Always stress that the core issue is protecting seriously ill patients from arrest and jail. It is crucial to avoid getting lost in side arguments. Whenever possible, remind your audience that federal and most state laws subject seriously ill patients to arrest and imprisonment for using marijuana. Most of the following responses can be enhanced by ending with the question, "Should seriously ill patients be arrested and sent to prison for using marijuana with their doctors' approval?"
The key issue is not that patients and advocates are trying to make a "new drug" available. Rather, the goal is to protect from arrest and imprisonment the tens of thousands of patients who are already using marijuana, as well as the doctors who are recommending such use. Always bring the discussion back to the issue of arrest and imprisonment.
Remember: Patients for whom the standard, legal drugs are not safe or effective are left with two terrible choices: (1) continue to suffer, or (2) obtain marijuana illegally and risk suffering such consequences as:
• an insufficient supply of marijuana due to prohibition-inflated prices or scarcity;
• impure, contaminated, or chemically adulterated marijuana purchased from the criminal market; and
• arrests, fines, court costs, property forfeiture, incarceration, probation, and criminal records.
CHALLENGE #1: "There is no reliable evidence that marijuana has medical value. Existing evidence is either anecdotal, unscientific, or not replicated."
Response A: There is abundant scientific evidence that marijuana is a safe, effective medicine for some people. In 1999, the National Academy of Sciences' Institute of Medicine (IOM) reported, "Nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana."1 Regarding marijuana's safety, the IOM also noted, "[E]xcept for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications."2 (The issue of smoking is dealt with in Challenge #27, below.)
Response B: On September 6, 1988, after hearing two years of testimony, the Drug Enforcement Administration's chief administrative law judge, Francis Young, ruled: "Marijuana, in its natural form, is one of the safest therapeutically active substances known ... It would be unreasonable, arbitrary, and capricious for DEA to continue to stand between those sufferers and the benefits of this substance."3 Indeed, a 1997 review found more than 70 modern studies published in peer-reviewed marijuana policy project • p.o. box 77492 • capitol hill • washington, d.c. 20013 tel: 202-462-5747 • fax: 202-232-0442 • [email protected] • http://www.mpp.org
journals or by government agencies verifying that marijuana has medical value.4 Many more have appeared since then.
Response C: In a detailed review published in May 2003, The Lancet Neurology evaluated current knowledge regarding marijuana's active components, called cannabinoids. This esteemed, peer-reviewed medical journal stated, "Cannabinoids inhibit pain in virtually every experimental pain paradigm. ... That we are only just beginning to appreciate the huge therapeutic potential of this family of compounds is clear ... some people suggest that cannabis [marijuana] could be the 'aspirin of the 21st century'"5
CHALLENGE #2: "Other drugs work better than marijuana. We should not make marijuana medically available unless it is shown to be the most effective drug for treating a particular condition."
Response A: No other drugs are required to be the most effective before they are made medically available — just effective (as well as safe enough). The reason is that different people respond differently to different medicines. The most effective drug for one person might not work at all for another person. That is why there are different drugs on the market to treat the same ailment.
Response B: Treatment decisions should be made in doctors' offices, not by federal bureaucrats. Doctors need to have numerous substances available in their therapeutic arsenals in order to meet the needs of a variety of patients. That's why the Physicians'Desk Reference comprises 3,000 pages of prescription drugs, rather than just one drug per symptom.
Response C: Consider all of the over-the-counter pain medications: aspirin, acetaminophen, ibuprofen, etc. We do not just determine which is ""best" and then ban all of the rest. Because patients are different, doctors must have the freedom to choose what works best for a particular patient. Why use a double standard for marijuana?
Response D: The 1999 Institute of Medicine report explained:
• "Although some medications are more effective than marijuana for these problems, they are not equally effective in all patients."6
• [T]here will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for certain conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting"7
• "The critical issue is not whether marijuana or cannabinoid drugs might be superior to the new drugs, but whether some group of patients might obtain added or better relief from marijuana or cannabinoid drugs"8
CHALLENGE #3: "Why is marijuana needed when it is already available in pill form?"
Response A: THC, marijuana's main psychoactive ingredient, is sold in pill form as the prescription drug Marinol (with the generic name "dronabinol"). But people who use the pill find that it commonly takes an hour or more to work, while vaporized or smoked marijuana takes effect almost instantaneously. They also find that the dose of THC they have absorbed (in the pill form) is often either too much or too little. Avram Goldstein, M.D., one member of an expert panel convened by the National Institutes of Health in 1997 to review the scientific data on medical marijuana, explained during the group's discussion on February 20, 1997: (1) "[T]he bioavailability is generally very good by the smoked route, and generally very predictable, whereas bioavailability by the oral route [pills] is both not good and not predictable in general," and (2) "[B]y the smoking route, the person can self-regulate or titrate the dosage."9 The Lancet Neurology came to the same conclusion in May 2003, stating, "Oral administration is probably the least satisfactory route for cannabis."10
Response B: The price of the pill is 10-20 times that of the price of naturally grown marijuana. In an era of rapidly rising medical costs, we should not prevent people from accessing the most economical alternatives.
Response C: As Mark Kris, M.D., one member of an expert panel convened by the National Institutes of Health in 1997 to review the scientific data on medical marijuana, explained during the group's discussion on February 20, 1997: "[T]he last thing that [patients] want is a pill when they are already nauseated or are in the act of throwing up."11
Response D: Marijuana contains at least 60 active cannabinoids in addition to THC.12 Many of these compounds are believed to interact synergistically to produce therapeutic effects that THC alone does not. For example, cannabidiol seems to be primarily responsible for controlling spasticity, and it also moderates THC's effects so patients are less likely to get excessively "high."
Response E: Thousands of patients continue to break the law to obtain marijuana, even though they could legally use the THC pill. Why would they risk arrest and prison to use something that doesn't work?
CHALLENGE #4: "Why not isolate the other useful cannabinoids and make them available in a pure, synthetic form?"
Response A: Marijuana contains at least 60 naturally occurring cannabinoids. While spending time and money testing and producing pharmaceutical versions of these chemicals may someday produce useful drugs, it does nothing to help patients now. As the Institute of Medicine noted in 1999, "[I]t will likely be many years before a safe and effective cannabinoid delivery system, such as an inhaler, is available for patients. In the meantime there are patients with debilitating symptoms for whom smoked marijuana might provide relief."13
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