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Respectable Reefer

How a pulverized, liquefied, and doctor-prescribed form of marijuana could transform the drug-war landscape

SINCE POT was prohibited in 1937, there's been a virtual epidemic of this malady in the U.S., and GW's posturing seems designed to exploit its latest manifestation: the strange politics of the pitched battle over medical marijuana. The federal government lists cannabis in all its forms on Schedule I of the Controlled Substances Act, a designation reserved for drugs that it says are unsafe and have no known medical use. But medical marijuana activists, drawing on a growing body of evidence indicating that cannabis is a safe and effective medicine, especially for nausea and spasmodic pain, have clamored for its legalization for medical purposes. And they've gained support among the general public. Eleven states have passed medical marijuana laws; no state ballot initiative put before voters has ever failed to pass.

Some of the resulting controversy breaks down along predictable lines—chronically ill people accusing the government of withholding treatment while the government denounces medical marijuana as a "cruel hoax"; legalization advocates hoping to use medical marijuana as a wedge issue while drug warriors warn that it's a Trojan horse. But recently new political fissures have opened up. In Gonzales v. Raich, a case brought to the Supreme Court after the feds busted a medical marijuana patient over the objections of California sheriffs, the Court recently determined that this was "a valid exercise of federal power," but Justice John Paul Stevens' majority opinion was rife with regret about "the troubling facts of the case." Alabama, Louisiana, and Mississippi, three states not exactly known for their liberal traditions, filed briefs in support of the patients, urging the justices to allow states to exercise their function as "laboratories for experimentation." And three justices—including Clarence Thomas and William Rehnquist—dissented on the grounds that medical marijuana should be an issue for individual states to decide, thus placing two of America's most prominent conservatives on the same side of the issue as George Soros and Barney Frank, another ideological divide gone up in smoke.

The significance of the medical marijuana skirmish goes well beyond its fractured politics or its implications for federalism. Even as the government ratchets up prohibition—it currently spends $4 billion a year just arresting and prosecuting people for marijuana-related crimes—evidence of cannabis' safety and efficacy accumulates and the cornerstone of marijuana prohibition weakens. With stakes this high, it's no wonder that judges and politicians, and maybe the rest of us, are dazed and confused about medical marijuana. And it's also no wonder that GW is already garnering notice in the U.S. or that it has managed to attract prominent drug warriors, including the government's leading anti-medical-marijuana spokeswoman, to its cause. Sativex, the pot that dares not speak its name, may be exactly what the doctor ordered: a way for drug warriors to squeeze between the rock of prohibition and the hard place of patients clamoring for medicine. With a prescription version of cannabis available in pharmacies, the feds could regain their moral authority to raid your backyard garden, disrupt the delicate alliances the medical marijuana movement has spawned, and deprive legalizers of what may be their most powerful wedge issue. GW may end up, that is, with a shareholder's dream: a monopoly welcomed by policymakers and enforced by the police, leaving medical marijuana activists to wish they'd been more careful about what they'd asked for.


 

ENGLAND ISN'T the only place where clinical trials of cannabis are being conducted. In fact, on ward 5-B of San Francisco General Hospital—once the site of the world's first dedicated AIDS unit—there are two rooms with oversize exhaust fans where patients can smoke marijuana in the name of science. Sometimes the staff has to put towels under the doors to prevent the smoke and smell from permeating the hallway, but not today. Emily, the healthy volunteer sitting in a half-lotus on a bed in room 29, is only going to smoke half of a joint, while David, the AIDS-related-pain patient reading his Bible in the room next door, won't smoke until tomorrow. Emily, 26, is outfitted for her six-day stay at the research center—during which she will take pot each day at precisely 10 a.m., alternating between smoking and taking it through a high-tech vaporizer device called a Volcano—with a stack of books and videos, a suitcase filled with comfortable clothes, a boom box, and a cell phone. She's been relaxed and chatty and looking forward to the study—"a lounging, couch potato-y thing to do," she says—but that was before nurses Lorna Aquino and Hector Vizoso took her through the final preparations. Aquino has just finished listing the various exams—the blood draws, the breath test for carbon monoxide levels, the survey of her levels of intoxication, the computerized pattern-recognition test—that she will be taking each day, once before she gets high and five times after. Now Vizoso hands her the "Instructions to Smoke Marijuana"—a laminated card detailing the Fulton Puff Procedure. He goes over the method—5 seconds on the draw, hold it for 10, exhale, and wait for 45—and explains that Aquino will watch her from a window in the hallway to make sure she gets the timing right. Now Emily seems self-conscious and flustered. "You're really going to watch while I do this?" she asks.

It's a perfect moment for Dr. Donald Abrams to come in. Although he's wearing a crisp pin-striped shirt and shiny shoes instead of a cardigan and sneakers, he looks like Mister Rogers, and he introduces himself in a neighborly way that immediately puts Emily at ease. "I need to do a little exam here," he says apologetically, fixing his stethoscope to his ears. "It's just that when you're stoned you don't want someone coming at you like this." His exam is brief. On the table in front of Emily, Aquino has arranged a blue plastic ashtray, a Bic lighter, and a shiny hemostat—for a roach clip. In the ashtray is precisely half of a marijuana cigarette, as everyone around here calls the government-issued, machine-rolled joint, which is bright white and perfectly round. Emily lights it up and draws deeply while Abrams coaches her through the Fulton procedure.

She starts to hack, and he assures her in his doctorly tones: "If you don't cough, you don't get off." Abrams, a professor of medicine at the University of California-San Francisco who was one of the first people to suggest that a virus causes AIDS, knows all about working with stoned people. He's one of the few American scientists allowed to study pot in human subjects. Since 1992, he's been trying to bring some scientific law and order to the medical marijuana frontier, where patients take pot for complaints ranging from chemotherapy-related nausea to menstrual cramps and where, in California anyway, dispensaries function without much regulation. But progress has been slow, in part because it has been difficult to fill his studies: He recently had to close down a cancer pain trial for lack of subjects, and patients don't always complete the studies. Half the subjects in the neuropathy study get pot that has been denuded of THC. "Nobody gets fooled for long," says Abrams, and he worries that David may go the way of a recent subject who said, "I don't want to be here for a week smoking a placebo when I can get real pot out on the street," and bailed.

But at least he's fretting about recruiting and retaining patients rather than whether he's going to be allowed to do the research in the first place. It took five years to get his first trial—initially a study to determine whether marijuana would help people with AIDS-wasting syndrome—under way. He had his FDA approval within a year, but acquiring the pot to actually run the study proved nearly impossible. He couldn't just buy it on the street or grow it in his back yard like everyone else. He needed a drug that the FDA would accept as pure and that was legally obtained. So he applied for a license from the Drug Enforcement Agency to import research-grade weed (from the same Dutch company that supplies GW). The DEA stone- walled him, as did the National Institutes on Drug Abuse, the nation's only legal supplier, when he asked for some of the pot grown for NIDA at the University of Mississippi. NIDA eventually denied his request, on the grounds that the FDA-approved study was not "scientific" enough. Abrams persisted, however, and NIDA finally relented in 1997, after Abrams overhauled his study so as to investigate marijuana's potential harms to people taking protease inhibitors—a strategy he says he adopted after Alan Leshner, then NIDA's director, reminded him that "we're the National Institutes on Drug Abuse, not the National Institutes for Drug Abuse." (Leshner declined to comment.)

Abrams says he can now get NIDA pot when he needs it. But the six studies he has run have enrolled only 161 people and are still in the preliminary stages of proving pot's efficacy and safety. Meanwhile, GW has tested Sativex on more than 1,000 subjects, and is well into the late stages of the kind of clinical testing required by the FDA. Abrams won't comment directly on Sativex. ("I'm just not a political person," he says repeatedly.) Nor will he speculate about the commercial implications of his research, about how, or even whether, pot ought to be brought to market (or back to market; Abrams points out that cannabis was used medically for thousands of years prior to its prohibition), or about GW's lead in the race to restore cannabis to legitimacy.

Rick Doblin, on the other hand, will. Doblin heads the Multidisciplinary Association for Psychedelic Studies, a nonprofit organization that first applied to develop marijuana as a treatment for AIDS wasting (Abrams' first study was originally intended for MAPS), and he has been trying unsuccessfully to launch medical marijuana research for nearly 15 years. MAPS, like GW, wants to develop cannabis as a pharmaceutical drug, but, as Doblin puts it, "in the least refined, least expensive way possible—as plant material that people can get in pharmacies or as plants or seeds that they can grow and process themselves." Doblin envisions patients choosing among a number of methods of taking the drug, but he's especially keen on vaporizing, which he thinks may answer concerns about smoking. But he hasn't been able to investigate this hunch. "We can get the FDA to work with us, but we can't get pot from NIDA," says Doblin. "We've been waiting for two years just for a decision on whether they'll sell us 10 grams for our vaporizer study." Doblin thinks that NIDA is "scared of the research. If we prove that it's not true that pot pushes people into schizophrenia or causes lung cancer, if it's not doing the things the government says are the reasons it's bad, then we undercut their credibility."

But even if NIDA were a reliable supplier, Doblin says, "we don't want their weed." NIDA's brown, stems-and-seeds-laden, low-potency pot—what's known on the streets as "schwag"—cannot stack up against the dense green, aromatic, and powerful sinsemilla favored by most medical marijuana patients (and grown by GW). Doblin asked the University of Mississippi to grow the good stuff for him, but they refused, so he approached a botanist at the University of Massachu- setts, who applied to the DEA to grow research-grade pot in a 200-square-foot room in the basement of a building in Amherst. This started a whole new kind of collegiate rivalry, the Rebels squaring off against the Minutemen over the quality of their pot. In a letter to the DEA, Mississippi's botanist—after pointing out that no one had ever officially complained about the "adequacy" of their product—trumpeted recently acquired "custom-manufactured deseeding equipment" and a new stock of seeds that had allowed Ole Miss to amass more than 50,000 joints' worth of a "special batch" of high-potency, smooth-smoking weed. Three and a half years after UMass kicked off the battle—and only after a judge ordered the feds to make their decision—the Rebels prevailed, its monopoly preserved when the DEA denied UMass the license necessary to grow pot legally.

MAPS is appealing the decision through the DEA's administrative law court. But while the bureaucratic process crawls along, the organization's attempt to bring pharmaceutical-grade, inexpensive pot to patients is at a standstill. "We can way outcompete GW in a legal market," Doblin says. (In Canada, a month's supply of Sativex will cost patients using nine sprays a day about $500, comparable to other multiple sclerosis drugs and about the same as a month's supply of pot bought at California medical marijuana clubs.) "But if you're going to invest millions of dollars in drug development," he continues, "you have to have an uninterrupted supply. We don't even have a pilot study. We're nowhere." As a result, GW, with its government-sanctioned greenhouses yielding 60 tons of high-quality pot every year, is lightyears ahead of its nearest American competitor and, according to Doblin, it has drug warriors to thank for its lead. "They're going to let this whole market go to the Brits."

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