While naturally-grown cannabis is still classified as a Schedule I federally illegal substance, there are currently 3 approved medications in the USA based on THC which can be prescribed by physicians and are covered by some health insurance plans. Sativex is the only medication containing natural THC as well as CBD; Cesamet (nabilone) and Marinol (dronabinol) both contain synthetic formulations of THC. There are significant differences between these substances and the plant-based products available to Florida medical cannabis patients. A Florida Medical Marijuana Doctor can explain these differences to you as well as directing you to the best products for your health concerns. To find out if you pre-qualify to become a medical cannabis patient, take our quick 5-minute eligibility survey.
Prior to 1937 cannabis was a popular drug in the United States, used to treat everything from insomnia and hysteria to cholera and insanity. In spite of protests by the American Medical Association, it was made an illegal substance thanks to the Marijuana Tax Act as part of efforts to control the large numbers of Mexicans who immigrated to states like Texas and Louisiana after the Mexican Revolution. Many Americans were not aware that the same “marihuana” being demonized by the government was the same cannabis they had in their own homes. In 1970, the Controlled Substances Act replaced the earlier law when it was declared unconstitutional. Cannabis was relegated to the same category as heroin, Ecstasy, LSD, and peyote. (1) This effectively ended the potential for any kind of research into the potential of cannabis as a beneficial medication since it was viewed as having no therapeutic value and a high risk for addiction.
The National Cancer Institute supported the research and development of Marinol, or synthetic THC, for use in treating the nausea and vomiting that frequently accompanied with chemotherapy given to cancer patients. The capsule was approved exclusively for this use in 1985. In 1992 the FDA granted permission for Marinol to also be prescribed for appetite loss and wasting caused by the AIDS virus. Originally classified as a Schedule II drug, the medication was moved to Schedule III status in 1999, which allowed it to be used by a wider class of patients. Currently, while the majority (about 80%) of patients using Marinol have AIDS, around 10% use it for chemotherapy-related issues, and it is being explored for possible use in Alzheimer’s patients with loss of appetite as well as behavioral changes, though it has not received FDA approval for this purpose yet.(2)
Characteristics of Marinol
- It is synthesized in the laboratory, not extracted from a plant. This is an expensive process, which results in a cost to the average cash-paying patient of over $8,000 yearly. It may or may not be covered by health insurance, depending on the patient’s healthcare plan.
- It offers poor bioavailability due to solubility issues and first-pass metabolism through the liver, with only 10%-20% of the medication actually reaching the circulation.
- It has a slow onset of action, not reaching peak concentrations in the blood for 2-4 hours after taking the capsule.
- It has some pretty nasty side effects including confusion, abnormal thinking, depersonalization (loss of identity); paradoxical or unexpected nausea, vomiting, or abdominal pain; dehydration, seizures, changes in blood pressure, fainting, tachycardia; depression, schizophrenia, or mania; altered mental state, and impaired mental ability. (3,4,5)
What Makes Marinol and THC Different?
- Synthetic THC lacks cannabinoids. CBD helps moderate the psychoactive effects of THC. Since Marinol is strictly a chemically-created form of THC, it lacks this counter-balancing property and can become overwhelming, especially for first-time patients who may not be used to the effects.
- How it’s made. Marinol is created by spraying chemicals on a plant, and the amount of chemicals can vary based on a number of contributing factors. This means the dose in each batch or capsule can vary and be quite unpredictable. Some of the compounds created during this process can affect or activate CB1 receptors, leading to unexpected results and even negative or dangerous side effects. In fact, Marinol can be up to 200 times stronger than naturally-grown cannabis.
- Marinol and other forms of synthetic marijuana can kill you. “Since 2015, there have been at least 20 deaths linked to the use of synthetic marijuana. Some of the most common side effects include severe anxiety, kidney damage, and, in the most serious of cases, life-altering strokes.” (6)
- The presence of additives. Marinol contains artificial flavors and colors, chemical preservatives called parabens, glycerin, and gelatin in addition to the sesame oil the synthetic THC is suspended in. (7)
- Different effects. As Marinol is broken down in the liver, one of the results is a chemical called 11-hydroxy-THC, which can be up to 4X as potent as THC. Not only is it stronger, but it’s produced in greater quantities than THC; this can lead to increased psychoactive effects as well as the possibility of suffering an adverse psychological reaction. This is complicated by the fact that there is no CBD present in Marinol to moderate the effects of these chemicals. (8)
- Marinol cannot produce the entourage effect. The cannabinoids and terpenes found in cannabis, in combination with other chemical compounds, work together to provide health benefits and balance that simply cannot be recreated by one chemical compound. The entourage effect is essential to the overall medicinal effectiveness of cannabis; they also help temper the psychoactive effects of THC and work with it to help re-establish optimal health.
- Patients prefer cannabis when given a choice. It is easier to control the dose taken, side effects are less intense and dangerous, and there are a wide variety of options for consuming cannabis. In addition, if one strain of cannabis doesn’t work, there are other choices. There is no such alternative with Marinol. (9)
- Finally, there is no avoiding the psychoactive effects of Marinol. Unlike cannabis, there are no other cannabinoids or terpenes to help lessen the high felt by patients using this drug. Patients cannot choose to use a variety with more CBD, different terpenes that interact with the THC to dampen its effects, or go with a strain that doesn’t affect them as intensely. It is an all-or-nothing drug, and one that can lead patients to choose to discontinue using the drug because of undesirable side effects. (10)
Marinol may indeed benefit some patients with cancer, AIDS, and other disease processes it is currently being tested on. However, the side effects and negative aspects of using a chemical substitute for a natural plant treatment can make patients have to choose between getting some relief with the associated consequences of having no relief at all. With your Florida medical cannabis recommendation, you can have the option of choosing a natural way of treating nausea, vomiting, and appetite loss related to these life-altering conditions. Using the whole plant or as much of it as possible depending on your situation can be much more beneficial than the alternative.
**Editorial credit for image: Margaret M Stewart / Shutterstock.com