DEA Ignores the Evidence; Keeps Marijuana on Parity with Heroin

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In a long-awaited announcement, the U.S. Drug Enforcement Administration denied requests to loosen the classification of marijuana as a dangerous drug with no medical use.

DEA denies requests to reclassification #marijuana as a dangerous #drug with no medical use. Click To Tweet

The decision, reported by Reuters, is the DEA’s response, surprising to many, to a 2011 petition by two former state governors who had urged federal agencies to re-classify marijuana as a drug with accepted medical uses.

In a letter to the petitioners, the DEA said it had asked the Department of Health and Human Services for a scientific and medical evaluation of the issue.

“HHS concluded that marijuana has a high potential for abuse, has no accepted medical use in the United States, and lacks an acceptable level of safety for use even under medical supervision,” the letter said.

For decades, marijuana has been classified that way as a “Schedule I” drug, on par with heroin. The government has repeatedly rejected appeals over the years to reclassify marijuana.

“Right now, the science doesn’t support [the reclassification],” Chuck Rosenberg, acting DEA administrator, said. In a separate interview with National Public Radio, Rosenberg said the decision “isn’t based on danger” but rather on “whether marijuana, as determined by the FDA, is a safe and effective medicine.And it’s not.”

Currently, marijuana is classified as a “Schedule I” drug with no “accepted medical use and a high potential for abuse.” That puts it in the same category as heroin, ecstasy and gamma-hydroxybutyrate, known commonly as the “date rape” drug. Loosening that definition could encourage scientific study of a drug that is being used to treat diseases in several states.

Twenty-five states have taken matters into their own hands–sanctioning some form of the plant for medical purposes. Colorado, Alaska, Washington, Oregon and the District of Columbia have taken it a step further, legalizing its recreational use.

And in November, a handful of other states including California, Nevada, Arizona, Massachusetts and Maine, will have recreational or medical marijuana proposals on their ballots.

The DEA did indicate it would allow researchers and drug companies to use marijuana grown in other places. Currently, it’s cultivated only at a facility at the University of Mississippi. Increasing the supply and the variety of marijuana made available for scientists seeking to study particular strains of the drug was seen by some observers as a consolation prize.

Steve’s Take: When I first read the tagline for the DEA’s decision to keep marijuana classified as a Schedule I drug, I honestly thought the report’s author was joking.

I thought the DEA’s decision to keep #marijuana classified as a Schedule I drug was a joke. Click To Tweet

Sadly, and apparently relying on the fear tactics and uninformed attitudes of a century ago, the DEA–reportedly leaning heavily on the FDA’s conclusions about cannabis–rejected a five-year-old petition to reclassify the drug from Schedule I to Schedule II, which includes oxycodone.

Whether or not the decision helps or harms patients in the long run remains unclear, but I fully agree with Emily Willingham, a contributor to Forbes, who in her Aug. 13 piece says the decision,

“…certainly reflects a dangerous and hypocritical throwback attitude about cannabis that will only add to distrust of governmental oversight agencies, making their decisions look like political or moral judgments rather than being evidence-based.”

The sole factor in this entire scheduling decision process is that a conclusion be based on medical and scientific evidence. A wide-ranging summary of how various organizations view the current evidence about marijuana and their conclusions is available at ProCon.org.

The general conclusion of the authors and the Canadian Center on Substance Abuse is:

“there is sound evidence from animal experiments and well-designed clinical trials involving humans that cannabis and cannabinoids are effective for the relief of nausea/vomiting and certain types of pain, as well as for the stimulation of appetite.”

Further, two cannabis-derived drugs (dronabinol and nabilone) are already FDA approved for these uses, but both are orally administered. It’s clear that the DEA also doesn’t communicate much, if at all, with established medical bodies like the National Cancer Institute, which also says:

“Cannabis and cannabinoids may have benefits and treating the symptoms of cancer for the side effects of cancer therapies. There is growing interest in treating children for symptoms such as nausea with cannabis and cannabinoids although studies are limited.”

Then there are federal budgetary issues, apparently gone unnoticed by even Health and Human Services. I reported recently that physicians wrote significantly fewer prescriptions for painkillers and other medications for elderly and disabled patients who had legal access to medical marijuana, according to a new study (MondayMorning: 7/11/16 — for all my reports please consider subscribing to my full weekly newsletter).

In fact, Medicare saved more than $165 million in 2013 on prescription drugs in the District of Columbia and 17 states that allowed cannabis to be used as medicine, researchers calculated.

“If every state in the nation legalized medical marijuana, the study forecast that the federal program would save more than $468 million a year on pharmaceuticals for disabled Americans and those 65 and older. No health insurance, including Medicare, will reimburse for the cost of marijuana. Although medical cannabis is legal today in 25 states and the District of Columbia, federal law continues to prohibit its prescription in all circumstances.”

The new study, published July 6 in Health Affairs, was the first to ask if there’s any evidence that medical marijuana is being used as medicine, said senior author W. David Bradford. The answer is yes, said Bradford, a health economist and a professor at the University of Georgia in Athens.

“When states turned on medical marijuana laws, we did see a rather substantial turn away from FDA-approved medicine,” he said.

Researchers analyzed Medicare data from 2010 through 2013 for drugs approved by the U.S. Food and Drug Administration to treat nine ailments–from pain to depression and nausea–for which marijuana might be an alternative remedy.

They expected to see fewer prescriptions for FDA-approved drugs that might treat the same conditions as cannabis. Indeed, except for glaucoma, doctors wrote fewer prescriptions for all nine ailments after medical marijuana laws took effect, the study found.

The number of Medicare prescriptions dropped significantly for drugs that treat pain, depression, anxiety, nausea, psychoses, seizures and sleep disorders. For pain, the annual number of daily doses prescribed per physician fell by more than 11%. “The results show that marijuana might be beneficial with diverting people away from opioids,” Bradford said.

Sheigla Murphy, a medical sociologist who was not involved in the current study, praised it as a major contribution to the literature on the role of medical marijuana in older adults. Murphy directs the Center for Substance Abuse Studies in San Francisco and has conducted prior research on marijuana and baby boomers.She said some older adults prefer marijuana to painkillers and sleeping pills.

“It fits with the problems of older age, problems with sleeping, depression, arthritis, worn-out body parts that begin to hurt. Marijuana can relieve these without the side effects of grogginess and worrying about addiction,” she said.

Some medical professionals like Carl L. Hart, a professor of psychiatry at Columbia University, say changing marijuana’s classification to a “Schedule II” drug would have “represented a major step toward resolving the hypocritical mess that characterizes our current laws on marijuana.”

Hart, who has studied the drug for decades and has had to jump through numerous regulatory and bureaucratic hoops, says the DEA’s punt decision strips credibility from scientists and researchers who study the drug for medical purposes.

“It’s time we lessened the outside influence of a law enforcement agency on medical decisions and started to rebuild our credibility as scientists on the marijuana issue,” he wrote in Scientific American.

In summary, the DEA said the decision to keep marijuana as a Schedule I narcotic “is tethered to the science.” Well, actually, it’s not.

What it proves, however, is keeping that classification continues the ever widening (and, frankly, embarrassing to us citizens) disconnect between: federal policy and the medical evidence; federal and state policy; and federal policy and the electorate.

As Willingham points out, more than half of registered voters think cannabis should be legalized, and more than 89% favor allowing it to be medically prescribed.

“Popular vote shouldn’t determine these decisions, of course,” she says rightly. “But the public long ago saw through the smoke screen the government used for decades to justify criminalization. When promises of dire outcomes from use didn’t become reality and reports of benefits moved beyond anecdote and into dataland, the public in this case could see the evidence.”

But DEA Chief Chuck Rosenberg can’t.  And that ain’t no joke.