Marijuana. It’s a small word that generates a large reaction (for better or for worse). People are polarized on the topic. Yes, there is a definite social stigma surrounding this infamous, leafy plant. Consequently, the potential for cannabis-based drugs has been greatly hindered by legal and political considerations - obstacles that researchers and pharmaceutical companies do not normally find themselves battling. After all, it’s not everyday that research and development teams are looking to create novel drugs from a Schedule I substance – a substance that by definition is not considered to have a legitimate medical use. However, with the recent recommendation by the American Medical Association (AMA) that marijuana’s Schedule I drug classification be reconsidered in order to facilitate research and development of cannabinoid-based medications, could this be the dawn of a new era?
I believe that the AMA’s recommendation is right on the mark. From the limited number of clinical trials conducted on smoked cannabis, the description conferred by a Schedule I classification – namely, that there is no legitimate medical use – no longer appears to apply. According to the executive summary of the Council on Science and Public Health’s (CSAPH) report accompanying the new recommendation, trials have suggested that smoked cannabis can reduce neuropathic pain, improve caloric intake and appetite in patients with reduced muscle mass, and possibly reduce pain and improve spasticity in patients with multiple sclerosis. Thus, it seems plausible that cannabis-based medicines could be developed. The re-classification of marijuana from its current Schedule I status is a necessary step to take if we hope to further explore and take advantage of the ameliorating properties of cannabis.
The question then becomes, should pharmaceutical companies dedicate some of their research and development budgets to cannabis-based drugs? From a scientific perspective, the answer is a resounding yes. Scientists steer their investigations based on preliminary experiments and promising results, and as articulated in the CSAPH report, preliminary trials suggest a variety of medicinal uses for cannabis. Furthermore, assuming that there are legitimate medicinal applications for cannabis, the development of cannabis-based medicines (in the form of pills, for example) would work to neutralize much of the stigma associated with medicinal marijuana (only 13 states even allow the use of marijuana for medicinal purposes). Cannabis-based drugs, a few steps removed from the plant itself, would allow patients access to the therapeutic effects of cannabis, while distancing the treatment from the contentious issue of smoked marijuana. This is, of course, in addition to the obvious advantage that an efficacious cannabis-based pill or other medication medium is much safer than toxic, unrefined smoke.
So what is the greatest obstacle threatening to hinder the development of cannabis-based drugs? Ironically, it is the same thing that I just mentioned above: medicinal marijuana. While the current guidelines regarding medicinal marijuana leave much to be desired – and in fact invite the development of safer, easier-to-regulate cannabis-based treatments – the fact of the matter is, pharmaceutical companies are looking to make a profit. Nobody is going to invest the funds necessary to get a drug on the market unless there is a foreseeable fortune to be made on that product. Drug companies are in the business of “blockbusters,” after all. As long as the raw marijuana plant is legal in some states for medicinal purposes, there really isn’t a market for other cannabis-based treatments. (At least, not the financially-fruitful market for which drug companies are always on the lookout.) A consequence of the legalization of marijuana for medicinal purposes is the creation of numerous, often poorly-regulated marijuana shops and boutiques (just look at the 800+ dispensaries in California). Given the diversity of outlets from which to purchase the plant, as well as the wide variety of plant strains and price range for medicinal marijuana, patients in need could no doubt find a cheaper alternative to expensive pills. Thus, if cannabis-based drugs are ever to be developed, not only does the federal classification of marijuana need to be changed, the availability of the raw plant for medicinal purposes needs to be restricted. It’s a game of supply and demand – and that’s a game that pharmaceutical companies are looking to win.