Even the federal government acknowledges the medical utility of cannabis’s most controversial cannabinoid, THC. When AIDS patients started lobbying for its legalization in the 1980s, the government responded with Marinol.
Marinol® (dronabinol) is, simply, synthetic ∆9-THC encapsulated with sesame seed oil. It is consumed orally. It does not contain CBD, which partially blocks the euphoric effect of THC, nor does Marinol contain any of the other more than 480 molecules besides THC found in cannabis. The Marinol story is a rather pathetic tale of government perversion of law and science.
It is cheaper to extract THC from the cannabis plant but the pharmaceutical company was originally required by the federal government to produce synthetic THC. It would seem the main reason for this was so the government could still twist logic around and say marijuana has no known medical use in the United States. THC is one of the two most pharmacologically active constituents of cannabis. It has both a therapeutic effect and a euphoriant effect. The FDA approved Marinol in 1985 for two very narrow indications: treatment of nausea and appetite problems caused by radiation and chemotherapy for cancer treatment and for appetite stimulation in AIDS patients.
Marinol is useful not only for the FDA-approved indications but subsequent research and clinical evidence has demonstrated its utility in treating several other symptoms and conditions such as anxiety, sleep problems and ADD. These uses are called off-label indications; about 40% of all prescriptions written in the United States are for off-label indications.
In many cases Marinol may not be as effective as marijuana. This is for at least four reasons. Primarily, many of the 483 compounds in cannabis have therapeutic value and the herb’s therapeutic ingredients tend to act collectively. This may be why cannabis is usually more effective than Marinol. Second, when using Marinol, far more patient complaints of dysphoria than with whole-plant cannabis. The reason for this is cannabis contains CBDs (and likely other molecules) that counteract or modulate the effects of THC.
Third, since Marinol is consumed orally, it is absorbed into the blood stream through the gastrointestinal tract. Like most drugs taken by mouth, it takes about 45 minutes to an hour to be absorbed into the blood stream in high enough concentrations to act therapeutically. When cannabis is inhaled, either by vaporizing or smoking, the cannabinoids go immediately from the lungs into the blood stream, so the cannabinoids and terpenes begin to act on the human body in less than a minute.
Finally, Marinol is quite expensive. Marinol tends to run about 3-6 times the monthly cost of an equivalent dosage of botanical cannabis.
Marinol’s FDA approval puts the federal government in an odd position. On the one hand, the FDA’s opposition to the supervised medical use of marijuana increasingly depends on the claim that, because of the plant’s psychoactive properties, the drug carries a “high potential for abuse.” This federal claim creates some cognitive dissonance. How does the government explain its own contradictory policies on synthetic versus natural THC?
In 2004, synthetic THC was deemed so safe, with such a low risk of abuse, that dronabinol became the only drug ever moved from Schedule II to Schedule III. That means the synthetic version of the principle euphoric substance in cannabis, THC, is readily available as a schedule III drug but the milder, less euphoric cannabis, is not. Go figure.
Unfortunately, law enforcement agencies untrained in medicine erroneously claim Marinol is marijuana. Even if Marinol were chemically identical to marijuana, by what logic does a free country allow its federal government to prohibit a private citizen from growing a plant on their property for their own personal medical use?
This is an excerpt from my book Drugs Are Not the Devil’s Tools. The first edition is available now on Amazon and the second edition will be released in the Spring of 2017.
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