By Blamuel Njururi, Kenya Confidential Editor in Chief, Nairobi – December 24, 2017
Denying a patient knowledge of and access to a therapy that relieves pain and suffering, especially when the patient has a terminal disease, violates the basic duty of a physician
Welcome to the first of a series of articles Kenya Confidential will be publishing regularly in pursuit of convincing the Kenya Government to explore, as a matter of economic necessity, production of Cannabis Sativa popularly known as Bhang, for medical purposes. We have used the United States of America as a case study on the fast moving change of legal heart towards medical marijuana farming with all most of its big corporates driven by multi-billion-dollar economic gear led by Microsoft Bill Gates.
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Medical marijuana is still a new idea. But, it’s growing at breakneck speeds.
In Canada alone, legal marijuana sales have surged 17,400%.
In the U.S., it’s 2,800%.
There’s no doubt cannabis is taking off.
American Cannabis Corp jumped 2,066% in three months leading up to Trump’s victory.
And Agritek Holdings did a complete 180-degree turn, popping 5,800% right up to November 8th.Studies in the United States, Canada and Australia have shown beyond any reasonable doubts that the plant offers great potential for medical use in control, treatment and management of many chronic diseases. There is no record of people who ever died out of Bhang overdoes the world over.
A British pharmaceutical company has been developing drugs derived from cannabis compounds THC and the non-psychoactive cannabidiol (which, unlike THC, does not produce a “high”) for more than a decade. GW Pharmaceuticals (GWPH, +0.69%) is currently testing a new cannabidiol-based drug, called Epidiolex, that is intended to treat severe epilepsy in children and young adults. At the same time, investors who are eager to pump money into the cannabis industry’s expanding medical research segment are sending up the company’s shares.
Growing of Bhang for medical use can be introduced in Kenya initially for export market, under strict controls, to United States, Canada, Britain and Australia which have established pharmaceutical factories that are already manufacturing a wide variety drugs out of the plant.
United States perspective
Marijuana, as Bhang is called in the US, is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis as well as epilepsy seizures.
These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients.
The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government’s stance of zero-tolerance, which has led to a heated legal debate in the United States.
After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and non-maleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights.
Debate about medical marijuana is challenging the basic foundations of the accepted practice in the medical, legal and ethical communities. A major criticism of alternative therapies like medical marijuana is they have not been scientifically tested, leading many to question their safety and efficacy.
However, proponents in the medical community argue for medical marijuana use based on its effectiveness in managing debilitating pain, nausea and vomiting associated with chemotherapy, as well as its efficacy in treating severe weight loss commonly experienced by AIDS sufferers. Medical marijuana can be used as a stand-alone treatment for these conditions or as a complement to conventional ones in order to help patients better withstand the conventional treatments’ effects and thereby obtain the full benefit, whether a cure or improvement of their condition.
In recognition and acceptance of the effectiveness of medical marijuana, sixteen states have approved initiatives to make marijuana legal for medicinal purposes, including Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington, as well as the District of Columbia. However, the leading opponent to legalization is the federal government, which has continued to trump state law rights by threatening patients and physicians with criminal prosecution and closing or obstructing dispensaries in states with medical marijuana legislation in place.
The history of marijuana use for medicinal purposes extends back through millennia. The medical use of marijuana can be traced back to 2737 B.C., when Emperor Shen Neng was prescribing marijuana tea to treat gout, rheumatism, malaria, and even poor memory. The drug’s popularity spread throughout Asia to the Middle East and into Africa, and many ancient physicians prescribed marijuana for numerous ailments, from pain relief to childbirth.
In Western medicine, between 1840 and 1900, more than 100 articles citing marijuana’s therapeutic qualities were published in American and European medical journals. These early American medical journals were recommending hemp seeds and roots for conditions including inflamed skin, incontinence and venereal disease, and in 1851, the United States Pharmacopoeia included hemp in its catalog of medicines. Marijuana was routinely prescribed by American physicians and enjoyed legal status in the United States until 1937 when U.S. legislature passed the first federal law against marijuana – the Marijuana Tax Act.
This Act imposed a $1 per ounce tax on marijuana purchased for medical intention. Later, in the 1950s, Congress passed the Boggs Act and the Narcotics Control Act, which outlined mandatory sentences for drug offenders, including marijuana possessors and distributors . Eventually, the 1970 Uniform Controlled Substance Act classified marijuana as a Schedule I drug, thus making possession of a Schedule I drug like marijuana, heroin, ecstasy, LSD, GHB and peyote illegal.
Under this Act, there are five schedules of drugs – Schedule I, II, III, IV, and V. A Schedule I drug has a high potential for abuse, and has no accepted medical use in treatment due to a lack of accepted safety for use of the drug. A Schedule II drug has a high potential for abuse like a Schedule I drug, but it has an accepted medical use for treatment. Schedule III, IV, and V drugs have a low potential for abuse and are accepted for medical treatment. The federal government’s basis for threatening prosecution is due to the 1970 classification of marijuana as a Schedule I drug.
While the subject of medical marijuana is becoming an increasingly heated medical issue, it also continues to stir the embers of legal arguments. Advocates on both sides continue to battle at federal and state government levels. One such state where legal battles have raged is Montana. Montana’s state legislature legalized the medical use of marijuana in 2004, but in the past year, Montana residents have seen increased legal opposition to this ruling.
The issue of medical marijuana is now firmly encased in the halls of the judicial system in states like Montana and California. In California, there are now certain cities like Anaheim that have taken their case to ban marijuana dispensaries to the local courts. In August 2011, an Orange County Superior Court Judge ruled that the restriction of distribution of medical-marijuana in Anaheim was not a contradiction to state law. The judge supported his ruling by saying that state legislature allows local laws to “fill in the gaps that exist in state medical-marijuana law”.
States like Delaware, Pennsylvania, and others including Alabama, Connecticut, Idaho, Illinois, Massachusetts, New Hampshire, New York, North Carolina, Ohio have created environment where medical marijuana is legal. Delaware, a state that legalized medical marijuana, pioneered in a bill signed into law on May 13, 2011. Pennsylvania followed in 2009 when it proposed a bill for medical marijuana legalization.
The ethical dilemma at the core of this debate is whether the federal ban on the use of medical marijuana violates the physician-patient relationship. The argument can be framed by the ethical principles of autonomy and beneficence. Patients have the right to expect full disclosure and discussion of all available treatment options from their physicians.
Denying a patient knowledge of and access to a therapy that relieves pain and suffering, especially when the patient has a terminal disease, violates the basic duty of a physician. As a result, physicians find themselves at the center of this controversy, searching for a compromise between medical necessity and government restrictions.
The main objection to the medical use of marijuana by the federal government is largely attributable today to a national policy of zero-tolerance toward illicit drugs. This objection is extended to include a prohibition on legalizing marijuana for medical purposes as well, and is underscored by three suppositions initially outlined during the Clinton Administration.
- First, marijuana is an illegal drug that remains unproven in terms of safety or efficacy.
- Second, it is argued that marijuana is a “gateway drug” that leads to more serious drug use.
- Third, any legalization of marijuana for medical purposes will send the wrong message to the public, and in particular to our children, namely that marijuana is acceptable for recreational use and even beneficial.
The Kenya Government led by National Agency for the Campaign against Drug Abuse (NACADA) can use the same argument and dismiss and oppose any efforts to allow growth of the plant as a medicinal crop purely on the basis that it is considered to be a drug. The medical world however is a fast changing one and Kenya will not be static for long. Indeed, the Kenya government should enlist Kenya Medical Research Institute (KEMRI), Kenyatta University and Moi University to establish a joint medical benefits that accrue from Bhang and exploit its potential with a BANG!
With regard to US documenting of the effectiveness of medical marijuana, early analysis in medical literature was issued on March 17, 1999, by a White House-commissioned committee of 11 independent scientists appointed by the Institute of Medicine. The researchers concluded that, “the benefits of smoking marijuana were limited by the toxic effects of the smoke, but nonetheless recommended that the drug be given under close supervision to patients who do not respond to other therapies”.
The report continued that, “there was no evidence that giving the drug to sick people would increase illicit drug use in the general population. Nor is marijuana a ‘gateway drug’ that prompts patients to use harder drugs like cocaine and heroin”. This government-sponsored study presented solid scientific data that indicated the potential therapeutic value of marijuana in controlling some forms of pain, alleviating nausea and vomiting, treating wasting due to AIDS, and combating muscle spasms associated with multiple sclerosis (MS). Neither does it increase drug usage or lead to harder drugs.
Despite their own findings, the federal government continues to prohibit this effective drug from being prescribed by physicians for patients suffering from specific treatment side-effects, which have led to strong objections to the government’s stance by medical researchers, physicians, legal experts, and ethicists, not to mention the patients that rely on marijuana to improve their medical condition.
Attempts to reassign marijuana to a Schedule II drug classification have been rejected by the Drug Enforcement Administration (DEA). The basis for rejection has previously been the assertion that, “there was no scientific evidence showing that marijuana was better than other approved drugs for any specific medical condition”. The federal government’s argument is further asserted to have logical grounding, to legal wit: marijuana is an illegal drug; no one should ever use illegal drugs; therefore, no one should ever use marijuana for any reason.
Other opponents of the legalization of medical marijuana, such as certain members of the medical community and anti-marijuana organizations, assert that marijuana is too dangerous for medical use, it lacks FDA approval, and that several legal drugs make marijuana use unnecessary. The DEA maintains this position outlined under the Clinton Administration and, in July 2011, ruled that marijuana has “no accepted medical use” and should therefore remain illegal under federal law, in spite of differing state legislation allowing medical marijuana. However, with scientific evidence pointing to the contrary, some perceive the US government’s treatment of this issue as more of a political matter than a medical issue.
The purpose of this article, therefore, is fourfold: first, to explore the medical aspect of marijuana by examining pertinent scientific research; second, to study the legal issues related to medical marijuana legalization; third, to provide an ethical analysis of the arguments for and against medical marijuana legalization; and fourth, to conclude with specific recommendations.
Marijuana is taken from the leaves and flowering tops of the hemp plant, Cannabis Sativa, known as Bhang in Kenya, which grows in most regions of the world. Cannabis Sativa contains over 460 known compounds, of which 60 are cannabinoids, or compounds unique to cannabis. The main psychoactive compound of marijuana is delta-9-tetrahydrocannabinol (THC).
The harmful effects of marijuana include rapid heartbeat, some loss of coordination, and impaired immediate memory. In addition, the drug can adversely affect one’s critical skills, including those skills necessary to operate vehicles safely, such as judgment of distance and reaction time. As reported by a 2010 Harvard Medical Study, marijuana seems to induce psychotic symptoms and worsen conditions in patients already diagnosed with schizophrenia or other psychotic disorders.
One such study of more than 50,000 young Swedish soldiers found that those who had smoked marijuana at least once were more than twice as likely to develop schizophrenia as those nonsmokers. For those who said they had used marijuana more than 50 times, research showed that they were six times more likely to develop schizophrenia as the nonsmokers.
More evidence is being gathered demonstrating early or heavy marijuana use might not only trigger psychosis in people who are already susceptible, but might also cause psychosis in some people who might not otherwise have developed it; however, direct cause and effect cannot be asserted with absolute certainty from that individual study.
About 20 years ago, scientists discovered a system in the brain that responds to 60 chemicals in marijuana, also known as cannabis. It’s called the endocannabinoid system. This system plays a role in many of the body’s functions, such as in the heart, along with the digestive, endocrine, immune, nervous, and reproductive systems. The discovery sparked interest in finding specific chemicals made from marijuana that could be targeted for specific conditions.
Since that time, scientific projects around medical marijuana worldwide have sped up dramatically. Many of the studies that have been done show that chemicals in marijuana can help treat some conditions. They have helped manage pain and reduced muscle spasms in MS patients. They’ve worked as an appetite stimulant, and as an alternative drug for brain disorders such as schizophrenia and Tourette’s syndrome.
Despite clinical findings in support of medical marijuana, the DEA has classified marijuana as an illegal Schedule I drug which has “no accepted medical use.” The DEA will not reschedule marijuana without an official determination of the safety and efficacy from the Food and Drug Administration (FDA).
In order to reschedule marijuana, the FDA requires controlled, double-blind clinical trials. However, there is a major obstacle preventing these trials. Like all other herbal medicines, marijuana faces a major roadblock that inhibits conducting sophisticated clinical trials: a lack of patentable product. Without the financial incentive of being able to patent the substance as a commercial product, few have pursued the path of carrying out research using the sophisticated, difficult, and expensive procedures proscribed by best practice.
Another federal restriction is the requirement that clinical studies be funded from scarce grant money controlled by the National Institutes of Health (NIH). These restrictions have discouraged researchers from studying the medical benefits of marijuana. For example, the 2012 estimate for clinical research on cancer accounts for approximately six billion dollars of the NIH budget, which totals 31.2 billion dollars.
The 2011 NIH budget allocated the following funds available for marijuana research for qualified organizations: $2 million in 4–5 awards. According to NIH Grant guidelines on marijuana, applicants may request budgets with direct costs up to $500,000 per year for a maximum period of 5 years.
Therefore, the total budget would be $10 million over the 5 year period. Of the yearly NIH budget of approximately $31.2 billion, the $2 million going toward marijuana research can be calculated as comprising 0.006% of the yearly budget, thus illustrating how marijuana research is vastly underfunded. But that has changed in the last one year. Research in Medical marijuana is currently receiving millions of dollars through investments billionaires excited about its medicinal breakthroughs.
Despite the obstacles, three FDA-approved drugs are made from marijuana. They include:
- Marinol and Cesamet: Both drugs are used to treat nauseaand lack of appetite related to chemotherapy and in AIDS patients. They are man-made versions of THC, the primary chemical in marijuana that gives users a “high.” Both were approved in the 1980s.
- Epidiolex: This drug to treat children’s epilepsy received FDA approval in 2013. Its use is highly restricted.
Another drug, Sativex, is in clinical trials in the U.S. for pain with breast cancer. It is a combination of chemicals from the marijuana herb and is sprayed into the mouth. Sativex is approved in more than 20 countries to treat muscle spasms from MS and cancer pain.
Controlled clinical studies would need to manage medical testing of marijuana and its various forms. Today, smoked marijuana is not the only form in circulation. There are a number of forms of marijuana that are used for medical purposes, including a synthetic form, Marinol (dronabinol), which is taken orally.
Marinol, manufactured by Unimed Pharmaceuticals, Inc., is a Schedule III prescription drug, approved by the FDA in 1985 for treatment of nausea and vomiting of cancer chemotherapy patients who have not responded to the conventional antiemetic therapy. In 1992, the FDA also approved it for use in loss of appetite and weight loss related to AIDS. However, there are three major concerns associated with Marinol.
- First, some patients complained that the effects of the pill were too strong at first, and then wore off quickly.
- Second, it is very expensive, costing patients anywhere from $200–$800 monthly.
- Third, Marinol can be difficult for nauseous patients to consume; some patients fail to keep the pill down long enough for it to be effective.
Another synthetic marijuana-based drug is Nabilone, a Schedule II drug, similar to Marinol, used to treat nausea and vomiting. Nabilone uses a moderately different preparation of synthetic THC, which makes it more completely absorbed into the bloodstream as compared to Marinol.
Nabilone is now a controlled drug; however, Nabilone is perceived to produce more undesirable side effects, have a longer onset of action and to be more expensive than smoked cannabis. The cost associated with Nabilone is $20 for a 1-mg capsule, and the estimated cost per year is $4000.
Another form used in Canada is a spray alternative called Sativex. In 2006, the Food and Drug Administration (FDA) issued an investigational new drug (IND) application for Sativex. The IND allows a drug to be studied with the goal of approving it for marketing if it is deemed safe and effective.
In 2010, the efficacy of Sativex for bladder dysfunction as a symptom of multiple sclerosis (MS) was tested. It was a 10 week, double-blind, randomized, placebo-controlled, parallel-group trial in 135 subjects with MS and overactive bladder. Researchers concluded that Sativex did have an impact on MS patients with overactive bladder, citing some improvement in symptoms associated with the patients’ bladder dysfunction.
Sativex is a controlled drug, and was licensed for managing MS. One of the biggest problems with Sativex was the cost. A vial of Sativex lasting 10 days costs $124.95 in Canada, which amounts to about $375 monthly. When legalized in Britain, a 10 milliliter vial (enough for 11 days) cost £125, or approximately 205 U.S. dollars.
Looking to the future, there may be safer alternatives on the horizon. Baking marijuana directly into foods is another way to reap the benefits of marijuana while avoiding the toxic effects of smoking the drug.
From a health law perspective, physicians must carefully balance their medical and ethical responsibilities to their patients, with their own moral and legal responsibilities in following the law of the land. it is currently unclear to what extent a prescribing physician could be criminally charged with drug trafficking or to what extent medical malpractice is implicated if a physician prescribes medical marijuana to a patient without explaining the possible legal consequences.
Further, while that may not be the prescribing physician’s legal duty to convey such information, it may be his or her medical or ethical duty in obtaining a patient’s informed consent. If this analysis has shown anything, it is the paramount importance that prescribing physicians and patients alike are aware that the legal status of medical marijuana, despite the laws of sixteen states and the District of Columbia, is entirely unresolved.
Society, in general, has always recognized that in our complex world there is the possibility that we may be faced with a situation that has two consequences – one good and the other evil. The time-honored ethical principle that has been applied to these situations is called the principle of double effect. As the name itself implies, the human action has two distinct effects. One effect is the intended good; the other is unintended evil.
As an ethical principle, it was never intended to be an inflexible rule or a mathematical formula, but rather it is to be used as an efficient guide to prudent moral judgment in solving difficult moral dilemmas. The principle of double effect specifies four conditions which must be fulfilled for an action with both a good and an evil effect to be ethically justified:
The action, considered by itself and independently of its effects, must not be morally evil. The object of the action must be good or indifferent.
The evil effect must not be the means of producing the good effect.
The evil effect is sincerely not intended, but merely tolerated.
There must be a proportionate reason for performing the action, in spite of the evil consequences.
The principle of double effect is applicable to the issue of whether it is ethical for a physician to prescribe marijuana for medical reasons because it has two effects, one good and the other evil. The good effect is that smoked marijuana is more effective than conventional therapies in helping patients withstand the effects of accepted, traditional treatments which can bring about a cure or the amelioration of their condition.
The evil effect is that marijuana smoke has toxic effects and as a Schedule I illegal drug it has been argued it could lead to more serious drug abuse and send a wrong message that illegal drug use is safe and even condoned. To determine if it is ethical for physicians to prescribe medical marijuana for patients as a medical therapy, this issue will be examined in light of the four conditions of the principle of double effect.
The first condition allows for the medical use of marijuana because the object of the action, in and of itself, is good. The moral object is the precise good that is freely willed in this action. The moral good of this action is to help treat pain, nausea, severe weight loss associated with AIDS and to combat muscle spasms associated with multiple sclerosis that cannot be treated adequately by traditional medicines.
The immediate goal is not to endorse, encourage or promote illegal drug use. Rather, the direct goal is to relieve patients of their unnecessary pain and suffering . The second condition permits the medical use of marijuana because the good effect of relieving pain and suffering is not produced by means of the evil effect. The two effects happen simultaneously and independently.
The third condition is met because the direct intention of medical marijuana is to give patients suffering from life-threatening illnesses relief from the effects of accepted treatments that could cure their medical condition. Recent studies have shown that medical marijuana is more effective in controlling pain and nausea from chemotherapy treatments and in boosting the appetites of AIDS patients so as to combat wasting than any of the traditional FDA approved medications.
To deny a physician the right to discuss, recommend, and prescribe marijuana to patients is a direct violation of the physician-patient relationship. To make an informed decision about their treatment, patients have the right to expect full disclosure and discussion of all available treatment options from their physicians. Failure to do this violates the patient’s right of informed consent
Will some people view the legalization of medical marijuana as the condoning and encouraging of marijuana for recreational drug use? The answer is “yes.” But this is not the direct intention of legalizing medical marijuana. The direct intention is to relieve pain and suffering that cannot be relieved by presently approved medications. This misinterpretation of the legalization of medical marijuana can be corrected through public education.
Finally, the argument for the ethical justification of marijuana for medical use by the principle of double effect focuses on whether there is a proportionately grave reason for allowing the foreseen but unintended possible consequences. Proportionate reason is the linchpin that holds this complex moral principle together.Proportionate reason refers to a specific value and its relation to all elements (including premoral evils) in the action.
The specific value in legalizing medical marijuana is to relieve pain and suffering associated with treatment for life-threatening illnesses. The premoral evil, which can come about by trying to achieve this value, is the foreseen but unintended possibility of the potential harmful effects of the smoke and the possibility that some may view this as condoning and even encouraging illegal drug use.
The ethical question is: does the value of relieving pain and suffering outweigh the premoral evil of the potential harmful effects of the smoke and the possibility of scandal? To determine if a proper relationship exists between the specific value and the other elements of the act, ethicist Richard McCormick proposes three criteria for the establishment of proportionate reason:
The means used will not cause more harm than necessary to achieve the value.
No less harmful way exists to protect the value.
The means used to achieve the value will not undermine it.
The application of McCormick’s criteria to the legalization of medical marijuana supports the argument that there is a proportionate reason for allowing physicians to prescribe marijuana. First, the most comprehensive scientific analysis to date by the Institute of Medicine cautioned that the benefits of smoking marijuana were limited because the smoke itself is toxic, but recommended that it be given, on a short-term basis under close supervision, to patients who do not respond to other therapies.
The possible damage to an individual’s lungs is a legitimate health concern; however, the patients who would benefit from smoked marijuana are suffering from cancer, AIDS, MS, etc. Many of these conditions are terminal and the treatments they are undergoing also have toxic effects – chemotherapy, radiation, the AIDS cocktail, etc.
The point is that the benefit of the treatments outweighs the burdens. The focus should be on encouraging the federal government to direct its research resources toward the development of alternative methods of delivering cannabinoids in the form of patches, capsules and bronchial inhalers. In this way the toxicity could be eliminated.
The Institute of Medicine study also reported that there was no evidence that prescribing medical marijuana would increase illicit drug use or that it is a “gateway drug” that prompts patients to use harder drugs like cocaine or heroin. Second, at present, there does not seem to be an alternative medication that is as effective as smoked marijuana. Thousands of patients who have smoked marijuana illegally for medical purposes have attested to its effectiveness.
Those patients who were and are involved in the government sponsored compassionate care program also attest to smoked marijuana’s effectiveness. In addition, scientific studies have shown that Marinol, Nabilone and Sativex are less effective, more difficult for nauseous patients to consume, and more expensive than smoked marijuana. There are also other approved antiemetic drugs or combinations of these drugs which have been shown to be effective in relieving pain and suffering in some cancer patients.
However, for others these medications have proven ineffective. To date, the only therapy that relieves their nausea and vomiting is smoking marijuana. Third, smoking marijuana for medical reasons does not undermine the value, which is the relief of pain and suffering. Many of the patients who would use medical marijuana are suffering from terminal conditions and are undergoing therapies that have serious side-effects.
Since this seems to be the only therapy to date that relieves the pain and suffering of these patients, one can argue convincingly that it is a medical necessity. The US government’s concern that legalizing medical marijuana could lead to the possibility of the slippery slope in regards to drug use is a real fear. But, this has not occurred with other prescription psychoactive drugs (e.g., morphine, codeine, cocaine, etc.) and there is no evidence it would occur with marijuana.
Therefore, it is ethically justified under the principle of double effect for the federal government to legalize marijuana for patients who do not respond to traditional therapies. Seriously ill patients have the right to effective therapies. To deny them access to such therapies is to deny them the dignity and respect all persons deserve. The greater good is promoted in spite of the potential evil consequences.
After reviewing pertinent scientific data, it is evident that there is ample evidence to warrant the Obama Administration to authorize the DEA to reclassify marijuana as a Schedule II drug, which would allow the drug to be used for medical purposes. As a candidate, President Obama promised to maintain a hands-off approach in the this matter and Attorney General Eric Holder also stated that federal prosecutors would not prosecute patients or providers in accordance with state law; however, recent crackdowns suggest otherwise. In order to ensure the proper regulation of medical marijuana and the issues currently surrounding the topic, the following recommendations are proposed:
1. Government rescheduling of marijuana
The top priority of governments, in regards to medical marijuana, should be to reclassify the drug. This would enable dispensaries, clinics, pharmacies and physicians to provide patients with standardized, unadulterated forms of marijuana. If marijuana continues to be unregulated, patients will be forced to seek black-market marijuana, and risk possible legal repercussions to alleviate their condition.
This argument is grounded in harm reduction, both legally and medically. Utilizing the proper legal and medical controls can provide an effective strategy to identify and reduce health hazards associated with smoked marijuana, as well as help to reduce legal prosecution faced with unregulated marijuana.
2. Regulation of medical marijuana growth
Marijuana contains over 460 known compounds, sixty of which are cannabinoids. There are also a number of carcinogens present in smoked marijuana. The main psychoactive compound in the drug is THC, which controls the strength or potency. THC concentration in black-market marijuana can vary greatly, which can lead to adverse effects for patients who may seek alleviating effects for their condition.
To minimize such health risks, the government must monitor Bhang produced for medical purposes. Recently un US, there have been numerous crackdowns on people who grow marijuana for medical uses. This problem is therefore two-fold, with medical and legal aspects. If the FDA was to intervene and oversee the production of marijuana, this would reduce the number of questions surrounding the growing of marijuana and the arrests that follow, as well as control the hazardous aspects of marijuana.So should NACADA in Kenya.
If regulation is present in medical marijuana production, the THC concentration and concentration of other hazardous compounds in marijuana can be controlled, thus reducing the harmful effects that impact the health of numerous patients.
3. Advance research into medical forms of marijuana and cost effective alternatives
The medical community has provided studies proving the efficacy of marijuana in treatment of patients who have not responded to other treatments. Specifically, these studies have shown the therapeutic value of marijuana in controlling pain, alleviating nausea and vomiting, as well as alleviating symptoms of multiple sclerosis (MS) and AIDS. In 2011, a randomized controlled trial of cannabinoids’ treatment of chronic non-cancer pain also demonstrated positive outcomes.
Significant analgesic effects were seen in treating neuropathic pain, fibromyalgia, and rheumatoid arthritis. The most effective cannabinoid available to patients is smoked marijuana, however due to varying THC concentrations and the fact that the mode of ingestion is inhaled smoke, there are also adverse effects. Two options that may help to reduce these adverse effects are more pure forms of smoked marijuana and cost effective alternatives.
A more pure form of smoked marijuana (i.e. less toxic compounds) would reduce the harmful effects of smoked marijuana, and therefore increase the benefits. Cannabinoid alternatives reduce the amount of these harmful compounds in marijuana. Such alternatives like Marinol, Nabilone, and Sativex do exist, however the two concerns that these alternatives pose are efficacy and cost. Smoked marijuana continues to be substantially more effective than these alternatives, and the cost of smoked marijuana is significantly less. In order to improve these alternatives and create new options, more research is needed.
4. Increased funding enabling agencies to accomplish this research
Medical marijuana research is contingent upon National Institutes of Health (NIH) funding. For 2011, the NIH has allocated only $2 million in the form of 4–5 grants for research in marijuana. In order to properly research safer and cost effective alternatives, more NIH funding is necessary, and must be done to provide suffering patients with a beneficial treatment.
5. Increased pharmaceutical research into new medical marijuana alternatives (i.e. marijuana patch, inhaler, etc.)
To advance the development of new marijuana treatment alternatives, pharmaceutical companies should be given incentives to continue to explore new avenues for suffering patients. One such company that has begun development on a medical marijuana patch is Medical Marijuana Delivery Systems (MMDS) LLC. In February 2011, MMDS announced that they had acquired United States Patent rights to develop a marijuana patch for medical use.
Walter Cristobal, the patch inventor, is working with MMDS to develop the patch-based delivery, as well as other delivery systems like creams and gels. Another recent development in the marijuana industry has come from the pharmaceutical company Medicinal Genomics. As of August 2011, the company has successfully sequenced the entire genome of the cannabis plant, a breakthrough which has the potential to grow the number of treatment options available to patients.
Ethically speaking, denying physicians the right to prescribe a therapy that relieves pain and suffering to their patients is a violation of the physician-patient relationship. Patients are entitled to full disclosure of all possible treatment options from their physician in order to make an informed medical decision regarding their health.
It is the medical responsibility of a physician to offer adequate relief from pain for their patients so that the patient may have an acceptable quality of life. Failure to provide an available therapy that has been proven effective would violate the basic ethical principle of beneficence, which is the obligation of physicians to seek the well-being or benefit of the patient.
Under beneficence, a physician’s duties include preventing and removing harm, as well as promoting the good of their patient. To allow a patient to suffer when an effective treatment is available is to directly harm the patient, and therefore a violation of beneficence. Scientific research has shown that the benefits of medical marijuana greatly outweigh the burdens.
Overall, all people, especially in the government and the medical field, should be concerned over the quality of life of those suffering from neurological and movement disorders, cancer, wasting syndrome attributable to AIDS, etc. A 2010 Gallup poll of Americans showed significant support for making marijuana legally available for doctors to prescribe for patients.
The poll found that seventy percent of Americans are in favour, as negative feelings continue to decline. Medical marijuana has proven invaluable in the battle against terminal illnesses; however, unless the federal government publicly acknowledges this fact, numerous terminal patients will continue to suffer needlessly.
The fight against drug abuse is important because many lives are lost to drug addiction, but the effects of devastating illnesses impacts a substantially greater number of people all over the world. Medical marijuana can be an important treatment for physicians to confront the challenges of patients’ pain and suffering. The apparent political motivations present in government must be eliminated because the quality of numerous Kenyans lives and their economic survival hangs in the balance.