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Marinol closely resembles the effects of marijuana and is easily the best substitute. It basically consists of pure THC in oral capsules. The THC is synthesized chemically by an expensive patented process, then dissolved in sesame oil and placed in soft gel capsules.
Solvay Pharmaceuticals markets Marinol in doses of 2.5, 5, and 10 milligrams. In 1986, it was first introduced as an anti-nauseant for chemotherapy patients. By 1993, it had been approved for nausea and appetite loss for AIDS sufferers. The FDA approved both uses for Marinol on the basis of controlled safety and efficacy studies.
As of right now, Marinol is a Schedule 3 controlled substance. At its outset, it was classified as a Schedule 2 drug which meant that it was tightly controlled and not easy to access. Indeed, Schedule 2 prescriptions must be filled in triplicate so that the authorities can monitor them. As a result of these requirements, doctors were hesitant to prescribe Marinol. In 1999, however, Marinol received Schedule 3 distinction and no longer required triplicate prescriptions. The decision to reschedule the drug was influenced by a study from the Haight-Ashbury Free Clinic that found that Marinol had a very low abuse potential and wasn’t frequently found on illicit markets. Since rescheduling, doctors have little reason to worry about government harassment when prescribing Marinol.
Marinol’s development was promoted by federal officials in the Reagan administration as a worthy substitute for actual marijuana. The availability of Marinol is generally cited as a reason to keep natural forms of marijuana illegal. Proponents argue that Marinol is actually preferable because it is a chemically pure pharmaceutical that’s produced in controlled doses and sterile environments rather than a smoked herb that contains a number of different chemicals depending on the plant. In all honesty, Marinol has proven to be a poor and imperfect proxy for natural marijuana. Despite its usefulness to some patients, others report that it doesn’t work as well as the real thing.
One of Marinol’s most obvious limitations is that it contains only one medically active cannabinoid: THC. All the other cannabinoids (like CBD), terpenoids, and flavonoids found in natural marijuana are absent in Marinol. All of these ingredients working in concert might create unique medical benefits. Pure THC might actually be detrimental for some patients and certainly not ideal for others.
Perhaps Marinol’s greatest limitation is that it only comes in oral doses. Inhalation is often preferable in many circumstances and is only made available in natural marijuana forms. Chemotherapy patients, for instance, are often so nauseated that they have great difficulty trying to hold down any oral medication. The easiest way to get marijuana and its beneficial effects into their systems is through inhalation.
Inhalation is also good at facilitating fast relief for patients in sudden or extreme pain. Oral doses, on the other hand, can take as long as an hour or more to produce any effect. Inhaled marijuana can even be used to treat oncoming seizures or muscle spasms with great swiftness.
Another advantage of inhalation is that it provides patients with an immediate internal barometer to regulate their dosage more accurately through a process called self-titration. When you inhale marijuana, you can instantly sense if it was too little, too much, or just right to produce the desired effect. If you’re not satisfied, you can just readjust accordingly. With oral doses, though, predicting proper dosage is all guesswork and can only be verified an hour or so later when it starts to take effect. Overshooting or undershooting the mark is much more common with oral doses.
All of this makes the claims of opponents of marijuana seem like nonsense. The idea that Marinol’s status as scientifically-controlled makes it any better than natural marijuana is almost risible. Patients who use the drug to provide relief of pain, discomfort, and/or nausea are in a better position if they can adjust their own dose through self-titration instead of letting a doctor guess the appropriate oral dose.
In fact, despite Marinol’s well-defined doses, it is difficult (and virtually impossible) to predict how much of it will be absorbed into your system. This is because the bioavailability of oral THC is different and depends on the state of your digestive system, metabolism, and other individual factors. A certain oral dose might be insufficient on one occasion and completely overpowering the next. Accordingly, misdosage is a common problem with Marinol. It’s particularly egregious for the large swath of patients who experience a high incidence of anxiety due to overdose—a problem that is likely aggravated by the lack of CBD in Marinol.
Some users have reported better results by dissolving a Marinol capsule under their tongues. This “sublingual” route allows the THC to be absorbed directly into the bloodstream through oral tissues without having to deal with the digestive route. Sublingual administration delivers THC much more quickly (around 15 to 20 minutes) and reliably than oral ingestion. Despite this, Marinol’s label discourages against sublingual administration and directs patients to only swallow the pill.
Conversely, because Marinol is formulated with sesame oil, it is nearly impossible (and certainly not desirable) to administer it by inhalation. The sesame oil creates an irritating smoke when burned and also makes Marinol impossible to vaporize.
Another major drawback of Marinol is the hefty price tag that can extend into the thousands for a bottle of 60 capsules. Some patients have been known to run through several bottles a month and, unless you have good insurance, this is a tough medicine to keep taking. Marinol is so expensive because it is chemically synthesized, but, as we’ll see later on, it’s possible to produce the same kind of high-potency extracts of THC from homegrown marijuana at a fraction of the cost. When cannabis was still on the market in the 1920s, a one-pint bottle full of 4700 doses could be purchased for as little as $4 or one tenth of a cent per dose! It’s certainly ironic that the cost of health care is through the roof and our government has outlawed one of the most affordable and effective forms of medication.
Marinol does maintain some advantages, however. It’s medically pure and there’s never going to be any contamination from outside bacteria, fungi, pesticides, or other contaminants that can find their ways into black-market marijuana. In addition, Marinol contains none of the respiratory hazards involved with smoking. Of course, they share that advantage with oral preparations of natural cannabis, but Marinol’s consistency and purity provide a certain predictability of strength when taken on a consistent basis. The potency of homemade oral preparations can vary from batch to batch.
Overall, the prime importance of Marinol is its legality. It can be prescribed by any physician who has a DEA license and for any indication even if it’s not on the label. When Marinol was first approved, the DEA attempted to limit its use to cancer chemotherapy patients, but this was never really enforced. These days, doctors are prescribing Marinol for a wide range of indications just like they would have done with actual marijuana. Still, doctors are usually reluctant when it comes to prescribing Marinol for off-label indications, especially when no solid scientific evidence proves the efficacy of THC for that ailment. Also, health insurance companies won’t pay for prescription drugs used for off-label indications. To use Marinol for anything other than nausea from chemotherapy treatments or weight loss from AIDS (wiki), you’ll have to pay the hefty price yourself.
Marinol, marijuana, and drug testing
Marinol’s legal status has important implications for anyone who is subjected to drug testing for any reason. As long as marijuana remains a Schedule 1 drug, you don’t really have a right to use it, even medically. You can even be dismissed from a job or insurance claim on the basis of a positive drug test. Since urine tests can detect marijuana metabolites for one to five days following a single use and up to six weeks for chronic users, medical marijuana users will obviously run into some problems.
An easy solution to this problem is to obtain a prescription for Marinol. Marinol is based on THC and is virtually indistinguishable from marijuana on the most commonly used drug screens. In most cases, workers have the right to test positive for any drug legally prescribed to them. Thus, if they have a prescription for Marinol, they can’t technically be disqualified for a marijuana-positive test!
Of course, there are restrictions to this tactic. Prior to taking the test, you’ll first have to inform the medical review officer that you are taking Marinol. This requires that you disclose your medical condition which might lead to an excuse not to hire you in the first place. Second, some new drug screens make it possible to distinguish between marijuana and pure THC. According to Dr. Mahmous Elsohly, director of the government’s University of Mississippi marijuana research program, it is now possible to detect certain non-THC cannabinoid metabolites that can only be found in natural marijuana. This is determined through the use of expensive and sophisticated gas chromatograph mass spectrometer (GCMS) tests.
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