Comment: Why is in Opinion: Former Drug Czar Barry McCaffrey "100%" for Medical Marijuana on Opposing Views

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(Opinion) Former Drug Czar Barry McCaffrey "100%" for Medical Marijuana

By Reason Foundation

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Deceptive.

Why is

marinol useless? I probably would have liked some to relieve my terrible nausea and suppressed appetite when I was younger and getting chemo, but it wasn't approved for children .

Now they just need to come up with a drug to prevent the hair loss crap from chemo. Luckily it grew back, but it made me really sad for a time period ='(.

- caelum October 26, 2009 12:09AM

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- Marinol.
  
  All the studies that I have read about have said that marinol is not as effective as smoking marijuana . Years ago when my brother was dieing of cancer the hospital was letting him smoke marijuana for a while but then they took it away and gave him marinol. He said that the maijuana helped but not the marinol.
  
  - mike1948 October 26, 2009 1:54PM
  
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  - Well,
    
    saying something is may be more or less effective doesn't make the original product worthless. For example, in some cases Depakote is more effective than Topamax, but that doesn't make Topamax worthless.
    
    Individual anecdotes usually aren't good gauges for the efficacy of something. I mean, people have taken saline and supposedly felt better so we have to be careful with individual stories.
    
    Very little studies have been done on medical cannabis , really. At least not nearly enough to conclusively conclude anything. Even fewer studies have done comparative effectiveness research between the two.
    
    If I might make a conjecture about your brother, though. Most of the studies that have demonstrated greater efficacy of smoked marijuana versus synthetic marinol have showed that since the nausea and vomiting are so severe they are not actually able to ever retain the pill since it takes longer for it to initially become active in their system. That may be why he experienced no effect from it and returned to his prior state. Unless we are talking about different symptoms he was trying to suppress, I was mostly talking about nausea / appetite suppression.
    
    I'm personally against the FDA putting such harsh restrictions on research about medical cannabis anyway, but that's how it is I suppose.
    
    - caelum October 27, 2009 11:06AM
    
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    - Political.
      
      The problem with some issues, marijuana for one, is each side has their studies but very little objective research is being done.
      
      - mike1948 November 4, 2009 11:10PM
      
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- Reasons marinol is worse
  
  Marijuana contains dozens of active chemicals in a variable balance, most of which serve to modulate the effects of others. This is the same reason why smokers will ascribe different effects to different plants -- one might be energetic and make you want to run around and play sports , another might make you want to sit on the couch, and another might make everything hilarious: each has a slightly different mixture of the active chemicals. Which balance exactly you prefer for your condition will of course be entirely up to you; many cannabis users have a favourite strain, and they don't all agree that one is superior to all the others. What they do agree on, however, is that 100% pure THC, without all the other active chemicals, is just not nearly as good, because while THC is the most potent, some of the others serve to make its effects more "well rounded" or similar.
  
  Then there's ability to self-regulate. When you smoke, the onset is fast and the high might last for a couple hours, but not into the next day. Users typically become very good at figuring out exactly how much they need to smoke... they keep smoking bit by bit until they're as high as they want to be, and then they stop, and smoke again once they've sobered up to the point that they want more. In other words, they can easily control how high they're going to be at any particular time. With Marinol, however, you get a delayed onset and a prolonged duration, such that it's very easy to either not get the amount you needed, or to take way too much, and have no idea which of these two you've done until you're already a couple hours in and it's too late to really do anything about it.
  
  The duration/onset also means that if you're looking for immediate relief, but don't want to be stoned for the rest of the day, smoking is far better, because in a few hours you'll be sober. This is particularly relevant if you're talking about a condition that isn't constant, but instead flares up occasionally.
  
  Oh yeah, and the cost for Marinol is also much higher.
  
  - Michael Vipperman October 26, 2009 3:32PM
  
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  - I didn't attempt
    
    to answer which was better. I was saying marinol is not "useless", I didn't bother getting into efficacy.
    
    There are so few studies that have compared the efficacy between them no one can claim with any confidence that one is truly more effective than the other.
    
    Actually, marijuana contains chemicals that no one has studied the long-term effects from. It's not " safe " because no one has truly studied all of the health effects from them in proper controls (at least there aren't enough studies to conclude anything). No study exists confirming the 100%, the highest number I've ever seen is 23%. Most studies show no preference among patients. Of those that do show a preference you will usually see a split on who prefers dronabinol and those that prefer smoked.
    
    What you are describing about smoking is something the National Academy of Sciences and the National Institute of Health has concluded is more dangerous for patients who are not familiar with marijuana smoking and will do them more harm because of their tendency to either overdose or underdose. This has issues with decreasing therapeutic benefit (underdose) or promoting things like acute pain, delirium, rapid respiratory and pulmonary function decline. Leaving it up to the patient can be quite dangerous.
    
    Smoked marijuana has shown to have a larger effect on daily behavior by promoting apathy. Marinol doesn't "stone" the overwhelming majority of users for a significant part of the day. Smoked marijuana is less effective throughout the day and so you have to do the process you described in the second paragraph, that really does make you stoned for most of the day.
    
    Nobody really knows anything, all of the studies are too preliminary to conclude either way. No one should frame a hypothesis because the data I cited above is likely questionable, at best, due to the lack of proper scope of comparative research.
    
    - caelum October 27, 2009 11:30AM
    
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    - Hmm
      
      The plant, as a whole, has not been shown to be dangerous. It's completely meaningless to say that the individual chemicals haven't been studied, when what we're comparing is "pure THC" and "the plant as a whole," both of which have been studied. Which, exactly, are the harmful effects of smoking the plant that we'd be worried are being caused by an active chemical other than THC? Are there any? The failure of modern chemistry and clinical pharmacology to gain a complete understanding of all the drug's effects/constituents and their subsequent inability to reproduce those effects with a synthetic is precisely what we're talking about. It's not necessary that we know why the plant is better, as long as it appears to be, and doesn't appear to be terribly dangerous. Remember that we're talking about something with thousands of years of use as a therapeutic agent, not something that was just discovered last week -- its use need not be contingent on gaining approval from an industrial complex which has a vested interest in keeping it illegal .
      
      "What you are describing about smoking is something the National Academy of Sciences and the National Institute of Health has concluded is more dangerous for patients who are not familiar with marijuana smoking and will do them more harm because of their tendency to either overdose or underdose. This has issues with decreasing therapeutic benefit (underdose) or promoting things like acute pain, delirium, rapid respiratory and pulmonary function decline. Leaving it up to the patient can be quite dangerous."
      Would you care to present a little logic here? Like, why it makes it more dangerous? I think that conclusion (whether drawn by you or an Institute) is completely asinine; tolerance is highly variable between individuals, and a standardized dose is simply inferior to a user controlled dose for things like pain/nausea relief, particularly when the dangers of "abuse" are negligible: avoiding underdose is exactly what an easier to control high with a faster onset allows. What's this "overdose" thing you're talking about? Please describe what a cannabis overdose looks like and how much is necessary.
      
      "Smoked marijuana has shown to have a larger effect on daily behavior by promoting apathy. Marinol doesn't "stone" the overwhelming majority of users for a significant part of the day. Smoked marijuana is less effective throughout the day and so you have to do the process you described in the second paragraph, that really does make you stoned for most of the day."
      The Marinol users I've spoken to say that it does, in fact, "stone" them. Where are you getting your data? And what's this "promoting apathy" thing you're talking about? I thought the demotivational syndrome stuff got debunked years ago.
      
      - Michael Vipperman October 27, 2009 2:27PM
      
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