How Does Marijuana Compare to Marinol in the Treatment of Appetite and Nausea?


We have broken the comparison between medical marijuana and Marinol into eight (8) subsections, some of which are also available in other questions and responses on this website:

1. Could it be good medical procedure to recommend marijuana and/or prescribe Marinol to treat nausea/appetite?
Marijuana Marinol
Yes, according to California Health & Safety Code 11362.5, (A):
"To ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where that medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief."
Nov. 1996 CA Health & Safety Code 11362.5

No, according to the Institute of Medicine's (IOM) Mar. 1999 report Marijuana and Medicine, Assessing the Science Base, which stated on Page 157:
"Considering current knowledge about malnutrition in HIV patients, cannabinoids, by themselves, will probably not constitute primary therapies, such as anabolic agents.

Specifically, the proposed mechanism of action of increasing food intake would most likely be ineffective in promoting an increase in skeletal muscle mass and functional capacity -- the goal of treatment of cachexia in AIDS patients."
Mar. 1999 Institute of Medicine
No, according to the Crohn's & Colitis Foundation of America (CCFA), which wrote in its Aug. 4, 2005 website article "Cannabis and IBD: A Fragile Connection":
  "While marijuana might temporarily reduce pain and nausea... CCFA's expert consensus remains: The harmful side effects of marijuana far outweigh its potential benefits."
Aug. 4, 2005 Crohn's & Colitis Foundation of America
Yes, according to Unimed Pharmaceutical's website on Marinol:
"Based on extensive research, the United States Food and Drug Administration has approved MARINOL® for two purposes: The treatment of anorexia (loss of appetite) associated with weight loss in patients with AIDS ... [and] The treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments..."
2006 Unimed Pharmaceutical

No, according to Bill Zimmerman, PhD, who wrote in his 1998 book Is Marijuana The Right Medicine For You? :
"Patients experiencing extreme nausea find it difficult to swallow any medication in pill form. Some patients vomit when trying to swallow the capsule and are unable to use it.

When Marinol does work, many patients claim it takes over an hour re relieve their symptoms. This probably results from the fact that the THC passes through the liver before reaching the receptors in the brain...

Because Marinol takes so long to reduce nausea, some patients have complained that they are at risk of overdosing when they are driven to get quick relief from their violent symptoms."
1998 Bill Zimmerman
 
2. What is the daily dosage of marijuana or Marinol usually used to increase appetite?
Marijuana Marinol
The Institute of Medicine's (IOM) Mar. 1999 report Marijuana and Medicine, Assessing the Science Base stated on page 156:
"Some people report a preference for smoked marijuana over oral THC [Marinol] because it gives them the ability to titrate the effects, which depend upon how much they inhale."
Mar. 1999 Institute of Medicine

The Los Angeles Cannabis Resource Center told ProCon.org in a 2004 phone discussion:
"Usually a few puffs prior to each meal is sufficient for many patients. Some will require about half to a whole joint prior to each meal. These are usually thinly rolled, about 0.5 grams in weight. Those who prefer non-smoked will often eat one quarter to half a brownie, or use about 0.25 grams in a vaporizer, prior to each meal."
2004 L.A. Cannabis Resource Center
Unimed Pharmaceuticals, Marinol's manufacturer, stated in its website guide to Marinol dosage for appetite stimulation:
"Initially, 2.5 mg MARINOL® Capsules should be administered orally twice daily (b.i.d.) before lunch and supper.

For patients unable to tolerate this 5 mg/day dosage of MARINOL® Capsules, the dosage can be reduced to 2.5 mg/day, administered as a single dose in the evening or at bedtime.."
2004 Unimed Pharmaceuticals
3. Is medical marijuana and/or Marinol suitable for general medical use in patients under the age of 18?
Marijuana Marinol
Bernard Rimland, PhD, of the Autism Research Institute, stated in a 2003 article published in Autism Review International: 
"Clearly, medical marijuana is not a drug to be administered lightly. But compare its side effects to the known effects of Risperdal, which include massive weight gain, a dramatically increased risk of diabetes, and an elevated risk of deadly heart problems, as well as a host of other major and minor problems....

Moreover, the reports we are seeing from parents indicate that medical marijuana often works when no other treatments, drug or non-drug, have helped."
2003 Bernard Rimland
Unimed Pharmaceuticals, the manufacturer of Marinol, stated on its website:
"..the United States Food and Drug Administration has approved MARINOL...

MARINOL® Capsules is not recommended for AIDS-related anorexia in pediatric patients because it has not been studied in this population. The pediatric dosage for the treatment of chemotherapy-induced emesis is the same as in adults. Caution is recommended in prescribing MARINOL® Capsules for children because of the psychoactive effects."
2006 Unimed Pharmaceuticals
  [Editor's Note: Although not recommended by its manufacturer, it remains legal under federal law to prescribe Marinol to pediatric patients.]
4. How long does medical marijuana and/or Marinol usually take to work?
Marijuana Marinol
Bill Zimmerman, PhD, wrote in his 1998 book Is Marijuana The Right Medicine For You? :
"Because smoking permits an almost instantaneous transmission of the THC in the marijuana to sites in the brain where it works to control nausea, patients are able to simply continue smoking until the nausea subsides.

This allows some to stop smoking before they get high.

When the antinausea effects wears off, they can smoke a little more if they need to."
1998 Bill Zimmerman

The Los Angeles Cannabis Resource Center told ProCon.org in a 2004 interview:
"For appetite, about 10-15 minutes, sometimes less. For stomach pain, nausea and vomiting, about 5 minutes. Vaporized takes about the same time as smoked to take effect. Edible takes about 30-60 minutes to take effect, sometimes longer."
2004 L.A. Cannabis Resource Center
Lynn Zimmer, PhD, and John Morgan, MD, wrote in their 1997 book Marijuana Myths, Marijuana Facts:
"When Marinol is swallowed, it must move from the stomach to the small intestines before being absorbed into the bloodstream. After absorption, orally consumed THC passes immediately through the liver, where a significant proportioned is transformed into other chemicals.. the onset of effect is an hour or more."
1997 Lynn Zimmer and John Morgan

Unimed Pharmaceuticals, the maker of Marinol, states on their website:
"Most people with HIV/AIDS in clinical studies noticed a significant improvement in their appetite within 4 weeks, but your response may be different. Even if you think it isn’t working fast enough, do not stop taking MARINOL® without talking to your doctor first."
2006 Unimed Pharmaceuticals
5. How long do the effects of medical marijuana or Marinol usually last?
Marijuana Marinol
The L.A. Cannabis Resource Center told ProCon.org in a Mar. 2004 interview:
"The effects of smoked marijuana generally lasts about an hour to two hours. Edibles can last 4-6 hours, vaporized about an hour to two hours."
Mar. 2004 L.A. Cannabis Resource Center
Lynn Zimmer, PhD, and John Morgan, MD, wrote in their 1997 book Marijuana Myths, Marijuana Facts:
"When THC (Marinol) is swallowed, the effects last longer -- up to six hours, compared to one or two hours when marijuana is smoked."
1997 Lynn Zimmer and John Morgan
6. Do people feel "stoned" from the medical (not recreational) use of marijuana or Marinol?
Marijuana Marinol
The L.A. Cannabis Resource Center told ProCon.org in a Mar. 2004 discussion:
"Most medical users smoke until they feel the 'buzz' because that let's them know it's 'working.' Many medical patients claim they don't feel high from using a few puffs, although a slight 'buzz' is usually felt. If used very moderately, a patient can titrate (calculate or estimate) their doses so that they reap the medical effects without the 'stoned' feeling. With edibles, small doses can increase the appetite without the 'stoned' feeling. Larger doses will keep the person 'stoned' for up to 4 hours. With careful titration, vaporization can take effect without the 'stoned' feeling."
Mar. 2004 L.A. Cannabis Resource Center
Lynn Zimmer, PhD, and John Morgan, MD, wrote in their 1997 book Marijuana Myths, Marijuana Facts:
"Another problem with swallowed THC [Marinol] is that the psychoactive side effects may be more intense than those that occur from smoking....

With oral ingestion, patients experience psychactive effects from THC and 11-hydroxy-THC, increasing the likelihood of adverse psychological reactions....

In a study of elderly patients, the large dose of oral THC [Marinol] needed to reduce nausea and vomiting produced severe psychoactive effects, reducing its utility as a medicine."
1997 Lynn Zimmer and John Morgan

Marinol's manufacturer, Unimed Pharmaceuticals, stated on its website:
"The most frequently reported side effects in patients with AIDS during clinical studies involved the central nervous system (CNS). These CNS effects (euphoria, dizziness, or thinking abnormalities, for example) were reported by 33% of patients taking MARINOL®. About 25% of patients reported a minor CNS side effect during the first 2 weeks of treatment and about 4% reported such an event each week for the next 6 weeks. You should be aware that your body may be more sensitive to MARINOL® when you first start using it, so you may experience dizziness, confusion, sleepiness, or a high feeling. These symptoms usually go away in 1 to 3 days with continued dosage. If these symptoms are troublesome or persist, notify your doctor at once."
2006 Unimed
7. What are some of the risks of medical marijuana and Marinol?
Marijuana Marinol
The Institute of Medicine's (IOM) Mar. 1999 report Marijuana and Medicine, Assessing the Science Base stated on pages 126-127:
"Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harm associated with smoking, the adverse effects of marijuana use are within the range tolerated for other medications. Thus, the safety issues associated with marijuana do not preclude some medical uses."
1999 Institute of Medicine

The United States Drug Enforcement Administration (DEA) stated in its Nov. 2001 publication "DEA Briefing Book, Drugs of Concern":  
"Marijuana contains known toxins and cancer-causing chemicals that are stored in fat cells of users for up to several months. Marijuana users experience the same health problems as tobacco smokers, such as bronchitis, emphysema, and bronchial asthma. Some of the effects of marijuana use also include increased heart rate, dryness of the mouth, reddening of the eyes, impaired motor skills and concentration, and frequent hunger. Extended use increases risk to the lungs and reproductive system, as well as suppression of the immune system. Occasionally, hallucinations, fantasies, and paranoia are reported."
Nov. 2001 US DEA

The California Narcotics Officers' Association (CNOA) stated in its position paper "The Use of Marijuana as a Medicine," (accessed Oct. 8, 2003): 
"Common sense dictates that it is not good medical practice to allow a substance to be used as a medicine if that product is:
  • not FDA-approved,
  • ingested by smoking,
  • made up of hundreds of different chemicals,
  • not subject to product liability regulations,
  • exempt from quality control standards,
  • not governed by daily dose criteria,
  • offered in unknown strengths (THC) from 1 to 10+ percent, and
  • self-prescribed and self-administered by the patient."
    Oct. 8, 2003 CA Narcotics Officers' Association
Marinol's manufacturer, Unimed Pharmaceuticals, states on their website:
"MARINOL® should not be taken by anyone with a history of hypersensitivity to any drug in the cannabinoid class or to sesame oil ...

Caution is recommended in prescribing MARINOL® Capsules for children because of the psychoactive effects."
2006 Unimed

Unimed Pharmaceuticals, the manufacturer of Marinol, states on its website (as of April 2004):  
  • "MARINOL® should be used with caution in patients with cardiac disorders because of occasional hypotension, possible hypertension, syncope, or tachycardia.
  • MARINOL® should be used with caution in patients with a history of substance abuse, including alcohol abuse or dependence, because they may be more prone to abuse MARINOL® as well. Multiple substance abuse is common and marijuana, which contains the same active compound, is a frequently abused substance.
  • MARINOL® should be used with caution and careful psychiatric monitoring in patients with mania, depression, or schizophrenia because MARINOL® may exacerbate these illnesses.
  • MARINOL® should be used with caution in patients receiving concomitant therapy with sedatives, hypnotics, or other psychoactive drugs because of the potential for additive or synergistic CNS effects.
  • Although no drug/drug interactions were discovered during clinical trials of MARINOL®, cannabinoids may interact with other medications."
    Apr. 2004 Unimed


Risk Comparison of Legal and Illegal Anti-Emetics

According to Complete Guide to Prescription & Nonprescription Drugs, Marijuana and Marinol have idendical risks. The risks associated with Compazine, Tigan and Mataclopromide vary (2002 Edition, pages 334-335. Revised and Updated by Stephen Moore, M.D.), as do the risks associated with Zofran and Kytril (obtained from the drug manufacturer as noted below).


Risks Marijuana Marinol Compa-
zine
Tigan Metaclo-
pramide
Zofran1 Kytril2 Dolasetron3
Year approved by FDA N/A 1985 1980* 2001 1980* 1991 1999 1997
1. Smoking x None None None None None None None
2. Rapid, pounding heartbeat (common) x x x None x x None None
3. Euphoria (common) x x None None None None None None
4. Decreased coordination (common) x x x x x x x None
5. Red eyes, dry mouth (common) x x x None None None None x
6. Dizziness, irritability, drowsiness (common) x x x x x x x x
7. Dramatic mood changes (infrequent) x x None None None None None None
8. Depression, anxiety, nervousness, headache (infrequent) x x x x x x x x
9. Hallucinations (infrequent) x x None None x None None None
10. Blurred or changed vision (infrequent) x x x x none x none none
11. Fainting (rare) x x none none none none none none
12. Frequent or difficult urination (rare) x x x none x none none none
13. Convulsions (rare) x x x x x none none none
14. Shortness of breath (rare) x x x none x x x x
15. Paranoia (rare) x x none none none none none none
16. Nausea (rare) x x x none x none x none
17. Loss of appetite (rare) x x x none x none x none
18. Dizziness when standing or after sitting/lying (rare) x x x x x x x x
19. Diarrhea (rare) x x none x x x x x
20. Coma none none x x none none none none
21. Seizure none none x x x x none none
22. Rash none none none x x none none x
23. Frequent Vomiting none none none x none none x none
24. Chest pain none none none none none none none x
25. Constipation none none none none none none none x
1 Information on Zofran obtained from Glaxo Wellcome website Feb. 27, 2002
2Information on Kytril obtained from Roche Laboratories website Feb. 27, 2002
3Information on Dolasetron (Anzemet) obtained from official dolasetron website (www.dolasetron.com) July 17, 2003
- Risk Comparison of Legal and Illegal Anti-Emetics