Mitch Earleywine, and former deputy drug czar under Bush 1.0 Herb Kleber, which strongly underlines the differences between credible and not credible on the topic of cannabis.

Credible:

[One] problem with Marinol is that it’s orally administered,” Dr. Mitch Earleywine, an associate professor of Clinical Psychology at the State University of New York at Albany, said in an email. “Therefore, it takes longer to work than cannabis inhaled from a vaporizer. (Usually 90 minutes at best rather than 15 seconds – a meaningful amount of time to the nauseated.)”

“It’s harder to control dosage, too, so folks end up discombobulated or without symptom relief,” he added. “In addition, folks who are vomiting can’t hold down the pills.” Earleywine also said that a dose Marinol costs three to five times as much as a comparable dose of medical marijuana.

Not Credible:

“Are there actions in the whole plant that you don’t get from just the Marinol? I would be surprised if there wasn’t,” he continued. “The problem is that most of the data about the potential medical actions of the smoked form are anecdotal.”

Dr. Kleber, who said he has prescribed Marinol to a patient and found it to be effective, points to what he characterizes as a significant advantage of the pill over traditional marijuana: “People don’t abuse it.”

“Marijuana addiction is becoming common and as a result I’m seeing an increasing number of people who have trouble stopping marijuana,” he said. “Contrary to popular beliefs that there is no marijuana withdrawal, there is marijuana withdrawal. It’s very clear cut.”

Talk about anecdotal! Dr. Kleber would have readers believe, that cannabis today, as compared to the prior 2,000 years of documented cannabis use by humans is that “Marijuana addiction is becoming common”.

Really?

“I’m seeing an increasing number of people who have trouble stopping marijuana”

Of course you are Herb because as it has been well documented by NORML that the criminal justice system throughout most of the United States presents minor cannabis offenders with the Hobson’s Choice of either going to jail or to visit the offices of the ‘Dr. Klebers’ in America for ‘treatment’.

Dr. Kleber well knows this, so his statement is for me the working definition of disingenuous!

Lastly, there is nothing new about Marinol as it has been legal and available for medical patients since the mid 1980s. If the pill worked as Dr. Kleber claims, voters and legislators in the 13 states with medical cannabis laws would not have opted for a whole plant solution.

Marinol was supposed to be the government’s great ’silver bullet’ back in the mid 1980s to end the public debate about patients’ need for whole-smoked cannabis–an analog of one of the plant’s major ingredients isolated in pill form.

Want to know more about ‘pot’ pills vs. the real thing? Checkout NORML’s published paper ‘Marinol vs. Natural Cannabis‘.

Does the Pot Pill Work?
The Government Says a Pill Called Marinol Offers the Same Benefits as
Medical Marijuana. Is it True?

By Brian Montopoli
August 4, 2009

(CBS) “Medical marijuana,” the U.S. Drug Enforcement Administration says, “already exists.”

They don’t just mean in California. A pill known as Marinol has been legal and approved by the Food and Drug Administration for use with a prescription anywhere in America since 1985.

It’s active ingredient? Dronabinol, better known as THC, the primary psychoactive element of the cannabis plant.

“Marinol provides standardized THC concentrations, does not contain the other 400 uncharacterized substances found in smoked marijuana, such as carcinogens or fungal spores, and is not associated with the quick high of smoked marijuana,” said Neil Hirsch, a spokesman for Marinol manufacturer Solvay Pharmaceuticals.

But Marinol is not the same thing as traditional, smokable marijuana. It is a less complex substance lacking both some of the good components found in traditional marijuana (such as cannabidiol, which has been found to have anti-seizure effects) and the bad or not-yet-fully-understood components (among them potential carcinogens) that can also come with the drug.

Ken Trainer, a 60-year-old Massachusetts resident who has battled Multiple Sclerosis for 25 years, said he has long been smoking marijuana to deal with the regular tremors he gets in his arms and legs.

“If I smoke a joint, the tremors go away most times before the joint is gone,” he said. “It makes my life a little easier.” Marinol, by contrast, “didn’t really do much of anything for me,” he said.

56-year-old Des Moines resident Jeff Elton, who was diagnosed with gastroparesis six years ago, had a similar experience when he was prescribed Marinol to deal with his chronic nausea and vomiting.

“I felt no relief, I didn’t feel ill, I felt nothing,” he said. “It might as well be M&M’s.”

Elton said he switched to marijuana, which he smokes through a vaporizer – a device that heats the active ingredients into a vapor instead of burning them. He said it allows him to keep down his food and regain some of the weight he lost while on Marinol.

“[One] problem with Marinol is that it’s orally administered,” Dr. Mitch Earleywine, an associate professor of Clinical Psychology at the State University of New York at Albany, said in an email. “Therefore, it takes longer to work than cannabis inhaled from a vaporizer. (Usually 90
minutes at best rather than 15 seconds – a meaningful amount of time to the nauseated.)”

“It’s harder to control dosage, too, so folks end up discombobulated or without symptom relief,” he added. “In addition, folks who are vomiting can’t hold down the pills.” Earleywine also said that a dose Marinol costs three to five times as much as a comparable dose of medical marijuana.

Defenders note that Marinol is not meant to be a cure-all: It has been approved specifically for treating nausea and vomiting associated with cancer chemotherapy and for treating anorexia associated with weight loss in patients with AIDS.

“When the whole push for the smoked product came along, it was often for those two indications,” said Dr. Herbert Kleber, a professor of Psychiatry at Columbia University and the former deputy drug czar under President George H.W. Bush. “And in general, I’ve not seen any need for the smoked form of marijuana for those two indications. Marinol had already been shown to be quite effective for those two things.”

“Are there actions in the whole plant that you don’t get from just the Marinol? I would be surprised if there wasn’t,” he continued. “The problem is that most of the data about the potential medical actions of the smoked form are anecdotal.”

Research into the effects of medical marijuana is ongoing: The University of California, San Diego, for example, boasts a Center for Medicinal Cannabis Research engaged in “focused controlled clinical trials on the efficacy of cannabis in patients diagnosed with HIV/AIDS,
cancer, seizures or muscle spasms associated with a chronic debilitating condition, or any other serious condition providing sufficient theoretical justification.” (The director of the UCSD program, Dr. Igor Grant, was out of the country and could not be reached for this story.)

The Los Angeles Times, which offers a nice overview of the current research, writes that “a growing body of research supports [medical marijuana's] medical usage, but some of it is cautionary.” Marijuana has been found to be effective in counteracting severe pain, nausea and loss of appetite, though questions remain about the drawbacks, among them possible respiratory damage and increased cancer risk.

Dr. Kleber, who said he has prescribed Marinol to a patient and found it to be effective, points to what he characterizes as a significant advantage of the pill over traditional marijuana: “People don’t abuse it.”

“Marijuana addiction is becoming common and as a result I’m seeing an increasing number of people who have trouble stopping marijuana,” he said. “Contrary to popular beliefs that there is no marijuana withdrawal, there is marijuana withdrawal. It’s very clear cut.”

The calculus, then, isn’t quite as simple as the Drug Enforcement Administration suggests: Marinol and medical marijuana may share an active ingredient, but they offer somewhat different benefits and different drawbacks. Proponents of medicinal marijuana say it’s disingenuous to hold up Marinol as a direct alternative to the more traditional form of the plant.

“I just don’t understand how they won’t let me smoke a joint, but they’re more than happy to write me out prescriptions for anything that I want,” Trainer said.

By Dale Gieringer, Ph.D, Director, California NORML

California NORML has recently heard increasing reports that Marinol patients are being drug tested and denied employment for use of marijuana. In particular, we have heard from legal Prop. 215 patients who were denied jobs despite presenting Marinol prescriptions after being re-tested specifically for marijuana. Until recently, Marinol and marijuana were indistinguishable on the standard drug tests, so that patients with a Marinol prescription had a valid medical excuse under federal law for testing positive for marijuana.

However, special testing techniques have been developed that make it possible to distinguish the two by testing for non-standard cannabinoids that appear in marijuana but not Marinol. Until recently, these tests were expensive and rarely used except in high-profile criminal cases. However, it appears that they are now being routinely used by certain laboratories in cases where Marinol use is claimed. In particular, we have heard reports of such testing being used to disqualify Marinol-using Prop 215 patients by the transportation industry and by Walmart.

California NORML has accordingly altered its drug testing information to warn against relying on Marinol RXs as a screen for marijuana use: http://www.canorml.org/healthfacts/testing.tips.html

There is of course no valid scientific or health justification for allowing patients to use Marinol but not marijuana. The only purpose is to enforce compliance with the law. It is a tribute to the power and influence of the drug testing industry that they have prevailed in foisting the costs of this unnecessary and obnoxious procedure on employers.

California NORML, 2215-R Market St. #278, San Francisco CA 94114

(415) 563-5858 / www.canorml.org

Investigators at the University of Mississippi report the discovery of eleven new non-cannabinoid constituents in cannabis, several of which possess “anti-microbial” (think MRSA), “anti-malarial,” and “anti-leishmanial” (a common skin parasite) activity. Scientists also reported that several of the compounds also possessed anti-inflammatory properties and acted as potent anti-oxidants.

(The US government, Depart of Health and Human Services actually holds a patent on the use of certain cannabinoids as anti-oxidants and neuroprotectants, which you can read here.)

In other words, when we speak about the healing powers of the cannabis plant, we really mean the entire cannabis plant. We’re not talking about isolating particular cannabinoids, and we’re most certainly not suggesting patients be forced to consume an oral synthetic version of a single compound a la Marinol.

Therapeutic cannabis means just that — the therapeutic prowess of the whole plant. We should not advocate for, or accept, anything less.

The US government’s longstanding denial of medical marijuana research and use is an irrational and morally bankrupt public policy. On this point, few Americans disagree. As for the question of “why” federal officials maintain this inflexible and inhumane policy, well that’s another story.

One of the more popular theories seeking to explain the Feds’ seemingly inexplicable ban on medical pot — and the use of cannabis by adults in general — goes like this: Neither the US government nor the pharmaceutical industry will allow for the use of medical marijuana because they can’t patent it or profit from it. A related, yet equally common hypothesis argues: Big Pharma lobbies the federal government to keep pot illegal because it won’t be able to compete with patients growing their own medicine.

They’re appealing theories, yet I’ve found neither to be accurate nor persuasive. Here’s why.

First, let me state the obvious. Big Pharma is busily applying for — and has already received — multiple patents for the medical properties of pot. (The US government has too, but that’s a different story all together.) These include patents for synthetic pot derivatives (such as the oral THC pill Marinol), cannabinoid agonists (synthetic agents that bind to the brain’s endocannabinoid receptors) like HU-210 and cannabis antagonists such as Rimonabant. This trend was most recently summarized in the NIH paper, “The endocannabinoid system as an emerging target of pharmacotherapy,” which concluded, “The growing interest in the underlying science has been matched by a growth in the number of cannabinoid drugs in pharmaceutical development from two in 1995 to 27 in 2004.”

In other words, at the same time the American Medical Association is proclaiming that pot has no established medical value, Big Pharma is in a frenzy to bring dozens of new, cannabis-based medicines to market.

Not all of these medicines will be synthetic pills either. Most notably, GW Pharmaceutical’s oral marijuana spray, Sativex, is a patented standardized dose of natural cannabis extracts. (The extracts, primarily THC and the non-psychoactive, anxiolytic compound CBD, are taken directly from marijuana plants grown at an undisclosed, company warehouse.)

Does Big Pharma’s sudden and growing interest in the research and development of pot-based medicines mean that the industry is proactively supporting marijuana prohibition? Not if they know what’s good for them.

First, any and all cannabis-based medicines must be granted approval from federal regulatory bodies such as the US Food and Drug Administration — a process that remains as much based on politics as it is on scientific merit. Chances are that a government that is unreasonably hostile toward the marijuana plant will also be unreasonably hostile toward sanctioning cannabis-based pharmaceuticals.

A recent example of this may be found in the Medicine and Health Products Regulatory Agency’s recent denial of Sativex as a prescription drug in the United Kingdom. (Sativex’s parent company, GW Pharmaceuticals, is based in London.) In recent years, British politicians have taken an atypically hard-line against the recreational use of marijuana — culminating in Prime Minister Gordon Brown’s declaration that today’s pot is now of “lethal quality.” (Shortly thereafter, Parliament elected to stiffen criminal penalties on the possession of the drug from a verbal warning to up to five years in jail.)

In such an environment is it any wonder that British regulators have steadfastly refused to legalize a pot-based medicine, even one with an impeccable safety record like Sativex? Conversely, Canadian health regulators — who take a much more liberal view toward the use of natural cannabis and oversee its distribution to authorized patients — recently approved Sativex as a prescription drug.

Of course, gaining regulatory approval is only half the battle. The real hurdle for Big Pharma is finding customers for its product. Here again, a culture that is familiar with and educated to the use therapeutic cannabis is likely going to be far more open to the use of pot-based medicines than a population still stuck in the grip of “Reefer Madness.” (For example, Marinol, despite having been approved by the FDA in 1986, was rescheduled so that doctors might prescribe it more liberally in 1999 — three years after California and other states began approving medical marijuana use legislation. Coincidence? I doubt it.)

Will those patients who already have first-hand experience with the use of medical pot switch to a cannabis-based pharmaceutical if one becomes legally available? Maybe not, but these individuals comprise only a fraction of the US population. Certainly many others will — including many older patients who would never the desire to try or the access to obtain natural cannabis. Bottom line: regardless of whether pot is legal or not, cannabis-based pharmaceuticals will no doubt have a broad appeal.

That said, many argue that the legal availability of pot would encourage patients to use fewer pharmaceuticals overall and significantly undercut Big Pharma’s profits. To a minor degree this may be a possibility, though likely not to an extent that adversely impacts the industry’s bottom line. Certainly most individuals in the Netherlands, Canada, and in California — three regions where medical pot is both legal and easily accessible on the open market — use prescription drugs, not cannabis, for their ailments. Further, despite the availability of numerous legal healing herbs and traditional medicines such as Echinacea, Witch Hazel, and Eastern hemlock most Americans continue to turn to pharmaceutical preparations as their remedies of choice.

Should the advent of legal, alternative pot-based medicines ever warrant or justify the criminalization of patients who find superior relief from natural cannabis? Certainly not. But, as the private sector continues to move forward with research into the safety and efficacy of marijuana-based pharmaceuticals, it will become harder and harder for the government and law enforcement to maintain their absurd and illogical policy of total pot prohibition.

Needless to say, were it not for advocates having worked for four decades to legalize medical cannabis, it’s unlikely that anyone — most especially the pharmaceutical industry — would be turning their attention toward the development and marketing of cannabis-based therapeutics. That said, I won’t be holding my breath waiting for any royalty checks.

So, if Big Pharma isn’t a significant player in the ongoing prohibition of the personal use of cannabis, then who is responsible? Based on my experience, the answer is obvious. First and most importantly, there’s federal government — as represented not only by the lawmakers who continue to vote in favor of America’s Draconian drug policies, but also the numerous acronymn ladened bureaucracies (such as the ONDCP, NIDA, etc.) who actively lobby against any change in direction.

The second most powerful player in maintaining pot prohibition? That’s easy: law enforcement, as represented by bigwigs like the US Drug Enforcement Administration and the California Narcotics Officers Association, all the way down the line to small-town police forces — all of whom consistently finance efforts to derail any relaxation of federal, state, or local marijuana policies.

The third and final primary player responsible for maintaining modern-day pot prohibition? Unfortunately, that would be us, the general public — a majority of whom have repeatedly voiced disapproval for legalizing the use personal use of pot by adults in both national polls and on statewide ballot initiatives, most recently in Colorado and in Nevada in 2006. (By contrast, more than half of Americans do support — and have consistently voted for — legislation in support of the qualified medical use of cannabis by authorized patients.)

In short, until there is a significant sea-change in the attitudes and actions of the Feds, cops, and the general public, expect prohibition — particularly the broader prohibition on the recreational use of cannabis — to continue.