Is Marinol Better Medicine Than Marijuana?
Robert L. DuPont, MD, President of the Institute For Behavior and Health, wrote to ProCon.org in a Jan. 12, 2002 email:
“The approval of Marinol by the FDA in 1985 showed that synthetic THC was judged by the legal process used to approve medicines to be a safe and effective medicine for the treatment of nausea and vomiting. That is not the same thing as approving ‘marijuana’ as a ‘medicine.’
There is no possibility of approval of any plant as a medicine to treat any illness, now or ever because the chemicals in whole plants (to say nothing of smoked plants which are composed of many, many more chemicals) could be approved as a medicine. Plants are unstable mixtures of different chemicals which cannot be used directly to provide a ‘dose’ of a specific chemical to be used as a medical treatment.
To think that the approval of Marinol by the FDA meant that marijuana was approved by the FDA as a medicine is to misunderstand both what medicines are and the value of the modern approval process for specific chemicals to be used as medicines.”Jan. 12, 2002 - Robert L. DuPont, MD
The Office of National Drug Control Policy (ONDCP) stated in its website article “Marijuana Myths and Facts” (accessed on Apr. 14, 2006):
“Under the Comprehensive Drug Abuse Prevention and Control Act of 1970, marijuana was established as a Schedule I controlled substance. In other words, it is a dangerous drug that has no recognized medical value.
Whether marijuana can provide relief for people with certain medical conditions, including cancer, is a subject of intense national debate. It is true that THC, the primary active chemical in marijuana, can be useful for treating some medical problems. Synthetic THC is the main ingredient in Marinol, an FDA-approved medication used to control nausea in cancer chemotherapy patients and to stimulate appetite in people with AIDS.
Marinol, a legal and safe version of medical marijuana, has been available by prescription since 1985.
However, marijuana as a smoked product has never proven to be medically beneficial and, in fact, is much more likely to harm one’s health.”Apr. 14, 2006 - Office of National Drug Control Policy (ONDCP)
Andrea Barthwell, MD, former Deputy Director for Demand Reduction at the US Office of National Drug Control Policy (ONDCP), told PBS NewsHour on Oct. 14, 2003:
“Physicians who are compassionate and practicing scientifically based, evidence based 21st century medicine would much prefer to use Marinol, which is available to them, than suggest that their patients smoke a plant.
They would not want to engage in asking a patient to smoke opium to treat pain or to chew deadly Nightshade to stabilize their heart beat.”Oct. 14, 2003 - Andrea Barthwell, MD
Gabriel Nahas, MD, PhD, Professor Emeritus at Columbia University, wrote in a Mar. 1997 editorial published in the Wall Street Journal:
“Plasma THC concentration following oral administration [of Marinol] reaches a more sustained, steady level, lasting three to four hours, twice as long as after smoking.
Such prolonged concentration should be more effective than a rapid rise and fall of THC concentration after smoking.”Mar. 1997 - Gabriel Nahas, MD, PhD
The US Drug Enforcement Administration (DEA) stated in its website article “Medical Marijuana: The Facts” (accessed Apr. 14, 2006):
“Unlike smoked marijuana — which contains more than 400 different chemicals, including most of the hazardous chemicals found in tobacco smoke — Marinol has been studied and approved by the medical community and the Food and Drug Administration (FDA), the nation’s watchdog over unsafe and harmful food and drug products.
Since the passage of the 1906 Pure Food and Drug Act, any drug that is marketed in the United States must undergo rigorous scientific testing. The approval process mandated by this act ensures that claims of safety and therapeutic value are supported by clinical evidence and keeps unsafe, ineffective and dangerous drugs off the market.
There are no FDA-approved medications that are smoked. For one thing, smoking is generally a poor way to deliver medicine. It is difficult to administer safe, regulated dosages of medicines in smoked form.
Secondly, the harmful chemicals and carcinogens that are byproducts of smoking create entirely new health problems. There are four times the level of tar in a marijuana cigarette, for example, than in a tobacco cigarette.”Apr. 14, 2006 - US Drug Enforcement Administration (DEA)
The California Narcotics Officers Association (CNOA), in a policy statement titled “The Use of Marijuana as a Medicine” on its website (accessed May 22, 2002), stated:
“Marinol differs from the crude plant marijuana because it consists of one pure, well-studied, FDA-approved pharmaceutical in stable known dosages.
Marijuana is an unstable mixture of over 400 chemicals including many toxic psychoactive chemicals which are largely unstudied and appear in uncontrolled strengths.”May 22, 2002 - California Narcotics Officers Association (CNOA)
Lester Grinspoon, MD, Professor of Psychiatry at the Harvard Medical School, stated in the 2001 issue of the International Journal of Drug Policy:
“I have yet to examine a patient who has used both smoked marijuana and Marinol who finds the latter more useful; the most common reason for using Marinol is the illegality of marijuana, and many patients choose to ignore the law when they believe that the difference between the two puts their health, comfort or economic well-being at risk.
If patients were legally allowed to use marijuana, relatively few would choose Marinol.”2001 - Lester Grinspoon, MD
The Institute of Medicine stated the following in its 1999 report titled “Marijuana and Medicine: Assessing the Science Base”:
“It is well recognized that Marinol’s oral route of administration hampers its effectiveness because of slow absorption and patients’ desire for more control over dosing.”1999 - Institute of Medicine "Marijuana and Medicine: Assessing the Science Base"
Andrew Weil, MD, Director of Integrative Medicine at University of Arizona’s College of Medicine, stated in a June 6, 2002 article published in the San Francisco Chronicle:
“Unfortunately, the only legal substitute [to marijuana] available now — a prescription pill containing synthetic THC, marijuana’s main psychoactive component — is not EFFECTIVE enough for many patients. I hear regularly from patients that the pill does not work as well as the natural herb, and causes much greater intoxication.”June 6, 2002 - Andrew Weil, MD
Debasish Tripathy, MD, Professor of Medicine at the University of Southern California, declared in sworn testimony on Feb. 13, 1997 in Conant v. McCaffrey:
“I have prescribed Marinol to some of my patients and it has proven effective in some cases. However, scientific and anecdotal reports consistently indicate that smoking marijuana is a therapeutically preferable means of ingestion. Marinol is available in pill form only. Moreover, Marinol contains only one of the many ingredients found in marijuana (THC). It may be that the beneficial effects of THC are increased by the cumulative effect of additional substances found in cannabis. That is an area for future research. For whatever reason, smoking appears to result in faster, more effective relief, and dosage levels are more easily titrated and controlled in some patients.”Feb. 13, 1997 - Debasish Tripathy, MD
Donald Abrams, MD, Professor of Clinical Medicine at the University of California, San Francisco, noted in a lecture on May 17, 1999:
“When we look at the pharmaecopia, when taken by mouth, delta-9 THC [Marinol] has a very low 6 to 20 percent absorption, and it’s very variable from one person to another….
Smoking THC, the THC is rapidly absorbed into the blood stream and redistributed with a considerable amount of it destroyed by combustion. Peak plasma levels are achieved at the very end of smoking and decline rapidly over 30 minutes, as if it were given intravenously, whereas, if taken by mouth, it’s a slow and doesn’t reach very high peaks and takes a long time to disappear.
The amount of THC one is exposed to might be the same, but certainly the effects are much different. In patients who say, ‘I can control the onset and the duration much easier if I smoke than if I swallow it’ are telling us just what we know from the pharmaecopia.”May 17, 1999 - Donald Abrams, MD
Mitch Earleywine, PhD, Associate Professor of Psychology at University at Albany at the State University of New York, wrote in a March 5, 2009 article titled “Medical Marijuana Benefits” published at CBSNews.com:
“Opponents of medical marijuana often point to dronabinol, the synthetic version of one of marijuana’s active ingredients that is available in pill form. The use of only one active ingredient makes dronabinol less effective than medical marijuana. Many ailments respond better to a combination of marijuana’s active ingredients rather than just one. In addition, because dronabinol is a pill, it is difficult for people with nausea and vomiting to swallow. Finally, like any medication that’s swallowed, dronabinol takes a long time to digest and have its effects. Inhaled marijuana vapors can work markedly faster.”Mar. 5, 2009 - Mitch Earleywine, PhD
Robert Gorter, MD, PhD, Associated Professor at University of California, San Francisco’s Medical School, stated in an Oct. 1998 interview with AIDS Treatment News:
“My patients who had experience with both cannabis and Marinol almost always preferred cannabis, because Marinol had more side effects, including headaches and a hung-over feeling.”Oct. 1998 - Robert Gorter, MD, PhD
Jerome Kassirer, MD, former editor of the New England Journal of Medicine, wrote the following in the journal’s Jan. 30, 1997 editorial:
“Paradoxically, dronabinol [Marinol], a drug that contains one of the active ingredients in marijuana (tetra-hydrocannabinol), has been available by prescription for more than a decade. But it is difficult to titrate the therapeutic dose of this drug, and it is not widely prescribed.
By contrast, smoking marijuana produces a rapid increase in the blood level of the active ingredients and is thus more likely to be therapeutic. Needless to say, new drugs such as those that inhibit the nausea associated with chemotherapy may well be more beneficial than smoking marijuana, but their comparative efficacy has never been studied.”Jan. 30, 1997 - Jerome P. Kassirer, MD