Sunday, January 20, 2019
The title of this post is the headline of this provocative Wall Street Journal commentary authored by Peter Bach, "a pulmonary physician at Memorial Sloan Kettering Cancer Center in New York [who] directs the Center for Health Policy and Outcomes." Here are excerpts:
Ten states and the District of Columbia have legalized recreational marijuana use, and another eight look likely to do so in 2019. I favor the move but am troubled by the gateway to it: All these jurisdictions first passed laws permitting the use of “medical” marijuana. We should set the record straight, lest young people (and old ones) think marijuana is good for you because it is wrongly labeled a medication.
Actual medicines have research behind them, enumerating their benefits, characterizing their harms, and ensuring the former supersedes the latter. Marijuana doesn’t. It’s a toxin, not a medicine. It impairs judgment and driving ability. It increases the risk of psychosis and schizophrenia. Smoking it damages the respiratory tract. A 2017 report from the National Academy of Medicine called the evidence for these harms “substantial.”
Claims that marijuana relieves pain may be true. But the clinical studies that have been done compare it with a placebo, not even a pain reliever like ibuprofen. That’s not the type of rigorous evaluation we pursue for medications. What’s more, every intoxicant would pass that sort of test because you don’t experience pain as acutely when you are high. If weed is a pain reliever, so is Budweiser.
Some advocates say marijuana is better than opiates for pain. Yet while opiates have risks, there are no studies comparing them to marijuana, and untested claims in medicine don’t get the benefit of the doubt. Testing such a hypothesis often disproves it.
Decades ago, several studies suggested that marijuana might relieve nausea in chemotherapy patients. But again most compared it with a placebo, while a few compared it with older nausea treatments not used today. None were very convincing. More important, no study has compared marijuana to today’s Neurokinin-1 antagonists. While such treatments are sometimes ineffective, that shortcoming doesn’t impart efficacy on marijuana either.
In writing medical-marijuana laws, state lawmakers and initiative authors have gone well beyond pain and nausea control, lauding the plant as an effective treatment for a long list of conditions, including hepatitis, Alzheimer’s and Parkinson’s. Beyond the lack of data, what these conditions have in common isn’t biology, but modern medicine’s failure to treat them satisfactorily. Heartbreaking as that is, marijuana isn’t the answer....
Marijuana belongs in the same category as alcohol and tobacco — harmful products that adults can choose to enjoy.... Decades passed before we took on smoking and drinking with education, labeling and other forms of regulation. But it worked, and deaths from lung cancer, heart disease and alcohol-associated accidents are in sharp decline. We need this same approach with marijuana. Acknowledging that it is not a medicine is a necessary first step.
I think it valuable and important to highlight ways in which many of the forms of the plant cannabis, at least right now, is not comparable to the kinds of medicines we access at a drug store. But it is also important to highlight ways in which medical marijuana laws do not treat marijuana as comparable to other medicines. For starters, public and private health insurance systems general do not help cover the cost of marijuana used medicinally and there are all sorts of distinctive limits on the whos and hows of medical marijuana access. In many ways, all modern medical marijuana laws are still just elaborate variations on the original law created by California in 1996, which simply created a limited exception to marijuana prohibition for those eager to try marijuana for various therapeutic purposes. Had marijuana never been criminalized, there would have been no need to seek exceptions from prohibition for medical uses (and, it bear recalling, there was much discussion and special laws around alcohol access for medical use during the Prohibition era).