Marinol is the brand name for dronabinol, the legally prescribable synthetic THC pill. In 1999, the DEA, FDA and NIDA allowed Marinol to be re-classified from Schedule II to Schedule III. According to the drug manufacturer, “the decision for rescheduling was greatly influenced by the findings done by the Haight Ashbury Free Clinics, which concluded Marinol has a low abuse potential and that diversion is virtually non-existent.”[i]
Marinol contains synthetic THC and sesame oil in a gelatin capsule. Cannabis contains natural THC and a group of interrelated compounds that are shown to have an assortment of similar therapeutic qualities. The US government approves of the use of Marinol, but rejects the medical use of marijuana. Marinol is currently a Schedule III drug, easily prescribable by physicians, but cannabis is listed in Schedule I: Simple possession is a felony punishable by imprisonment.
In1983, the Tennessee Board of Pharmacy released a report evaluating the effects of marijuana as an antiemetic in cancer patients, reporting that, “We found both marijuana smoking and THC capsules to be effecting antiemetics. We found an approximate 23% higher success rate among those patients smoking than among those patients administered THC capsules.”[ii] Similar findings are reported in other studies.[iii] [iv] A medical journal called Patient Care published the following explanation of marijuana’s superiority to Marinol:
The bioavailability of dronabinol (Marinol) and marijuana vary tremendously in individuals from day to day in the same person. Even though synthetic THC is available in three strengths, it can be very difficult to define appropriate does and determine what time of day the patient needs to take it. Some studies suggest that smoking is a more efficient delivery system for THC than dronabinol because the patient gets near immediate results and can self-titrate [control dosage].[v]
Taking Marinol is often a frustrating experience. At one time of day the medicine can seem to be completely ineffective. At another point in the patient’s fluctuating rate of bioavailability, the same dose can cause intense anxiety, light-headedness, nausea, and deep sedation. This perplexing inconsistency was the Institute of Medicine’s primary criticism of Marinol in 1999.[vi] The cannabis smoker’s ability to determine the required dose is a critical virtue. The synthetic THC pill contains only one of 61 naturally occurring cannabinoids, some of which are known to offset the strong psychoactivity of synthetic THC. Other cannabinoids are shown to have additional and superior medical properties evidencedin other sections of this text. Although the 1999 IOM report calls for further study of all therapeutic cannabinoids, THC is the only one of those naturally occurring medicinal compounds currently available by prescription.
Another important consideration, according to the Federation of American Scientists, is the comparative price of Marinol versus marijuana:
Even a black market prices, whole cannabis is substantially less expensive per bioavailable milligram of THC than is the legal synthetic, sold under the trade name Marinol.[vii]
Black market sources may be more reasonable than pharmaceutical companies, but depending on outlaw drug dealers for a life-saving medication is at best a flawed proposition. Although federal drug warriors force the closure of medical marijuana clubs and co-ops, there is another alternative. High-potency cannabis rich in THC and other medicinal compounds can be a cheap renewable resource requiring only a modest investment in equipment and supplies. Comparatively, Marinol treatment usually costs thousands of dollars per month.
[ii] Randall, Cancer Treatment and Marijuana Therapy, Washington, DC: Galen Press, 1990
[iv] Vinciguerra, Moore, and Brennen, “Inhalation of Marijuana as an anti-emetic for chemotherapy.” New York State Journal of Medicine, Vol. 88, pp. 525-527, 1988
[v] Capaldina, Tashkin, Vilensky, and Talarico, “Does marijuana have a place in medicine?” Patient Care, Vol. 32, No. 2, p. 41, January 1998
[vi] Wishnia, “The IOM Medical-Marijuana Report.” High Times, July 1999
[vii] “Medical use of whole cannabis.” Statement of the Federation of American Scientists, 1996