Medicalized marijuana

| Comments (1) | Pharma
William Saletan has a confusing article in Slate about GW Pharma's new cannabis-based product, Sativex:
Sativex is a cannabinoid pharmaceutical product standardized in composition, formulation, and dose, administered by means of an appropriate delivery system, which has been, and continues to be, tested in properly controlled preclinical and clinical studies. Crude herbal cannabis in any form--including a crude extract or tincture--is none of those things.
So there. Sativex isn't pot. It's a carefully refined derivative: "Once the plants have matured, they are harvested and dried. GW then extracts the cannabinoids and other pharmacologically-active components ... [to] arrive at a pharmaceutical grade material." Patients are further expected to regulate their intake to separate pot's approved effects--relief of pain and spasms--from its unapproved effects:
By careful self-titration (dose adjustment), most patients are able to separate the thresholds for symptom relief and intoxication, the 'therapeutic window', so enabling them to obtain symptom relief without experiencing a 'high'.


Every feat of re-engineering challenges our moral and legal assumptions. In the case of Sativex, two positions are under attack: the left's lazy tolerance of recreational marijuana in the guise of legalizing medical marijuana and the right's opposition to medical marijuana on the grounds that it's just a pretext. By refining, isolating, and standardizing pot's medicinal effects, pharmaceutical companies are showing us how to separate the two uses. Are you for symptom relief or getting stoned? That used to be a fuzzy question. Now it's concrete: Do you want the reefer or the spray?

As far as I can tell from the above, the story is that Sativex does get you high if you take enough; it's just that they're packaged it in a such a way that it's easy to take a small enough dose that it relieves whatever symptoms you allegedly have without getting you high. On the other hand, if you take a higher dose, presumably you do get high. But of course, the same thing is true of pharmaceutical opioids as well, and people abuse them. To the extent to which we have deterred such abuse it's because we have found opioids which provide pain relief with less euphoria and/or we've adulterated them so it's unsafe to take enough to get really high (e.g., the acetaminophen in vicodin). And of course we still have plenty of abuse of high-end opioids like demerol. I don't see any evidence that either of these has happened with Sativex.

Maybe I'm missing something, but I don't see how this usefully divides the world between people who are in favor of getting high and people who are in favor of symptom relief. On the contrary, Sativex seems like a new cool way to get high without the inconvenience of lighters, coughing, smelling like smoke, etc. I'm sure there are some people who like the ritual of actually smoking pot, but I suspect most would be perfectly happy to skip that and just get high. How exactly does being able to buy the active ingredients at Walgreens discourage use by stoners?


Cost, most likely. That, plus the packaging will be really, really unhip. Marketing is seriously a big factor in getting high.

Having said that, and as someone who doesn't get high any more, I am very appreciative of efforts to make dosages for sick people more manageable. For example, if I have to go through a treatment with the side effects of huge nausea and pain, I would prefer this to the hit-and-miss anti-nausea drugs plus an opiate.

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