American College of Physicians Takes Pro-Cannabis Stand (Mostly)

One-and-a-half cheers for the American College of Physicians, which has issued a statement "Supporting Research into the Therapeutic Role of Marijuana." The ACP is the nation's largest medical specialty group -124,000 internists- and is widely respected. "There are no more prestigious letters to have after your name," says Philip A. Denney, MD (president of the Society of Cannabis Clinicians), "than FACP -standing for Fellow of the American College of Physicians."

The statement commits the ACP to five positions:

1. ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of medical marijuana and the publication of such findings.
1a. ACP supports increased research for conditions where the efficacy of marijuana has been established to determine optimal dosage and route of delivery.
1b: Medical marijuana research should not only focus on determining drug efficacy and safety but also on determining efficacy in comparison with other available treatments.

2. ACP encourages the use of nonsmoked forms of THC that have proven therapeutic value.

3. ACP supports the current process for obtaining federal research-grade cannabis.

4. ACP urges review of marijuana's status as a schedule 1 controlled substance and its reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana's safety and efficacy in some clinical conditions.

5. ACP strongly supports exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who prescribe or dispense medical marijuana in accordance with state law. Similarly, ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted under state laws.

From the perspective of pro-cannabis doctors and patients in California, Position 5 is the best and bravest aspect of the ACP statement. The support for physicians who "prescribe and dispense medical marijuana under state law" could have been written with Marian Fry, MD, in mind. Fry and her husband, attorney Dale Schafer, were convicted under federal law for cultivation for sale (to her patients) and are soon to be sentenced.

Position 4 is long overdue. Marijuana was categorized as a Schedule 1 drug -as if it had no medical use and a high potential for abuse- by the federal Controlled Substance Act of 1970. In 1999 dependence on marijuana was deemed "relatively rare and... less severe than dependence on other drugs" by the Institute of Medicine in a report commissioned by the Drug Czar's office. The medical utility of marijuana has been confirmed in numerous ways and settings, including the IOM report and a recent study published in a prestigious peer-reviewed journal ("Cannabis in painful HIV-asssociated sensory neuropathy," by Abrams et al, Neurology, Feb 13, 2007).

Position 2 singles out the Volcano vaporizer as an efficient delivery system (right on, right on).

Position 3 seems to undermine the rest of the position paper. Why open wide the valves on the research pipeline while leaving the main closed and allowing only the slightest trickle? At present the would-be researcher must get an Investigational New Drug Application approved by the FDA and a Schedule I license from the DEA to receive marijuana grown by a NIDA-funded contractor at the University of Mississippi and processed into cigarettes at the Research Triangle Institute in North Carolina. The DEA can choke off research, the FDA can choke off research, NIDA can choke off research. Over the years they have taken turns doing so, working a four-cornered stall (the NIH and the Drug Czar's office get involved as needed) as if diagrammed by the Tarheels' legendary basketball coach, Dean Smith himself.

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