Marinol or Marijuana: Which Is Better?

Weighing the Pros and Cons of Medicinal Use

Medical marijuana and pill bottle
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Marinol (dronabinol) is a synthetic form of a tetrahydrocannabinol (THC), the main psychoactive ingredient of marijuana (cannabis). In addition to creating the "high" that many users seek, THC is known to reduce neuropathic pain, relieve nausea, and stimulate appetite. In U.S. states where marijuana is legal, people now have a choice as to whether Marinol or marijuana is the better drug to treat their medical condition. While there remains no clear consensus as to which is "better" or "worse," there are pros and cons that may help direct your decision.

Marinol

Marinol was for first approved by the U.S. Food and Drug Administration (FDA) in 1985 to treat nausea and vomiting related to cancer chemotherapy. Its approval has since been extended to include the treatment of weight loss and anorexia in people with advanced HIV infection.

As a result of its positive impact on people with HIV wasting, Marinol was rescheduled as a schedule III drug in 1999 (meaning that it has an accepted medical use). When used as prescribed, Marinol is considered safe and effective with a low risk of dependence.

Off-label uses include the alleviation of fibromyalgia pain, glaucoma-related eye pressure, menstrual migraines, postoperative nausea and vomiting, obstructive sleep apnea, and muscle spasticity related to multiple sclerosis (MS).

Current Evidence

As a regulated pharmaceutical drug, Marinol and other THC derivatives have undergone extensive clinical research to support their use. An extensive review of studies from the University of California Center for Medicinal Cannabis Research described the various benefits of Marinol in randomized trials.

Among the findings:

  • A 25-milligram (mg) dose of Marinol was 60 percent more effective in achieving pain relief in people with MS compared to a placebo.
  • A 5-mg dose of Marinol prescribed to people with AIDS over six weeks was nearly five times more effective in stimulating appetite (38 percent versus 8 percent) than a placebo.
  • A 25-milligram (mg) dose of Marinol was 50 percent more effective in reducing chronic neuropathic pain by 50 percent compared to a placebo (30 percent).

While the pain-relieving effects of a 10-mg dose of Marinol are comparable to a 60-mg dose of codeine, higher doses are associated with a greater risk of side effects compared to codeine (especially sedation).

Benefits

There are several benefits to Marinol, some of which stem from the fact that it is an FDA-approved drug. They include:

  • Marinol is legal in all 50 states and is regularly stocked in pharmacies.
  • Marinol is a pure isomer of THC, meaning that you won't be exposed to any potentially harmful chemicals found in marijuana.
  • Marinol does not contain any of the other psychoactive cannabinoids found in marijuana, meaning that it is less likely to make you "high."
  • Marinol has a long drug half-life and will remain at a therapeutic level in your blood for twice the length of time as marijuana.
  • Marinol is not smoked and is less likely to cause throat and lung irritation (an important consideration for someone with asthma or COPD).
  • Marinol is manufactured under controlled conditions, meaning that it is less likely to be tainted or contaminated.
  • Marinol is covered by most health insurance plans.

Drawbacks

Like any drug, Marinol also has cons to consider:

  • Marinol has a low absorption rate and can take up to an hour before the effects are felt (an important consideration from someone undergoing chemotherapy).
  • Marinol may be more expensive than marijuana if your insurance doesn't cover it.
  • Studies have been conflicted as to how effective Marinol is at controlling neuropathic pain.
  • Marinol can affect people differently. Some may experience extreme drowsiness, rapid heart rate (tachycardia), and dry mouth even at the prescribed dose. Others may experience dizziness, drowsiness, confusion, feeling "high," an exaggerated sense of well-being, nausea, vomiting, and stomachache as the body adapts to the medication. (A doctor should be notified if these side effects persist or worsen.)

Marijuana

Marijuana is most commonly smoked but may also be added to food, ingested in tinctures and oils, or inhaled through vaporizers ("vaping").

Medical marijuana was first legalized in California in 1996 at the height of the HIV crisis. Today, all but four U.S. states have some form of legalization on their books. With that being said, as a schedule I drug, marijuana has only been officially decriminalized in a handful of states.

Current Evidence

While many of the touted benefits of smoked marijuana remain loosely supported, the evidence regarding its effectiveness in treating chronic nerve pain is perhaps the most robust.

This includes a series of randomized trials from the University of California Center San Diego, which showed that a single a marijuana cigarette containing up to 8 percent THC was more than twice as effective in reducing nerve pain (46 percent to 52 percent) than a placebo (18 percent to 24 percent).

Similarly, a 2012 study published in the Canadian Medical Association Journal concluded that smoked marijuana delivered over the course of 11 days was twice as effective in reducing spasticity and four times as effective in reducing pain in people with MS compared to a placebo. 

Benefits

Supporters of medical marijuana often cite these pros:

  • Smoked marijuana has a rapid onset of action, bringing almost an immediate relief of symptoms.
  • Smoked marijuana "doses" are easier to control than oral medications like Marinol.
  • There is a variety of cannabis strains to choose from, some of which have fewer psychoactive effects and may be more effective in stimulating appetite, fighting fatigue, or curbing depression or anxiety.
  • Smoked marijuana generally won't interact with pain medications used during chemotherapy, meaning that you may achieve better pain control by using both.
  • Smoked marijuana contains other potentially beneficial cannabinoids, as well as potent antioxidant and anti-inflammatory compounds (such as terpenes found in medicinal oils).
  • Marijuana is easy and inexpensive to grow.

Drawbacks

There are, however, negatives to consider:

  • Marijuana is still considered illegal by the federal government.
  • There is no FDA-approved medical use of medical marijuana, despite evidence of its benefits.
  • Medical marijuana is not covered by insurance.
  • Medical marijuana can be prohibitively expensive in some states, particularly those that only allow it for medical purposes.
  • Marijuana contains over 400 chemicals, little of which is known about their long-term effects.
  • Marijuana may interfere with your mental acuity and mood.
  • Smoked marijuana may not be appropriate for people with respiratory diseases, including lung cancer.
  • Outside of smoking, other methods of intake are slower acting and more erratic in their effect.

Side effects of marijuana include a characteristic "high," dizziness, drowsiness, dry mouth, red eyes, dilated pupils, increased heart rate, increased appetite, euphoria, anxiety, restlessness, impaired coordination, and an altered perception of time and space. Symptoms are often dose-dependent, with higher doses sometimes triggering panic, paranoia, or hallucinations.

A Word From Verywell

Ultimately, the choice between Marinol and marijuana is largely dependent on your state laws. In some states, there may be no choice.

If you would like to explore medical marijuana use, start by checking the laws of your state on the National Organization for the Reform of Marijuana Laws (NORML) website. You should then speak with your doctor about the benefits and consequences of each drug as they to apply to your condition and overall health. Try to keep an open mind but take extra care to avoid medical advice from non-medical sources.

It is also good to keep an eye on other THC products undergoing development, some of which may be appropriate to your needs. One such example is Sativex (nabiximols), a THC mouth spray currently undergoing phase III clinical trials in the United States. The spray has already been approved for use in the United Kingdom for the treatment of neuropathic pain, spasticity, overactive bladder, and other symptoms of multiple sclerosis.

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