When I graduated from pharmacy school, I voluntarily
pledged to use my knowledge, experience, and skills to
the best of my ability to ensure optimal drug therapy
outcomes for the patients I serve, and to consider the
welfare of humanity with the full realization of the
responsibility entrusted by the public.
To me this means that we, as pharmacists, must step up
and speak the truth when it comes to claims about
“medical” marijuana.
In California in 1996, with the introduction of
Proposition 215, the “Compassionate Use Act,” too many
of us remained quiet about the claims being made by
people attempting to promote marijuana for their own
agendas.
The public approved the use of marijuana for seriously
ill Californians to obtain and use marijuana for medical
purposes, when recommended by a physician who has
determined that the person’s health would benefit from
the use of marijuana in the treatment of cancer,
anorexia, AIDS, chronic pain, glaucoma, arthritis,
migraine, or any illness for which marijuana provides
relief.
There was no need for any placebo-controlled,
randomized, FDA–approved study to be conducted — just
the physician’s recommendation.
The decriminalization of marijuana countered the
Controlled Substance Act of 1970, which categorized
marijuana as a Controlled Substance I, a category
encompassing all drugs characterized by the highest
abuse and addiction potential, withdrawal symptoms (both
physical and psychological), and no accepted medical
use.
Available
alternatives
In 1996, the United States already had dronabinol (Marinol),
approved by FDA since May of 1985. Dronabinol is a
synthetic psychoactive delta-9 tetrahydrocannbinol (THC)
product, free of molds, fungi, pesticides and other
harmful chemicals. FDA approved doses of 2.5 mg, 5 mg,
and 10 mg of THC (dronabinol) to increase appetite,
reduce nausea and vomiting associated with chemotherapy
for patients who have failed other drugs, and to reduce
weight loss due to AIDS wasting. Dronabinol has been
around so long, it is available as a generic product.
Another synthetic cannabinoid, nabilone (Cessamet) was
approved by FDA in December of 1985 for the treatment of
nausea and vomiting induced by cancer chemotherapy.
These agents are also very rarely used.
Several have attributed miraculous benefits to
marijuana. One of the many cannabinols in the plant is a
non-psychoactive component known as cannabidiol (CBD) (aka
“Charlotte’s Web”). As of September 26, 2015, the U.S.
National Institute of Health has approved 15 free
studies investigating CBD activity in connection with
its use in childhood epilepsy syndromes.
In a recent JAMA article (2015; 313(24):
2456-2473), a systematic review and meta-analysis of the
use of cannabinoids for medical purposes, derived from
28 databases, revealed 79 acceptable studies involving
6,462 participants. Potential use of cannabinoids may
include benefits seen in chronic pain (smoked THC and
nabiximols) and spasticity studies (nabiximols, nabilone,
THC/CBD capsules, and dronabinol).
There is evidence of low quality seen in connection with
chemotherapy nausea and vomiting (dronabinol, nabiximols),
weight gain in HIV infection (dronabinol), sleep
disorders (nabilone, nabiximols), and Tourette syndrome
(THC capsules).
Adverse effects were common and include balance
problems, confusion, dizziness, disorientation, dry
mouth, euphoria, drowsiness, fatigue, hallucination,
nausea, somnolence, and vomiting.
Clearly better randomized controlled studies are needed
to determine which cannabinoids work the best and in
which doses.
Newer agents
In 1991, with the release on ondansetron (Zofran), a new
class of drugs, the serotonin (5-HT3) receptor
antagonists, helped revolutionize the treatment of
nausea and vomiting caused by cancer chemotherapy,
radiation therapy, surgery, and gastroenteritis.
In 1995, FDA approved the protease inhibitor
antiretrovirals [saquinavir (Invirase) and ritonavir (Norvir)],
and the dire treatment of AIDS patients changed
forever.
Subsequently FDA has approved other drug classes,
including the attachment and entry inhibitors, and
integrase inhibitors.
Duped
The public has been duped by individuals whose main goal
is to promote the legalization of marijuana.
In an interview provided to the Emory Wheel in
February 1979, Keith Stoup, legal counsel for the
National Organization for the Reform of Marijuana Laws (NORML),
was quoted as saying, “We will use [medical marijuana]
as a red herring, to give marijuana a good name.”
In 2009, Allen St Pierre, NORML Director, stated to CNN
that “in California, marijuana has been de facto legalized
under the guise of medical marijuana.”
The numbers speak
Since 1996, more than 23 states has approved marijuana
for “medical” purposes, and four states (Colorado,
Washington, Oregon, and Alaska) and Washington, D.C.,
have allowed its recreational use, with taxation. To
date, this social experiment has met with devastating
consequences.
The following is what has occurred in Colorado since
legalization:
• Increased hospitalizations related to marijuana
(11,439 in 2014 compared to 2,539 in 2000).
• Increased homelessness and crime (property and violent
crime in Denver up 5% over past 5 years since
commercialization).
• 32 butane hash-oil home explosions in 2014 (12
explosions in 2013).
• Suicides and homicides involved with edible products
(containing upwards of 420 mg THC in a single product).
• An increase in ingestions by children 0-5 years old
(from 27 cases in 2005-2009 to 106 cases in 2010-2014)
and ingestions by children 6-14 years old (23 cases in
2005-2009 to 57 cases in 2010-2014).
• Drivers who test positive for marijuana or self-report
using marijuana are more than twice as likely as sober
drivers to be involved in motor vehicle crashes. When
marijuana is combined with alcohol, the risk increases
8-fold.
• Colorado automobile fatalities in cases involving a
driver using marijuana have risen from 47 cases in 2009
(commercialization) to 94 in 2014, with 77% of those
driving under the influence of drugs involving
marijuana.
In 2014, the state of Washington reported an increase in
fatalities connected with drivers affected by active
THC, a rise from 65% (38 of 60 drivers) in 2013 to 85%
(75 of 89 drivers) in 2014, the year Washington
implemented legal marijuana.
Depending on when you graduated from pharmacy school,
you pledged an oath. Whether you will abide by that oath
to stay educated about pharmaceuticals and be a voice
for appropriate drug use is up to you, but the public is
relying on you to hold up your end of your oath.
Phillip Drum is
an inpatient pharmacy consultant in northern California.
July
17, 2012