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Prescription Pot

Proposals for medicinal marijuana use earn mixed reviews from the medical community
Sunday, October 24, 2004 | 12:00 a.m. CDT; updated 11:18 a.m. CDT, Tuesday, July 22, 2008

Heather De Mian has vascular Ehlers-Danlos syndrome, a disorder that weakens the body’s collagen — what she calls the “rubber bands and glue that hold the body together.” She suffers from gastro-intestinal problems and is prone to dislocated bones and bruises because of ligament weakness and feeble blood vessels. Eventually, the disease may kill her.

De Mian takes seven prescription drugs, two of which, Zofran and Marinol, are used specifically to treat the nausea and vomiting she experiences regularly. Because she qualifies for Medicare and Medicaid, taxpayers pick up the tab for her prescriptions; the Zofran and Marinol alone cost $32,000 per year.

But De Mian says she has a way to save that money.

“If I could grow my own marijuana, it would save taxpayers $30,000 for one patient for one year,” she says. “I use a wheelchair most of the time, and if I’m lucky, I leave my house two times a week. If the money could be spent on attendant services instead of drugs, it would benefit me greatly.”

Eighteen months ago, in April 2003, Columbia voters turned down a proposal to legalize the medical use of marijuana. This prompted Columbia Police Chief Randy Boehm to declare the issue all but dead “for a while.”

[photo]

Since 1996, 11 states, most of them in the West, have passed laws eliminating or reducing penalties for marijuana used for medical purposes. (Source: National Organization to Reform Marijuana Laws)

It turned out to be a short while.

On Nov. 2, voters will once again weigh in on an issue that doctors, patients, lawmakers and civil libertarians across the country have been debating since the mid-1970s, when laws allowing the use of marijuana for medicine were first passed.

Under city law, possession of 35 grams or less of marijuana is a Class A misdemeanor, punishable by a maximum sentence of one year in jail and a $1,000 fine.

Passage of Proposition 1 would allow for the dismissal of charges against seriously ill people who obtain and use marijuana on a doctor’s recommendation. The new law would also protect physicians who prescribe marijuana from arrest and prosecution.

This year’s medical marijuana initiative is separate from a referendum, also on the Nov. 2 ballot, on whether to send all misdemeanor marijuana possession charges to Municipal Court. In 2003, when Proposition 1 was rejected by 57.8 percent of voters, the two measures were combined.

“The original Proposition 1 was relatively successful,” says Amanda Broz, president of the MU chapter of the National Organization for the Reform of Marijuana Laws. “It showed that a large majority of the town is open to changing. This time, we separated the issues.”

Eleven states -— Alaska, Arizona, California, Colorado, Hawaii, Maine, Maryland, Nevada, Oregon, Vermont and Washington — and several municipalities already have legalized medical marijuana. Several other states and municipalities are also voting on the issue Nov. 2.

Results of research

Three years ago, the American Medical Association issued a review of the scientific research on the therapeutic value of marijuana. Studies have found that marijuana has helped cancer patients and people with AIDS keep food down and gain weight. Other studies have found that THC — marijuana’s active ingredient — helps post-operative patients deal with pain.

Clinical trial data and anecdotal evidence support the view that smoked marijuana and oral THC, such as the brand-name drug Marinol, offers relief from spasticity, pain and tremors in patients with multiple sclerosis, according to the AMA.

“Lots of research is being done that shows the benefits of marijuana used as medicine,” says Columbia physician John Mruzik, an outspoken proponent of medical marijuana.

In its report, however, the AMA stressed that more research is needed to determine whether the benefits of marijuana outweigh its potential for harm. The AMA concluded that the future of medical marijuana lies in its “isolated components.”

Smoking marijuana is a crude delivery system that also delivers harmful substances, the AMA says: “Smoked marijuana should generally not be recommended for medical use.”

Mruzik concedes that marijuana has “some harmful effects.” He does not condone its use by patients with mental illness, and he acknowledges that “no doctor alive is going to tell you that smoke is good for you.”

But, Mruzik says vaporizers — machines that remove harmful carcinogens from marijuana smoke but retain the psychoactive cannabinoids of the plant, including THC — can reduce the lung damage caused by smoking marijuana.

In that case, Mruzik argues, “if it helps ease pain, what’s the problem?”

Physicians split on use

Physicians are split on whether marijuana should be legalized for medical purposes. The American Academy of Pediatrics, for example, says its members “are not of one mind” regarding the legal status of marijuana. In 1995, the academy asked its members their views on legalization. A minority — 18 percent — favored legalization, while just under a quarter said penalties for personal possession of marijuana should be reduced.

As for the medical use of marijuana, 31 percent felt that the drug should be available, by prescription, to certain patients. In June, the academy made official its opposition to the legalization of marijuana and argued that it would increase the already widespread availability of the drug to adolescents. The policy approved by the academy’s committees on substance abuse and adolescents notes that in 1997, 23 percent of eighth graders reported having used the drug at some time in their lives — an increase from 10 percent in 1991.

“The abuse of marijuana among teenagers has increased as the perceived harmfulness of regular use has decreased and the perception of peer acceptance has increased,” the statement says.

Moreover, the policy states that marijuana has “no currently accepted medical use” in the United States and warns that it is classified by the federal government as a Schedule I drug, which means it has a high potential for abuse.

Still, the academy continues to support “rigorous scientific research” on the use of cannabinoids — the various chemical constituents of marijuana — for the relief of medical symptoms that are not alleviated by existing drugs.

On the other hand, a 1997 editorial in the New England Journal of Medicine called policies that prohibit physicians from prescribing marijuana for seriously ill patients “misguided, heavy-handed, and inhumane.” While acknowledging the drug’s long-term adverse effects, including the possibility that it could lead to serious addictions, the author, Jerome Kassirer, a professor at Tufts University School of Medicine and an associate research scientist at the Yale University School of Medicine, argued that neither of those issues were relevant to the debate.

“It is hypocritical to forbid physicians to prescribe marijuana while permitting them to use morphine and meperidine to relieve extreme dyspnea (shortness of breath) and pain,” Kassirer wrote. “With both these drugs the difference between the dose that relieves symptoms and the dose that hastens death is very narrow; by contrast, there is no risk of death from smoking marijuana.”

Kassirer also argued that, while oral THC has been available by prescription for years, it is difficult to determine the proper dosage for individual patients and is not often prescribed. By contrast, he said, “smoking marijuana produces a rapid increase in the blood level of the active ingredients and is thus more likely to be therapeutic.”

Physicians who have the “courage” to prescribe marijuana for the sick will eventually “force the courts to adjudicate between the rights of those at death’s door and the absolute power of bureaucrats whose decisions are based more on reflexive ideology and political correctness than on compassion,” Kassirer concluded.

The realm of public opinion

Indeed, referendums such as Proposition 1 signal a shift in the debate on medical marijuana from the medical arena to the court of public opinion. Amanda Broz, the NORML president at MU, says the medical marijuana movement suffers from a stigma.

Many doctors and teachers support Proposition 1, she says, but are fearful of being associated with the controversy over an illegal substance.

“Some doctors aren’t vocal because they could face punishment,” she says. “I’ve encountered elementary school teachers supportive of the initiative, but they were afraid to sign the initial petition out of fear of losing their jobs.

“The word ‘marijuana’ is automatically a turnoff for some people. People are afraid to have their name associated with this because of the consequences, and I don’t think those fears are necessarily unfounded, sadly.”

Broz, whose group was instrumental in collecting the 2,276 petition signatures required to put the issue on the Nov. 2 ballot in Columbia, seemed surprised to find that support of, or opposition to, the referendum isn’t driven by conventional politics.

“You cannot stereotype anyone,” she says. “I assumed most students would be in favor of this but a lot of them aren’t. At the same time, I’ve had Republicans and Democrats sign the petition.”

Caleb Lewis, president of MU College Democrats, says that the ballot initiative has not garnered much discussion among his group —which has not taken a position on Proposition 1 — nor among Democratic candidates for office.

“I don’t think it will play a major role in any campaign,” he says.

MU Campus Libertarians supports the initiative unequivocally. Libertarians believe that laws should not limit options in terms of medical treatment, group member Adam Shahid says.

“The government has no business interfering with matters between doctor and patient when there is no fraud or malpractice involved,” Shahid says.

Public opinion polls strongly suggest that many Americans feel the same way. In October 2002, 80 percent of respondents to a Time Magazine/CNN poll said they supported allowing adults to “legally use marijuana for medical purposes.” The Center for Substance Abuse Research reported in January 2002 that 70 percent of poll respondents agreed that the use of medical marijuana should be allowed. And, in March 2001, when the Pew Research Center asked 1,513 people if doctors should be allowed to prescribe marijuana, 73 percent said yes.

“At some point, politicians will recognize that their constituents believe in it,” Mruzik says. “How can they oppose something so many people support?”

Columbia voters to decide

In August, the Columbia City Council, in a 3-3 tie, rejected an ordinance that would have called for the dismissal of charges against people caught with marijuana if their physicians approved its use. (Mayor Darwin Hindman did not attend the meeting.) Council members, however, did agree unanimously to put the issue on the Nov. 2 ballot.

Sixth Ward Councilman Brian Ash, who voted against the ordinance, says passing the proposal would have sent the wrong signal.

“People might stretch the definition of a medical problem to be able to use it,” Ash says. “It just opens Pandora’s Box.”

Ash says those already using marijuana for medical purposes should not fear prosecution. But Columbia Police Chief Randy Boehm says that, while he knows of no cases in which medical users have been punished, they now face the same criminal penalties as any other user if caught with marijuana.

Boehm says he opposes the initiative for several reasons. For one, he says, the ballot language doesn’t specifically address law enforcement’s responsibility.

“The wording of the petition is not quite clear,” he says. “It seems they’re directing us to make it a low priority.”

Boehm is also concerned about how patients would obtain the marijuana and how law enforcement would verify that a doctor has approved its use.

“There are concerns legally that even if this were to pass, there’s no way to legally obtain it,” he says. “There are complications with this on a number of levels.”

Are drug laws unjust?

Clearly, many supporters of Proposition 1 seem as concerned with current drug laws in the United States as they are about marijuana’s therapeutic effect on the sick. Chuck Thomas, executive director of the Interfaith Drug Policy Initiative, a lobbyist organization established in 2003, calls America’s drug policy “completely backwards.”

“Religions of the world all stress justice and compassion, and this drug war is one of our government’s most unjust and discompassionate policies,” Thomas says. “This is largely a culture war, and that’s another reason to involve people of faith.”

The Interfaith group’s efforts to reform U.S. drug laws have the support of other religious organizations, including the Unitarian Universalists, the United Church of Christ, Evangelical Lutheran Church in America, and the American Presbyterian Church. Interfaith has also garnered support from progressive Jewish congregations.

“If somebody is using marijuana for medical purposes, it’s clearly wrong to punish somebody with no criminal intent who is only using it to treat a medical condition and reduce pain and suffering,” Thomas says.

Others say the prohibition against marijuana is hypocritical. The AAP acknowledges that tobacco and alcohol, which are legal for 18- and 21-year-olds respectively, are more widely abused by adolescents than marijuana. Right now, it’s against the law for Heather De Mian to use marijuana to ease the symptoms of her disease, but at the homeless shelter where she works, “we’ve buried more alcoholics than I can count.”

“There are plenty of more dangerous prescription drugs, such as Oxycontin,” she says. “Even 7600 Americans die every year from aspirin, but there has been no case of death from just marijuana itself.

“I don’t understand how lawmakers have the gall to override a doctor,” she argues. “When all the politicians get their medical degrees, they can come talk to me.”

NORML’s Broz says that barring marijuana from people who could be helped by it doesn’t make sense, and that the apparently widespread public support for medical marijuana suggests that when it comes to pain and illness, anything that brings relief should not be punishable by law.

“It’s a quality of life issue,” Broz says. “People who know someone with a serious illness understand that it does help the pain. One of those patients could be my mom, my sister, or me.”


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