Marinol vs. Marijuana: What’s the Difference?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Let’s start with the fact that Marinol is FDA approved for chemotherapy-induced nausea and vomiting, and anorexia from AIDS. Currently, there is no FDA-approved medical indication for prescribing marijuana. So, why is one approved and not the other? Do they work? And what are their differences?

 

 

What is Marinol?

Marinol is an FDA-approved medication with dronabinol, a synthetic form of THC (delta-9-tetrahydrocannabinol), as its active ingredient.

THC is a natural component of the marijuana plant, Cannabis sativa, and it’s psychoactive, which means it attaches to chemical receptors in your brain and produces a feeling of euphoria, or what we call a “high”. Oral dronabinol is the chemically manufactured form of THC that is FDA-approved to treat chemotherapy-induced nausea and vomiting (in patients who didn’t respond well to conventional nausea and vomiting treatment), as well as anorexia related to weight loss in patients with AIDS.

Both Marinol and dronabinol come in capsules of 2.5 mg, 5 mg and 10 mg strengths. The medication takes about 30 minutes to an hour to start working, with peak effects at 2 to 4 hours.

 

How much does Marinol cost?

Oral dronabinol is available as generic dronabinol with a cash price of about $250 for a typical prescription of 60 capsules of 2.5 mg, as well as brand-name Marinol, which costs about three times more for the same prescription.

 

 

What’s the difference between Marinol and marijuana?

Marinol is approved by the FDA for medical uses, whereas marijuana has not been approved for any medical use at all at the federal level. In states where medical marijuana is legal, a healthcare practitioner provides an “authorization” for use that is considered by the federal courts to be protected physician-patient communication.

Additionally, Marinol, or dronabinol, does not contain all the components of the full marijuana plant. The medication is a synthesized version of THC (delta-9-tetrahydrocannabinol), one of over 60 cannabinoids found in Cannabis sativa. Two cannabinoids in marijuana have been studied for medicinal uses: THC and cannabidiol.

 

Why do people use medical marijuana?

The use of medical marijuana for refractory cancer pain is very controversial as it hasn’t been well studied. However, severe or chronic pain accounts for more than 90% of the qualifying conditions for use of medicinal marijuana among registered users in the states in which it is legal. While there have only been a few studies done, it appears that smoking marijuana along with traditional pain medications for patients with cancer-related pain may be effective.

 

 

Do Marinol and marijuana work for pain?

Marinol (dronabinol) has been studied for post-surgical pain, nerve-related pain and chronic non-cancer pain. For the first two types of pain, Marinol was not found to be any better than placebo. For chronic non-cancer pain, it has been found to be only slightly better than placebo.

Marijuana has not been studied as much as cannabinoid pharmaceuticals, partly due to regulatory restrictions, but in the few studies that have been done, smoked marijuana was found to be better than placebo at relieving pain. Another study examined the effects of marijuana that was vaporized (not smoked) and found that it too was better than placebo at relieving nerve-related pain.

 

What about for appetite and nausea?

Both marijuana and Marinol have been shown to help for nausea and appetite in studies on HIV patients.

 

What’s coming?

There are currently four FDA-approved cannabinoid medicines available in the US: Marinol, Syndros, Cesamet and Epidiolex. Nabiximols (Sativex), an oral spray with two cannabinoids (THC and CBD) is not yet approved by the FDA, but is endorsed by the American Academy of Neurology for treatment of spasticity (muscle rigidity) and nerve pain in patients with multiple sclerosis.

 

Dr O.

 

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