To anyone with a passing interest in the subject, the stories have become routine: Following decades of manual labor, a 62 year-old cattle rancher in North Dakota suffers from chronic neck pain; In San Francisco, a young mother struggles with postpartum anxiety; In New Jersey, an Iraq War veteran endures stress and insomnia as he readjusts to civilian life. With caution, and even some reluctance, they all found relief through the use of medical marijuana. What does each story have in common, aside from therapeutic methods? They are all anecdotes – unique testimony from individuals. Even if we collected these stories by the hundreds, or thousands, we still wouldn’t have proof. That is not how medical experts study and approve new drugs.
To properly evaluate a drug’s efficacy, pharmacologists must perform carefully designed studies involving statistically significant sample sizes, and in order to isolate direct cause and effect, they must attempt to control for every possible variable. Failure to do so will allow other researchers – their competition, in some cases – to shoot down the study’s conclusions through a process of peer-review.
Anyone with a high school education should be vaguely familiar with these rules, and if you can name a drug and a symptom, chances are that someone, somewhere has already published a study on how they’re related. So, why are we repeatedly treated to articles and segments featuring individual patients and their personal experiences with medical marijuana? Case studies can add emotional gravity to a story, but when it comes to medical marijuana, there is a reason why these narratives are rarely followed by a review of hard data.
The short explanation? It’s hard to publish peer-reviewed studies on medical marijuana when the federal government makes the research itself illegal. In 1972, for reasons which remain controversial, the Nixon administration formally classified marijuana as a “Schedule 1” drug. Along with other Schedule 1’s, like ecstasy and peyote, marijuana was designated officially as “having no currently accepted medical use.” Control over Schedule 1 drugs is so strict that most attempts to obtain samples, even by hospitals or universities, are considered crimes.
Many who have faced this predicament use the same phrase to describe it: “It’s a catch-22,” Ryan Vandrey, of the Johns Hopkins University School of Medicine, told Scientific American. “It can’t come off of Schedule 1 to a different Schedule until the traditional drug development work has been done, and I don’t think the traditional drug development work [large phase III trials] really can be done while it’s Schedule 1.”
The study of controlled substances is not outlawed entirely, but for anyone attempting to try, the federal government’s rules are cruelly – one might even say deliberately – kafka-esque. In the rare event that a project is approved by the Food and Drug Administration and the Drug Enforcement Agency (permission from both agencies is required), actual research-grade marijuana can only be obtained through the National Institute on Drug Abuse (NIDA), which has been and remains under a congressional mandate to exclusively study the harmful effects of controlled substances.
Compounding their frustration, researchers are frequently reliant upon external support to finance their projects – whether through private donations, corporate grants, or federal funding. Money from the feds can obviously be ruled out, and drug companies have little interest in a remedy that they can’t patent and monetize. ”It’s hard to get funding,” Donald Abrams, a professor of medicine at the University of California, San Francisco and the chief of Hematology/Oncology at San Francisco General Hospital, told Popular Science. “There’s not a pharmaceutical company. It’s a plant,” he explained. ”There’s nobody other than the government.”
Innumerable appeals for reform by an array of well-respected officials and organizations have been submitted to, and rejected by the federal government over the years. As early as 1944 a committee from the New York Academy of Medicine concluded that marijuana was not physically addictive, not a gateway drug and that it did not lead to crime. Harry Anslinger, head of the then-Federal Bureau of Narcotics, declared the report unscientific. The American Medical Association and the American College of Physicians have each called for more research into the therapeutic uses of marijuana and for the U.S. government to reconsider its classification, to no avail. In 2009, even a DEA judge ruled that allowing some medical research would serve the public interest. Her advice was formally dismissed. As if the nonsense behind their logic hasn’t been abundantly clear to everyone for decades, the DEA clings to the charade: “Risks of marijuana use have not been shown to be outweighed by specific benefits in well-controlled clinical trials,” repeated DEA Administrator Michele Leonhart upon refusing to reclassify marijuana, once again, in 2011.
If it were any other “recreational” drug, it probably wouldn’t be a scandal. Micro-dosing LSD, for example, has allegedly helped treat depression in some individuals. MDMA, the active ingredient in Ecstasy, is being considered as a possible medication for soldiers with PTSD. It may be a long time before we complete a body of clinical research into either LSD or MDMA, but the potential applications for each drug are quite narrow. Not so for marijuana, which has been demonstrated through preliminary research to help alleviate symptoms of pain and nausea in patients with HIV, cancer and multiple sclerosis.
Anecdotally, as we know, the range of potential uses is far wider. The paucity of data has led some states with new legislation on medical marijuana, like New York, to approve its use for patients with Parkinson’s disease, Lou Gehrig’s disease and epilepsy, despite there being no high-quality proof that such treatment is effective. This is unfortunate. The side effects of cannabis are relatively benign, but by continuing to obstruct the medical community, the DEA is not only denying some patients access to safe treatment, they’re now denying others encouragement that their treatment will work at all.