“I just heard that the DEA isn’t going to reschedule medical marijuana. What’s up with that?”
That’s right. As far as Uncle Sam is concerned, cannabis is an illegal drug with no medical value whatsoever.
“How can that be, in a country where half the states have medical marijuana laws?”
Because the federal government doesn’t give a damn about your state’s laws. According to the feds, marijuana is a Schedule I drug.
“What’s a Schedule I drug?”
That’s any drug the feds say has a high potential for abuse, no currently accepted medical use in treatment in the United States, and is unsafe for use under medical supervision. You know, illegal drugs like heroin.
“Really? Marijuana is in the same category as heroin, cocaine, and meth?”
Oh, no, only heroin. Cocaine and meth are actually Schedule II drugs.
“What’s a Schedule II drug?”
That’s a drug that’s dangerous like a Schedule I drug, but it does have medical uses, so doctors are allowed to prescribe it, with a lot of restrictions.
“Wait, there’s medical meth?”
“And medical cocaine?”
Yes, it’s used as a local anesthetic in oral and nasal surgeries. Now, this doesn’t mean your street cocaine and meth are legal. It just means there are medical versions of them that are legal.
“But there are no legal medical versions of marijuana?”
On the contrary. In the mid-1980s, the federal government approved synthetic forms of THC, the psychoactive ingredient in marijuana, as medicines in pill form. Nowadays, they are sold as Marinol and Cesamet.
“So these synthetic marijuana drugs aren’t Schedule I?”
Right. Originally, they were Schedule II, but they were found to be safe enough to move down to Schedule III.
“Let me get this straight. If I have a cannabis bud and it’s got, say, 20 percent natural THC in it, it’s a dangerous Schedule I drug that has no medical value…”
“…but if I have a Marinol pill that’s 100 percent synthetic THC in it, that’s a safe Schedule III drug that any doctor can prescribe?”
“This is insane. It’s like saying that vitamin C is nutritious, but oranges are not.”
I completely agree, but this has been the federal law on marijuana since 1970.
“All right, so why is everybody talking about this rescheduling?”
Because back in 2011, the governors of Washington and Rhode Island sent a letter to the DEA, asking for a review of the scheduling of marijuana, since so many states have passed medical marijuana laws.
“2011? You mean this petition is five years old and they’re just now getting around to answering it?”
Yep. And this is the fourth time someone has tried to petition for rescheduling marijuana. NORML started that way back in the 1970s. Every time someone petitions, DEA takes years to respond, and they always say no.
“How can they? Clearly, marijuana has medical value! Can they not see that?”
They don’t have to.
“Come on! They say that Schedule I means there is no currently accepted medical use in the United States, but there are 25 states with medical marijuana laws.”
Ah, but California doesn’t decide for the federal government whether there is accepted medical use in the United States. Neither does Oregon or Michigan or any other US state. The US Food & Drug Administration (FDA) decides for the federal government whether something has an accepted medical use in the United States.
“So, the fact that states are recognizing medical use and doctors in those states are recognizing medical use doesn’t mean there is recognized medical use in the United States?”
Now you’re getting it.
“No, I’m not. You’re saying that all the medical use in the world doesn’t mean anything unless the FDA says so?”
See, I knew you’d get it.
“All I’m getting is pissed off. So, the FDA doesn’t think there is any medical use… why? They can’t see all the medical use going on?”
What FDA can see is irrelevant. The way FDA decides if a drug has an accepted medical use is by evaluating all the double-blind, placebo-controlled studies on the drug…
Scientific studies, basically. The FDA says that marijuana has no accepted medical use in the United States because there aren’t enough scientific studies that say so.
“Well, that’s bull, because I see studies in the news all the time that say marijuana has some medical value.”
Except that most of those studies are evaluating marijuana’s constituents, like THC, or they aren’t double-blind, placebo-controlled studies that meet the FDA’s criteria.
“So it can’t just be a study, it has to be the right kind of study? OK, then, let’s just do some of those kinds of studies.”
It’s not that easy. Since marijuana is a Schedule I drug, it is very difficult to get any marijuana to study. You have to get it from the US government’s cannabis farm at the University of Mississippi…
“Wait, the government has a pot farm?”
Yes, it’s the only place cannabis can legally grow under federal law – though the feds did decide just now to allow more universities to grow it for research purposes.
“So, then, we just get some of the federal marijuana to research on with the right kind of studies and bam! – we get marijuana rescheduled!”
There’s only one catch. To get your federal marijuana, you have to get your study approved by the National Institute on Drug Abuse (NIDA).
“Drug Abuse? We’re talking about studies to show marijuana use, not abuse.”
And therein lies the problem. NIDA is very interested in studies that show the dangers of marijuana abuse. Studies that might show the potential for marijuana’s use… not so much.
“Argh! So marijuana can’t be medicine because we don’t have enough studies, which we cannot do because marijuana is not a medicine?”
Now you’re beginning to understand.
“No, I’m beginning to go crazy. What about the other conditions, like the high potential for abuse? Pot’s not like heroin, coke, or meth – no pothead’s going to commit crimes to get his next joint.”
That’s not really how the feds determine whether a drug is abused. The DEA administrator even admitted that marijuana’s not as addictive and harmful as those drugs.
“So where do they come up with the high potential for abuse?”
Marijuana is abused because “a large number of individuals use marijuana”.
“That’s it? Lots of people use it, therefore, it’s abused?”
The Department of Health & Human Services (HHS) puts it like this, “Individuals are taking the drug … on their own initiative rather than on the basis of medical advice from a practitioner licensed by law to administer such drugs in the course of his professional practice.”
“But marijuana’s Schedule I, right? Doctors can’t administer such drugs!”
Indeed, but 33 million people are using marijuana anyway, so therefore, it is being abused.
“But that Marinol – that Schedule III THC – isn’t a drug that can be abused?”
Nope, because the people who use it get it from a doctor. Nobody really takes Marinol for fun, either, because it lacks the CBD that marijuana has, so the effect can be very unpleasant.
“Hold on, you mean the synthetic THC is worse than the marijuana?”
Oh, absolutely. CBD – cannabidiol – has a mitigating effect to the high you get from THC. While modern cannabis strains contain only scant amounts of CBD, they also rarely exceed 20 percent THC. Since it is smoked or vaporized, patients can immediately feel the effects and stop using before they reach discomfort. With Marinol, it’s a pill and patients have to wait until it is digested to learn whether they took too little or too much, where too little means continued suffering and too much means an unpleasant, paranoid high.
“This is depressing, but I have to ask, what about the third point, that marijuana’s unsafe under medical supervision? Surely, they can see that there are thousands of doctors caring for millions of patients by now.”
Again, they could, but they don’t have to, so they don’t. Since FDA has not recognized any safe medical use, there is none.
“Sigh. So, all we need to do to get marijuana rescheduled is to do studies that NIDA won’t approve to show FDA that there is a medical use so that HHS will recognize a medical use so that DEA will reschedule it?”
Not quite. Now you need to breed a cannabis plant that always produces exactly the same bud.
According to HHS, “the chemistry of marijuana, as defined in the petition, is not reproducible in terms of creating a standardized dose.” Without a standardized dose, there is nothing for FDA to evaluate.
“Are you kidding me? There’s no plant in the world that produces a standardized dose!”
Exactly, and that is why marijuana in its raw plant form is never going to be placed in Schedule II.
“Schedule II? What about Schedule III, where the synthetic THC is? Or lower, like IV or V?”
Nope. Synthetic THC gets to be a medicine because it comes in a standardized dose. Besides, thanks to international treaties the Unites States signed as far back as 1961, the only other place marijuana could be is Schedule II.
“So, really, there is never going to be federal recognition of medical marijuana.”
Probably not as long as the Controlled Substances Act exists, and that has to exist for us to be compliant with the international drug control treaties.
“Then what’s next for medical marijuana?”
The states can continue to pass medical marijuana laws either through initiatives or the legislatures. But those laws are increasingly denying patients the ability to cultivate their own cannabis plants or to even possess any marijuana in raw form.
Meanwhile, big drug companies like Britain’s GW Pharmaceuticals are perfecting new cannabinoid medicines, like Sativex and Epidiolex, that do fit the FDA’s definition of medicine. As those medicines come online it will become more difficult to convince legislators or voters that whole plant cannabis is necessary for patients.
Eventually, everybody who needs marijuana for medical purposes will have the choice of pills, sprays, tinctures, and inhalers, all approved by the FDA as Schedule III drugs, prescribed by your doctor, available at your pharmacy, paid for by your health insurance. Whole plant cannabis will be seen only as a crude drug that some people abuse to get high.
“That’s depressing. Is there any hope for legalizing whole plant cannabis for medical use nationwide?”
Yes, but it lies in legalizing cannabis, period. So long as we’re fighting only for medical marijuana, it underscores that non-medical marijuana is a drug of abuse and forces us to try to process cannabis through a regulatory system that can never approve of a plant.