Marinol: clinical applications and mechanisms of action

Marinol

Medicine is designed to treat the sick and the injured. Its function is to either treat a condition or to better severe symptoms from a medical or physical condition. Some medicines, when first introduced, are controversial because of the ingredients that are used. In the modern era, Marinol has become the subject of heated debate over whether or not it should be provided to patients. Despite the fact that it has been proven to help people when other medications have failed, there are still some places where the medication cannot be gotten simply because it contains a synthetic form of a substance which is illegal in most states. Marinol is not made from an illegal material, but a synthetic version which replicates the effects of that illegal substance. The drug Marinol is a brand name of a medication which is a synthetic form of tetrahydrocannabinol, or THC which is dissolved in sesame oil (Mack & Joy 2001,-page 142). This material, also known as delta-9-tetrahydrocannabinol is the primary psychoactive material in the cannabis plant. Dronabinol is the generic name for Marinol which is available in the western world as a medical treatment for pain management and nausea suppressant in people with chronic or serious illnesses. People who have not had success with other medications or treatments have turned to the use of Marinol to help them survive or to ease their final days in the case of a terminal condition. It is not marijuana but a synthetic form of the same active ingredient.

Marinol is given in gelatin capsules and are taken orally. There are many medical conditions for which Marinol can help patients. It is most often prescribed to patients in order to treat the nausea and vomiting that accompanies chemotherapy treatments. It is usually only prescribed when other medications to treat such conditions have proven unsuccessful in the alleviation of symptoms. Some patients who suffer from acquired immunodeficiency syndrome (AIDS) receive the medication in order to treat loss of appetite and severe weight loss known as cachexia (Armentano 2005). There are also recorded instances where the drug was used to treat other symptoms and conditions. Besides cancer and AIDS, Marinol has been used to treat rheumatoid arthritis, severe anxiety, and in patients with chronic pain conditions like fibromyalgia (Loughlin & Generali 2006,-page 40). Marinol has been found to help these patients, but not as much as natural cannabis. Some patients do not respond to Marinol, but do respond well to the cannabis in its non-synthetic form. Actual marijuana has been shown to the be the most effective means of treating nausea, vomiting, and drastic weight loss in seriously ill individuals (Institute 2002,-page 24). Another reason for the difference is that Marinol only synthesizes tetrahydro-cannabinol whereas marijuana also contains "naturally occurring terpenoids (oils) and flavonoids (phenols)" which further help patients in their illness (Armentano 2005).

As with any medication, there are some potential side effects of using Marinol, some of them highly unsettling. Among the most prolific side effect experienced by patients was a "cannabinoid dose-related high" which included a feeling of elation and constant unmotivated laughing by the patient (Marinol 2012). In addition, about one-third of patients with AIDS report that while on the medication they had negative reactions involving their central nervous systems. This leads to tremors, heart palpitations, and other issues with the nervous system. Other side effects of the drug Marinol include but are not limited to: seizures and convulsions, paranoia or extreme fear, a fast heart rate, a light-headed feeling, fainting, or unusual thoughts or behaviors.

In addition to the side effects of Marinol, scientists and researchers have found several other problems with the drug. Firstly, the Marinol is far more expensive than medical marijuana because of what is required to produce the medication. The medicine enters the body through the mouth but takes a long time for the body to break down and then process. According to Max & Joy (2001):

Dronabinol's greasy consistency presents several problems to a drug manufacturer. First, it makes the compound difficult and expensive to purify. Second, because dronabinol does not dissolve readily in water, only a fraction of the orally ingested compound reaches the patient's circulation. That amount is further reduced by the action of the liver, which recognizes dronabinol as a contaminant and removes it from the bloodstream. As a result, researchers have estimated that only 10 to 20% of the dronabinol in each capsule actually reaches its target in the body (page 143).

It has been reported that because the medicine is difficult to absorb, as evidenced in this passage, it will also take the body a lot longer for the medicine to take effect than if the person had ingested marijuana.

Marinol is a controlled substance and is illegal for non-patients to take the medication. A patient who is prescribed the medicine and then sells or gives the material to others is of course also illegal. Marijuana is illegal in all fifty states for recreational use, although two states have passed laws to legalize it which contradicts federal law and will likely be overturned because of this conflict. Medical marijuana is legal is several states for medical use only. However, Marinol is legal in all fifty of the United States of America so long as it is used by the patient prescribed (Morrow 2009). It is also approved by the Federal Drug Administration, more often known as the FDA.

Since the psychoactive components in Marinol are also present in cannabis, the two products have similar reactions and can become habit-forming. This can lead to "both psychological and physiological dependence" (Marinol 2012). However, Marinol abuse is uncommon and only found in patients who have used the medication for long periods at a high dosage. Unlike marijuana abuse which has reportedly led to impairments of a person's neurological system as well as problems with cognition, making judgments, and with a person's perception, no such long-term physiological or psychological effects have been found with the use of Marinol.