing the mandatory DEA paperwork

required of all Schedule II drugs. In essence, it would remove another

level of bureaucratic interference from sales, and it would make their

product seem less potentially harmful. All of these sorts of medical,

governmental, theoretical, policy-based, complex issues sit squarely

in the borderlands shared between science and politics.

 

Having extensively analyzed the Marinol versus marijuana debate from a

popular culture perspective, and within a historical and theoretical

context, it is now apparent just how differently America treats two

essentially similar substances. Marinol enjoys cultural and medical

legitimacy from society, as well as tax breaks and open market

privileges from the government. Marijuana users still risk

incarceration and social marginalization, while simultaneously

suffering from debilitating illnesses. Despite the wealth of

scientific information and the bevy of organizational support

illustrating marijuana's numerous medical benefits, the federal

government chooses to validate the inferior Marinol medication, and to

continue its war on drugs and drug users. Considering America's

history of vilifying marijuana, and given the American penchant to

promote pharmaceuticals over all other medicines, the current drug

policy should not shock us, but it should disappoint us.