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Position Papers and Speeches


There are No Compelling Medical Reasons to Prescribe Marijuana or Heroin to Sick People

Source: US Drug Enforcement Agency

It is often suggested that, even if currently controlled substances are not made available to the general public, some of them, particularly marijuana and heroin could be used to relieve suffering.

Participants in the Anti-Legalization Forum acknowledged that arguments urging the medical use of marijuana are often used as an entree into the legalization debate. Medical use arguments can garner public support because they seem harmless enough to the well-intended audience. The experts agreed that these issues are peripheral to the real issue.

Medical professionals best debate the medical pros and cons of prescribing marijuana and heroin to sick people. It should be kept in mind, however, that the American Medical Association, the American Glaucoma Society, the American Academy of Ophthalmology, the International Federation of Multiple Sclerosis Societies, and the American Cancer Society have rejected marijuana as medicine.

Not one American health association accepts marijuana as medicine. Statements issued by these organizations express concern over the harmful effects of the drugs and over the lack of solid research demonstrating that they might do more good than harm.

In January 1997, the Office of National Drug Control Policy (ONDCP) requested that the Institute of Medicine (IOM) conduct a review of the scientific evidence for assessing the potential health benefits and risks associated with marijuana and its constituent cannabinonoids. In response to this request Marijuana and Medicine: Assessing the Science Base was released by IOM in March 1998. The following six recommendations were enumerated in the aforementioned document:

  • Recommendation #1 - Research should continue into the physiological effects of synthetic and plant-derived cannabinoids and the natural function of cannabinoids found in the body. Because different cannabinoids appear to have different effects, cannabinoid research should continue, but not be restricted to, effects attributable to THC alone.

     

  • Recommendation #2 Clinical trials of cannabinoid drugs for symptom management should be conducted with the goal of developing rapid-onset, reliable, and safe delivery systems.

     

  • Recommendation #3 Psychological effects of cannabinoids such as anxiety reduction and sedation, which can influence medical benefits, should be evaluated in clinical trails.

     

  • Recommendation # 4 Studies to define the individual health risks of smoking marijuana should be conducted, particularly among populations in which marijuana use is prevalent.

     

  • Recommendation #5 Clinical trials of marijuana use for medical purposes should be conducted under the following limited circumstances: trials should involve only short-term marijuana use (less than six months); should be conducted in patients with conditions for which there is reasonable expectation of efficacy; should be approved by institutional review boards; and should collect data about efficacy.

     

  • Recommendation #6 Short-term use of smoked marijuana (less than six months) for patients with debilitating symptoms (such as intractable pain or vomiting) must meet the following conditions;

     

    • failure of all approved medications to provide relief has been documented;

    • the symptoms can reasonably be expected to be relieved by rapid-onset cannabinoid drugs;

    • such treatment is administered under medical supervision in a manner that allows for assessment of treatment effectiveness; and

    • involve an oversight strategy comparable to an institutional review board process that could provide guidance within 24 hours of a submission by a physician to provide marijuana to a patient for a specified use.

The American Medical Association policy statement on marijuana says, in part, "The AMA believes that cannabis (marijuana) is a dangerous drug and as such is a public health concern." This is not a new position for the AMA; it was adopted in 1969 and reaffirmed in 1994.

The following facts, which confirm the observations of the forum participants, may be used in debates:

  • Under the federal statute known as the Controlled Substances Act (CSA), (please refer to page 24) regulated drugs are divided into categories known as schedules. In Schedule I, for instance, are drugs with a high potential for abuse and no currently accepted medical use in treatment in the United States. At the other end of the spectrum is Schedule V, which is for drugs that have a low potential for abuse and have a currently accepted medical use in treatment in the United States. The Act provides a mechanism for substances to be controlled (added to a schedule), decontrolled (removed from control), or rescheduled (transferred from one schedule to another).

Heroin and marijuana are in Schedule I; cocaine, which is sometimes used as a local anesthetic, is in Schedule II. Much of the debate about medical uses for currently illegal drugs concerns substituting heroin for morphine, supplying marijuana to AIDS and glaucoma patients, or using it to treat side effects of chemotherapy.

  • A petition to put marijuana in a less restrictive schedule of the CSA was rejected by then DEA Administrator John C. Lawn, after public hearings, on December 29, 1989. The United States Court of Appeals ordered further proceedings, however, to clear up what it felt were some ambiguities in the record. Administrator Robert C. Bonner, who succeeded Lawn, complied and issued a new ruling on March 26, 1992. "By any modern scientific standard, marijuana is no medicine," Bonner said. The three-judge appeals court upheld the ruling unanimously on February 18, 1994. "Our review of the record convinces us that the Administrator's findings are supported by substantial evidence," the court said, noting the "testimony of numerous experts that marijuana's medicinal value has never been proven in sound scientific studies."

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