By Paul Armentano NORML Deputy Director
The cannabis plant and its biologically active constituents, known as cannabinoids, possess an impressive safety profile compared to other conventional therapeutic agents. According to the National Academy of Sciences, Institute of Medicine marijuana possesses an estimated dependence liability of less than ten percent. This percentage is approximately the same as anxiolytic drugs and far lower than that of many other licit prescription drugs or recreational substances, like alcohol (15 percent) and tobacco (32 percent). Cannabinoids are relatively non-toxic and possesses no lethal overdose potential. As acknowledged by no less than the DEA’s own administrative law judge, “Marijuana, in its natural form, is one of the safest therapeutically active substances known to man.”
Cannabis has been consumed for spiritual, medicinal, and recreational purposes for thousands of years, thus providing society with ample empirical evidence of the plant’s relative safety and efficacy. Moreover, despite the US government’s nearly century-long prohibition of the herb, marijuana is nonetheless among the most studied biologically active substances of modern times. A search on PubMed, the repository for all peer-reviewed scientific papers, using the term “marijuana” yields more than 21,000 scientific studies referencing the plant and/or its constituents, nearly half of which have been published within the past decade. This sum is greater than the total number of scientific papers available for ibuprofen, Ritalin, hydrocodone, Adderall, and Oxycodone combined.
A review of the available literature identifies over 100 controlled studies worldwide, involving thousands of subjects, evaluating the safety and efficacy of cannabis or individual cannabinoids. By contrast, most FDA-approved pharmaceuticals are approved based on only two pivotal trials.
A recent review of FDA-approved medical marijuana concluded, “Based on evidence currently available the Schedule I classification (for cannabis) is not tenable; it is not accurate that cannabis has no medical value, or that information on safety is lacking.”
Numerous medical and health organizations – such as the American Nurses Association, the American Public Health Association, and the Epilepsy Foundation of America – support allowing qualified patients to legally access to cannabis therapy. Most practicing physicians do too. According to survey data by WebMD/Medscape, nearly 70 percent of doctors, including over 80 percent of oncologists and hematologists, acknowledge the therapeutic qualities of cannabis and 56 percent agree that it should be a legal option for patients.
Not so concludes a study published in 2014 the scientific journal PLoS ONE. Investigators tracked crime rates across all 50 states in the years between 1990 and 2006, during which time 11 states legalized medical cannabis access. Authors reviewed FBI Uniform Crime Report data to determine whether there was any association between the enactment of medical pot laws and rates of statewide criminal activity, specifically the number of reported crimes involving homicide, rape, robbery, assault, burglary, larceny, and auto theft. They concluded, “The central finding gleaned from the present study was that MML (medical marijuana legalization) is not predictive of higher crime rates and may be related to reductions in rates of homicide and assault. … [T]hese findings run counter to arguments suggesting the legalization of marijuana for medical purposes poses a danger to public health in terms of exposure to violent crime and property crimes.”
Similarly, a 2012 federally commissioned study reported that the establishment of cannabis dispensaries is not associated with elevated rates of either violent crimes or property crimes. It concluded, “There were no observed cross-sectional associations between the density of medical marijuana dispensaries and either violent or property crime rates in this study. These results suggest that the density of medical marijuana dispensaries may not be associated with crime rates.”
Wrong again. Most recently, researchers at Rhode Island Hospital and Brown University assessed the impact of medical cannabis laws over a 20-year period by examining trends in self-reported drug use by high schoolers in a cohort of states before and after legalization. Investigators compared these trends to geographically matched states that had not adopted medical marijuana access laws during this time. They determined, “[O]ur study of self-reported marijuana use by adolescents in states with a medical marijuana policy compared with a sample of geographically similar states without a policy does not demonstrate increases in marijuana use among high school students that may be attributed to the policies. … [C]oncerns about (medical marijuana laws) ‘sending the wrong message’ may have been overblown.”
According to a 2012 study published in the Journal of the American Medical Association, subjects exposed to moderate levels of cannabis smoke over an extended period of time do not experience the sort of significant pulmonary harms associated with tobacco smoking. “Our findings suggest that occasional use of marijuana … may not be associated with adverse consequences on pulmonary function,” the study concluded. Further, the long-term inhalation of pot smoke is not associated with increased incidents of lung-related cancers. According to the results of the largest case-controlled study ever to investigate the matter, ganja smoking is not associated with higher incidences of cancers of the lung or upper aero-digestive tract, even among subjects who reported smoking more than 22,000 joints over their lifetime. Summarizing the study’s findings to the Washington Post, the study’s lead researcher, Dr. Donald Tashkin of the University of California at Los Angeles affirmed: “We hypothesized that there would be a positive association between marijuana use and lung cancer, and that the association would be more positive with heavier use. What we found instead was no association at all, and even a suggestion of some protective effect.”
Yet patients inhale many conventional medications, such as anti-asthma drugs. These patients inhale conventional medications for largely the same reasons as do medical cannabis smokers: they require rapid onset of therapeutic drug effect, they desire the flexibility to self-regulate their dosage depending on the circumstances, and the medication they are administering lacks lethal overdose potential.
Further, clinical studies assessing the efficacy of vaporization as a cannabinoid delivery device have determined it to be a safe alternative to smoking, concluding: “Vaporization of marijuana does not result in exposure to combustion gases and [was] preferred by most subjects compared to marijuana cigarettes. … [It] is an effective and apparently safe vehicle for THC delivery.”
Marinol/dronabinol is an FDA-approved synthetic version of a single isolated compound in cannabis. Consequently, Marinol lacks dozens of other identified, therapeutically active components available in the plant, as well many of the terpenes present in pot. It possesses poor bioavailability compared to inhaled plant cannabinoids, and its mood-altering effects tend to be far more dysphoric compared go inhaled cannabis. When given the choice between Marinol and whole-plant cannabis, the majority of patients choose the herbal alternative.
The FDA evaluates patented, synthetic products developed by private companies. It generally does not evaluate naturally occurring botanical products such as cannabis. That is not to say that cannabis, in particular a standardized variety of the plant, could not arguably meet the conventional FDA standards of safety and efficacy. Humans have consumed cannabis for thousands of years and it possesses adequate safety profile. Further, its therapeutic utility is demonstrated in numerous controlled trials. Arguably, by any objective analysis, cannabis and cannabinoids exceed the FDA’s existing standards for safety and efficacy.