Op-Ed: Legalized cannabis is widely popular yet still restricted. What gives? The Pharmaceutical Industry is likely to blame.

By: Rebecca Abraham RN, BSN

Per Market Watch, just this week Pfizer purchased Arena Pharmaceuticals for 6.7 billion, focusing on an interest in their medical cannabis development. Over 90% of Americans support legalized medical cannabis. This support is not restricted by political ideology, geographic location, or population demographics. Cannabis is medically legal in 36 states and recreationally legal in 21 states. There are 5.5 million medical cannabis cardholders in the US and the legal market is worth billions of dollars, and growing exponentially. In 2020 there were over 3000 global studies on cannabis, and in 2021 there were more than 3500 studies published. This rapidly expanding research is showing more and more potential therapeutic uses for a wide variety of disorders. Over 20,000 studies show that cannabis has no lethal dose and has a good safety profile when compared to over-the-counter medications and pharmaceuticals. The “War on Drugs’’ has been extensively documented as an overall failure. It did not stop addiction, crime, poverty, or violence.

The “War on Drugs’’ has been extensively documented as an overall failure. It did not stop addiction, crime, poverty, or violence. It was an expensive project that took vital resources away from the populations and communities that needed it and used those dollars to lock people up for minor drug offenses. This led to the destabilization of many already precarious communities — leading to increased poverty, violence, and crime.

In the 75 years since prohibition, a majority of American citizens believe that cannabis was incorrectly classified as a Schedule 1 Substance under the Controlled Substance Act [CSA], meaning the federal government sees cannabis as a dangerous substance with a high likelihood for abuse and no therapeutic benefit. Prohibition and the war on drugs rapidly lost support with increased medical use, stories from victims jailed with inappropriate sentencing, the erosion of trust in healthcare and pharmaceuticals, and the rapid growth of the opioid epidemic.

Continued federal restriction, even in the setting of state legalization, continues to lead to headaches for millions of people. The folks that use, grow, sell, and work in these legal markets still risk a wide variety of hurdles and punishments for participating in this gray market. For medical and adult-use patients there is still the risk of federal prison, loss of professional licenses, difficulty finding employment, and even risks to having a stable family life, as the Department of Child Services can still choose to remove children in homes that have medical cannabis privileges. For those that work in the industry, there is no banking available, credit card processors won’t work with cannabis businesses, advertising is restricted, and employment after working in the industry can be difficult to obtain. For patients, American research is stalled because there is no NIH [National Institute of Health Sciences] funding available for cannabis studies. Hospitals and healthcare facilities risk losing federal funding and Medicare dollars by participating in cannabis research. The lack of research leaves a gap in care and knowledge, which allows stigma and outdated theories and science to remain.

There have been solutions put forth on the federal level. The quickest and easiest solution to rescheduling medical cannabis would be an executive order from the President. The Marijuana Opportunity Reinvestment and Expungement Act of 2020 [MORE Act] in the House of Representatives and The Cannabis Administration and Opportunity Act in the Senate are both pieces of legislation that could also make a huge stride forward. The MORE Act has passed the house and is stalled in the Senate. There was also the Safe Banking Act proposed that would allow for banking for cannabis companies in legal states — this did not pass.

The failure to pass or change federal prohibition and classification in any capacity, leads to a curious question: if cannabis is overwhelmingly popular, why would politicians not support this easy political win to secure re-election? The pharmaceutical industry is a likely culprit as to why, despite its overwhelming popularity, cannabis remains federally illegal.

The industries that have the most to lose with cannabis legalization are the alcohol, tobacco, private prison, and pharmaceutical industries. They have banded together in the past to support “The War on Drugs,” and created a majority of the propaganda via mainstream media outlets. One popular commercial had an egg frying in a pan with a spooky voice saying, “this is your brain on drugs.” Per the Center on Juvenile and Criminal Justice, “this commercial was sponsored by Partnership for a Drug-Free America which was comprised of alcohol, tobacco, and pharmaceutical companies. The major donors to this organization include American Brands (Jim Beam whiskey), Philip Morris (Marlboro and Virginia Slims cigarettes, Miller beer), Anheuser Busch (Budweiser, Michelob, Busch beer), R.J. Reynolds (Camel, Salem, Winston cigarettes), and Big Pharma firms like Bristol Meyers-Squibb, Merck & Company and Proctor & Gamble.”

Why would these industries do this? The answer is they have a lot of money to lose. Currently, cannabis has about 20 therapeutic uses: chronic pain, anxiety, seizures, migraines, and appetite stimulation, plus the ability to create euphoria. Cannabis provides a lot of relief with little risk. It also is a complex plant that can do a lot without being chemically altered. This can lead to the loss of billions to the pharmaceutical industry. Cannabis has shown the potential to keep people off opioids, benzodiazepines, and NSAIDS.

One might attempt to refute this claim by stating the industry has nothing to worry about because the federal government states with much authority that there is no therapeutic use for cannabis per the CSA. However, the pharmaceutical industry has patented two cannabis-based medications and is looking to patent more. Marinol was patented in the 1990s. It is a synthetic compound of cannabis that is used for nausea and vomiting in chemotherapy patients. It works less well than plant cannabis and comes with more side effects. This is because synthetic cannabis over binds to neurotransmitters in the Endocannabinoid System [ECS], the place in our central nervous system that cannabis activates. GW Pharmaceuticals recently patented Epidiolex for seizure disorders. Epidolex is synthetic CBD. It is curious how plant cannabis can both be a schedule 1 restricted substance while synthetic cannabis has two current patents out with more on the way.

It seems highly likely that the pharmaceutical industry is behind the intentional stall in research and legalization. The pharmaceutical industry has the nation’s largest and most influential lobbying group. They have also built a reputation of being dishonest, greedy, and ruthless. It is entirely possible that they are using their lobbying powers and large pocketbooks to fend off legalization until they have patented every combination of cannabis. This is common in the industry’s playbook. They follow capture theory that states that industries have a bigger stake and power over policy than citizens. They use this power to decrease the power of the competition and strengthen their position in the stocks and markets (Zaitchik). This is exactly what the industry is doing to cannabis. Punishing and making it difficult for early adopters in the field to make gains, while developing their own cannabis products. When they are ready is when we will see fully legalized cannabis.

The reason the pharmaceutical industry uses capture theory is their wealth is built upon gaming regulatory systems. Per Joel Lexichin, the industry intentionally has deep ties to regulatory agencies within the government to control regulation, as they need it. The industry would not survive without its monopoly on intellectual property and price gouging (2018).

The way to stop this corrupt market and regulatory manipulation is for the cannabis industry to take notice and begin to use its money to fight back. The cannabis industry needs to fight fire with fire and go toe to toe in lobbying and involvement in regulatory agencies. It also is up to the American people to demand action by direct action, lobbying, and sponsoring candidates running on a platform that is cannabis-friendly, along with a refusal to take donations from pharmaceutical industry PACS. There is also a place for doctors and nurses to push back against stigma and aggressively educate on the benefits and affordability of plant-based cannabis. Cannabis care can help reshape healthcare with affordability, quality, safety, and improved therapeutic results but we must keep cannabis and the pharmaceutical industry separate. The only companies that sponsor private research are pharmaceutical companies, which have little interest in researching something that they cannot profit off of.

References

Clark, Carey. Cannabis: A Handbook for Nurses. Lippincott Williams & Wilkins, 2021.

Goldstein, Bonni. Cannabis Is Medicine: How Medical Cannabis and CBD Are Healing Everything from Anxiety to Chronic Pain. Hachette UK, 2020.

Huberfeld, Nicole. “Health Equity, Federalism, and Cannabis Policy.” BUL Rev. 101 (2021): 897.

Hudak, J. & Wallack, G. “Clearing up misconceptions on marijuana rescheduling: What it means for state systems.” The Brookings Institute. (2016, May 27). https://www.brookings.edu/blog/fixgov/2016/05/27/clearing-up-misconceptions-about-marijuana-rescheduling-what-it-means-for-existing-state-systems/

Lexchin, Joel. “The pharmaceutical industry in contemporary capitalism.” Monthly Review 69.10 (2018): 37–50.

Linnane, L. “Pfizer to acquire Arena Pharmaceuticals in deal valued at about $6.7 billion.” MarketWatch, December 13 (2021) https://www.marketwatch.com/story/pfizer-to-acquire-arena-pharmaceuticals-in-deal-valued-at-about-67-billion-2021-12-13

MacCallum, Caroline A., Lindsay A. Lo, and Michael Boivin. ““Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations.” European Journal of Internal Medicine (2021).

Males, M. Partnership for a Drug Wrecked America. Center on Juvenile and Criminal Justice. (2013).

Marijuana Policy Project.Medical Marijuana Patient Numbers. (2021) https://www.mpp.org/issues/medical-marijuana/state-by-state-medical-marijuana-laws/medical-marijuana-patient-numbers/

Zaitchik, Alexander. “How Big Pharma was captured by the one percent.” New Republic, June 28 (2018).