Prescriptions for Medical Marijuana

MS. DIANE REHM

11:06:54
Thanks for joining us. I'm Diane Rehm. Medical marijuana has been legalized in 14 states and the District of Columbia. There's no national model regulating the business, so each is doing it in its own way. Joining us to talk about what this means for sellers and buyers of cannabis for medical use, here in the studio is Allen St. Pierre, of the National Organization for the Reform of Marijuana Laws, or NORML. Joining us from the Viewpoint Creative Studio in Needham, Mass., Dr. Lester Grinspoon of the Harvard University Medical School and Stephen DeAngelo, he's with the Harborside Health Center in Oakland and San Jose, Calif., he joins us by phone from the Burning Man event in the Black Rock Desert in Nevada. And throughout the hour, we'll take your calls on 800-433-8850. Send us your e-mail to drshow@wamu.org. You can send us a tweet, you can join us on Facebook. Good morning to all of you.

MR. ALLEN ST. PIERRE

11:08:37
Good morning, Diane.

DR. LESTER GRINSPOON

11:08:37
Good morning.

REHM

11:08:38
Glad to have you with us and let me start with you, Stephen DeAngelo. Have you gotten any sleep at all?

MR. STEPHEN DEANGELO

11:08:51
I'm sorry, Diane. Did I get what at all?

REHM

11:08:54
Any sleep. I'm wondering if you had any sleep last night.

DEANGELO

11:09:00
Yes. I did. I got about five or six hours sleep and I'm feeling pretty chipper here in the nice sunshine of the desert, cool morning.

REHM

11:09:09
I'm glad to hear that. All right. Dr. Grinspoon, let me ask you first what is the advantage of marijuana over other prescription medication for some patients?

GRINSPOON

11:09:26
The advantage of marijuana over many prescription medicines for which it can be substituted, are one, it's remarkably non-toxic. Two, once it is free of the prohibition tariff, it will be relatively inexpensive. Certainly less expensive than the drugs, the conventional pharmaceutical products, that it will displace. And thirdly, it is remarkably versatile. There are so many different symptoms and syndromes for which marijuana is, in my view, one of the best, if not the best, pharmacological approaches.

REHM

11:10:21
Such as?

GRINSPOON

11:10:22
Such as pain, such as nausea and vomiting, Crohn's disease, migraine, glaucoma. I could go on and on. There are -- the list is very long.

REHM

11:10:40
Sounds as though you're talking about a magic formula, Dr. Grinspoon.

GRINSPOON

11:10:46
Well, you know, in 1928, Fleming discovered penicillin and it was put back on the shelf until 1941, when, because the United States was entering WWII and we had only one antibiotic, sulfonamide, and that wasn't a great one. It was clear that we needed some antibiotics, some new ones and two investigators took this penicillin off the shelf and in just six patients with different infectious diseases proved that this substance was a powerful antibiotic. And from that point on or shortly after that point, it became known as a wonder drug. It was a wonder drug for the same three reasons that cannabis is eventually gonna be known as a wonder drug.

REHM

11:11:41
Dr. Lester... go ahead.

GRINSPOON

11:11:44
One, it's very -- it was remarkably non-toxic, two, it was very versatile, it could treat almost every Gram-positive infection, plus several spiral ketil infections, like syphilis and three, once it was produced on an economy of scale, it was quite inexpensive.

REHM

11:12:10
Dr….

GRINSPOON

11:12:10
It was a wonder drug.

REHM

11:12:11
Dr. Lester Grinspoon, he's associate professor of psychiatry emeritus at the Harvard University Medical School. And turning to you, Allen St. Pierre, if you don't smoke, how else are you going to get medical cannabis?

PIERRE

11:12:31
Well, there's a number of different ways. Pharmaceutically, there's a number of different ways it can be delivered. Through thermal patching, through sublingual sprays under the tongue, eye drops, suppositories, that'll be an all new type of pot party in the future. Those are the type of pharmaceutical drugs that are coming down the pike right now, but in the United States, outside of smoking marijuana, you can vaporize it, you can orally ingest it, you can put it in a bomb if you have rheumatoid arthritis, there are many different delivery methods beyond smoking, which clearly is problematic.

REHM

11:13:10
Allen St. Pierre, he's executive director of NORML and, of course, that's a non-profit foundation established to better educate the public about marijuana and marijuana policy options. One more question, Allen, what's behind this move across states and soon the District of Columbia to legalize medical marijuana?

PIERRE

11:13:40
Well, this began in earnest in 1972 when NORML launched the first lawsuit to simply put marijuana in the same schedule with OxyContin, Percocet, Vicodin, all these drugs which we all don't need a degree from this fine university in pharmacology to figure out, marijuana's probably been miss scheduled. So we began this battle 38 years ago and what really tipped us off was in '96, when the voters of California voted to medicalize marijuana and now we have 90 million Americans who live in the 14 states with medical marijuana.

REHM

11:14:12
And now turning to you, Stephen DeAngelo, you've heard Allen St. Pierre talk about all the various ways that medical marijuana may be given. What about quality control? Who's gonna grow it? What kind of form will it take and be controlled so that people can know it's safe? Are you there? We lost Stephen DeAngelo. Oh, I'm sorry about that. Let's try to get him back, please. Dr. Grinspoon, can you answer the question?

GRINSPOON

11:14:59
Well, the -- it's a problem now, quality control. I mean, first of all, one has to be sure that the marijuana is not -- does not have insecticides or under other uncomfortable chemicals.

REHM

11:15:18
Sure.

GRINSPOON

11:15:18
One has to be sure there isn't fungus in it and so forth. Generally speaking, I mean, countless millions of people in this country use marijuana illegally and we see very little problems from possible contaminants, but nevertheless, it is important, quality control, because it merges into something else and that is to say to know what kind of marijuana one is smoking.

REHM

11:15:46
Sure.

GRINSPOON

11:15:47
Mr. DeAngelo can address this better than I, but it's...

REHM

11:15:51
And I think he is back with us. Are you there, Stephen?

DEANGELO

11:15:56
I am, Diane, and at Harborside Health Center in Oakland, we have a two step quality control process which consists of first and first place, a bio-essay of the particular medicine, which is performed by a very extensively trained staff member.

REHM

11:16:15
So you have a bio-essay that's done on every single sample of cannabis that comes in to you? See, I think we keep losing him. Oh, this is so sad.

PIERRE

11:16:32
Diane, if I will. I've actually...

REHM

11:16:33
Sure.

PIERRE

11:16:33
... toured his facility.

REHM

11:16:35
Okay.

PIERRE

11:16:35
And they actually do test every single bit of cannabis that comes in to their system and they determine whether it has mold or anything else and they simply won't purchase it. And they track the cannabis from the moment it comes in the door to the moment it's sold. And so like a pharmaceutical company, they do a reasonably good job of organic control, despite no federal or state regulation.

REHM

11:16:59
That's interesting. Describe for us, if you would, Dr. Grinspoon, and if you can, a typical dispensary.

GRINSPOON

11:17:11
Well, there again, I’m not involved with the dispensaries. That would be a question for Mr. DeAngelo.

REHM

11:17:19
Okay and unfortunately, we've lost him.

GRINSPOON

11:17:22
Right, (laugh) right.

REHM

11:17:23
Can...

GRINSPOON

11:17:25
But I can describe, I've toured a number of them, but they vary enormously. In fact, the first dispensary was the one in San Francisco organized by a man by the name of Dennis Peron and it was my favorite because it didn't use a drug store or pharmacy as it's model, but indeed a patient could go in, see the various possible marijuanas that he could buy, buy one and then he could take it home and use it as a medicine at home or he could go into what looked like a huge living room where other people who were sick used their marijuana. And it had the advantage of -- these people had an opportunity to share in this group and I thought that was very advantageous. Most of them are set up so that there is a large display of not only smokable marijuana, but edible marijuana, all sorts of preparations of marijuana so that the patient has an opportunity to decide for himself whether he wants to smoke it or eat it or what have you.

REHM

11:18:41
All right. Dr. Lester Grinspoon, he's at the Harvard Medical School. Short break and we'll be right back.

REHM

11:20:03
And as we talk about the dispensing of medical marijuana around the country, the number of states and even the District of Columbia, which apparently will allow the distribution of medical marijuana after January 1. Sadly, we have lost Steven DeAngelo. He was on a satellite phone in the desert, which did not hold up. Instead, we are joined by Dr. Donald Vereen, he's a physician and director of community-based public health at the School of Public Health at the University of Michigan. He's former deputy director of the Office of National Drug Control Policy. Good morning to you, Dr. Vereen.

DR. DONALD VEREEN

11:21:00
Good morning, Diane Rehm.

REHM

11:21:02
So glad to have you with us. Tell us about this idea of these legal dispensaries. How are they going to work?

VEREEN

11:21:16
Well, the legal dispensaries have been developed in a number of different states and each state has challenges and rules about how they think these dispensaries would or should work. So I'm in Michigan now and Michigan has a plan to develop a way to certify certain folks who would be able to dispense. There are some folks that would be given permits to grow a certain amount. They have to prove a relationship with the person who might be able to benefit from the marijuana. It's a challenge, it's a big challenge, but...

REHM

11:22:02
Allen...

VEREEN

11:22:02
...but the states are doing the best they can.

REHM

11:22:03
Of course. Allen St. Pierre, talk about Colorado's medical marijuana laws.

PIERRE

11:22:10
Colorado is fascinating in that this state already has a billion dollar medical marijuana industry that's already thriving. There are over 800 dispensaries on the Front Range alone. Almost every major ski valley has them. And so the governor signed a bill about a month ago that is going to try to reel in, collapse the industry down to maybe 40 or 50 within the state. That's the ideal, so Colorado is really the first state to pass state laws and taxation when there's an existing thriving marijuana industry. Unlike New Jersey and the District of Columbia that has passed laws to allow for this, but they haven't put for the regulations yet.

REHM

11:22:50
So you're dealing with both non-profit and for-profit dispensaries?

PIERRE

11:23:00
In Colorado specifically, they can be for profit.

REHM

11:23:04
So that means that the dispensers are going to make tons of money?

PIERRE

11:23:10
Well, some of them now do very, very well...

REHM

11:23:11
Yeah.

PIERRE

11:23:11
...there's no doubt about it, whether it's a non-profit collective model or whether it's a straight up business one. Mr. DeAngelo's company is reported to do $20 million a year or $50,000 a day in cash sales, so this is real genuine money that many municipalities are now looking for for tax money.

REHM

11:23:31
So Washington D.C. is now setting up its own laws for medical marijuana. Describe what they are doing.

PIERRE

11:23:40
The District of Columbia will have very strict laws. It will look nothing like California and Colorado. No home cultivation, very limited disease types, you have to have more than one doctor's recommendation. There'll likely be five to seven approved in the District of Columbia in a population of about 500,000 people. And the local neighborhoods will largely determine their existence through the Advisory Neighborhood Commissions.

REHM

11:24:06
How interesting. Dr. Vereen, where does the federal government stand on this issue?

VEREEN

11:24:14
Well, I'm not with the federal government at this point, but one of the issues that -- the big issue that the federal government does recognize is that, you know, this is a very difficult issue. There are benefits within the cannabis plant that help people who don't have other options to treat some of their maladies, but the research is not -- hasn't been forthcoming quickly enough to help these folks, to make sure that the cannabinoids that are in the cannabis plant are in a form that can be used by people efficiently. So the federal government is doing as much research and supporting as much research as it can.

VEREEN

11:25:09
But as far as these other regulations, this is a -- it's a state issue and some of these state issues are in conflict or they don't match very well with the federal laws and I think it's going to take some leadership, perhaps on the part of some of the folks that you have on your show, to make sure that standards are addressed, that maybe they get help from the federal government to help set up standards to partner with the federal government to do the research, to generate the appropriate quality standards because, after all, the people that they want to help, in this case, deserve the best quality healthcare...

REHM

11:25:55
Of course.

VEREEN

11:25:55
...that's out there.

REHM

11:25:57
And Dr. Grinspoon, what about the pharmaceutical companies? Aren't they trying to get in on the market as well?

GRINSPOON

11:26:07
Yes. But first of all, let me point out that I disagree with Dr. Vereen in the sense that he's implying that people should wait until the kind of studies, which the federal government approves of, are available for them to use this substance. Now, there is a mountain of anecdotal evidence that this cannabis is a very interesting and versatile medicine. And while there are some so called double-blind studies now coming in, for example, just last week at McGill University, such a study was published in the, Canadian Medical Journal, which affirmed that smoked marijuana is useful in the treatment of neuropathic pain. Now, this is something we've known for a long time and I'd been advising patients for a long time to use this substance. It's usually much more effective in this kind of pain than other substances, so I think we can't afford to wait for that. And secondly, it's not necessary.

REHM

11:27:28
All right.

GRINSPOON

11:27:28
I mean, what the FDA does in these double-blind studies is a risk benefit analysis. And we know the results of the risk benefit analysis because of the enormous collection of anecdotal data in -- with regards to marijuana.

REHM

11:27:50
All right. Well, now...

GRINSPOON

11:27:51
Now, I've forgotten the question you asked me.

REHM

11:27:52
...let's for just a moment talk about the side effects and the fact that some people are going to get high on marijuana. Is there an advice to be given to each individual who may be taking this medical marijuana? For example, not to drive, Allen?

PIERRE

11:28:19
Of course. Absolutely. Not to drive, not to go to work impaired. The same mores and values that we largely have for alcohol and other prescription drugs are exactly what we must have for medical cannabis. There can be no deviation there.

REHM

11:28:32
And Dr. Vereen, what's your response to Dr. Grinspoon's point that studies indeed have been done and have shown that medicalized marijuana really does help where some medications simply don't reach?

VEREEN

11:28:55
I have absolutely no disagreement with that statement. The problem is the form. It's the root of the administration. Smoking is not an efficient -- it is an efficient way to get the aerosolized cannabinoids into the human body, but it's not an accepted way of getting in. We don't smoke medication. Right now, this is the best that we have. There are some studies that have been able to -- I guess the way to put it is a soap has been created to help dissolve the THC so that you could use an inhaler-type of instrument. To my way of thinking as a public health person, as a physician, that's what we should be focusing our efforts on. We, after all, are trying to ban smoking in most places. That root of administration is very helpful to folks and we should be putting all of our efforts into that root of administration in that form.

REHM

11:30:02
All right. Dr. Grinspoon, do you want to respond?

GRINSPOON

11:30:06
Yes. I again have to disagree with part of what Dr. Vereen says. I think smoking is a wonderful way to do it. First of all, one doesn't have to actually smoke it. One can use what's called a vaporizer, which separates the cannabinoids and the other useful constituents of the marijuana bud into a vapor free of all the products of burning the substance itself. Secondly -- and it has the same effect of smoked marijuana because one gets a response in just a minute or two. So, for example, I advise a patient who has never used marijuana, but is finding it very difficult to get any satisfactory relief for, for example, his Crohn's disease to -- if he's never used it, take a puff, wait for a few minutes, if -- and let the joint go out, if you will, and then take another puff and wait for a few minutes, so an experienced person doesn't have to do this.

REHM

11:31:20
All right.

GRINSPOON

11:31:20
But one who is just learning to has to wait to see whether he gets -- when he gets relief from the symptom and at that point, stop. As for the high, I think some people don't like it and I -- most people don't mind it at all. And secondly, if you have to use it frequently, you don't get much of a high. You can get a little high in the morning, but you won't worry about the high, You get a tolerance to the high on a 24-hour period.

REHM

11:31:53
All right.

GRINSPOON

11:31:53
But you don't get any tolerance to the therapeutic effect.

REHM

11:31:56
All right.

VEREEN

11:31:56
I agree with most of that, but normally, when medications are developed, all of those things are worked out ahead of time. The issue of dose, when you're inhaling this, is a real concern. Some people are more sensitive to the amount of THC that's in the marijuana and sometimes people don't know how much THC is in the marijuana.

GRINSPOON

11:32:17
But that's the point, Dr. Vereen, you can (word?) it.

REHM

11:32:17
All right. I do want to -- excuse me, I do want to get to some other issues. I know that that one's going to remain.

REHM

11:32:28
But turning to you, Allen, is legalizing marijuana for medical use a slippery slope to legalizing marijuana across the board?

PIERRE

11:32:39
I would say no in the purest political sense of the word, because right now, here are the important outliers. Seventy-five percent of Americans in almost all the polling support this notion of medical marijuana. Seventy-four percent support this notion of decriminalizing it, meaning you still can get arrested for it or you just pay a small amount and not get arrested for it, but here's the important point, only about 45 percent of Americans want it legalized, so there's a big huge gap there of American wisdom in this policy.

REHM

11:33:10
Allen St. Pierre, he's executive director of NORML and you’re listening to "The Diane Rehm Show.” Dr. Vereen, what about veterans, does the VA have a stance on medical marijuana?

VEREEN

11:33:28
I'm sorry, could you repeat that? I...

REHM

11:33:30
Certainly, I'll be happy to. What about veterans, does the VA have a stance on medical marijuana?

VEREEN

11:33:40
I'm not aware of their position.

REHM

11:33:44
All right. Allen?

PIERRE

11:33:45
Two weeks ago, the Veterans Administration released a memo indicating that where there are patients who are lawful in these 14 states, if they are in the VA, the VA cannot deny them medicine or keep them out of the pain clinic, so this is a big change at the federal level.

REHM

11:34:01
And Dr. Grinspoon, what about health insurance; do you see that paying for medical marijuana?

GRINSPOON

11:34:11
Well, not now, but I see it in the future because it's going to be a very important part of our armamentarium in treating of a huge number of symptoms and syndromes, so it's going to have to be. And, in fact, in Europe, in many places, it is. I mean, for example, buying a volcano vaporizer is now -- something to vaporize the marijuana to use as a medicine is now approved by the health services in Germany and people can buy them through their health plan.

REHM

11:34:53
So I gather, Allen St. Pierre, you really do have to have a doctor's prescription, for the most part; is that correct?

PIERRE

11:35:05
You have to have a doctor's recommendation.

REHM

11:35:06
Okay. A recommendation, but if you use it legally with a doctor's recommendation, your employer could still fire you for it. How come?

PIERRE

11:35:22
Unfortunately, the law has not caught up to the politics of this. It's clear -- and this case is coming out of Michigan, a Walmart employee, so it's your classic example of a brand name where an individual is a lawful user. And now the company finds itself torn between its insurance providers, the federal government and all of its regulations of the Drug-Free Workplace Act of 1988, so this is a conundrum that must be resolved by the courts. And one presumes it will rule in favor of the individual who, of course, cannot use cannabis in the workplace, but should not be punished if they use it lawfully outside of the workplace.

REHM

11:35:59
But nobody punishes somebody who uses Paxil or one of those kinds of drugs in the workplace.

PIERRE

11:36:08
Exactly. That's why it doesn't pass the proverbial Joe Six-Pack sting test. Most people just do not appreciate that there could be a legal distinction here to fire somebody who uses a lawful medicine.

REHM

11:36:21
How do you feel about that, Dr. Grinspoon?

GRINSPOON

11:36:22
Well, I think that is fine, but I think, you know, what is lawful? I mean, in some states, as you've mentioned California and Denver, people can use it for -- if they've got back pain, they'll get permission. But in other states, where the states always arrogate the symptoms and syndromes for which people can use this drug and many of them are so restrictive, that I would guess a very small proportion of patients who actually could profit from using marijuana will be legally allowed to do so. So that eventually this has to change.

REHM

11:37:12
Yeah, I would think if somebody showed up at work high because they had been using medical marijuana, then an employer would have reason.

PIERRE

11:37:26
That's it.

REHM

11:37:27
But if that individual is using medical marijuana for back pain, took it the night before, how does the employer know in the first place? We're going to...

GRINSPOON

11:37:38
He won't know and...

REHM

11:37:38
...take a short break here. When we come back, we'll open the phones for your calls, your comments. Stay with us.

REHM

11:40:03
And as we talk about the legalization of medical marijuana in 14 states and the District of Columbia after January 1, here's our first email from Sandra in Manchester, N.H. She says, "I've never been a user of marijuana, but I'm interested in medical marijuana laws for compassion reasons. I've read the pharmaceutical companies charge about $500 per month for a supply of their synthetic marijuana pills. How involved is the pharmaceutical industry in trying to prevent the legalization and dispensation of medical marijuana, because it cuts into their hefty profits when marijuana plants are as easy to grow at home as tomatoes?" Allen?

PIERRE

11:41:06
Playing both ends of the middle, the pharmaceutical companies do, as I mentioned earlier, there are about five to six pharmaceuticalized versions of cannabis that are coming down the pike. The brand-name Sativex comes from GW Pharmaceuticals. At the same time, historically in the last 30 years, pharmaceutical companies were some of the largest donors of, for example, the Partnership for Drug-Free America or the DARE program, so surely a pharmaceutical company's about the last entity that would want a drug-free America.

REHM

11:41:33
Interesting. Thanks for that email. Now, to Brian, he's in Grand Rapids, Mich. Good morning to you.

BRIAN

11:41:44
Good morning, Diane, and good morning, guests. I've got a comment. From watching The History Channel on how marijuana was made illegal in the first place, one of the arguments had a racial aspect to it and that was to prevent Hispanics and blacks from using it as a way of fraternizing with white women. And I was wondering if they might be able to comment a little bit on the history of how it became illegal.

REHM

11:42:11
Allen?

PIERRE

11:42:12
Well, certainly in the 1930s, Reefer Madness, as most of us know it today to be, is absolutely routed in anti-Mexican immigrant bias, but anti-marijuana laws began in the 1880s in California, Nevada and other places. And the groups that were actually being targeted were people from the Middle East where marijuana's been used and consumed for thousands of years, where it is today, Israel, Syria, Beirut, Lebanon.

REHM

11:42:38
Interesting.

PIERRE

11:42:39
When they came to the Imperial Valleys of California, they brought with them seeds to make marijuana and hash.

REHM

11:42:44
Interesting.

BRIAN

11:42:45
And I'll add that it...

REHM

11:42:46
To Santa Barbara, Calif., Steve, you're on the air.

STEVE

11:42:51
Hi. I do not partake, first of all, I wanted to qualify that. My son is a grower for legal medical marijuana and he has to take it to Oakland, Calif. to sell it. And typically, as in all farming, he's a farmer and the farmers are probably -- they make the least amount of money for this very high quality organic marijuana that's being grown. He works the hardest and makes the least amount of money and it just doesn't seem fair. And typically, the people making the most money are the distributors and it is so inflated and it shouldn't be.

REHM

11:43:41
Can you comment, Allen?

PIERRE

11:43:43
Well, one thing that is very vexing for the patients in places like California and there are 2400 dispensaries in the United States today, is that generally speaking, the prices are just the same as if I begged up marijuana on K Street by my office. That prohibition prices are still in effect at these dispensaries. And the caller's point is correct, the wholesaler sees the least amount. The retailer makes the most amount. Right now, in California, marijuana sells from between $15 to $16 per gram, which is about two marijuana cigarettes.

REHM

11:44:14
So wouldn't it make sense for someone in a state where medical use has been legalized to begin growing it him or herself or would that be considered illegal?

PIERRE

11:44:30
Here in the District of Columbia and New Jersey, which I think is really the apex of this whole discussion in the last 20 years, was probably reached this January when New Jersey became the first state to ban home cultivation. The District followed. Maryland's gonna do the same in October, so ironically, government is pushing more towards a corporate model of growing it in a secure grow environment that is protected and bonded, but they're getting away from the homegrown model.

REHM

11:44:56
Interesting. To Terri in Alexandria, Va. Good morning, you're on the air.

TERRI

11:45:06
Hi. My question is based in scientific curiosity, mostly. Have the ingredients or the chemical entities of the cannabis plant extract been identified to the extent that one can determine which of those entities are leading to the beneficial effects, like pain relieving and, you know, glaucoma treatment versus the negative effects of, you know, mind altering...

REHM

11:45:32
Sure.

TERRI

11:45:32
...ramifications of having cannabis? So could you isolate the positive chemical (word?)...

REHM

11:45:38
Interesting.

TERRI

11:45:38
...and then just simply administer those as a drug for the beneficial effects?

REHM

11:45:41
Dr. Vereen?

VEREEN

11:45:43
Yes. There are hundreds of chemicals within the cannabis plant that get released when it's burned. I -- to answer your question, I would refer you to the, IOM report, the Institute of Medicine report that came out in 1998, which documented all of the research up to that point, and I'm sorry to say that there hasn't been that much more research since then, that documents what is known at the -- what is known now about what the contents of marijuana are and which diseases they benefit and which ones there's evidence that there isn't much benefit from. It's clear from that report that the cannabinoids are a helpful entity. Things like THC and its other forms that, you know, this whole process is trying to get after or get at to help people.

REHM

11:46:42
Dr. Grinspoon, do you want to add to that?

GRINSPOON

11:46:46
Yes. The cannabinoids, which number over 60, the exact number is not known, but the number one cannabinoid is called THC and it is the one that is most involved in the high and the medical effects. Another one, cannabidiol is -- leads to no psychoactive effect, but has enormous potential as a medicine. These two are the most important. And now there is a renewed interest in cannabidiol because it's such a good anti-inflammatory and antioxidant. It has a number of qualities which -- and the fact that it doesn't lead to a high. And the problem is, that in this search to develop a plant high in THC because of the market, the people who wanna get high want a high level of THC, they've achieved a high level of THC, but at the expense of the cannabidiol.

REHM

11:47:59
Oh, I see.

GRINSPOON

11:48:00
And so now a number of growers in California are gradually pulling the cannabidiol up and eventually, that will be a medicine. And people who do not want to get high, will probably be able to enjoy as many of the medicinal effects from this strain.

REHM

11:48:27
Terri, I hope that answers your question. Now, to Maurice, he's in Rockford, Ill. Good morning.

MAURICE

11:48:37
Hi, good morning. I take Lexapro in the morning. My insurance company has tried to get me to take Escitalopram, which is very similar to Lexapro, because it's generic. Are all these marijuana drugs, will they be patented? Will they be, you know, will there be, like, Lexapro versions and generic versions? And, I mean, it just, you know, have they talked about that, the patented, you know, the patents and, you know, the...

REHM

11:49:06
Sure.

MAURICE

11:49:07
...you know, the price of a patented drug...

REHM

11:49:08
Sure.

MAURICE

11:49:08
...as opposed to a generic?

REHM

11:49:09
Dr. Grinspoon?

GRINSPOON

11:49:11
Well, see, one of the advantages of marijuana is that it's a plant. It can't be patented. This is an advantage for the ultimate patient. Drug companies would like to develop something to compete with marijuana. They're frightened, as they should be, that marijuana's gonna displace many of their drugs, but they can't ultimate -- they can patent their own invention and I'm sure they will develop cannabinoids that will be very useful, but the gold standard at this point and until drug companies can come up with substances that can be as versatile as whole-smoked marijuana, this is important -- this is the important gold standard. When they come up with substances which are better than whole-smoked marijuana, then they will be competing with the marijuana only on the basis of price, because by the time they do this, marijuana will come down in price.

REHM

11:50:21
All right. To Missoula, Mont. Good morning, Ann. Thanks for joining us.

ANN

11:50:28
Hello, Diane and your guests. I just wanted to give a firsthand account...

REHM

11:50:32
Sure.

ANN

11:50:32
...of some benefits of medical marijuana. Montana is a medical marijuana state. And my mother who has tried -- she's 85 years old and has terrible restless leg syndrome and she went through all the various pharmaceutical-type stuff, Requip and even to the point of Ativan and she was up pacing all night. I mean, she was to the point where she would fall asleep standing up and fall down and at 85 years old, that's very bad.

REHM

11:51:00
Wow. Yeah.

ANN

11:51:01
Ativan seemed to help as far as her being able to sleep, but the side effects were horrendous. She couldn't even stay awake during the day. If she sat down, she'd just fall right to sleep and was not herself at all. Well, we finally went to some medical marijuana and getting the card was a process and all these things, you know, that you have to go through to make it okay to use it. We have a great supplier and my mom has been using an edible form and she is able to sleep. She can sleep at night, she's not groggy during the day. It has been a miracle for her. And I'm not kidding you, this has been a process of taking the regular pharmaceutical-type stuff for over five years with, you know, horrible side effects, not working that great. It's been a miracle. I'm not kidding you, I have my mom back. (unintelligible) .

REHM

11:51:48
I'm so glad for you...

ANN

11:51:50
Wonderful.

REHM

11:51:51
…Ann. Dr. Grinspoon, do you want to talk about that chewable form and why that seemed to have worked so well for Ann's mother?

GRINSPOON

11:52:05
Well, it's an edible form. I don't think she said chewable.

REHM

11:52:09
I'm sorry. You're right.

GRINSPOON

11:52:10
And that sounds like a very good solution to her mother's needs. Now, you know, when you take any form -- any edible form of marijuana, the dosage varies. That is most people absorb about 12 percent, but it's plus and minus about 5 percent, depending on the state of your bowel and so forth and so on. Nevertheless, it doesn't matter 'cause the other stuff is harmless, what is absorbed does the job and it has an advantage over smoking marijuana because you don't have to use it as often. The effect lasts six to eight hours perhaps and I'm sure her mother doesn't get any kind of a high because if you have it in you frequently, she's just not gonna get high.

REHM

11:53:04
All right. Dr. Vereen, do you wanna comment?

VEREEN

11:53:08
Yeah, this is an example of how the route of administration is important and sometimes that is matched with the disease or the condition that you're trying to treat. There are some folks where Marinol doesn't help them at all. AIDS Wasting Syndrome, for example, it's an inhaled form that is the most helpful for them. And that's why doing more research and clinical trials to help sharpen our knowledge about these things so that we can help people more efficiently.

REHM

11:53:46
What is...

VEREEN

11:53:46
So it's a good story, but the route of administration is an important thing to understand here.

REHM

11:53:52
Allen?

PIERRE

11:53:52
Well, that's absolutely true from a pharmacological point of view, but I think both doctors would agree that if you're faced with a Hobson's choice of using a product that is giving you great benefit or, if you will, being impaled on the altar of prohibition, it's a pretty easy choice.

REHM

11:54:06
And you're listening to "The Diane Rehm Show." Let's go now to Knoxville, Tenn. Good morning, William.

WILLIAM

11:54:16
Hi, how you doing?

REHM

11:54:17
Good, thanks.

WILLIAM

11:54:19
Well, first off, I'd like to comment on the edible form of marijuana, if I could. I am an avid marijuana advocator and I actually use marijuana quite regularly and I've done so since my discharge from the military in about 2005. I suffer from chronic anxiety and insomnia and I have been on every type of medication you could possibly think of, Xanax, Valium. I've been on a sleeping medication like Ambien. And the problem I've had with those is, is that not only do I feel completely groggy and helpless when I'm on the medication, but the next day, my thought process isn't clear and drugs like Valium and Xanax do have addictive potential. They do have potential for abuse. And, in fact, a lot of people I know in the military have become dependent on those drugs.

WILLIAM

11:55:08
Marijuana, to me, has no actual physical addiction. It might have some psychological addiction, but it's a God made -- it's made by God. It's from the earth. It's not synthesized in some laboratory and, in fact, I guess the problem I have with the pharmaceutical companies wanting to keep this illegal is that in Florida alone, we have over 400 pain clinics that distribute OxyContin and Oxycodone and Xanax like it's candy. I mean, they have no qualms about getting people addicted to pretty much synthetic heroin.

REHM

11:55:43
Now, that...

WILLIAM

11:55:43
But yet when it comes to a drug that has all these benefits for the human body and helps with so many conditions, they wanna get in an uproar about it because they're afraid they're not gonna make money.

REHM

11:55:54
Allen?

PIERRE

11:55:55
Well, he's definitely picking up on a conundrum I think everybody recognizes, that if you can go out and grow your own medicine, you're surely cutting out the government, you're cutting out the tax man and you're cutting out the pharmaceutical companies and that's probably why this prohibition has lasted as long as it has.

REHM

11:56:09
But do you believe eventually that people are going to be allowed to grow their own?

PIERRE

11:56:16
I think under legalization, that's clear. I mentioned earlier that we've reached this apex of states allowing home cultivation. I hope that stops and that patients can grow their own 'cause obviously, it fixes most of the solution regarding the cost, the potency, the purity, where it comes from, so a patient should be able to grow their own marijuana.

REHM

11:56:38
Allen St. Pierre, he's executive director of the National Organization for the Reform of Marijuana Laws, Dr. Lester Grinspoon is associate professor of psychiatry emeritus at Harvard University Medical School and Dr. Donald Vereen, he's a physician and director of community-based health school at the School of Public Health at the University of Michigan. Thank you all so much.

VEREEN

11:57:12
Thank you, Diane.

REHM

11:57:12
And thanks for listening. I'm Diane Rehm.

ANNOUNCER

11:57:16
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