Medical marijuana–boon or bane?

(First of two parts)

Is marijuana nature’s medicinal leaf, or is it a gateway to perdition?

This is a question I’ve been struggling to answer for quite some time now.

Occasionally, we get to handle patients with severe pain, nausea and vomiting unresponsive to conventional medicines, and excruciating spasticity of a paralyzed arm or leg following a stroke not amenable to treatment. We’ve tried all available medicines, but they just won’t work or are not good enough to make the patients feel better and more comfortable.

Sometimes the relatives would tell me that someone they know from abroad is suggesting to try drug preparations from the marijuana plant (also called hemp or cannabis). Always, my curt reply would be, “That would make me a drug pusher if I say ‘yes.’”

Pushing for legalization

Since 2007, a local group has been pushing for the legalization of marijuana. Called Pormal (Philippine Organization for the Reform of Marijuana Laws), this nongovernment, nonprofit organization has been organizing various forums on the purported benefits of the Cannabis sativa plant. They’ve been lobbying for the decriminalization of the possession and usage of any form of cannabis.

I can’t really understand though what they mean when they describe it as the “most amazing, dynamic and environmentally viable alternative solution that can help reduce poverty, drive up our nation’s gross domestic product and tourist arrivals and help Mother Nature recover from the devastation that we have been wreaking for too long.”

Hyperbolic statements like this obviously turn off a lot of people, including health authorities and legislators.

Medical uses

Objectively though, there are some scientific data to show that marijuana has some medical uses, foremost of which is the relief of pain, severe nausea and vomiting in cancer patients receiving anticancer chemotherapy or radiotherapy.

In terminally ill cancer and AIDS patients, when treatment has shifted to palliative from curative, cannabis —which is also available in capsule or pill form in other countries—can make the patients more comfortable, with less pain and angst during the remaining days or weeks of their lives. It can allow for a peaceful death—something which the family of a terminally ill patient would find comfort in, seeing that their loved one has gone with tolerable pain and distress. Some would call it “leaving with dignity.”

Cannabis has been reported to have other medicinal uses like relief of severe spasticity, chronic muscle and joint pains unrelieved by conventional treatments, psychological and mental conditions like attention deficit hyperactivity disorder, autism, bipolar disorder, childhood mental disorders, depression, alcoholism and Tourette syndrome.

Active ingredient

The active ingredient in the cannabis plant is tetrahydrocannabinol (or delta-9-tetrahydrocannabinol, commonly known as THC). Other cannabis extracts or cannabinoids include delta-8-tetrahydrocannabinol, cannabidiol, cannabinol, cannabicyclol, cannabichromeme  and cannabigerol. All of these other cannabinoids are less potent than THC but may also play a contributory role in the overall effect of cannabis in the body.

I can imagine that our health authorities, particularly our Food and Drug Administration (FDA), are mentally struggling on the issue whether to legalize medical marijuana or not.

Dr. Kenneth Hartigan-Go, FDA director general, says in an e-mail communication that any policy on any medicinal substance must be dictated by the “good of all and equity, and reality of implementability.”

The FDA is a science regulatory agency and, as such, it must closely scrutinize and validate the quality of any product, its efficacy and safety as proven by well-designed studies in humans. For a medicinal product derived from marijuana, it’s a lot more complicated. “We cannot dissociate legit use from the potential for recreational abuse and misuse,” writes Kenneth in his e-mail.

He reiterates that the FDA must firstly protect the society and all patients/consumers from making wrong choices.  “FDA decides based on science, numbers and evidence. It balances innovation with sound regulations; but it also respects risk-benefit and precautionary principle,” Kenneth explains.

Indeed, for a double-bladed substance that has good and bad effects, and can either benefit or harm its users, finding an ideal middle ground can be a challenging dilemma.