Marijuana and Medicine

Although many states in the US have been passing laws allowing for medical and even recreational use of cannabis, the substance remains illegal at the federal level.  Specifically, cannabis is classified as a Schedule I substance under the Controlled Substances Act.  This classification is on the basis of three main criteria:

1. The drug or other substance has a high potential for abuse.

2. The drug or other substance has no currently accepted medical use in treatment in the United States.

3. There is a lack of accepted safety for use of the drug or other substance under medical supervision.

Cannabis is classed with Heroin and LSD.  Cocaine, Morphine, and Oxycodone are less tightly regulated Schedule II substances.

As cannabis use persists among teenagers and adults, both legally and illegally, more and more people — especially young people — are seeing first hand that the risks associated with the use of cannabis don’t square properly with the federal government’s treatment of cannabis.  If the government has an interest in protecting young people from the risks of substance abuse, they also have an interest in providing accurate information and formulating sensible policies that don’t simultaneously undermine their own credibility.

Problems with the Current Classification of Cannabis

The Schedule I classification of cannabis has a number of problems.  First, abuse is hard to quantify, and just what patterns of cannabis usage fall under this rubric are not well defined.  Second, there are few quantifiable safety concerns with cannabis:   the substance is profoundly non-toxic, and it is, for all practical purposes, impossible to overdose on cannabis.  This distinguishes cannabis from other Schedule I substances like heroin, and even from legal recreational drugs like alcohol, which is a contributing factor in the death of some 80,000 Americans each year.  Third, the current federal scheduling of cannabis does not take into consideration the accepted medical use of cannabis in a number of states.  The Department of Veterans Affairs has issued a formal directive permitting the clinical use of cannabis in those states where medical uses are approved.  Researchers studying the relative risks and merits of the substance encounter great difficulties acquiring suitable samples to study, and their findings are of limited applicability to the way the substance is routinely consumed in a non-standardized, non-regulated black market.

Perhaps the most dramatic difficulty with the federal government’s position on cannabis is that the US Department of Health and Human Services holds a patent on medical uses of cannabis.  Issued in 2003, US Patent #6630507 is titled “Cannabinoids as antioxidants and neuroprotectants.”  The patent examines a molecule found in cannabis, CBD, though the chemical mechanism the patent identifies should be present in all cannabinoids, including THC.  The patent notes that “cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease and HIV dementia,” and also indicates that cannabinoids offer a unique delivery mechanism due to the facility with which these molecules can cross the blood-brain barrier.

When cannabis was originally listed as a Schedule I substance in 1970, the classification was intended to be provisional, pending the results of an ongoing study.  The National Commission on Marijuana and Drug Abuse issued the study findings in 1972, finding that there “is little proven danger of physical or psychological harm from the experimental or intermittent use of the natural preparations of cannabis.”  Although the study recommended de-criminalizing cannabis and treating use or possession akin to alcohol, President Nixon chose not to implement the Commission’s recommendations, and marijuana has remained a Schedule I substance since.  Although whole-plant marijuana remains a Schedule I substance, the synthetic THC called dronabinol — sold under the brand name Marinol — is classified as a less-restricted Schedule III substance.

Social Attitudes Affecting Cannabis as Medicine

In the United States, a lot of opposition to medical cannabis laws have presumed that such laws are just a “first step” towards outright legalization.  While there is little to suggest such an outcome would be inherently detrimental, there is also ample evidence that supports medical uses of cannabis on the substance’s own merits.

What presents a more profound problem to the public is in part a tacit sociology of medicine that limits and proscribes how individuals view treatment.  Politicians have adopted these cultural attitudes unquestioningly — indeed, the authoritarian personalities of these politicians wouldn’t allow them to ask such questions.  Those who are open to such questions don’t dare assert themselves, despite polling results that show 70-85% of Americans favor significant changes in current federal policy.

Of particular note in this regard is the unexamined notion that medicine has to come in the form of an expensive bitter pill.  The notion that medicine might also be pleasurable is anathema, and that healing might be enjoyable is equally heretical.  Medicine is still penance, disease is sin, the new medical complexes are cathedrals, and doctors are the high priesthood, mediating between this world and the next, serving as both the front line and the last defense against the forces of corruption, decay, and disorder.

We apologize when we call in sick to work, and are stigmatized by our ailments.  Just as the medieval church was one of the largest landlords in Europe, today’s medical industry claims vast swaths of the GDP.  In the US, healthcare spending exceeds the 10% tithe commanded by the medieval church.  The religion analogy is quite complete, and includes the irreligiousness of the most ardent devotees.  Hospitals, gathering together the diseased, are diseased.  They are morally perverse and rotten with wealth.

Data from multiple nations detailing spending on the medical industry as a percentage of GDP

Along with unexamined notions of how medicine fits into our culture, there is another factor promoted by our culture, related to the ideology of Progress.  Progress holds that the future will always bring improvements, that all new technology is better technology, and that what is new must replace what is old.  From within the confines of this ideology of Progress, it seems on the face of things obvious that any new pill is inherently superior to “natural preparations.”  This is, unfortunately, quite difficult to establish with any certainty.

There are easy-to-identify counter-examples where modern medicine has delivered a harmful product: the recall of pills like VIOXX make a big splash in the media, and create the impression that these are exceptions to the general rule that modern medicine routinely delivers improvements.  But these issues have been with medicine for a long time: heroin, for example, was originally invented by the pharmaceutical company Bayer, and marketed as a non-addictive alternative to morphine.

The litany of prescription painkillers marketed since Bayer invented heroin have now surpassed car crashes in the number of annual deaths they cause, accounting for some 90% of all poisonings.  The number killed by these drugs amounts to about ten 9-11’s each year — every year.  Instead of figuring out how to deal with this plague, however, the US throws more and more money at the medical industry, which keeps developing new drugs with serious side effects and abuse potential.  The broader, social implications of this are even more troubling.

The Decline of Western Medicine

Most of modern medicine is unnecessary.  After sanitation and hygiene, antibiotics, analgesics and anesthetics, and vaccines, most of modern medicine is devoted to coping with the side effects of industrialization.   This effect can be seen in diet particularly, but also with respect to such vectors as environmental pollution.  Environmental pollution may take the form of contaminants in the air and water, particulate matter in the air (which causes diseases like asthma), or increased radiation in the environment (due to industrial processes, residues from atmospheric nuclear testing, or because of solar radiation that is increased by a depleted ozone layer in the upper atmosphere).

If he or she lives past the age of 15, the typical hunter-gatherer stands a reasonable chance of remaining healthy and active into their 70’s, with a strong social support network to care for them as they age.  The modern US health care industry really doesn’t do all that much better.  A sizable portion of the modern improvements in life expectancy over what is offered by a hunter-gatherer society come from improved infant mortality, a hygiene problem identified by Ignaz Semmelweis in 1847.  Hand washing is a an extraordinarily cheap and effective medical technology.  Antibiotics, which were developed for around $20,000 of basic research, have saved many more individuals from childhood disease, and increased the range of surgeries that are possible.

As modern medicine grows more expensive, its productivity declines precipitously.  This decline in productivity can be measured in terms of substantive outcomes or in terms of the cost per patent.  Either way, the role of diminishing returns in this field is not adequately addressed in the contemporary discourse.

Most of the big medical breakthroughs of the last 300-500 years were inexpensive.  Everything recent is increasingly expensive and of rapidly declining effectiveness compared to basic innovations like sanitation or antibiotics.  Most modern medicines and medical procedures could be avoided through less expensive means, specifically, through dietary and behavior modification.

The cost of medicine detracts from other public welfare programs, such as nutrition, food security, education, and mass transit, all of which yield a far greater return on investment than modern medicine.

At some point, the moral aspects of modern medicine need to be evaluated in terms of the social cost.  For example: as a percentage of GDP, the US spends three times more money on the healthcare industry than on education.  We know that basic education makes us smarter, better socialized, and better equipped for employment; but most medicine isn’t really making us all that much healthier.

Marijuana and Medicine

Progress makes a raw agricultural commodity like cannabis seem suspect as a medicine, through really, it is modern medicine that should be suspect.  Whereas a typical television commercial for a new pharmaceutical product will often devote more than half its airtime to potential side effects, no similarly funded social initiative exists to teach Americans how to eat properly, or how to prepare nutritious foods.  Nutritious foods or vegetarian diets are routinely mocked by Americans.

Somehow, none of this is a medical problem.  Rather, in the discourse, these are treated as political problem.  So doctors, not being politicians, stay out of politics; and, somehow, proper diet is only of tangential concern to the medical industry, while new drugs of dubious effectiveness are promoted as indispensable innovations.

Somehow health is not a medical issue, only disease warrants attention.  And where medicine and politics do intersect on this issue of cannabis, instead of informed discussion, the public is treated to a wall of silence, or else jokes about hapless stoners.