Another Domino Falls

The American Medical Association this week adopted a report from the Council on Science and Public Health that encourages the Federal government to reclassify marijuana away from a Schedule I drug. Schedule I drugs, by definition, have no medical value, and now even the more conservative AMA is recognizing that marijuana does not belong in that category. The full report is here.

The AMA also concluded that more research should be done and that the current body of evidence doesn’t meet the standard for FDA approval (Bruce Mirken discusses that in more detail here), but they also rejected an amendment that would have added that doctors shouldn’t recommend smoked marijuana. The topic of smoked marijuana is largely an irrelevant distraction, considering that alternative forms of ingesting the drug, such as vaporizing, are readily available to anyone who’s concerned about the side effects of smoking it.

Kudos to local medical marijuana expert Dr. Sunil Aggarwal, who played a role in reviewing the CSAPH paper and has long been pushing the AMA to recognize the research being done on cannabinoids and the endocannabinoid system. It’s important to remember that when marijuana was first made illegal in 1937, it was an AMA representative who argued against it because doctors even then were concerned that a plant that was safe and had potential as medicine should not be restricted by the Federal government.

Comments

  1. 1

    X spews:

    It’s disgusting that we aren’t legalizing it and instead are going down this hypocritical “medical marijuana” path. I do not support medical marijuana, I support legalization only.

    Using “medical marijuana” as the path toward “decriminalization” is a losing proposal. In the end, stoners won’t be normal members of society (like their nightly beer-swilling peers), they will be disabled people who depend on “medicine.”

    “Medical marijuana” is not going to change the troubling situation that police officers must be able to say they have not smoke marijuana in X years.

    “Medical marijuana” is a stupid, self-imposed, “I’m not OK” label for stoners.

    Oh, and I do realize that 1% of card-holders actually receive a medical benefit from smoking, and believe me, I suppose 99% of card-holders are merely stoners with a card.

  2. 4

    X'ad spews:

    Regardless of putative health benefits, I know xillions of people who are addicted to ethanol, and none (or fewer) who are addicted to cannabis.

    Hardly makes sense to me to dispense ethanol in grocery stores and prohibit cannabis upon pain of excommunication.

    Full disclosure: I use neither.

  3. 5

    spews:

    The amendment he says was rejected, read:

    “smoking is an inherently unsafe delivery method for any therapeutic agent, and therefore smoked marijuana should not be recommended for medical use.”

    This remains sound policy, even if the grammatical construction is illogical.

    If Lee, Sunnil and other potheads would just be consistent with science, they would be a LOT more effective in getting rid other inane laws about wicked weed.

    As for Sunnil, the medical student Lee keeps touting as an expert, his self promotion as an expert in Naturopathy and Marijuana will be a lot more impressive if and when he completes his training. In the meantime, a PhD in Geography is hardly the credential most folks should care about in deciding how to enjoy THC.

  4. 6

    spews:

    By the way … these are the forms of THDC that any scientists can buy NIW for research use:

    (−)-Δ8-Tetrahydrocannabinol solution (1)
    Synonym: Δ6-Tetrahydrocannabinol
    Empirical Formula (Hill Notation): C21H30O2
    Formula Weight: 314.46
    CAS Number: 5957-75-5
    T2511 ethanol solution (Sigma) pricing
    (−)-Δ9-Tetrahydrocannabinol solution (4)
    Synonym: Δ1-Tetrahydrocannabinol, Δ9-THC
    Empirical Formula (Hill Notation): C21H30O2
    Formula Weight: 314.46
    CAS Number: 1972-08-3
    56296 drug standard, 1 mg/mL in ethanol, ≥97% (HPLC) (Fluka) pricing
    91613 drug standard, 10 mg/mL in ethanol, ≥97.0% (HPLC) (Fluka) pricing
    T2386 ethanol solution (Sigma) pricing
    T4764 drug standard, 1.0 mg/mL±5% in methanol (Fluka) pricing
    11-Nor-Δ8-tetrahydrocannabinol-9-carboxylic acid (1)
    Synonym: Δ6-Tetrahydrocannabinol-7-oic acid, 9-Carboxy-11-nor-Δ8-tetrahydrocannabinol
    Empirical Formula (Hill Notation): C21H28O4
    Formula Weight: 344.44
    CAS Number: 39690-06-7
    N4641 vacuum-dried powder (Sigma) pricing
    Anti-Wiskott-Aldrich Syndrome/WASP antibody produced in goat (1)
    Synonym: Anti-IMD2, Anti-THC, Anti-Thrombocytopenia 1 (X-linked), Anti-WAS
    SAB2501113 affinity isolated antibody, buffered aqueous solution (Sigma) New pricing
    Monoclonal Anti-WAS antibody produced in mouse (1)
    Synonym: Anti-IMD2, Anti-THC, Anti-WASP, Anti-Wiskott-Aldrich syndrome (eczema-thrombocytopenia)
    WH0007454M5 clone 3H5, purified immunoglobulin, buffered aqueous solution (Sigma) pricing
    11-Hydroxy-Δ9-tetrahydrocannabinol (1)
    Synonym: 7-Hydroxy-Δ1-tetrahydrocannabinol
    Empirical Formula (Hill Notation): C21H30O3
    Formula Weight: 330.46
    CAS Number: 36557-05-8
    H5019 vacuum-dried powder (Sigma) pricing
    Air, Zero (THC <1ppm) (4)
    501212 aerosol can of 4 L (Supelco) pricing
    details (Supelco) pricing
    501220 cylinder of 14 L (Supelco) pricing
    501239 cylinder of 48 L (Supelco) pricing
    JWH-133 (1)
    Synonym: 3-(1,1-Dimethylbutyl)-1-deoxy-Δ8-THC, 3-(1,1-Dimethylbutyl)-1-deoxy-Δ8-tetrahydrocannabinol
    Empirical Formula (Hill Notation): C22H32O
    Formula Weight: 312.49
    CAS Number: 259869-55-1
    J2753 solid (Sigma) pricing
    Cannabinol (1)
    Synonym: CBN
    Empirical Formula (Hill Notation): C21H26O2
    Formula Weight: 310.43
    CAS Number: 521-35-7
    C6888 (Fluka) pricing
    Cannabinol solution (1)
    Empirical Formula (Hill Notation): C21H26O2
    Formula Weight: 310.43
    CAS Number: 521-35-7
    C6520 drug standard, 1.0 mg/mL±5% in methanol, ≥98% (Fluka) pricing
    Δ9-Tetrahydrocannabinol-d3 (1)
    Synonym: Δ1-Tetrahydrocannabinol-d3, 6α,7,8,10α-Tetrahydro-6,6,9-trimethyl-3-(pentyl-5,5,5-d3)-6H-dibenzo(b,d)pyran-1-ol
    Empirical Formula (Hill Notation): C21H27D3O2
    Formula Weight: 317.48
    CAS Number: 81586-39-2
    T4406 ethanol solution (Sigma) pricing
    Sigma Pseudo™ Narcotic Scent Marijuana formulation (1)
    P7309 (Fluka) pricin

  5. 8

    spews:

    As for research funding and Sunnil ..

    Lee gives the flase impression that Sunnil is an established expert and that the needs to overcome the law to do his science.

    Just so folks here know the facts …

    Sunnil, is completing the MD part of his doctorate. After that he will need to choose options for both clinical and research traijning, a process that can easily add ten years to his student life.

    Sunil certainly could decide to pursue training that would enable him to compete for NIH funds.
    What Lee and his ilk may not like is that NIH funds science to find new ways to understand and treat disease, no to promote some drug because folks like to use it or even because there has been a prejudice against the drug.

    Aside from marijuana, Sunnil promotes a set of ideas much like those of the Bastyr School. These ideas are that “natural” .. that usually means impure .. mixes of compounds are better than “artificial” .. that is chemically opure drugs. As state in Lee’s link, the FDA does not allow a drug company to market therapeutics that do not have pure content.

    If Sunnil chooses a research career with cannabis as his focus, he will need to “sell” his peers on the idea that there is reason to believe that this plant has ingredients that disrupt existing ideas abut how diseases arise or at least would improve our chances of treatment.

  6. 9

    spews:

    @7 X’ad

    Sunnil will get a normal MD fvorm the UW.

    However, he favors ideas about “natural drugs” that are the same as those underlying Bastyr.

    This creates an odd legal issue. Bastyr’s NDs are not allowed to prescribe most things that can be proven to have a pharmacological effect. This effectively means that thyey focus on natural compounds that have been proven NIOT to be harmful.

    Once he has his degree, Sunnil will be regulated in the same way, except that he will be free to use both the (hopefully) “natural” products as well as the approved drugs.

  7. 10

    Politically Incorrect spews:

    Just legalize marijuana, regulate and tax it, then call it a day. It’s long past time for Prohibition to end.

  8. 11

    A Nonymous spews:

    The AMA report on the Use of Cannabis for Medical Purposes which Lee linked actually addresses SJ’s objections about plant medicine:

    “In 2004, the FDA issued a Guidance for Industry Botanical Drug Products monograph. This document provides the pathway by which botanical agents can be approved as prescription drugs. The crude botanical substance can become a “botanical drug substance” through processes of extraction, blending, addition of excipients, formulation, and packaging in a defined manner. Particular attention is devoted to product composition because botanicals are complex mixtures of chemical/structural components. Similar to conventional products, a botanical drug substance must undergo animal toxicity studies, and demonstrate its safety and efficacy in randomized, double blind, placebo-controlled trials. Additional pharmacologic and toxicologic studies are required if a non-oral route (e.g., inhalation) of administration is contemplated. If the substance is intended to
    treat chronic conditions, 6 to 12 months in long-term safety extension studies is considered sufficient.”

    Way to think about plant medicine, Food and Drug Administrators!

  9. 12

    spews:

    The AMA report on the Use of Cannabis for Medical Purposes which Lee linked actually addresses SJ’s objections about plant medicine:

    “In 2004, the FDA issued a Guidance for Industry Botanical Drug Products monograph. This document provides the pathway by which botanical agents can be approved as prescription drugs. The crude botanical substance can become a “botanical drug substance” through processes of extraction, blending, addition of excipients, formulation, and packaging in a defined manner. Particular attention is devoted to product composition because botanicals are complex mixtures of chemical/structural components. Similar to conventional products, a botanical drug substance must undergo animal toxicity studies, and demonstrate its safety and efficacy in randomized, double blind, placebo-controlled trials. Additional pharmacologic and toxicologic studies are required if a non-oral route (e.g., inhalation) of administration is contemplated. If the substance is intended to
    treat chronic conditions, 6 to 12 months in long-term safety extension studies is considered sufficient.”

    Way to think about plant medicine, Food and Drug Administrators!

  10. 13

    spews:

    @5
    If Lee, Sunnil and other potheads would just be consistent with science, they would be a LOT more effective in getting rid other inane laws about wicked weed.

    If you can point out a single instance where either Sunil or I have been inconsistent with science, maybe someone will start taking you seriously.

  11. 14

    spews:

    @3
    someday Lee will worry about facts.

    Maybe someday you can point out a single instance where I’ve said something inaccurate. I’ve already challenged you to do so and you couldn’t.

  12. 15

    SJ TrollPatrol (c)2009 spews:

    #11 Sunil

    What this policy states is the obvious … that is anything including a plant product that can show reproducible benefit should be considered for use.

    I know of NO policy of the FDA the NIH, or for that matter drug companies that says otherwise.

    In the meantime, I assume you were alos offended by the exposure of children at hempfest to benzpyrene in mj smoke?

  13. 16

    SJ TrollPatrol (c)2009 spews:

    @12 Lee

    “If you can point out a single instance where either Sunil or I have been inconsistent with science, maybe someone will start taking you seriously.”

    This is a game like the one you play with your your image contest?

    Not sure what prize you are offering here. All that ever happens when I point out your exaggerations and misstatements is that you let forth with diatribes, phone calls to my employer, sexist posts assaulting your view iof my gender, etc.

    I have offered to have debates with you and Sunil ans that offer is open anytime you want.

    here are the posits I would offer:

    1. The toxic effects of marijuana smoke is of sufficient concern that people including patients, should be discouraged from inhalation of marijuana and public smoking should be regulated.

    2. Given 1., prescriptions for marijuana should not include the inhalation of smoked marijuana.

    3. There in not sufficient evidence for a therapeutic benefit of marijuana to justify its clinical use in preference over THC administered in different ways. Patients should be encouraged to use THC over the impure product.

    4. When and of marijuana is legalized, the product should be controlled to assure users that toxic content is not present. This may include safety tests of forms of inhalation not expected to release carcinogens.

    Finally there is a posit I would enjoy hearing Sunil address.

    Sufficient evidence exists for therapeutic benefit from marijuana to justify an NIH Request for Applications* to identify novel therapeutic agents in marijuana or novel therapeutic benefit from unprocessed marijuana that can not be replicated by THC.

    *An RFA is a set aside of funds intended to encourage submission of competitive research grants.

  14. 17

    SJ TrollPatrol (c)2009 spews:

    @10 PI

    We all ought to agree on that one.

    At that point Lee and Sunil will go ballistic over the American Tobacco Company, Archer Daniel and Kraft foods taking the market over.

    I wonder if the Indian reservations can make a buck this way too?

  15. 18

    spews:

    Yes, SJ, a funded NIH RFA with corresponding access to multiple varieties of research-grade cannabis would be great. The AMA certainly thinks so as well in their policy. Most of this research has been blocked over the decades to the monopoly control that NIDA has had over the plant.

    Re: cannabis smoke and cancer — does the following statement from the AMA report offend the causation hypothesis underlying your statement about hempfest air quality?

    “Like tobacco, chronic cannabis smoking is associated with markers of lung damage and increased symptoms of chronic bronchitis.86-88 However, results of a population-based case control study of cannabis smokers found no evidence of increased risk for lung cancer or other cancers affecting the oral cavity and airway.89 Another population-based case-control study of marijuana use and head and neck squamous cell carcinoma (HNSCC) concluded that moderate marijuana use is associated
    with reduced risk of HNSCC.90 Furthermore, although smoking cannabis and tobacco may
    synergistically increase the risk of respiratory symptoms and COPD, smoking only cannabis is not associated with an increased risk of developing COPD.91″

  16. 19

    Chris Stefan spews:

    I love it, there’s an anti-marijuana ad appearing at the top of the page. Sign up now to get your free “Truth about marijuana” booklet and DVD. Let’s cost them a little money while making some money for David!

  17. 20

    spews:

    @17

    Is there some impediment to research on THC? Or are you arguing that the research funds should be made available to do research on the impure plant material? I know that the Institute for Alternative Medicine is having a hard time finding findable grants so I assume yo9u could get the finds once you have the training.

    As for the AMA statement you cite, I would assume you or whoever approved that statement is just being fair by citing a surprising study. If the data there were reproducible and not attributable either to an extrinsic variable or to an unknown confounding variable, my guess would be the NCI would be thrilled with a proposal to dientify the agent preventing cancer. Why not get the trai8ning to do such work and then get a grant? Or, raise the funds from private sources .. I am sure VC woulod help if you can convince them that you have strong evidence of a new class of Ca preventing drugs?

    Unfortunately, as I assume you know, such studies also occurred during the analysis of risk of tobacco. w the problems with any single study. Moreover, I assume you do understand the difference between proving that something is unsafe and proving that that is safe?

    If Lee wants an example of your acting irresponsibly, this sorft of post is pretty good evidence.

    So, yes, given the widespread concern about inhalation of carcinogens, I think the folks running Hempfest were irresponsible.

  18. 21

    spews:

    Sunil

    Just trying to be clear .,. my “causre” is rationalism. I object when either side of an issue misuse science.

    BTW, to be fair to YOUR side, I suggest you google the NIH for current RFAs with THC. There is one and it rather stupid. Take a look!

    This kind of RFA, and the misstatements of fact by the institutes are very objectionable. Given the opinions of most scientists on these issues, I suspect you would have little trouble getting folks to write letters on that subject.

    I would certainly sign such a letter if it was well written.

  19. 22

    spews:

    @18 Chris ,,

    I notice that HA attracts a lot of ridiculous right wing remnant ads.

    There must be a biot someplace that just places these where pol discussion occurs … or maybe Goldy has a demographic that says the right reads HA?

    I have suggested that Piper Scott, a paid right wing flack, get his Foundation, the EFF, to contribute money to HA since they already pay him to be here.

    For that matter, given the quality of some of Lee’s arguments on the subject, maybe Goldy could get the DEA to buy “Just Say No” ads here?

  20. 23

    spews:

    Description in lay press of study 1 cited in AMA report:

    Tashkin’s team interviewed 1,212 cancer patients from the Los Angeles County Cancer Surveillance program, matched for age, gender, and neighborhood with 1,040 cancer-free controls. Marijuana use was measured in “joint years” (number of years smoked times number of joints per day).

    It turned out that increased marijuana use did not result in higher rates of lung and pharyngeal cancer, whereas tobacco smokers were at greater risk the more they smoked. Tobacco smokers who also smoked marijuana were at slightly lower risk of getting lung cancer than tobacco-only smokers.

    http://www.alternet.org/drugre.....ng_cancer/

    Abstract to Study 2 cited above:

    Cannabinoids, constituents of marijuana smoke, have been recognized to have potential antitumor properties. However, the epidemiologic evidence addressing the relationship between marijuana use and the induction of head and neck squamous cell carcinoma (HNSCC) is inconsistent and conflicting.

    Cases (n = 434) were patients with incident HNSCC disease from nine medical facilities in the Greater Boston, MA area between December 1999 and December 2003. Controls (n = 547) were frequency matched to cases on age (±3 years), gender, and town of residence, randomly selected from Massachusetts town books. A questionnaire was adopted to collect information on lifetime marijuana use (decade-specific exposures) and associations evaluated using unconditional logistic regression.

    After adjusting for potential confounders (including smoking and alcohol drinking), 10 to 20 years of marijuana use was associated with a significantly reduced risk of HNSCC [odds ratio (OR)10-<20 years versus never users, 0.38; 95% confidence interval (CI), 0.22-0.67]. Among marijuana users moderate weekly use was associated with reduced risk (OR0.5-<1.5 times versus <0.5 time, 0.52; 95% CI, 0.32-0.85). The magnitude of reduced risk was more pronounced for those who started use at an older age (OR15-<20 years versus never users, 0.53; 95% CI, 0.30-0.95; OR20 years versus never users, 0.39; 95% CI, 0.17-0.90; Ptrend < 0.001). These inverse associations did not depend on human papillomavirus 16 antibody status. However, for the subjects who have the same level of smoking or alcohol drinking, we observed attenuated risk of HNSCC among those who use marijuana compared with those who do not.

    Our study suggests that moderate marijuana use is associated with reduced risk of HNSCC.

    http://cancerpreventionresearc.....rt/2/8/759

    I conclude my debating here.

  21. 24

    spews:

    Are you trying to use HA as a place for debate? Then someone besides you or I needs to moderate and decide when the debate ends.

    First, let me state again that no responsible scientist is going to advocate inhaling mj smoke given the simple fact that mj smoke has a very high content of known carcinogens.

    Tashkin’s study is a good study. So how does one account for Tashkin’s study? Could there be some surprise in inhaled MJ, something wonderful that prevents cancer? The answer is yes, but …

    The but is part of the basic tools of modern science. Tashkin’s study does not prove that mj is safe and certainly did not “prove” that it prevents cancer. No association analysis can prove a specific hypothesis.

    I would hope, given Sunil’s PhD in the social sciences that he would have taken a course in causal analysis? For those who might care, the difference between causal analysis and association is HUGE.

    For example, studies have shown that children of parents with hi IQ do better on exams. This association s valid but not causal because IQ scores are confounded by other variables, eg inherited wealth. When there is a surprising association, good scientists never decide on causality, they design hypothesis testing experiments to determine if the surprise is correct.

    Justifying such studies is difficult because they are very expensive. A friend of mine owns and runs a drug company that exploits traditional Chinese medicine t find new drugs. Perhaps Sunil would like to try t convince that company to spend money on marijuana?

    Sunil would have trouble convincing my friend t spend this money because there is so much evidence that inhaled mj SHOULD cause cancer. Sunil, however, is devoted to the naturopathic idea that complex extracts from plants, have better therapeutic outcomes than the effects of pure ingredients. This would be similar to Lilly saying it is no longer going to sell “pure” insulin because there is some other useful ingredient in pig pancreatic extract. As a diabetic patient, I am very glad that genetic engineering now allows Lilly to synthesize pure insulin.

    For now let me point out that nothing in Tashkin’s study suggests that such a wonderful effect is due to the properties of marijuana. Suggesting that folks be encouraged to inhale benzpyrene, one of the carcinogens in mj smoke, is irresponsible and forcing children to do so at Hempfest may be a criminal act.

    Cross Posted at SJ

  22. 25

    SJ on Troll Patrol spews:

    Sunil .. a Constructive Challenge

    I have recently begin using one of the e-cigarettes.

    These seem to me to be a very logical alternative to reefers. They should be safe yet one can easily incorporate any form of mj into the delivery capsule. All that is needed is some simple aqueous extract.

    Plus, I suspect the form factor of an oral device is an important issue that motivates many mj users.

    So, here is the challenge …

    The first stage of promoting this device as an alternative delivery device would be simple. The devices themselves are very inexpensive. I suspect one of the manufacturers would gladly supply them, The manufactuers or even the Tobacco Research Foundation might be willing to fund the project.

    All that one would need would be funding to acquire a small quantity of legal mj and assemble the accepted apparatus for evaluation of the content of the inhaled vapor.

    If, as I suspect, both mj and tob vapor are clean of known carcinogens, there would be a strong argument for making e-cigs with THC or even botanical extracts available for MM patients.

  23. 26

    SJ on Troll Patrol spews:

    Sunil

    I conclude my debating here.

    Seems as if Sunil does not want to state his case. Sad.