THE POT DOCTOR HAS A BACKACHE.
As Mahmoud ElSohly, Ph.D. shakes my hand, he’s wincing. Two days ago, ElSohly—the director of the University of Mississippi’s Marijuana Project—bent down the wrong way and threw out his back. And unfortunately, this morning’s visit to his chiropractor didn’t help him much.
Ironically, just outside ElSohly’s office in the Waller Complex—behind bolted doors, coded chambers, and security cameras—lies a government-guarded farm where acres of a pain-relieving drug grow in his care. Only Elsohly isn’t thinking about lighting up: He knows too much.
READ A HEADLINE TOUTING A POT STUDY, and it’s likely referencing the University of Mississippi’s carefully cultivated Mexican marijuana. In fact, the National Institute on Drug Abuse has named this lab the country’s one legal source of marijuana for scientific studies. It’s been operating quietly since about 1968—growing, harvesting, processing, standardizing, and analyzing marijuana.
The farm grows strains for testing with varying amounts of pot’s potent ingredient, tetrahydrocannabinol or THC—also known as the chemical that makes you “high.” But it does more than that. “There are many indications for which THC would be a good medicine if you have the right formulations and dosing,” says Dr. ElSohly.
The marijuana plant is made up of more than 500 chemical compounds. Many of these compounds are cannabinoids, which bind to receptors in your body and then affect your immune system and brain. Researchers have pinpointed two main cannabinoids—THC and cannabidiol, or CBD—as beneficial, Dr. ElSohly tells me. (The biggest difference: CBD doesn’t make you high.)
Trouble is, when exposed to the high temperature of a burning joint, the 500 or so chemical compounds in marijuana can produce hundreds or thousands of byproducts—many of which are thought to be carcinogens. Research suggests that marijuana smoke can contain up to 70 percent more carcinogenic materials than tobacco smoke. And while many researchers think that—logically—marijuana smoke should cause lung cancer, studies remain inconclusive. (See Does Smoking Pot Cause Lung Cancer?)
But ElSohly contends that the smoke itself isn’t the biggest issue at this point. “There’s an inherent problem with the smoking of marijuana as a delivery system,” he says.
FORTY-FIVE YEARS AGO, Lester Grinspoon, M.D., now an associate professor emeritus of psychiatry at Harvard Medical School, would have never agreed with the idea of marijuana as a medicine. He thought his friends who lit up were ruining their health. Who would blame him? The U.S. government seemed to agree. In 1970, it classified marijuana as a Schedule I drug—alongside heroin and LSD—as a substance with high abuse potential and no accepted medical purpose.
But in 1967, Dr. Grinspoon’s teenage son was diagnosed with acute lymphocytic leukemia. Chemotherapy left him with no appetite, vomiting spells, and nausea—“the kind you feel right down to your toe nails,” the doctor remembers. The drugs that were supposed to ease the pain didn’t. So Dr. Grinspoon’s wife pulled up to Wellesley High School and asked her son’s friend for weed.
A few minutes before his treatments, Dr. Grinspoon’s son would take a few puffs. “We never—for as long as he lived—had to deal with that awful experience of seeing what he went through again,” he says.
But bring something you smoke to the medical world, and chances are they’ll balk at the idea. “Smoking is not an accepted route of administration for medication,” says Peter Friedmann, M.D., M.P.H., professor of Medicine & Community Health at Brown University. “There are so many variables in the smoking process. It’s ludicrous to think you could come up with a dosage,” Dr. ElSohly adds.
This is, in part, why the FDA approved Marinol—a low-dosage formulation of synthetic THC that comes in capsule form. The drug is used to stimulate appetite in people with HIV and control the nausea and vomiting that’s associated with chemotherapy. It’s a good option for people with conditions like cancer who don’t respond to common drugs. It’s also incredibly versatile. “Does it lower intraocular pressure for glaucoma patients? Yes it does. Does it reduce anxiety? Yes it does. Does it stimulate appetite? Yes it does,” Dr. ElSohly says.
The problem: Marinol is one of only two FDA-approved THC-based drugs and, unlike say, Advil, your body doesn’t absorb it well. Only about 10 to 20 percent of the dose becomes available for your body to use. That makes it unpredictable: For some people, the drug works great; others see no benefit whatsoever, says ElSohly. What’s more, it often makes those who it does work for higher than if they had smoked pot—another absorption issue.
Which leaves a clear challenge for researchers: Create a THC delivery method that leads to better absorption while reducing its psychoactive effect. ElSohly and his team are on track to do this at their Ole Miss research facility. They’ve developed a patch that would be applied above your gum line and deliver THC in a way that circumvents Marinol’s absorption problems. If approved, the product could be effective for relieving everything from nerve and cancer pain to glaucoma and anxiety.
You don’t need much THC to experience medicinal benefits, and street pot—as well as pot sold in dispensaries—is just getting more potent.
NO SUBSTANCE IS WITHOUT ITS SIDE EFFECTS. Researchers believe that regular cannabis use can have neurotoxic effects on maturing brain structures. A 2012 study in the Proceedings of the National Academy of Sciences found that people who started smoking before age 18 showed a greater decline in IQ and cognitive functioning than people who started toking as adults. Even more: Heavy teen users—an average of four or more times a week—who continued to smoke as adults experienced an 8-point IQ drop which couldn’t be blamed on booze, other drugs, or less education.
THC has what doctors and researchers know as biphasic activity. “At low doses it has certain effects, and at high doses it has opposite effects,” Dr. ElSohly explains. “Somebody using to get high at the right dose will be calm, happy, getting the munchies, and all of that,” Dr. ElSohly says. Someone using at the right dose could see medicinal benefits, too. But take in too much THC, and you can become irritable, even psychotic. “There are more emergency room admissions today than ever because of marijuana use,” Dr. ElSohly says. “That’s simply because of the psychoactive side effects of the high THC content that the public uses.”
That’s part of the reason weed became illegal in the first place. Post-prohibition, the federal Bureau of Narcotics (a forerunner of the Drug Enforcement Administration) turned its attention to a plant that newspapers reported was making people violent and crazy—from jazz musicians in New York, to workers on the Mexican border. In 1937, the federal government passed the Marihuana Tax Act to prevent its recreational use . And in the past 10 years, enforcing pot laws has cost taxpayers more than $211 million in the state of Washington alone, according to recent research by the American Civil Liberties Union of Washington State.
Certainly we have legal medicines that have greater risks than marijuana, says Dr. Friedmann, who also notes that these drugs have proven benefits. Watch a commercial for Cymbalta—a common anti-depressant—and roughly half of the nearly 90 seconds are drug warnings, one of which warns antidepressants may increase the risk of suicidal thoughts in children, teens, and young adults. FDA-approved sleeping-aid Ambien even includes this warning: “After taking Ambien, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night.”
To this effect, doctors like Grinspoon preach pot’s safety: “Marijuana is not only non-toxic—but remarkably non-toxic.” If you look in the literature, you’ll be hard pressed to find a death caused by marijuana, he says: “I couldn’t find evidence of a single death, and the most toxic thing is death.”
Other doctors will remind you that FDA-approved drugs have been tested in clinical studies. They know the implications for using them—how they work, and how they don’t. And although marijuana has been around the U.S. for hundreds of years, “we don’t know a lot of that information about it,” says Dr. Friedmann.
WALK INTO A MEDICAL MARIJUANA DISPENSARY in any of the 18 states—or Washington, D.C.—where it’s legal, and you have your choice of remedies: chocolates, drinks, and different strains of weed. None are FDA-approved, but show your medical marijuana card and you can use it to treat what ails you.
In Colorado, there are many conditions which can make you eligible for a doctor’s recommendation, says Ken Lamkin, a family physician in Colorado who evaluates patients for the cards. If you have cancer, glaucoma, HIV or AIDs, cachexia, chronic pain—including migraines—severe nausea, epilepsy or seizures, or persistent muscle spasms, a medical exam and written documentation from a doctor stating that you may benefit from medical marijuana can land you a registration card. Then you have access to varying amounts of weed in your state.
The problem: “How do you prove if the pain is severe or moderate?” Dr. Lamkin asks. While he conducts full examinations on patients, there is no way to objectively tell how severely a patient is experiencing pain.
In California, a mental health condition—such as depression or anxiety—can score you a medical marijuana card. Walk up and down Venice Beach and you’ll see doctor-office storefronts boasting 24-hour live patient verification. If you have some cash, an ID, and a qualifying medical condition, you’re well on your way to weed.
“I think we have to be real about what that’s all about,” says Dr. Friedmann. “It’s really about legalization—not the health benefits or risks.” Sure, tobacco and alcohol—which are both legal—harm many more people than cannabis, but we don’t use them as medicines, Dr. Friedmann adds. “During Prohibition, one of the few ways to get alcohol was by prescription, and some unscrupulous doctors and clinics made good money—just as they are for medical marijuana.”
So could the pot you pick up with a medical marijuana card ease anxiety like many people claim it does? “It could,” says Dr. ElSohly. “But it could also exacerbate it.”
You don’t actually need much THC to see medicinal benefits. But street pot—as well as pot sold in dispensaries—is just getting more potent. Dr. ElSohly and his team at Ole Miss track the THC content in confiscated marijuana in this country. “In the 1970s, the THC content was around 1 or 2 percent,” he says as he shows me weed sent to the lab from the Drug Enforcement Administration after a raid. “Today it’s more like 11 or 12 percent.”
Why that matters: It’s the lowest dose of Marinol—2.5 milligrams of THC —that works best for appetite stimulation in HIV patients, Dr. ElSohly says. This is equivalent to smoking about a half-gram joint at 1 percent THC. The same thing goes for a good high: A 2007 Clinical Pharmacology & Therapeutics study found that of 1.7, 3.4, and 6.8 percent THC pot, most people preferred the experience from the 3.4 percent weed. What you won’t read in that study is that it was originally designed to include 8 percent THC weed, but “even the most experienced marijuana smokers couldn’t tolerate it,” Dr. ElSohly explains. “So what the heck do you want more THC than that for?”
Look at the Colorado population using marijuana for pain, Dr. ElSohly says. “It’s mostly youth—people who should be pain free.” It takes him about a minute to stand up—he’s wincing again. “I have back pain right now, but I’m not about to smoke marijuana for it. You know what I’m saying?”