Editor and General Manager
Monoclonal antibodies. PCR. High-throughput screening. Pot. What do they have in common? They were, or are, going to change the world. The first three no doubt have had significant, but not world-changing, impact. The same will likely be true for pot, or cannabis, as it’s known in those circles where there is hope that it will continue on the road to legitimacy.
So, what’s the buzz all about? A number of things, starting with this—people like intoxicants. As these things go, cannabis seems somewhat innocuous. Alcohol, tobacco and (often illegally used) prescription drugs kill more people than heroin, which has as much to do with their ready availability as their level of toxicity. The long-term effects of cannabis on recreational users are—well, I think we’re about to find out. It is probably safe to say that chronic or habitual use of any drug will have some deleterious health effects.
Then there’s the money. A fair amount, it seems. The sale of recreational and medical marijuana products is becoming a big business, one that will generate substantial economic activity and related tax revenues. Most importantly, it seems that at least some compounds from the plant are indeed beneficial to patients, with great potential both as a curative and in mitigation of a range of symptoms. But where will medical weed live? Is its future in the largely unregulated world of herbal supplements and remedies, or will mainstream pharma take over?
According to the website ProCon.org, there are 10 cannabis-based pharmaceutical products in various stages of development. The most prominent are: Sativex (nabiximols, GW Pharmaceuticals), a mouth spray used to treat neuropathic pain and spasticity in patients with MS, which was approved and launched in the U.K. and is widely available under licensing agreements throughout Europe. It contains chemicals taken directly from the plant. Marinol (dronabinol, Unimed Pharmaceuticals) is FDA approved (moved from Schedule I to Schedule III) for use as an appetite stimulant. Go figure. It contains synthetic versions of compounds found in marijuana. Cesamet (nabilone, Valeant Pharmaceuticals) contains chemicals similar to those found in marijuana but not found in the plant. Not much so far.
Meanwhile, the bustling market for various cannabinoids is similar to the market for herbal remedies. And there is a relatively new model out there, the medical dispensary, at which patients with a variety of health issues can get marijuana or products from extracts that can be smoked, eaten, absorbed, etc.
I have to bet on big pharma. First, it’s big, with all the attendant benefits. Second, as products come into widespread use, there will be a need to address concerns about contra-indications, interactions and many other issues that are out of the scope of dispensaries and online purveyors. There is a struggle coming for the soul of cannabis. Many of the early entrants and participants in the recreational and medical-use pot business are former members of the demimonde. Their mindset is countercultural. The approach to therapeutics comes from a holistic school that is anti-“Western medicine.” They have also put down early stakeholder claims, building on weed’s very viable medical properties to leverage their positions. There is a lot to be said for and against the arguments that come out of the mainstream and alternative camps. While a lot of testing is done on current cannabis products, it mostly has to do with potency levels and checking for contaminants. And as much as I like the idea of a local dispensary, vendors are not going to know whether or not the products they sell have negative interactions with other drugs or supplements if that testing is not done. Isolating the many compounds, testing their efficacy and the full range of ADME/tox implications, whether they work alone or in concert with other active compounds in pot, best delivery systems, etc., are all important concerns.
All that said, purveyors of medical marijuana are correct—it seems the current system is withholding very useful and often beneficial compounds from people suffering from diseases as far-ranging as multiple sclerosis, cancer and epilepsy.
It is time to disregard age-old prohibitions; marijuana does not belong on the list of Schedule I drugs. Federal acceptance will free up research money, open the door for more states to relax their statutes and encourage those on the sidelines to step into the fray. There is too much strong evidence out there to not pursue this course, full steam ahead.
What states and the federal government want to do in terms of the kinds of intoxicants they legalize is another matter. I have no personal interest in weed (at least not yet) and view this as a public health matter. Jailing people for pot possession and saddling them with a criminal record seems misguided, if not cruel. And people—more often than not those with limited resources and connections—are still being arrested and jailed for infractions. Laws that strictly address the types of activities that are prohibited while high are needed more than laws that focus on the substance. And if it’s important to keep stoned people from operating vehicles, whatever they are high on, it is imperative to enforce those laws uniformly.
But therapeutic products from cannabis? It’s a no-brainer.
Steve Ernst is editor and general manager, American Laboratory/Labcompare; [email protected]