American College of Physicians Takes Pro-Cannabis Stand (Mostly)

By FRED GARDNER

One-and-a-half cheers for the American College of Physicians, which has issued a statement "Supporting Research into the Therapeutic Role of Marijuana." The ACP is the nation's largest medical specialty group -124,000 internists- and is widely respected. "There are no more prestigious letters to have after your name," says Philip A. Denney, MD (president of the Society of Cannabis Clinicians), "than FACP -standing for Fellow of the American College of Physicians."

The statement commits the ACP to five positions:

1. ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of medical marijuana and the publication of such findings.
1a. ACP supports increased research for conditions where the efficacy of marijuana has been established to determine optimal dosage and route of delivery.
1b: Medical marijuana research should not only focus on determining drug efficacy and safety but also on determining efficacy in comparison with other available treatments.

2. ACP encourages the use of nonsmoked forms of THC that have proven therapeutic value.

3. ACP supports the current process for obtaining federal research-grade cannabis.

4. ACP urges review of marijuana's status as a schedule 1 controlled substance and its reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana's safety and efficacy in some clinical conditions.

5. ACP strongly supports exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who prescribe or dispense medical marijuana in accordance with state law. Similarly, ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted under state laws.

From the perspective of pro-cannabis doctors and patients in California, Position 5 is the best and bravest aspect of the ACP statement. The support for physicians who "prescribe and dispense medical marijuana under state law" could have been written with Marian Fry, MD, in mind. Fry and her husband, attorney Dale Schafer, were convicted under federal law for cultivation for sale (to her patients) and are soon to be sentenced.

Position 4 is long overdue. Marijuana was categorized as a Schedule 1 drug -as if it had no medical use and a high potential for abuse- by the federal Controlled Substance Act of 1970. In 1999 dependence on marijuana was deemed "relatively rare and... less severe than dependence on other drugs" by the Institute of Medicine in a report commissioned by the Drug Czar's office. The medical utility of marijuana has been confirmed in numerous ways and settings, including the IOM report and a recent study published in a prestigious peer-reviewed journal ("Cannabis in painful HIV-asssociated sensory neuropathy," by Abrams et al, Neurology, Feb 13, 2007).

Position 2 singles out the Volcano vaporizer as an efficient delivery system (right on, right on).

Position 3 seems to undermine the rest of the position paper. Why open wide the valves on the research pipeline while leaving the main closed and allowing only the slightest trickle? At present the would-be researcher must get an Investigational New Drug Application approved by the FDA and a Schedule I license from the DEA to receive marijuana grown by a NIDA-funded contractor at the University of Mississippi and processed into cigarettes at the Research Triangle Institute in North Carolina. The DEA can choke off research, the FDA can choke off research, NIDA can choke off research. Over the years they have taken turns doing so, working a four-cornered stall (the NIH and the Drug Czar's office get involved as needed) as if diagrammed by the Tarheels' legendary basketball coach, Dean Smith himself.

Botanist Lyle Craker of UMass Amherst applied in 2001 for a DEA license to grow marijuana for privately funded research. There was an extensive hearing in 2005. In February, 2007, an Administrative Law Judge recommended that Craker's application be approved. The DEA Administrator keeps sitting on it, of course, and is not bloody likely to give Craker a license. This is the system the ACP endorses sanctimoniously: "Obtaining research-grade cannabis is critical to conducting well-designed clinical trials on the safety and efficacy of marijuana and its cannabinoids. In addition, because of the drug's widespread general use and high potential for abuse, it is imperative that the federal process is followed for obtaining research-grade marijuana and conducting clinical trials."

Note that the trials being contemplated in the argument for Position 3 -and Position 1b- involve "safety and efficacy." Why the former? The safety of cannabis has been established by countless NIDA studies seeking to establish its harmfulness (not to mention the data collected by California doctors as published in O'Shaughnessy's Winter/Spring 2007).

"More research is needed" is a lie when applied to safety, and spending money on more safety studies is a way of delaying the much-needed efficacy studies. It's almost as if a Prohibitionist within the ACP committee that drafted the position paper asserted him or herself at key points. The ACP statement includes the following re adverse effects: "Chronic use of smoked marijuana is associated with increased risk of cancer, lung damage, bacterial pneumonia, and poor pregnancy outcomes." A footnote cites the IOM Report (no pages specified) to back these assertions. But chronic use of marijuana does NOT cause cancer of the lung, upper airways, or esophagus, according to the definitive study reported to the American Thoracic Society in June 2006 by Donald Tashkin and colleagues from the UCLA School of Medicine. Although tars in cannabis damage bronchial tissue, the damaged cells, for some unknown reason, don't become malignant. Evidently something in cannabis is exerting an anti-cancer effect! This is an area that truly warrants more research.

The ACP's assertion of "poor pregnancy outcomes" is based on the IOM Report, which is based on a NIDA-funded project -the Ottawa Prenatal Prospective Study- led by a man named Peter Fried, who determined that the children of mothers who had smoked marijuana during pregnancy showed impaired "executive function." Fried measured "executive function" by having the kids press a clicker whenever they heard a musical tone. The tone consisted of two quick beeps, one emphatic, one a sort of echo. The kids whose moms had smoked pot tended to make two quick clicks in response. The other kids tended to make one click, which Fried -well aware of what his NIDA funders wanted- defined as superior executive function!! (He might have defined it more logically as a sign of laziness, bad hearing, or even a form of cheating.) When the kids whose moms had smoked pot were found to have higher IQs and more friends in school, Fried attributed it to what he called "the earth-mother effect." He claimed that the same women who had harmed their babies in the womb by smoking pot, gave them ample attention and good nutrition when they emerged, so they turned out quite well on the whole.

Peter Fried's far-from-rigorous finding of "impaired executive function" underlies the ACP's assertion of "poor pregnancy outcomes" and the medical establishment's line that pregnant women should not smoke marijuana. Once the results of a study get published in "the literature" they can be cited as if they were proven fact -as if the process of peer-review guaranteed the publication of Incontrovertible Truth. This reverent attitude towards "the literature" belongs in the realm of religion, not science.

Quotable Quotes

Eric Bailey got some quotes worth quoting for a Feb. 14 Los Angeles Times article about the ACP statement.

"We felt the time had come to speak up about this," said ACP president David Dale. The implication being: 'We've known the truth about this for years, but were afraid to make a peep." California voters passed Prop 215 in 1996 with the ACP on the sidelines. The Institute of Medicine Report was published in 1999. What took the ACP so long to say that the government ought to act on it?

Bailey quotes Bruce Mirken of the Marijuana Policy Project describing the ACP statement as "an earthquake that's going to rattle the whole medical-marijuana debate." Isn't it amazing how many tipping-point victories we've won over the years? Reform bureaucrats need "wins" to impress their backers and keep the money coming in. By unreservedly praising a flawed document like the ACP statement, Bruce Mirken et al confer undeserved credibility on it. And these things sometimes come back to bite the movement in the butt. The DEA could very well cite the ACP's Position 3 as grounds for denying Prof. Craker a license in the period ahead.

Bailey elicited this verbal gem from Bertha Madras, deputy director for demand reduction at the Drug Czar's office (the White House Office of National Drug Control Policy): "'What this would do is drag us back to 14th-century medicine,' said Madras. 'It's so arcane.'"

Since "arcane" means "hidden," we infer that the Czarette meant to say, "it's so archaic." People who misuse fancy words are pretentious. Since pretense is what the Drug Czar's office is all about, we can also infer that Ms. Madras is perfectly suited to her job at Demand Reduction HQ.

Fred Gardner edits O'Shaughnessy's, the journal of Cannabis in Clinical Practice. Reach him at [email protected]