Dear friends in marijauna law reform,
I have completed a long, investigative report on Marinol, its manufacturers, and its treatment in popular culture. To date, I have not found any similar articles on this specific topic. The essay was completed in late 1997, and it has not been published anywhere (I haven't really sought publicaton AND I don't know if my research warrants greater exposure and attention).
Please review the essay at your earliest convenience. The short, 11 page, version does not contain footnotes, although the long, 26 page, version contains numerous footnotes. Since nothing has really changed in terms of the legality and perception of Marinol, I assume that my research is still timely. I have been a strong advocate of marijuana law reform for many years, and I finally decided to REALLY look into Marinol as it compares to marijuana in modern American society.
I sincerely hope that this research helps bring about change in America's perception of medical marijuana and Marinol. I apologize for any inconsistencies or typographic errors since I wrote the essay as a UCLA gradute student and not as a medical researcher. Feel free to reproduce any parts of this research. Thanks again for your efforts to bring some sanity into the national discussion of medical marijuana. Cheers!
Marinol vs. Marijuana: Politics, Science, and Popular Culture
Politics and Medicine
Groups favoring marijuana over marinol
Marijuana has been used as a medicine for millennia by cultures spanning the globe. Ever since 1937, that medical necessity has fallen in America to political pressure, and the cannabis plant remains illegal regardless of intended use. Since then, patients have continued demanding marijuana's therapeutic effects, thus prompting the pharmaceutical industry to find a legitimate means of meeting their needs without violating federal law. This quest for "legal weed" resulted in the introduction of dronabinol (a synthetic drug commonly referred to by its trade name Marinol), into contemporary American pharmacopoeia. However, this "solution" to the medical marijuana question now poses a double standard: whereas, medical marijuana users still face severe penalties, including loss of property and mandatory incarceration, for therapeutically using an illegal substance, Marinol users enjoy the benefits of marijuana's active ingredient, tetrahydracannibidol (THC), without the criminal penalties or the social stigma. With this paradox in mind, I intend to examine the vastly different public perceptions of these two essentially similar substances, marijuana and Marinol, while framing this complex analysis within a broader historical and theoretical structure. This examination will focus first on each of these two drugs individually, and will then illustrate the disparate public discourse in American pop culture surrounding natural and synthetic THC, respectively. Without taking a definite position on this hotly debated issue, this analysis will reveal how politics influence science, how marijuana has garnered such a distinctively negative reputation, and how Marinol has successfully appeased the anti-marijuana American public.
Marijuana boasts a long and pertinent history of medicinal use, based in the earliest known civilizations. The first recorded use of medical cannabis dates back to 2800 B.C., when the Chinese Emperor Shen-nung used it as a muscle relaxant and painkiller.1 The ancient Egyptians also found medical benefits in cannabis, as evidenced by their usage of it to quell the pangs of childbirth. Numerous other civilizations, including the Assyrians, Persians, Zulu, Spaniards, and countless others, have since established traditional medical applications of cannabis.2 Underlying this historical trend is the simple fact that the medical benefits of marijuana have and continue to serve numerous cultures.
Certainly, the medical use of marijuana was once commonplace in America, as well. Over one hundred articles recommending cannabis were published between 1840 and 1900 alone. In fact, marijuana was a prominent part of the pharmacopoeia from 1870 up until 1937, when the Marijuana Tax Act effectively banned the plant from public consumption regardless of intended use. Employed primarily as a painkiller during childbirth, as a treatment for asthma and gonorrhea symptoms, and as a relaxant for anxiety-prone patients, marijuana was formerly a well-documented drug in standard texts on pharmacology and therapeutics. When Congress first considered banning the cannabis plant, the respected American Medical Association (AMA) testified before federal committees in defense of marijuana's medical applicability.3 Despite the AMA's efforts, the political motivations behind outlawing the plant far outweighed any medical considerations, and in 1937, cannabis became illegal. The sudden and severe public reaction to this "new" drug was surprising, considering that no one in America had even hear the word "marijuana" until the late 1920s. A closer examination of marijuana's entry into the American public reveals the source of its stigmatization..
The term "marihuana" (later spelled "marijuana") was invented in the early 1930s to confuse Americans who had positive associations with hemp, a major cash crop, and cannabis, a well-known medicine and mild intoxicant. By ascribing various social ills to the heavily maligned drug "marihuana," politicians used this term, with which the public was unfamiliar, to pass legislation banning an otherwise commonly known substance. Numerous theories exist about the motives behind the sudden vilification of cannabis; however, I will limit my analysis to those aspects of vilification which underscore the strange relationship between politics and medicine. For example, many newspapers reported that "degenerate Mexicans" smuggled the evil "marihuana" into America, raping Anglo women, or murdering innocent citizens while under its influence. These newspapers, ranging from well-known national journals like the Christian Science Monitor and the Washington Herald to little-known local papers like the Rocky Mountain Times, contributed heavily to the growing anti-marijuana hysteria, by identifying marijuana-crazed ethnic minorities as the root cause of crime in America.4 The Federal Bureau of Narcotics offered this statement to corroborate these claims:Police officials in cities of those states where it [marihuana] is most widely used estimate that fifty per cent of the violent crimes committed in districts occupied by Mexicans, Spaniards, Latin-Americans, Greeks, or Negroes may be traced to this evil.5
Evidently, the medical necessity of cannabis could not withstand the onslaught of such negative associations with marijuana, and political motives ultimately swallowed medical concerns entirely.
Marijuana remained illegal in America for several years, although medical and recreational use did not disappear whatsoever. Retaining popularity among American subcultures, such as Black musicians in the 1940s, Beatniks in the 1950s, and Hippies in the 1960s (just to name a few), marijuana remained a prominent aspect of social life despite its prohibition. In fact, cannabis consumption reached well beyond the subcultures of these eras and into the American mainstream. Many people from varying social backgrounds and ideologies used marijuana at some point, solely for recreation, including current President Bill Clinton, Vice-President Al Gore, Speaker of the House Newt Gingrich, and countless doctors, lawyers, professors, and engineers, among others. While recreational use remained popular, new medical uses for marijuana were also discovered, prompting many suffering people to illegally medicate themselves. The treatments of glaucoma, chemotherapy induced nausea, spastic disorders, AIDS wasting away syndrome, and other less severe illnesses were significantly aided with the therapeutic use of marijuana. Those same officials who tried the drug recreationally now subject people with an obvious medical need for marijuana to the constant threat of arrest for violating U.S. federal law.
Although authorities have perpetuated the vilification of marijuana since its prohibition in 1937, they nonetheless responded partially to growing demands for medical marijuana in 1969 by supplying researchers with government-grown marijuana for scientific experimentation. The "pot farm" at the University of Mississippi in Oxford raised thousands of cannabis plants (and still grows them today) behind a 12 foot tall barbed wire fence for the National Institute of Drug Abuse (NIDA), the federal agency which retains sole rights to supply marijuana to researchers.6 Barrels of the low-grade marijuana get shipped to the Research Triangle Institute in Raleigh, North Carolina where the dried leaves are rolled at a cost of $2 per joint for patients participating in experimental programs. This system of farming has resulted in a "highly standardized ...reliable and reproducible method of administering the drug." according to Dr. Monroe Wall of the Research Triangle Institute. Thanks to research conducted with government pot acknowledging marijuana's medical benefits, New Mexico boldly strayed from federal drug policy in 1978 and passed the first state law recognizing the medical value of marijuana. Comparable medical needs around the country prompted over 30 states to enact similar legislation within the next few years. Glaucoma patient and medical marijuana user, Robert Randall, remembers, "By the summer of 1980, there was building pressure on the federal government to provide marijuana through an experimental program." The most remarkable example of this growing trend for medical marijuana consumption involved California's request for one million joints from NIDA. Rather than accept the obvious solution to increase production at the "pot farm" in order to meet the growing demand (a remedy deemed "imponderable" by anti-marijuana government officials), bureaucrats decided to pursue a pharmaceutical alternative. They hoped to encourage the giant pharmaceutical industry to create a synthetic drug with properties similar to cannabis.7
The first attempt to synthetically reproduce the medical effects of marijuana failed miserably. The Eli Lilly pharmaceutical company had responded quickly to the federal challenge by manufacturing nabilone, otherwise known as Cesamet, which soon became hailed as the "great white drug" that would replace marijuana. In 1978, they began double-track testing on cancer patients as well as animals in order to gain FDA approval quicker; however, their lofty aspirations came crashing down tragically, when dogs on nabilone suffered convulsions and dropped dead. The door remained open, anticipating another pharmaceutical product to fill the marijuana demand.8
In pertinence to the history of medical marijuana, Congress' passing of the Controlled Substances Act of 1970 added a new dimension to the cannabis as medicine controversy. Upon ranking the various drugs according to levels of danger, the Act placed marijuana in Schedule I, the most dangerous category. In order to attain Schedule I classification, a drug must meet three requirements: 1) high potential for abuse; 2) no accepted safety even under supervision; and most significantly, 3) no medical use.9 In placing marijuana in Schedule I, the government not only ignored cannabis' previous medical use in this country, but also overlooked the numerous experiments proving the drug's therapeutic efficacy. Still, bureaucrats needed to help severely ill patients without acknowledging marijuana as a potential therapeutic agent. The government prayed for a pharmaceutical alternative to marijuana, and with Marinol's entrance into the medical arena, their prayers were adequately answered.
In 1980, the National Cancer Institute (NCI) began experimental distribution of a new drug called Marinol, an oral form of THC (the primary active ingredient in marijuana), to cancer patients in San Francisco. Simultaneously, six states conducted studies comparing smoked marijuana to oral THC in cancer patients who had not responded to traditional antivomiting medication. These state-sponsored studies revealed that thousands of patients found marijuana safer and more effective than synthetic THC. Meanwhile, the NCI experiments showed that some patients responded well to Marinol, although one patient reportedly stormed into her doctor's office and accused him of trying to poison her with the drug (the doctor later dropped out of NCI's experimental program). Confronted with two different medical recommendations, the government chose to dismiss the state studies and give Marinol the green light. In 1981, the government sold the Marinol patent to a small pharmaceutical company named Unimed based in Somerville, New Jersey. By 1985, after one unsuccessful attempt at FDA approval, Marinol was finally approved as a Schedule II drug (a relatively quick approval by FDA standards). Thus, Unimed, with government backing, began targeting terminal cancer patients in order to accumulate profit.10
With Marinol's acceptance behind them, executives at Unimed launched a massive sales enterprise in conjunction with their distributor Roxanne Laboratories, a subsidiary of pharmaceutical giant Boehringer-Ingelheim. A combined sales force of about 60 people roamed the country promoting Marinol to oncologists and AIDS doctors. Building from early profits, Unimed invested money into testing new uses for Marinol. In 1992, the drug received approval as an appetite stimulant for patients with AIDS cachexia, otherwise known as wasting away syndrome. This new use coupled with Marinol's recent approvals in various international markets, like South Africa (where it is marketed under the trade name Elevat) with its incredibly high AIDS rate, along with Canada, Puerto Rico, Israel, and Australia, significantly boosted Unimed's profits and prestige.11 Furthermore, the FDA granted Marinol the highly prized Orphan Drug Status, a privilege that allowed Unimed exclusive manufacturing rights to Marinol, as well as protocol assistance, and tax breaks for its investors.12 As a business, Unimed still specializes primarily in niche pharmaceutical markets, namely AIDS drugs. However, among the few drugs manufactured by Unimed, Marinol easily garners the highest profits, drawing in over 90% of total revenues.13 Unimed has reported greater sales nearly every year since 1985, reaching a high of $9.7 million in 1995. President and CEO Stephen Simes predicted that sales will reach between $50-100 million by the year 2000.14 Based on their growth rate, this figure seems unlikely; however, the company clearly has high hopes.
Despite enormous financial backing and rapid FDA approval, few proponents of Marinol are aware of the intricate, physical processes involved in manufacturing synthetic THC. Unlike marijuana which requires only light, water, and some nutrients to grow, Marinol manufacture involves numerous time-consuming steps, the efforts of several companies, and multiple complex chemical processes. Unimed contracts Norac Industries in Azusa, California to manufacture the synthetic THC which is then shipped to Roxanne Laboratories in Columbus, Ohio where it is encapsulated and sent to pharmacies around the country. Intrigued by the process of synthetically reproducing a natural psychoactive product, I interviewed an informant at Norac extensively. Apparently, the basic elements of delta 9 tetra-hydra-cannibidol, marijuana's primary-though by no means only-active ingredient, are derived from the compounds tempere olivitol and paramenthide (PMD). Norac used to purchase olivitol from Aldrich Labs, but opted to manufacture it themselves in order to save money. Norac also used to acquire its other raw material, PMD, from the German lab Ferminic until frequent explosions caused the company to halt its PMD production. As of 1993, Norac was forced to produce its own PMD as well. My informant at Norac explained that they too have experienced explosions due to the highly unstable characteristics of PMD, but that the volatile compound currently remains largely in check. The final synthetic THC solution is approximately 98% pure-a very high concentration compared to that of the cannabis plant, where THC amounts normally range between 2% and 10%.15 Since the Orphan Drug Status for chemotherapy related nausea expired in 1992, I assumed that other pharmaceutical companies would attempt to infiltrate Marinol's markets by producing their own versions of synthetic THC. However, my source at Norac explained that manufacturing THC is a very expensive, and thus cost-prohibitive, process.16 The encapsulation procedure also requires elaborate and expensive chemical processes that use fairly common preservatives like methylparaben and propylparaben, as well the whitening agent titanium dioxide, in a sesame oil capsule.17 The once unstable synthetic THC compound now has a long shelf-life in the sesame oil capsules, although all Marinol products are marked with 6 month expiration dates for added safety.18 Obviously, reproducing marijuana's therapeutic effects is no easy task, even with today's most cutting-edge technologies.
Since marijuana and Marinol derived from two entirely different processes (arguably polar opposites), it seems ironic that Marinol functions as the only legal alternative to marijuana. Considering their vastly disparate backgrounds, one can logically conclude that the therapeutic effects must also differ, but according to many researchers, the results are essentially the same. In fact, the two drugs' reported side effects are quite similar, although advocates of medical marijuana claim that Marinol produces more damaging side effects. Marinol proponents argue, in turn, that marijuana possesses more undocumented side effects. Upon analyzing a 1995 product brochure explaining the benefits and possible effects of using Marinol, I discovered new information that completely undermined my original assumptions about Marinol.
Considering that Marinol is legal while marijuana is not, I assumed that Marinol would have far fewer side effects than those attributed to marijuana; however, this assumption and numerous others proved quite inaccurate. According to the 1995 product insert, Marinol may be habit forming, a condition commonly linked with cannabis. In addition, Marinol may cause the following side effects: feeling "high" (i.e. easy laughing, elation, and heightened awareness), abdominal pain, dizziness, confusion, depression, nightmares, speech difficulties, chills, sweating, and even psychological and physiological dependence.19 Some of these potential side effects seem quite serious for any legal pharmaceutical. Even less comforting, the 1992 product insert explains what to do in case of accidental overdose:A potentially serious oral ingestion, if recent, should be managed with gut decontamination. In unconscious patients with a secure airway, instill activated charcoal via a nosagastric tube. A saline cathartic or sorbitol may be added to the first dose of activated charcoal. Patients experiencing depressive, hallucinatory or psychotic reactions should be placed in a quiet area and offered reassurance.20
Considering the enormous sales of Marinol, patients must desperately need medication to risk such potentially severe reactions. While marijuana may produce such side effects as: euphoria, laughter, anxiety, dry mouth, red eyes, sleepiness, clumsiness, increased appetite; these conditions pale in comparison to those attributed to Marinol. A 1985 edition of The Medical Letter listed the side effects of Marinol as "disorientation, depression, paranoia, hallucinations, and manic psychosis." A 1986 Marinol product insert explains that even patients on low doses of the drug may experience "a full-blown picture of psychosis;" this reference was conspicuously dropped from their later product inserts.21 Given the intensity of Marinol's side effects, marijuana appears less dangerous than its synthetic Schedule II counterpart.
Many patients believe that the much higher THC content in Marinol produces these more extreme side effects. Robert Randall, a glaucoma patient who currently receives a legal supply of marijuana from the government, describes his experiences with Marinol, "It was way too psychoactive. When I took Marinol, I found it anxiety-provoking and intense, like I had wandered into a short story by Flannery O'Connor." He further explains, "I talked to hundreds of AIDS patients, and only one preferred Marinol to marijuana. It's not just that marijuana helps them gain weight-it's that Marinol is so scary." Dr. Robert Gorter, a San Francisco AIDS expert, corroborated Randall's anecdotal conclusions in the Journal of the Physicians Association for AIDS where he stated, "Again and again patients have testified that they preferred marijuana above dronabinol [the scientific term for Marinol]..."22 Further evidence citing the potential dangers of Marinol exists in the 1995 Marinol product insert itself, which warns against giving dronabinol to children and to the elderly (although Unimed is currently in Phase III testing for approval of Marinol in the treatment of Alzheimer's patients) because of the drug's "psychoactive effects."23 It seems odd that Marinol supposedly functions better as a medicine than marijuana, a substance casually consumed by millions of Americans without such debilitating side effects.
Hoping to discover specific patient complaints against Marinol, and not just potential side effects or anecdotal information, I contacted the Food and Drug Administration (FDA) for more information on adverse effects caused by Marinol. I was told that this information was confidential, and that only by using the Freedom of Information Act (and enclosing a check for $70) could I attain limited access to this knowledge, and even then, certain details would remain censored.24 By contrast, if I needed information on marijuana's adverse effects, I could contact hundreds of sources (including elected officials, rehabilitation centers, law enforcement, internet sites, parent groups, local libraries, pharmacies, etc.) from whom I could receive a deluge of free information. Another medical paradox exposing the sharp contrast between the popular conception of marijuana and Marinol involves carcinogenic studies. Anti-marijuana government studies had very tentatively linked marijuana smoke (and not ingested marijuana) with lung cancer in an unpublished report (although a recent panel of scientists re-examined that report and found that marijuana was actually found to prevent malignancies not cause them).25 Despite the presence of THC, common to both marijuana and Marinol, no carcinogenic studies have been performed on Marinol.26 Culturally, marijuana continues to face vilification while Marinol enjoys legitimacy and government backing. Sick people face harsh criminal penalties for self-medicating with natural THC, while patients using synthetic THC get insurance coverage and freedom from persecution and prosecution. The influential role that politics plays in science and medicine can explain the enormous rift in the cultural perception of these two essentially similar substances. Only a close examination of political influence in medicine can explain popular culture's polarity regarding marijuana and Marinol perception.
POLITICS AND MEDICINE
Medicine may seem like a domain completely outside of political debate, but the information garnered in this examination thus far suggests otherwise. Scientists and medical researchers compete for funding from government agencies and private business. If the government has strong anti-marijuana policies, then logically, the studies which they fund will attempt to further indict marijuana. John Falk, a researcher from Rutgers University, explains,Policy can be a closed, self-validating system, almost impervious to scientific facts: While science considers new facts and alternative explanations and rejects them on logical or empirical grounds, policy can be dismissive of facts and alternatives simply on the grounds that they are distasteful.27
Governments regularly accept or reject scientific studies based on their relation to desired policies. For example, President Richard Nixon hand-picked a federal commission to determine an improved marijuana policy. After several years of research, the commission concluded that decriminalization of marijuana was the best drug policy option. Since this result was intolerable to the drug warrior Nixon, he ignored the recommendations of his own counsel.28 Another example of government ignoring science involves the Compassionate Investigative New Drug (IND) program which supplied government grown medical marijuana to a handful of patients from 1978 until 1992. Due to a rising number of applications from AIDS patients, President George Bush terminated the program, not because it harmed people or led to increased drug abuse, but because he wanted a "zero-tolerance" stance towards all illegal substances in his War on Drugs, and because the legal pot might "send the wrong message" to children. Only eight patients (known as the Acapulco Eight) continue to receive medication under that program thanks to a hard-fought grandfather clause; the rest have already died. 29
The terminology spouted by politicians in the War on Drugs further illuminates the often subtle (or not so subtle) relationship between politics and medicine. From the popular phrase of the 1930s referring to marijuana as the "assassin of youth," to contemporary use of such militaristic phrases as "war on drugs" or "combating the drug menace," such highly dramatic linguistic manipulation reveals an underlying attempt to influence the uncritical American public.30 In the 1930s, marijuana intoxication was popularly referred to as "reefer madness," implying insanity, unpredictability, and hyperactivity. Today, the terminology for that same state of intoxication has shifted 180 degrees to "amotivational syndrome," implying indolence and slovenliness. The complete inversion of negative accusations maligning marijuana only reveal how arbitrary and unfounded the indictments really are.31 Continuing the semantic war after the passage of Proposition 215 in California and Proposition 200 in Arizona, federal bureaucrats, including "Drug Czar" Barry McCaffrey, quickly claimed that voters were "duped" by wealthy "potheads" promoting "Cheech and Chong medicine."32 Anti-marijuana rhetoric continued streaming from the lips of politicians and from newspaper presses despite the majority approval of both propositions. Like medical authority, Stanton Peele, remarked, "To put it simply, saying bad things about drugs is never questioned, and disconfirming information never requires revision of original claims."33 Medical issues lay dormant under the political cloud raised by vociferous opponents of marijuana, while advocates only prayed that a strong grassroots effort would influence public opinion to the extent of changing policy. Even though voters approved both propositions, the Clinton administration announced that physicians prescribing marijuana were still subject to criminal punishment, proving that neither medical arguments, nor voter approval, can change an entrenched government policy.
During these medical marijuana debates, Marinol remained elusive, yet ever-present. Newspapers and magazines loosely referred to dronabinol as a legal alternative to smoked marijuana, although very few reporters commented on Marinol's numerous side effects, or on patient claims that marijuana worked much better than synthetic THC. Unimed's National Sales Director, Brian Jennings, explained to me in a telephone interview that Unimed knew about the propositions before hand but chose not to officially participate, because they felt medicine should remain outside of the political sphere. Jennings stated, "It is not for us to determine what should be medicine and what shouldn't." When asked if Unimed had received thank you mail from recovering patients, Jennings exuberantly responded, "Yes! But you won't hear that on the media," meaning positive representations of Marinol allegedly pale in comparison to those of marijuana, a favorite topic of journalists. Based on this telephone interview, it seemed as if Unimed was sincerely interested in helping sick people, and not in fanning the flames of marijuana hysteria, or simply in making larger and larger profits. 34 However, after carefully reading their roughly 200 page investor portfolio, only one mention was made of assisting sick people in need. The bulk of their literature focused on profits, plans, and bottom lines.35
To guarantee that they lost no precious profits to decriminalized marijuana, Unimed hired a top public relations firm during the West Coast medical marijuana debates. This publicity company sent news releases to every major newspaper in America explaining the existence of Marinol and its benefits over marijuana.36 Although Unimed's National Sales Director informed me that his company preferred not to participate in the debates, he neglected to mention that they had hired someone to participate for them. In these press releases, much of the information was exactly accurate; however, several statements were simply untrue. Unimed claimed that "patients using Marinol do not experience a 'high' and are thus able to work and perform normal daily functions unimpaired."37 This claim directly contradicts Marinol's 1995 product insert which explains that "dose-related 'high' has been reported by patients receiving Marinol..."38 Evidently, Unimed hoped to draw a clear distinction between Marinol and marijuana, and although numerous differences already exist, they chose to create false ones, hoping to capitalize on the further maligning of cannabis. Other examples of Unimed's attempt to infiltrate mainstream media with marijuana lies include the blatantly false claim that Marinol pills are taken only once per day, while marijuana must be smoked several times per day, thereby causing inconvenience, lung damage, and other more serious complications.39 The user directions on Marinol's product insert specifically state that two capsules per day are required as a starting dosage, after which more daily capsules are suggested.40 In addition, medical marijuana consumers self-medicate as needed; which, for patients using cannabis to prevent the nausea associated with chemotherapy, equals about one cigarette every few weeks.41
Although the Unimed press release cites the absence of controlled clinical studies proving marijuana's safety and effectiveness, such studies remain impossible to conduct because of NIDA's refusal to grant cannabis to researchers who support medical marijuana. Dr. Donald Abrams of the San Francisco Community Consortium gained authorization from the FDA and the National Institute of Health (NIH) to study marijuana and Marinol's effects in AIDS cachexia.42 Unfortunately, NIDA denied him access to their pot supplies. They claimed that if they granted marijuana to Dr. Abrams then they might become deluged by other research proposals requiring marijuana.43 This bureaucratic entanglement represents one aspect of drug policy in popular culture; however, to fully explore the scope of this issue, one must examine the debate through more mainstream media sources.
Americans consistently support medical marijuana in polls, but that majority seems to disappear in the public sphere. While Rolling Stone magazine contends that the war on marijuana exists for political purposes completely outside of medical considerations, the New Republic argues that Proposition 215 serves as a front for drug legalization advocates and that medical cannabis clubs are populated by a "sorry lot of smokers who are not sick."44 This disparity in public opinion mirrors itself regularly throughout popular American culture. For example, a Los Angeles Times Column Right author, Charles Krauthammer, angrily exclaimed, "The cannabis clubs are a sham, an invitation to every teenager with a hangnail to come in and zone out."45 In contrast, the Los Angeles gay magazine 4Front ran a cover article titled, "Clinton/McCaffery Declare War on People With AIDS!!!," wherein they vehemently declare, "This two bit General [McCaffery] has declared war on people with AIDS. It's outrageous that the President who 'didn't inhale' is denying sick and dying people the relief that medical marijuana provides."46
Further examples of the public polarizing around this issue abound throughout American pop culture. For instance, Newsweek magazine claimed that, "The problem with Marinol is that is doesn't always work as well as smoking marijuana.", while my local newspaper, The Daily Breeze, printed an article claiming that, "With smoked pot, the dosage varies substantially, so it is usually a lot easier to prescribe a pill."47 Gary Trudeau, creator and cartoonist of Doonesbury, also joined the cultural melee by creating a Sunday comic strip about Proposition 215. When the main character, Zonker Harris, learns about California Attorney General Dan Lungren's massive raid on the San Francisco Cannabis Buyer's Club, he incredulously asks, "What country are we living in? Germany? Russia? Idaho?" Lungren must have realized that a major act of aggression against a medical supplier to severely ill patients would not earn him much popularity; however, Trudeau's biting comic strip angered him so much that he demanded Doonesbury's distributor, Universal Press Syndicate, to promptly remove the comic. Much to his chagrin, they refused.48
Even advice columnist Ann Landers joined in the cannabis debate by stating, "I do believe that medical marijuana should be available for medical needs, since this serves a humane purpose." Although other contributors to her column challenged her position, citing marijuana's alleged "gateway" effect leading to harder drugs. One respondent from La Grange, Illinois, sarcastically commented, "[the] idea of releasing marijuana prisoners is great, but...doesn't go far enough. Let's release all of the murderers too...Free the rapists. Then, put all the child molesters back on the streets." Clearly, passion underlines all opinions, but consensus seems hopeless.
The medical marijuana versus Marinol debate rages among medical practitioners as well. After DEA Associate Chief Counsel Steven Stone suggested that only a fringe group of oncologists accepted marijuana as an antiemetic, two Harvard scholars conducted a poll to verify that statement, and discovered a vastly different reality. They sent detailed questionnaires to over 2,000 registered oncologists, and found that 44% of respondents think that marijuana is safe and efficacious, and would prescribe it regardless of legality. Nearly 90% of respondents accepted the medical use of Marinol, thereby leaving dozens of doctors who reject its use. Interestingly, respondents who graduated from medical school during the "Just Say No" Reagan era were significantly less likely to favor medical marijuana, while those who graduated in the 50s, 60s, and 70s had higher rates of approval. Based on these findings, the study's authors concluded that smoked marijuana remains superior to oral THC because:The bioavailability of THC absorbed through the lungs has been shown to be more reliable than that of THC absorbed through the gastrointestinal tract, smoking offers patients the opportunity to self-titrate dosages to realize therapeutic levels with a minimum of side effects, and there are active agents in the crude marijuana that are absent from pure synthetic THC.49
The two essential points that greater bodily absorption and greater self-medicating control are possible with medical marijuana use (and not Marinol use) cannot even be denied by much hyped anti-marijuana studies, like those of the notorious Dr. Gabriel Nahas.50 The argument that marijuana contains more than one active ingredient, thereby implying that Marinol cannot possibly replicate all of marijuana's medical effects, finds favor among many physicians and physicians' groups. Arthur Leccese of Gambier College further explains this sentiment, "Consideration of the basic pharmacology of marijuana reveals the error of public policy that denied therapeutic benefit to those who might profit from inhalation, or oral consumption of more than one psychoactive component of the crude marijuana plant."51 Since marijuana is composed of hundreds of compounds, it seems arbitrary for U.S. medical policy to only accept one of those compounds as medically valid. Many other respected organizations share this disapproval of current U.S. drug policy.For example, the following medical groups and journals favor medical marijuana over Marinol: National Academy of Sciences, American Public Health Association, California Academy of Family Physicians, San Francisco Medical Society, Federation of American Scientists, Psychopharmacology, and most recently, the New England Journal of Medicine.52 Although these organizations normally carry tremendous influence, the current government drug policy disfavors medical marijuana to such an extent, that even these organizations lose their voice.
With prominent medical organizations and journals being ignored by federal policy makers, and with many mainstream magazines and newspapers creating a general uproar over the medical marijuana issue, the recent furor in America sparked by the passage of Propositions 200 and 215 truly highlights the relationship between science and politics. Dennis Peron, the driving force behind Proposition 215, wonders, "What in the world is a retired Army general doing telling doctors what to do?"53 Regardless of their position on synthetic vs. natural THC, most doctors agree that government does not belong in their medical affairs. Some oncologists find it extremely hypocritical that someone can acquire terminal cancer by smoking cigarettes, yet they cannot medicate themselves with marijuana. Cancer specialist, Elizabeth Lowenthal, writes about this paradox in the Journal of the American Medical Association,
It is ironic to inform cancer patients that they cannot partake of marijuana to relieve their metastatic lung cancer associated anorexia and cachexia acquired from years of partaking in 'the only consumer product sold legally in the United States that is unequivocally carcinogenic when used as directed.'54
Prominent medical marijuana expert Lester Grinspoon, author of Marihuana: The Forbidden Medicine, illuminates another paradox in U.S. drug policy, stating that, "Cocaine and morphine, for example, have always been available as prescription drugs, but no one believes that availability is a significant cause of illicit use."55 Both cocaine and morphine have maintained Schedule II classification since the Controlled Substances Act began in 1970. Marinol also rests in Schedule II, although Brian Jennings, National Sales Director for Unimed, informed me, "I think it is well known that we are trying to place Marinol in Schedule III."56 By dropping down to Schedule III, Unimed can sell Marinol without completing the mandatory DEA paperwork required of all Schedule II drugs. In essence, it would remove another level of bureaucratic interference from sales, and it would make their product seem less potentially harmful. All of these sorts of medical, governmental, theoretical, policy-based, complex issues sit squarely in the borderlands shared between science and politics.
Having extensively analyzed the Marinol versus marijuana debate from a popular culture perspective, and within a historical and theoretical context, it is now apparent just how differently America treats two essentially similar substances. Marinol enjoys cultural and medical legitimacy from society, as well as tax breaks and open market privileges from the government. Marijuana users still risk incarceration and social marginalization, while simultaneously suffering from debilitating illnesses. Despite the wealth of scientific information and the bevy of organizational support illustrating marijuana's numerous medical benefits, the federal government chooses to validate the inferior Marinol medication, and to continue its war on drugs and drug users. Considering America's history of vilifying marijuana, and given the American penchant to promote pharmaceuticals over all other medicines, the current drug policy should not shock us, but it should disappoint us.
1 Mikuriya, Todd H., Ed. Marijuana: Medical Papers (1839-1972). Oakland: Medi-Comp Press, 1973. p. i.
2 Bonnie, Richard and Charles Whitebread II. The Marihuana Conviction: A History of Marihuana Prohibition in the United States. Charlottesville: University Press of Virginia, 1974. p. 1-2.
3 Bonnie, Richard and Charles Whitebread II. p. 54, 64.
4 Ibid. p. 92.
Musto, David. The American Disease: Origins of Narcotic Control. Oxford: Oxford University Press, 1973. pp. 219-223.
Walker, William III. Drug Control in the Americas. Albuquerque: University of New Mexico Press, 1981. p. 99-117.
5 Bonnie, Richard and Charles Whitebread II. p. 100.
6 Meyer, Eugene. "Uncle Sam's Farm." Los Angeles Times. 11 December 1995: E1
7 Scott, Elsa. "Marinol: The Little Synthetic That Couldn't." http:www.hightimes.com/ht/tow/med/marinol.html. passim.
9 International Narcotics Control and United States Foreign Policy: A Compilation of Laws, Treaties, Executive Documents, and Related Materials. Prepared for the Committee on Foreign Affairs, U.S. House of Representatives. Washington, D.C." U.S. Government Printing Office, 1994. p. 119.
10 Scott, Elsa. passim.
FDA Consumer. September 1985. p. 35.
Grabowski, Henry and John Vernon. The Regulation of Pharmaceuticals: Balancing the Risks and Benefits. Washington, D.C.: American Enterprise Institute for Public Policy Research, 1983. p. 23.
11 Unimed Investor Portfolio, 1997.
Doblin, Rick. "MDMA Patentability and Orphan Drug Designation." Multi-Disciplinary Association for Psychedelic Studies. 1995.
13 John G. Kinnard & Co. Research Report. 08/27/96. Unimed Pharmaceuticals, Inc. p. 2.
14 Unimed Investor Portfolio, 1997.
15 Interview with informant at Norac Industries. 03/03/97.
Scott, Elsa. passim.
16 Interview with informant at Norac Industries. 03/03/97.
Scott, Elsa. passim.
17 Interview with UCLA Department of Chemistry pharmaceutical expert. 03/03/97.
Unimed Investor Portfolio, 1997.
18 Interview with informant at Norac Industries. 03/03/97.
19 Marinol product insert. Published by Roxanne Laboratories. 1995.
20 Scott, Elsa. passim.
23 Marinol product insert. Published by Roxanne Laboratories. 1995.
Unimed Investor Portfolio, 1997.
24 Interview with a legal expert at the Food and Drug Administration. 02/24/97.
25 Knox, Richard. "Study may undercut marijuana opponents - Report says THC did not cause cancer" Boston Globe. 30 January 1997: A1.
Scott, Elsa. passim.
Marinol product insert. Published by Roxanne Laboratories. 1995.
27 Falk, John. "Environmental Factors in the Instigation and Maintenance of Drug Abuse." Bickel, Warren and Richard DeGrandpre, Eds. Drug Policy and Human Nature: Psychological Perspectives on the Prevention, Management, and Treatment of Illicit Drug Abuse. New York: Plenum Press, 1996. p. 4.
28 Musto, David. pp. 262-263.
29 Meyer, Eugene. P. E4-E5.
30 Heath, Dwight B. "War on Drugs as a Metaphor." Bickel, Warren and Richard DeGrandpre, Eds. Drug Policy and Human Nature: Psychological Perspectives on the Prevention, Management, and Treatment of Illicit Drug Abuse. pp. 279-280.
Walker, William III. p. 99.
31 Heath, Dwight B. p. 287.
DeGrandpre, Richard. "Socially Constructed Knowledge and Drug Policy." Bickel, Warren and Richard DeGrandpre, Eds. Drug Policy and Human Nature: Psychological Perspectives on the Prevention, Management, and Treatment of Illicit Drug Abuse. p. 316.
32 Gorman, Peter. "Feds Fly Anti-Pot-Doc Balloon" High Times. April 1997. p. 20.
33 Peele, Stanton. ""Drugs and the Marketing of Drug Policy." Bickel, Warren and Richard DeGrandpre, Eds. Drug Policy and Human Nature: Psychological Perspectives on the Prevention, Management, and Treatment of Illicit Drug Abuse. p. 201.
34 Interview with Unimed National Sales Director, Brian Jennings. 02/24/97.
35 Unimed Investor Portfolio, 1997.
36 Interview with National Organization for the Reform of Marijuana Laws representative. 02/20/97.
Unimed Investor Portfolio, 1997.
38 Marinol product insert. 1995.
39 Unimed Investor Portfolio, 1997.
40 Marinol product insert. 1995.
41 Grinspoon, Lester and James Bakalar. "Marijuana as Medicine." Journal of the American Medical Association. December 20, 1995. p. 1838.
42 Voelker, Rebecca. "Medical Marijuana: A Trial of Science and Politics." Journal of the American Medical Association. June 1, 1994. p. 1645.
43 Brookhiser, Richard. "Lost in the Weed." U.S. News and World Report. January 13, 1997. P. 9.
44 Nadelmann, Ethan A. and Michael Simmons. "Reefer Madness 1997: the New Bag of Scare Tactics." Rolling Stone. February 20, 1997. pp. 51-55.
Rosin, Hanna. "The Return of Pot: California Gears Up for a Long Strange Trip." New Republic. February 17, 1997. pp. 18-25.
45 Krauthammer, Charles. "Pot Lovers Are Hiding Behind the Terminally Ill." Los Angeles Times. 11 January 1997: B7.
46 "Clinton/McCaffery Declare War on People With AIDS!!!" 4Front. January 22, 1997. pp. 19.
47 Adams, Emily and Lee Peterson. "Hazy Future for Legal Marijuana." The Daily Breeze. 18 November 1996: A4.
Conant, Marcus. "This Is Smart Medicine" Newsweek. February 3, 1997. p. 26.
48 Weinberg, Bill. "The California Medical-Marijuana Rebellion." High Times. April 1997. p. 48.
49 Doblin, Rick and Mark A.R. Kleiman. "Marijuana as Antiemetic Medicine: A Survey of Oncologists' Experiences and Attitudes." Journal of Clinical Oncology. July 1991. pp. 1314-1319.
50 Nahas, Gabriel and Colette Latour, Eds. Cannabis: Physiopathology, Epidemiology, Detection. Boca Raton, Florida: CRC Press, 1993. p. 6.
51 Leccese, Arthur P. "Pharmacology of Psychoactive Drugs." Bickel, Warren and Richard DeGrandpre, Eds. Drug Policy and Human Nature: Psychological Perspectives on the Prevention, Management, and Treatment of Illicit Drug Abuse. pp. 240-241.
52 "About Medical Marijuana" Published by National NORML. www.norml.com.
Chait, L.D. and James P. Zacny. "Reinforcing and Subjective Effects of Oral Delta 9 THC and Smoked Marijuana in Humans." Psychopharmacology. Spring 1992. pp. 255-262.
53 Condor, Bob. "Marijuana's Therapeutic Value Impresses the Ill." Chicago Tribune. 5 January 1997: A1.
54 Lowenthal, Elizabeth A. "Marijuana as Medicine." Journal of the American Medical Association. December 20, 1995. p. 1837.
55 Grinspoon, Lester and James Bakalar. p. 1838.
56 Interview with Unimed National Sales Director, Brian Jennings. 02/24/97.