The best way to take medical marijuana.

How to be the best consumer you can be.
May 5 2006 11:56 AM

Hits and Misses

What's the best way to take medical marijuana?

Download an MP3 audio interview with the author here, or sign up for Slate's free daily podcast on iTunes.

Medical-marijuana users, take heart. So what if the Food and Drug Administration told the nation last month that marijuana has no medical benefits? You've read about the widespread scoffing that followed, and the 1999 Institute of Medicine study that concluded marijuana might in fact ease some debilitating conditions. The ongoing debate is not just about whether medical marijuana works. It's about the best way to take it.

Choosing a marijuana delivery method involves weighing legality, safety and ease of use, and effectiveness. Back in 2004, when I was a staffer at the Marijuana Policy Project, an organization based in Washington, D.C., that works to legalize and regulate marijuana use, I met dozens of patients who used varying methods of marijuana consumption. Since I don't have any medical training, I brushed up on the latest technology by speaking to medical-marijuana patients including Angel Raich, who will be forever remembered by first-year law students as the plaintiff in the Supreme Court case Gonzales v. Raich; Philippe Lucas, president of the Vancouver Island Compassion Society and one of about 1,200 legally registered medical marijuana patients in Canada; and Alison Myrden, another Canadian patient. The reviews of the various delivery methods are based on what they told me about their experiences. 

METHODOLOGY

Security (10 possible points): Will using this product land you in jail? A legally prescribed product gets a 10. Everything else is rated based on the chances of getting arrested.

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Safety (5 possible points): Might this product give you lung cancer or a respiratory ailment like bronchitis? Because many medical-marijuana patients already have cancer or seriously debilitating illnesses, this won't matter to everyone. For more on attendant health risks, here's the medical journal BMJ's take.

Portability and Ease of Use (10 possible points): Can a sick or disabled person easily carry the product around or out of the house? And is preparation doable if you have a limited range of motion? Products that must be taken orally lose 5 points since many medical marijuana users suffer from nausea, which makes swallowing a pill or eating a brownie decidedly unappealing.

Medical effectiveness (25 possible points): The most important measure—How well does the product reduce pain and nausea, increase appetite, or enable sleep? Do the side-effects outweigh the benefits? Points are awarded for the nature of the beneficial effect, and how rapidly and predictably it sets in.

RANKINGS (worst to first)

Marinol

Marinol (dronabinol) Marinol, a synthetic version of Delta-9-Tetrahydrocannabinol, or THC, the main active ingredient in marijuana, is legal with a prescription. It's also resoundingly unpopular. First off there's the problem of taking a pill if you're throwing up. ("I felt nauseated but was hungry at the same time, which is a stupid concept," Raich reports.) Worse, Marinol takes a long time to kick in, often more than an hour. And once it does take effect, the feeling patients get can be an overwhelming high that leaves them disoriented and unable to function. Marinol's manufacturer warns of "dizziness, feelings of exaggerated happiness, paranoid reaction, drowsiness, and thinking abnormally."

"Marinol doesn't work," says Raich. "I took the lowest dose possible and I got really, really sick from it. My heart felt like it was beating so hard I called my doctor." According to Lucas, the intensity of the effect comes from taking the pill orally. In the liver, he says, the THC converts to a form four times stronger than when it's inhaled. "That's why people get so bloody stoned."

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