CHAPTER-10

This is the chapter I have avoided writing, it’s going to be painful. I have friends, we all have friends, who suffer and for whom marijuana seems to help. I don’t intend to criticize those people. Whatever respect I have maintained or earned thus far from those who sit on one side of this conversation I am likely to lose herein, and I’m bummed about that. I thought a great deal about omitting this whole chapter from the book but it is just too important to skip.

I might as well get right to it, I’m going to make a bunch of statements that are all true but many seem to contradict themselves; that’s why this issue is so complex.

Marijuana is a very interesting plant with real medicinal qualities. I have friends who have benefitted from consuming marijuana in a medicinal manner.

You don’t smoke medicine.

Consuming marijuana has improved many lives.

Consuming marijuana has ruined many lives.

Some people suffering from different ailments can find relief with marijuana.

Marijuana isn’t a miracle plant that cures everything.

Medicine isn’t produced or validated by public vote.

There are components within cannabis that might have the ability to really improve life for some people.

Evidence that marijuana does what many claim it does for a variety of ailments has yet to withstand rigorous study. Medicines are proven effective when they undergo double-blind testing and placebo controlled experiments.

We must consider the downsides as well as the upsides when considering if we want to call something medicine.

Also consider this: nobody is prescribed marijuana by a doctor. Since it’s a Schedule I controlled substance no doctor can prescribe it, even if they wanted to. All a physician can do in states where it is legal is “recommend” a patient use it. Doctors do not prescribe weed, for anything. Just keep that in mind.

Before I get specific let me say this very clearly: If marijuana relieves pain and suffering for the very sick and dying then go for it. No one I know in this conversation would wish suffering on others. For those of you who find relief by using weed, I wish you nothing but the best. If I were you I would be downright pissed that this conversation has devolved into what it is today because you are being exploited more often than not so that people can get high.

Weed does not cure anything. Weed does relieve some painful symptoms and makes some people feel better. Intoxicants do that. Think back to the snake oil of centuries past; it was good for what ailed you no matter what that was because it was mostly hard liquor, intoxicants will do that. To say it will cure a toothache isn’t true; however if one is intoxicated enough they won’t feel the toothache, so in a way it does help. In a society as pain averse as ours, I have no doubt that weed is helping people feel less physical pain. Going back to the toothache analogy, the tooth hurts because decay has exposed the nerves. You can numb the nerves so you won’t feel the pain, but unless you cure the problem by removing the decay, it will hurt again eventually when you aren’t drunk or stoned.

We know that the vast majority of people using “medical” marijuana do so for alleged pain. In Colorado, for instance, over 93 percent of the roughly 95,000 people on our medical marijuana registry are on it for pain. To get on the registry, you pay a $35 fee—pretty much anywhere, including at concerts—though you supposedly need to have a serious medical condition and have a doctor send in lots of paperwork. It has been watered down now to a point where it means nothing more than that you paid your fee. As far as pain goes, not only is it subjective, there isn’t a test for it other than what patients report. We can’t put your blood into a machine and tell you that your pain is a six out of ten, you have to tell the doctor what it is. Given that there isn’t a way to test for pain it is an easy thing to exploit, and it is exploited pretty profoundly. Consider these statistics:

In Colorado the total number of medical marijuana cardholders at the time this was written is 94,577

Of those cardholders, 88,209 of them claim “severe pain”

The age group with the highest number of people represented on the entire list is 21 to 30 representing 19,953 of those card holders

While there are certainly exceptions, young people typically aren’t suffering from the debilitating conditions that marijuana laws are passed to treat, such as Crohn’s disease, ALS, seizures, Parkinson’s disease, etc. People in that age demographic and in those numbers are not typically dying of cancer; they like to get high. To anyone in that age group reading this who does have a tragic illness, I wish you the very best and know that I am not talking about you. The reality is that most people on our marijuana registry are there because they want to get high, and in Colorado they can get high for less money if they have a med card; it’s a tax thing. Medical marijuana is taxed at a much lower rate than is recreational THC.

“Medical marijuana is a red herring to help usher in legalized marijuana.” 1 These are not my words; they belong to Keith Stroup, the head of NORML, in an article that appeared in Emory University’s The Emory Wheel in February 1979. The reality is that for all their talk about helping the sick and dying The Lobby has long used suffering people for their selfish ends: the commercialization of weed. They parade the sick in front of lawmakers, point the cameras at them, and have them tell their genuinely heart-wrenching stories. Then they use those stories as a smokescreen to get paid. It’s foul. No lawmaker who wants to be elected again can vote to keep “medicine” away from very old or very young people who say it helps them. While these people make up almost every single example given to lawmakers and to the public, cardholders in Colorado, under eleven and over seventy-one, represent less than 4 percent of everyone on the list. When we think of medical marijuana the images that come to mind are babies with seizures, senior citizens with crippling arthritis, and people undergoing harsh chemotherapy treatments.

But in reality, it’s a tiny portion of people using marijuana who look like these truly suffering people. Most users are younger than I am and cite a condition that can’t be quantified as the reason why they need weed. Stroup was right, it’s a hell of a “red herring.” For those of you with serious debilitating conditions, they are using you. You are a means to an end for them and that end looks like Colorado. Before A64 passed and we just had medical retail, I watched a young man—who looked to be about nineteen or twenty years old— get out of a car and walk into a medical marijuana dispensary while his three friends waited in the vehicle. A minute later, the door opened and he came out carrying a brown paper bag. He literally jumped off the porch and ran to his buddies in the car. Was he overjoyed because he could solve a serious medical issue? What do you think? This is what much of medical marijuana in this state really looks like.

Considerations for
Medical Marijuana Studies

Now that we’ve covered that part, there is some real evidence that weed helps with some conditions: wasting syndrome associated with AIDS/HIV; muscle spasticity associated with multiple sclerosis (MS); and improving appetite in some patients undergoing chemo. There is also some compelling anecdotal evidence that it might help a very specific type of seizure disorder in young people. This needs further study—and by doctors who care about patients and not selling weed. Not only does the federal government need to get out of the way of that research taking place, they should provide funds to get it done quickly.

Those medical marijuana studies will need to show:

a. It is much more helpful than harmful among the study group;

b. It is better than other treatments used to address the same condition(s);

c. How it interacts with other drugs; and

d. What dosages might look like.

Let’s take a quick look at each of these areas.

More good than harm

If someone is using weed to treat a condition but a more serious condition (addiction, psychosis, etc.) can come about as a result of its use, then the bad cancels out the good. The severity of the condition needs to be considered alongside the severity of the side effects. Medicines have side effects, so weed would be no different. To claim otherwise is to use the good in order to ignore the bad. Particular focus should be given to children and adolescents in this category. If we determine that weed reduces acne but increases mental illness then it’s not a good acne treatment no matter how many pimples it gets rid of. We also need to be careful using it as a substitute for established medicines. There are young patients at our Children’s Hospital in Colorado, for instance, who have very serious medical issues and are taking medicine prescribed by their doctors. If parents decided to pull them off these meds and give them weed or a weed derivative instead, some of the results could be-life threatening.

I spoke with a gentleman last year (family of a dear friend) who called to ask me about weed. He had a brain tumor and was dying. He read an article and wanted to smoke weed to cure the tumor. A report came out a few years ago showing synthesized CBD (about 10,000 times of that found in the plant) reduced the size and growth of some brain tumors. The unfounded message that was delivered was that weed cures brain cancer. I told this man that he needed to talk to his oncologist and not me. He said he was not going back to him because the treatment was awful and he was going to try weed instead. That was a mistake. His doctors knew what they were doing in treating his cancer better than the dude who wrote that article. I told him that if he wanted to smoke weed to go ahead, but certainly don’t let kids see and definitely don’t drive. But I begged him to make that decision with his doctor, not on his own based on something he read online—that’s scary.

Nothing better out there

The FDA has a rule when considering medicine; it’s kind of fun to say, “Drug X is less bad than drug Y.” Basically, that means there aren’t options available that do better or cause less harm. My friend Sarah, a brilliant chemist from Montana who now lives in Colorado, likes to say that she could get some pain relief from chewing hemlock bark but prefers aspirin, it works better. Five hundred years ago, the anti-inflammatory properties in CBD made it a good option to turn cannabis plants into paste and spread it on swelling, maybe even ingest it from time to time. Now that we have ibuprofen, it wouldn’t be as good an option. We have some really good drugs out there to treat almost all conditions for which people are using weed, and we know much more about those drugs than we do about weed. The FDA backs up these drugs, making sure they don’t contain pesticides, aren’t made by a dude in a garage, have dosage descriptions, and all that kind of good stuff. If weed is going to be considered a serious medicine it also needs to pass these tests.

Interactions

This one is gigantic but a little tough to explain in my preferred tone so I’ll give you the CliffsNotes. Drugs interact with other drugs in our bodies the same way any chemical interacts with other chemicals in Petri dishes or in test tubes. Bleach is good. Ammonia is good. Bleach and ammonia together, however, are dangerous. Gunpowder, cool. Fire, cool. Gunpowder plus fire equals BOOM. Not all drug/drug interactions are bad. Doctors know this stuff and prescribe with those things in mind. Sometimes drugs get more effective when combined. (Milk is good. Oreos are good. Milk and Oreos are awesome!) Some drug combinations are better than the sum of the two in the same way that the result of mixing substances can be better or worse than those substances alone. Very little is known about how weed, or the components of weed, interact with other prescription and nonprescription drugs—and that is scary. We need more time to study this issue well before we encourage people to play chemist with their bodies.

Marijuana is contraindicated (a bad idea medically) for some mental health conditions that we know of for sure. Further study needs to be done before we include those conditions on lists of things that weed supposedly “cures” like PTSD and anxiety. If it helps the suffering person sleep better but also increases their risk of psychosis or suicide several times over and they are already susceptible to psychosis, then we have a potential big problem.

Dosage

Somebody tell me another “medicine” that we hand out with these directions for the patient, “Take as much as you like, as often as you like, until you get the effect you prefer.” Sounds crazy doesn’t it?

I got to contribute ideas to New York’s medical marijuana law. One requirement in that proposal was central: a doctor had to tell a patient what the recommended dose was, not the other way around. They did a bunch of things right in that law, including a requirement that pharmacists had to be on site at all dispensaries. In addition, no marijuana that was smoked could be considered medicine and doctors who recommended medicinal weed needed to have real relationships with patients and prescribe a set amount of time for their patient’s use. It’s not a perfect law but a better law than most.

Moving on with it, consider that much in nature has medicinal qualities. Medicine extracts those qualities and puts them into a safe format and amount to administer. I highly doubt that rigorous scientific study will reveal that smoking the whole cannabis plant is the secret. Like a poppy plant, it will have the ability to make medicine but isn’t the best form of medicine in and of itself.

Official Positions of Organizations

I miss Chris Farley. There’s a great scene in the movie Tommy Boy, when Tommy’s dad was teaching him the art of the sale. He told the prospective buyer, “I can get a good look at a T-bone by sticking my head up a bull’s ass, but I’d rather take a butcher’s word for it.” (If you’ve never seen the movie, I highly recommend it.)

For our purposes, “the butchers” are the professional organizations who spend their time researching and thinking about things like medicines, mental health, and other illnesses. These are the groups whose collective knowledge far surpasses anything we will ever acquire on our own. We should pay careful attention and listen to the professionals who have expended considerable time and resources to seriously explore the issues surrounding medical marijuana. Rather than capture their entire statements, which would get boring, here’s a partial list of organizations that officially oppose marijuana as medicine:

American Medical Association

American Academy of Pediatrics

American Society of Addiction Medicine

American Cancer Society

American Psychological Association

American Glaucoma Foundation

National Institute of Drug Abuse

Substance Abuse and Mental Health Services Administration

Consider the likelihood of a nineteen-year-old “budtender” selling weed at the local medical marijuana shop actually knowing more than the American Medical Association. Not likely, right?

Real research into the medical qualities in cannabis is happening, not just in America but around the world. That is a good thing and here’s why. Suppose weed is the miracle substance we are told it is and can cure everything from athlete’s foot to cancer, that would be awesome! We’d put it in a pill and start passing it out but only after it stood up to rigorous testing. Not only am I in full support of continuing and even stepping up research, so are most of the organizations I work with who would be described as “anti” weed.

Sometimes, it seems to me like the only people who don’t want that kind of actual research are the people selling it at dispensaries and lobbying for its legalization. Our old friend Russ Belville wrote an article about the problem with CBD-only legislation, in which he says “[CBD-only laws] provide a rhetorical shield against the most powerful attack we have against marijuana prohibition, the suffering of patients who use cannabinoid medicines.” They want it to continue to be used for everything under the sun with no considerations toward potential harm or side effects. Their reality is that twenty-one to thirty-year-olds smoke a lot of weed and are therefore good customers. “Chronic pain” pays them well.

Until all of the research is done, we will have to settle for the pharma produced, quality controlled, and dose specific options that are out there, such as Sativex and Marinol. Whole books have been written about them and their failure to gain any traction in the market, so I don’t want to get into all of that. Bottom line: there are real medicines derived from cannabis or made almost entirely of cannabis but very few people seem to be using them. On the other hand, the media and lots of people everywhere are talking about and expanding new uses daily for weed.

CBD and Charlotte’s Web

Cannabis contains at least sixty known chemicals called cannabinoids, which activate cannabinoid receptors in the body. As we’ve discussed throughout this book, tetrahydrocannabinol, THC, is what gets you high. Cannabidiol, or CBD, is where the most interesting potential medicinal benefits are found in weed; a bit oversimplified but the statement works. Not only does CBD not get one high, as mentioned before, it actually counteracts the high delivered in THC, pretty cool, right?

Since I don’t know all of the specifics here I hate to weigh in but this one is brought up everywhere by people arguing for “medical” marijuana.

A couple of years ago CNN’s Dr. Sanjay Gupta fell in love with weed, kind of. In a CNN documentary called Weed, he presented the case of the Figi family in Colorado, who had a darling young girl named Charlotte. When she was an infant, Charlotte was diagnosed with a disorder called Dravet’s syndrome, a very rare type of childhood epilepsy. She was severely disabled—unable to walk, talk, or eat—and had almost constant seizures. It was very hard stuff to watch, even on tape. In an act of desperation, her family tried treating her with a derivative of weed that was mostly CBD in oil form that she ingested several times a day, and it seemed to really help her seizures. Gupta went all in and the popular takeaway became, “Weed cures seizures.” A more accurate one would have been “non-intoxicating oil derived from cannabis plant shows promise in the treatment of rare seizure disorder.”

As a parent, I sympathized with the family. If I were in their shoes, I would do anything to help my child in the same way that they did, and what a beautiful thing that she appears to be having fewer seizures. On the other hand, a nation or state can’t change its laws because of one case. Nobody ever would arrest her, her parents, or the people making the serum, nobody. This case presents more argument for study but unfortunately none for legalizing “medical” marijuana. We often hear how parents and children are flocking to Colorado to get this serum now renamed “Charlotte’s Web”—after Charlotte Figi mentioned above—to treat their loved ones’ seizures. Some media reports have made it sound like a modern-day migration with people selling everything they own just to get to the Promised Land. There are 191 children age ten or younger on the Colorado Medical Marijuana Registry with seizure disorders. This is a rare illness and not something that typically gets this kind of attention, unless of course somebody (the Industry) wants to use the kids as red herrings to get paid.

I am hardly scratching the surface of this issue but I am not the guy to go further with it. Much has been written and much more will be as we continue to learn. I believe the evidence shows that we can make real medicine out of cannabis and that there are yet-to-be-discovered/proven medical uses. I also believe the way medical marijuana is playing out in this country is a joke being told by the people who want to profit from selling it. Sick people are being exploited and real research isn’t being demanded because twenty-year-olds want to get high more than society and big pharma wants research to find medicines for people like Charlotte. There’s not much money to be made in that.

Consider this “evidence” of the true state of medical marijuana. Real pharmacies don’t have “patient drives” and a person who only prescribes one kind of medicine is a pusher, not a d36octor.

“Generation Health”—some of you are laughing but the kids are buying it (literally and figuratively).

The Budtender of the Month does look hipper than my real doctor, but would you want him giving you or someone you care about medical advice?

I agree, don’t gamble with your medicine, get it from a pharmacy.

Does your pharmacy run Black Friday deals?

While it might be nice, since when do real doctors offer raffle drawings with cash prizes and daily specials?

Remember, there is no such thing as “prescribed” marijuana—but using the language will help people think otherwise.

1 The Emory Wheel, February 6,1979, pp 18–19.