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Since 1986,
synthetic THC (Marinol) has been available as a
Schedule II drug, which allows physicians to
prescribe it under highly regulated conditions.
It is labeled as a anti-nauseant and an appetite
stimulant, but doctors prescribe it for other
conditions, such as depression and muscle
spasticity. However, for people suffering from
nausea and vomiting, who are unable to swallow
and hold down a pill, smoking marijuana is often
the only reliable method of delivery. Smoking
has the added benefit of providing relief
quickly, often producing relief in minutes,
whereas swallowed THC may take four hours or
more.
When THC is
swallowed, the effects vary considerably, both
from one person to the next and in the same
person from one episode to another. Much of the
swallowed THC is metabolized into other
compounds by the liver. Effective dosage rates
are difficult to achieve, since swallowed THC
takes so long to go into effect and since its
effects wear off slowly. Smoked marijuana is a
more flexible route of administration, not only
because its effects are more immediate, but also
because the patient can take only as much as
needed.
Another
problem with swallowed THC is that the
psychoactive side effects may be more intense
than those that occur from smoking. In a study
of elderly patients, the large dose of oral THC
needed to reduce nausea and vomiting produced
severe psychoactive effects, reducing its
utility as a medicine.
Still another
failure of synthetic THC medications is their
lack of the multiple ingredients which appear in
natural marijuana. Researchers are just
beginning to discover the importance of
ingredients such as cannabidiol (CBD), which not
only offers specific therapeutic effects in
muscle spasms, but also serves to reduce the
psychoactive effect of THC. CBD's balancing of
THC's psychoactive effect may be one reason many
patients prefer marijuana to Marinol.
Yet another
problem with Marinol and other synthetic forms
of THC is cost. Patients report monthly expense
of $500 to $900 for Marinol prescriptions.
Patients purchasing marijuana on the black
market could procure an approximately equivalent
supply for less than $500, while those allowed
to grow their own supply would be able to
produce their 'medicine' for zero cost.
In a 1990
survey of oncologists, researchers asked for
comparisons on the effectiveness of Marinol and
smoked marijuana. Only 28 percent felt familiar
enough with both drugs to answer the question.
Of these, only 13 percent thought Marinol was
better; 43 percent believed the two forms of THC
were equally effective, and 44 percent believed
smoked marijuana was better. Four hundred and
thirty-two oncologists (44% of respondents) said
they had recommended smoked marijuana to at
least one of their cancer patients.
In a 1994
survey, 12 percent of oncologists said they had
recommended smoked marijuana and 30 percent said
they might prescribe it if it were legal.
Click for more information
on Marinol
|
Comparison
Chart |
|
Synthetic THC
(dronabinol) |
Marijuana
(cannabis) |
|
Legally prescribed by physicians
usually under the trade name
Marinol. |
Currently illegal in AR but
legal in nine states. |
|
Oral medication to be swallowed
can be a significant problem for
those who are nauseated or
vomiting. |
With smoked medication -- no
swallowing. Even non-nausea
patients are relieved by fewer
pills to swallow. |
|
Oral ingestion is preferred if
patient cannot tolerate
inhalation |
Patient may have
contraindications for smoking.
Natural marijuana can be eaten. |
|
Dosage works slowly. |
Dosage works immediately. |
|
Must move to the small intestine
before being absorbed into the
bloodstream. After absorption,
it passes through the liver,
where much is biotransformed
into other chemicals. 90% fails
to reach sites of activity in
the body. In tests, after six
hours, 57% of subjects taking
oral THC had no measurable
amount in the bloodstream. |
Moves directly to the
bloodstream through the lungs.
Within a few minutes, effective
dosage levels are obtained |
|
Dosage is inflexible -- large
quantities must be taken, onset
of effectiveness is delayed, and
effects linger. |
Dosage can be adjusted. Smoking
allows patients to match usage
to their symptoms, meaning
smaller doses. |
|
Psychoative side effects are
greater with oral THC due to
changes in the liver and the
lack of other cannabinols which
may serve as buffers. |
Psychoactive side effects are
minimal due to patient control
over dosage and the presence of
other cannabinols which occur
naturally in marijuana. |
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Heavy psychoactive effects may
create unpleasant reaction,
especially in older patients. |
Lighter psychoactive side
effects may benefit patients by
producing mild euphoria and
sense of well being. |
|
Synthetic THC only; contains
none of the natural compounds
which work synergistically and
offer unique therapeutic
benefit. |
Natural marijuana contains other
elements and natural compounds
besides THC which work
synergistically and offer unique
therapeutic benefit |
|
Marinol and other similar
medications are often not as
effective as whole marijuana. |
In
one study of 56 patients who got
no relief from standard
antiemitic agents, 78% became
symptom free when they smoked
marijuana. |
|
Cost of prescription dosage
ranges from $362 to $624 per
month, with huge profits going
to multinational drug
corporations. |
Cost of equivalent supply of
black market marijuana ranges
from $200 to $400 per month.
Patients growing
their own plants would have
essentially FREE medicine. |
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