Marijuana Made Easy
For more than half a century, the US government has maintained a hard line on marijuana, denying that the plant has any medical value at all. But in the period since 1996, during which voters in several states have approved the medical use of marijuana and the Institute of Medicine has hailed the therapeutic effects of THC (one of the cannabinoids found in the natural plant), the Feds have scrambled to revise their position. Now, the drug warriors' line goes something like this: Who needs pot, an illegal substance that burns up your lungs, when you can take Marinol, a little white pill that contains synthetic THC?
The government threw its weight behind Marinol this past July, when the Drug Enforcement Administration moved the drug into Schedule III, lifting its dangerous stigma and making it easier for doctors to prescribe. While drug czar Barry McCaffrey insisted the move was based on "pure science," a review of the players involved suggests that the rise of Marinol is more the result of politics and profiteering. Indeed, one of the studies cited by the DEA as proof of Marinol's low abuse potential was funded in part by the drug's manufacturers.
Marinol is sold in the United States by Roxane Laboratories, based in Columbus, Ohio, and Unimed Pharmaceuticals, based in Chicago. It was introduced to the market in 1985 and subsequently approved by the FDA for the treatment of nausea and appetite loss--the same symptoms that lead cancer and AIDS patients to smoke marijuana. But the pill is not always effective for patients, some of whom complain that its therapeutic effects come on too slowly and that the Marinol "high" makes it impossible to function. As a result, only about one in ten patients prefers Marinol to smoking pot, according to a worker at a California "cannabis club," which distributes marijuana to sick people. In California, many doctors prescribe both Marinol and marijuana at the same time, to make sure the patient's needs are covered.
Chuck Thomas of the Marijuana Policy Project in Washington, DC, supports access to both marijuana and Marinol. When patients ask him for advice, he says, "I tell them to first ask your doctor about Marinol, because if Marinol works for you, then you don't have to worry about going to jail." Meanwhile, the US government and drug manufacturers seem intent on blocking the availability of marijuana, denying patients that alternative.
Roxane and Unimed have been assiduously promoting Marinol to AIDS and HIV patients by making the drug available for free to those who can demonstrate financial need. And in January 1999, Roxane began running an ad for Marinol in about twenty consumer and medical journals, including Poz and The Advocate. The ad shows two images: a muffin with a bite taken out of it ("This Is Your Appetite") and an empty muffin wrapper ("This Is Your Appetite on Marinol"). No one can miss the reference to the Partnership for a Drug-Free America's famous fried-egg ad or the pointed tagline "Ask your doctor about Marinol." As the ad is careful to point out, patients may experience some side effects (such as "a feeling of being 'high'") and should avoid "hazardous" activities, such as driving, until they get used to the drug. And one more thing, the ad copy implies in a backhanded way: While studies have shown that Marinol is an effective appetite stimulant, it has yet to be conclusively proved that the drug reduces nausea for cancer patients or results in weight gain for people with AIDS.
Ironically, given the manufacturer's competition with medical marijuana, Roxane has seen a "significant increase" in prescriptions of Marinol in the states that recently passed pro-marijuana initiatives, according to associate product manager David Querry. (The roster now includes Alaska, Arizona, California, Colorado, Nevada, Oregon and Washington.) As a result of the new laws, more patients ask for marijuana--but doctors have responded by prescribing Marinol first.
Standard practice dictates that doctors prescribe all conventional medications before offering an experimental drug as a treatment of last resort. But Roxane presents Marinol as a solution, not an option, for physicians who are "torn" when patients ask for marijuana. "What do they do?" asks Querry. "Honor the patients' wishes and recommend a medication that doesn't have identified medical studies to prove its safety and efficacy--or fall back on an FDA-approved product with fourteen years of history on the market?"