Respectable Reefer

If it weren't for the little photo gallery on the wall, the office where Dr. William Notcutt's research assistants keep track of their patients would be just like any other cubicle at the James Paget Medical Center in England. As phones ring and stretchers wheel by and these three women go about their business, the snapshots -- Cheryl Phillips, one of Notcutt's staffers, gently holding an emerald green bud of marijuana; a group of people in lab coats smiling for the camera, sinsemilla towering over their heads; a hangar-sized greenhouse stuffed to the gills with lush pot plants -- are about the only evidence that this hospital in East Anglia is at the epicenter of one of the most extensive medical marijuana research projects in the world.

In part, that's because there's no actual pot here; by the time it gets to Paget, GW Pharmaceuticals, the British startup that owns the greenhouses, has turned the plants into Sativex, a pure extract of pot that comes in a pharmacy-friendly bottle and is designed to be sprayed into the mouth. And in part it's because the frivolity is carefully confined to the photos, taken against company policy during a field trip to the secure, undisclosed location where GW grows its weed. After five years, Phillips and her colleagues have grown used to having cannabis -- as the British call marijuana -- in their workaday lives. Not only that, but their boss has been on a bit of a campaign to keep things sober.

"To get to the perception that this is a medicine," Notcutt says, "we've had to move away from the funnies that relate to the pot world. So no pot jokes."

Over a beer at the end of his day, this rumpled, 59-year-old anesthesiologist and contract researcher for GW is positively ebullient about the news that just today the Canadian government approved Sativex, a success he thinks is likely to be repeated soon in England and eventually in the United States. He'll gladly tell you how important earnestness has been in getting GW to this point, how Sativex owes its success not only to the rigorous science of its successful clinical trials but also to painstaking attention to matters of perception.

Take the spray concept. There are sound medical reasons for spraying cannabis under the tongue rather than smoking or eating it. The mucosa of the mouth will absorb the drug faster than the digestive system, indeed almost as fast as the lungs, but without irritating the respiratory system. And Sativex can be precisely metered -- a single one-tenth milliliter spray contains 2.7 milligrams of tetrahydrocannabinol (THC), pot's main psychoactive chemical; 2.5 milligrams of cannabidiol, which doctors think reduces anxiety and muscle tension; and all of pot's active ingredients known as cannabinoids -- so that it can be accurately studied.

But it also has "the advantage of looking like a medicine to the outside world," Notcutt says. "It has been served up like a medicine, prepared like a medicine, researched like a medicine. It looks like a medicine, and it's prescribed like a medicine." Taking pot out of joints scored on the street and putting it into bottles found on pharmacy shelves shows that "we're not just being silly about the herb, even though in the end that's exactly what it is. It's as if you just squeezed the plant," he says, wringing an imaginary stalk in his hands.

Notcutt began trying to medicalize cannabis more than a decade ago, and has been working with GW and its founder and executive chairman, Geoffrey Guy, since the company's inception in 1998. He credits Guy (who wouldn't be interviewed for this article) with hitting upon the spray, just one of the measures he's taken to distance Sativex from its unsavory origins.

Guy has styled GW, which he started solely to develop cannabis medicines, as just another drug company seeking to develop just another drug. He raised money in the usual ways -- first from private investors, then with a 2001 stock offering that garnered $48 million, and finally, in 2003, with an estimated $65 million licensing deal with German pharmaceutical giant Bayer -- and used it to purchase the rights to pot varieties that a Dutch company had spent millions of dollars and more than a decade developing for their medicinal properties.

Guy presents himself as neutral in the drug wars and gained the support of the British government by offering to institute extraordinary security measures at his grow facility to prevent "diversion." The British government, in turn, gave him permission to grow his pot and test it on human subjects and so exempted GW from an international treaty forbidding private production of outlawed drugs. Guy developed a way to blend the plants (a process he has likened to making blended burgundies) into precise mixtures whose chemical profiles can be standardized (which regulators like), patented (which investors like; cannabis itself can't be patented), and then described in company press releases as "a novel prescription pharmaceutical product derived from components of the cannabis plant."

Having successfully distilled pot's reputation as a medicine from its reputation as a way to get high, Notcutt says, "the powers that be at GW worked hard to maintain this myth. We start in that comfort area, we don't talk about anything outside this comfort area."

This hard work has no doubt paid off in Canada and England, reassuring regulators that, as Notcutt put it, "we're talking about a serious medical subject here." The real audience for all this mythmaking, however, isn't Britain or Canada, which will ultimately account for only a small percentage of the cannabinoid drug market, estimated to be almost $1 billion a year. It's the United States, where, Notcutt says, things are different. "Marijuanaphobia is much greater on your side of the pond," he told me. "We've never had the reefer madness."


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