In The Struggle Something Was Built
Over 75 years ago cannabis was locked away by the federal government in a little box known as the Marihuana Tax Act, which was later nailed shut by the Controlled Substances Act. While this prevented businesses from exploring the potential of the plant, it could be hypothesized that the restrictive governance surrounding Cannabis is also responsible for the un-squashable dispersed collective knowledge regarding the cultivation, processing, and use of the plant.
Consider the suffering of epilepsy, Multiple Sclerosis, AIDS, Crohn’s, ALS, and cancer patients over the past 70 years. In this sense, Cannabis prohibition has been a literal horror. These people have been denied access to a plant that could have alleviated some of their pain. At the time of the Marihuana Tax Act, Cannabis remedies were already in America’s medicine cabinet. The natural progression would have lead to a host of pharmaceutical grade Cannabinoid based medicines if it were not interrupted by a drug war. Someone would have in-depth knowledge of the endocannabinoid system, but who would that person be? Where would that knowledge be?
A large up front investment is necessary to bring a pharmaceutical product to market. That means that the cost of a pill is not just the cost of a pill, but also the $750 million in studies designed to prove safety and efficacy. The resulting product is then rigorously protected through patents and the life saving knowledge kept under lock and key. This investment was never made in Cannabis. Any organization with something to lose avoided researching the plant, but the demand still existed. This left it up to various “illicit” markets to quietly explore what the plant has to offer.
We find ourselves at the tail end of prohibition. There are still no widely successful FDA approved Cannabinoid medicines, yet there are flocks of sick people traveling to states like Washington and Colorado to see if Cannabis can work for them. The products they are taking are not the result of multi-million dollar studies, but rather decades of community knowledge about a plant, and how we can use it to help each other. Without any assistance from insurance companies or assurance from the FDA, billions of dollars are spent on Cannabis products because it has a public and decentralized track record of efficacy and safety.
Sativex is a Cannabinoid treatment for spasticity due to Multiple Sclerosis and is produced by G.W. Pharmaceuticals. Unfortunately, the drug was deemed too expensive to be part of the National Health Service program in the UK where it was created, sending M.S. patients back to the illicit market in search of Cannabis. But is that market really illicit? One could hypothesize the existence of a “bad actor” somewhere, but we can’t confidently say much more than; someone grew a plant and someone used it for relief. It was within this “illicit” market that doctors, activists, friends, and family, began to recognize the therapeutic potential of the plant. Communities began forming out of the desire or necessity to cultivate and distribute medical Cannabis to those who need it only because no one else was. It is in that conscientious objection that all current day Cannabis reform is rooted. As these communities were emboldened by success, the model spread and we now find ourselves with thousands if not millions of Americans creating, processing, and consuming Cannabis as a medicine without the need for their actions to support the existence of a large for profit pharmaceutical company.
Consider now the regulated system for producing and dispensing medical Cannabis that has been set up in New York. While it is by no means a beacon of access, it creates the framework for a Cannabis market that is truly disruptive to the existing norms of healthcare. Five organizations produce, process, and dispense Cannabis products that are engineered for the state’s short list of approved conditions. Doctors can “prescribe” brands, dosages, and routes of administration after they complete continuing education requirements and register with the state. Products are dispensed by board certified pharmacists and for all intents and purposes, the experience mimics that of procuring any other medicine. The question then becomes, what will this new miniature healthcare paradigm strive for? The state of New York will work to ensure the stability and longevity of these organizations. It is in this cooperation that the organizations themselves will set the tone of this fledgling market.
If the organizations pursue a strict for profit model, they will find themselves dancing around the same incentives that have left some disillusioned with the existing healthcare paradigm. Organizational efforts to educate healthcare professionals about products can be quickly tainted and become sales functions. Suggestive advertisements ending with “ask your doctor about...” could interject a marketing function into a doctor-patient relationship. On the other hand, if these organizations seek to mimic the spirit of the pioneers who brought us here, they will guide the State of New York into creating a system that allows millions of people to care for each other with an affordable and safe product.
As we dismantle the walls of prohibition let us not forget what we built for ourselves while they were up. Structure, regulation, and recreational markets are forming but they all have roots in community medicine. If we allow those roots to die we lose the spirit that has gotten us this far and commit an injustice on par with prohibition itself.