Let’s start with the fact that Marinol is FDA approved for chemotherapy-induced nausea and vomiting, and anorexia from AIDS or cancer. Currently, there is no FDA approved medical indication for prescribing marijuana. So—why is one approved and not the other? Do they work? What are their differences?
What is dronabinol?
Oral delta-9-tetrahydrocannabinol (THC) is available as Marinol, and the generic is dronabinol. This pill is a synthetic (chemical) form of THC, a naturally occurring component of Cannabis sativa (marijuana). The onset of action is 30 minutes to 1 hour, with peak effect at 2 – 4 hours. This drug is approved by the FDA for two indications: chemotherapy-induced nausea and vomiting and anorexia associated with weight loss in patients with AIDS.
What’s the difference between marijuana and dronabinol/Marinol?
Marinol (dronabinol) is a pill that is available by prescription and has FDA approval to treat certain conditions. Dronabinol is also known as THC, and it is the primary psychoactive cannabinoid in the prescription medication. Cannabinoids are derived from the cannabis (marijuana) plant, which contains over 400 compounds, including more than 60 cannabinoids. Although there are more than 60 cannabinoids in marijuana, two, in particular, have been studied for medicinal uses: delta-9-tetrahydrocannabinol (THC or dronabinol) and cannabidiol.
Do they work for pain?
Prescription dronabinol has been studied for postoperative and neuropathic pain and 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. There have been fewer studies of marijuana than cannabinoid pharmaceuticals, perhaps in part due to regulatory restrictions, but marijuana has better results for pain in the few studies that have been done. In all of these studies, smoked marijuana was found to be better than placebo in 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 neuropathic/nerve 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 does marijuana have FDA approval for?
Nothing, yet. The use of medical marijuana for refractory cancer pain is very controversial as it hasn’t been well studied. As you know, marijuana use is still illegal in the United States at the federal level—the federal government considers marijuana a schedule I controlled substance. In the 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.
Why do people use medical marijuana?
Severe or chronic pain accounts for more than 90 percent 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.
If smoking marijuana isn’t good for the lungs, what are the other options for medical marijuana?
Marijuana can be used to make hashish and hash oil, which contain concentrated cannabinoids, and can be consumed by drinking as a tea or eating after mixing into foods. Know this though: absorption after oral administration has been described as “slow and erratic,” resulting in “low and irregular” plasma levels.
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A new THC spray Nabiximols (sativex) is not yet available in the United States, but is on track to be approved for use in cancer pain and spasticity from multiple sclerosis.