I concluded my speech at St. Joseph's University's Institute of Catholic Bioethics in Philadelphia, Pennsylvania on November 14, 2007 with a version of the following remarks:

Finally, I'd like to briefly discuss the latest clinical study of smoked marijuana that was published in the Journal of Acquired Immune Deficiency Syndromes in August 2007. This study is literally hot off the presses. It was done by Columbia University and it compared Marinol with smoked marijuana. Marinol is a pharmaceutical preparation that contains a synthetic version of the main psychoactive ingredient in marijuana, and the smoked marijuana was supplied by NIDA from their farm in Mississippi. There are some very interesting things in the study.  For example, HIV positive patients are the largest group of patients using cannabinoids, with somewhere between 20% and 37% of all HIV positive patients use cannabinoids.  Of that group, 93% prefer smoked marijuana to Marinol. That's pretty remarkable--that 93% would prefer an illegal substance to a perfectly legal substance that can be purchased in a drug store. One of the benefits of smoked marijuana, the study points out, is that the effects peak rapidly, in less than 20 minutes, which allows for dose titration and immediate symptom relief. Marinol, on the other hand, has a slow rate of onset, about 120 minutes, and a long duration of action, which makes it difficult to titrate the dose, and nauseated patients have difficulty with an oral preparation. The study was a double-blind, placebo controlled study where they gave ten participants over 32 days different doses of Marinol and marijuana four times a day. The Marinol doses were 0 mg, 5 mg and 10 mg, and the smoked marijuana doses were joints with THC percentages of 0%, 2% and 3.9%.  Then they tested the participants for Diet, Mood, Cognitive Behavior and Sleep. (The recommended dose of Marinol is 2.5 mg twice a day for appetite, but larger doses were selected based on previous studies that showed this dose was ineffective.  Also, the marijuana NIDA provided was a low dose of THC, as the study pointed out that the average marijuana found on the streets of New York City was 4% to 5% THC.) The findings were:

• Both Marinol and smoked marijuana significantly increased daily caloric intake;
• Participants reported a positive experience from smoked marijuana and high dose Marinol--a good drug effect leaving them feeling friendly and mellow;
• Intoxication was not associated with cognitive impairment--neither marijuana nor Marinol altered performance on psychomotor or memory tasks compared with a placebo;
• Smoked marijuana had the added benefit of improving ratings of sleep;
• There was little evidence that withdrawal symptoms occurred--anxiety, sleep disturbance, irritability, and restlessness did not occur;
• Gastrointestinal symptoms--nausea and diarrhea--were relieved by both Marinol and smoked marijuana. One of the conclusions of the study was: "Present findings support the clinical utility of Marinol and contrast with reports that it is too poorly tolerated or unreliable to be clinically useful." So here is a study that proves, or thinks it has proved, that a high dose of Marinol, the FDA approved drug, is as good, or nearly as good, as a low dose of smoked marijuana, a drug the FDA and DEA says has no recognized medical uses in the United States. It's no wonder that the DEA has repressed the clinical studies of smoked marijuana for so long. When these studies are finally done, the results are an embarrassment to the ideological position of the DEA regarding medical marijuana.