Does SAM believe in rescheduling marijuana, to Schedule II or III for example, so that we can study the medicinal benefits of marijuana?
SAM wholeheartedly believes we need to fast‐track the FDA process to extract non-smoked medications from the cannabis plant. SAM also believes that in the meantime, before we have more cannabis-based FDA‐approved medications, the FDA and the U.S. Department of Health and Human Services should administer a program permitting the truly sick and dying to receive yet-to-be approved, non-psychoactive, non-smoked components of marijuana under a special research program. But rescheduling marijuana is neither necessary, nor desirable, for those actions to happen.
Rescheduling marijuana would do nothing to allow more cannabis-based medicines. Cocaine is Schedule II today and is not allowed in a widespread fashion. Rescheduling would simply be a symbolic victory for advocates who want to legalize marijuana.
Part of the confusion over the actual significance of Schedule II status stems from a misunderstanding of the interrelated, but distinct, functions of the CSA and the Food, Drug, and Cosmetic Act (FDCA). Under the FDCA, the FDA approves specific medical products produced by particular “innovator” (for branded products) or generic manufacturers. For example, oxycodone, an opioid, is in Schedule II. Specific products, such as OxyContin® (an extended-release form), are also in Schedule II. Physicians prescribe a specific branded or generic product, in a particular dose and dosage form. So, until the FDA approves a smoked marijuana product, it cannot be prescribed or sold in “dispensaries” for medical use. And the FDA has been clear that smoked marijuana does not pass its rigorous approval standards.
Imagine for a moment that the “medical marijuana” advocates were instead “medical opium” advocates and that various states passed laws decriminalizing (or affirmatively authorizing and regulating) the cultivation and distribution of opium plant material — in other words, opium latex or poppy straw. Even though opium latex and poppy straw are each in Schedule II, there still would be a conflict among such state laws and both the CSA and the FDCA. As a well-known drug reform advocacy website states: “If poppies are gown as sources for opiates, there is no question that it violates the CSA.” 1 Furthermore, physicians would not be authorized to prescribe, nor pharmacists to dispense, dried opium latex or poppy straw. 2 To be prescribed, a specific product containing opiates would have to pass muster in the FDA-approval process. The mere act of placing herbal marijuana in Schedule II would not make it available to patients or address the conflict between state and federal law.
But won’t rescheduling allow for research to be done?
No. Rescheduling is not necessary to make marijuana products available for research. A committee of the California Medical Association recently called for the rescheduling of marijuana “so it can be tested and regulated.” However, it is not necessary for marijuana to be rescheduled for legitimate research to proceed. Schedule I status does not prevent a product from being tested and researched for potential medical use. Schedule I research certainly does go forward. In a recent pharmaceutical company-sponsored human clinical study investigating a product derived from marijuana extracts, the DEA registered approximately 30 research sites in the U.S. and also registered an importer to bring the product into the U.S. from the U.K., where it was manufactured. 3 And a quick search of the National Institutes of Health’s news reveals more than $14 million of current research on marijuana and medicine is moving forward. Research is happening.
What about obtaining marijuana for research?
Researchers wishing to conduct studies with herbal/whole plant marijuana may obtain it from the National Institutes of Health (or import formulated extracts). Researchers who obtain grant funding from an institute of the National Institutes of Health (NIH), such as the National Institute on Drug Abuse (NIDA), can obtain marijuana for their study. Researchers who are externally funded must undergo the equivalent of a grant-review process (review of their study design by an expert committee of the Public Health Service) to obtain such marijuana at cost from NIDA. The NIH (via the University of Mississippi’s National Center for Natural Products Research, or NCNPR) has the ability to produce standardized marijuana of varying THC potencies. Its cultivation area of five acres has been adequate to supply all marijuana‐related studies to date. In theory, NCNPR could also produce marijuana extracts, or such products could be imported from outside the U.S. for research, as is currently the case with Sativex®.
What has been the impact on drug use rates in states with medical marijuana?
An in‐depth examination of medical marijuana and its relationship to the explosion in use and users came in 2012 from five epidemiological researchers at Columbia University. Using results from several large national surveys, they concluded, “residents of states with medical marijuana laws had higher odds of marijuana use and marijuana abuse/dependence than residents of states without such laws.”
States with medical marijuana laws also show much higher average marijuana use by adolescents, and lower perceptions of risk from use, than non-medical pot states. This would seem to indicate that relaxed community norms about drug use contribute greatly to an increased prevalence of use and users — a situation resulting from the spread of an attitude that “if pot is medicine and is sanctioned by the state, then it must be safe to use by anyone.”
Medical marijuana should really only be about bringing relief to the sick and dying, and it should be done in a responsible manner that formulates the active components of the drug in a non-smoked form that delivers a defined dose. However, in most states with medical marijuana laws, it has primarily become a license for the state-sanctioned use of a drug by most anyone who desires it. Developing marijuana-based medications through the FDA process is more likely to ensure that seriously ill patients, who are being supervised by their actual treating physicians, have access to safe and reliable products.