Pubdate: Mon, 26 Feb 2001
Source: Advance for Respiratory Care Practitioners (US)
Copyright: 2001, Merion Publications, Inc.
Contact:  2900 Horizon Dr., King of Prussia, PA 19406
Fax: (610) 278-1425
Author: Shawn M. Proctor


Patients, Physicians Draw Line In The Sand

Legalizing the use of marijuana for medical treatments has followers and 
detractors. At this time, the issue is rife with tangled information, with 
both sides using the same studies to prove their conflicting points. Even 
as words fly, an upcoming U.S. Supreme Court decision due soon may finally 
settle some of the dust.

Still, new drugs in the pipeline might have a big impact in the future. 
Among them, an arm patch or inhaler might deliver marijuana's chief 
ingredient medicinally.

If that sounds odd, then consider a typical pharmacy line. Today it is 
common for patients to present prescriptions for Allegra or Viagra. If 
pro-medical marijuana forces prevail in court, patients might be able to 
hand over a script for marijuana cigarettes, commonly known as "joints" on 
the street trade.

At least, that is the picture a growing community of patients, physicians 
and pundits would paint.


Leading champion on the pro side of the issue is author Lester Grinspoon, 
MD, professor of psychiatry emeritus at Harvard Medical School, and 
chairman of the National Organization for Rational Marijuana Legislation 
(NORML) Foundation. "The future of cannabis as a medicine is assured," he 
said. Currently he maintains a web site,, which contains 
supporting data from patients and doctors.

Marijuana will eventually be considered a wonder drug, Grinspoon told 
ADVANCE. "After three years of intensive study, I have come to conclusion 
that smoked marijuana is less harmful than alcohol or tobacco."

Marijuana--known by a plethora of slang names like pot, weed, Buddha and 
reefer-is a green-gray plant, which is often smoked. Experts believe the 
active ingredient in marijuana, or cannabis as it is also known, is THC, 
also known as delta-9-tetrahydrocannabinol. Marijuana induces a euphoric 
high in a smoker and may have some health benefits to counteract any 
perceived hazards.

Anecdotal evidence indicates cannabis may have the following medicinal values:

. Reduces nausea, . Stimulates appetite in wasting patients, . Reduces eye 
pressure in glaucoma patients, . Reduces pain, . Steadies spastic muscles, 
and . Helps prevent seizures.

However, there are dangers accompanying the smoking of the drug, according 
to 1997 and 1999 studies by the Institute of Medicine (IOM). Perils include:

. Throat and lung cancer, . Disrupted short-term memory, and . Suppressed 
immune defenses, causing chronic bronchitis.

IOM's studies concluded marijuana probably causes too many reactions in the 
body to be prescribed safely. Marijuana is hazardous for long-term use and 
its medical benefits are not entirely proven, IOM stresses.


Grinspoon contests those allegations. "This drug is not nearly as toxic as 
the U.S. government would have you believe," he said. "It is remarkably 
non-toxic drug. There has never been a death recorded due to marijuana," 
Grinspoon asserted. "It will be an inexpensive medicine, possibly as low as 
one dollar per marijuana cigarette. Lastly, it is versatile. Like 
penicillin, it is able to treat a great many conditions."

George McMahon, a long-time medical marijuana patient, agrees with that 
assessment. The Lake Palestine, Texas, man suffers from Nail Patella 
Syndrome, a rare genetic disorder that causes joints to be malformed or 
missing at birth and to degenerate prematurely.

McMahon was born without kneecaps, and medical marijuana allows him moments 
of pain-free existence. "Without marijuana I wouldn't have a quality of 
life," he said. For example, he can mows his small lawn over the course of 
a couple days when he uses marijuana. "I talk to everyone and try to 
explain this."

Currently, he smokes 300 marijuana cigarettes a month and claims the 
treatment is legal. His doctor petitioned the federal government and 
eventually won the right for him to receive a monthly dosage. He was the 
fifth of 15 patients approved, and currently one of eight remaining. Since 
patients in the program are considered terminal, many have died since their 

"I believe marijuana is the drug needed by a large portion of people using 
pharmaceuticals like synthetic THC and pain relievers," he said. "It is a 
wonderful medicine."

Any discussion about legalizing cannabis brings challengers to the 
foreground. Among the staunchest anti-legalization advocates are the 
Partnership for a Drug-Free America and the White House.


The Office of National Drug Control Policy in the White House advises the 
President about drug-related concerns. Because marijuana has a high 
potential for abuse and a lack of accepted medical use, the executive 
branch opposes the use of "marijuana outside of authorized research," 
according to materials outlined in the 2001 national drug control strategic 

White House officials, under President Clinton, advised states considering 
medical marijuana ballot initiatives to counter such moves on the basis 
that legalizing marijuana would "undermine the scientific process for 
establishing safe and effective medicines."

In a recent Rolling Stone interview, Clinton said he personally favored the 
legalization of use and sale of small amounts of marijuana.

McMahon bristled at Clinton's public comment. His lack of interest in the 
topic or action during his eight years in office is not easily wiped away, 
he said. More people have been arrested for using marijuana under Clinton 
administration than any other president, and words will not change the 
past, he added.

Debate could come to a head in U.S. Supreme Court this summer, when the 
case of the federal government versus an Oakland cannabis cooperative will 
be heard. The issue is the California Proposition legalizing medical 
marijuana against the current federal policy forbidding sale and use of the 


Another bone up for grabs is a definitive interpretation of the IOM reports 
which note: "Until researchers develop a safe and effective delivery 
system, caregivers must consider the health problems that can result from 
smoking when deciding whether to recommend marijuana to patients."

Still, the reports concede: "The adverse effects of marijuana are within 
the range of other tolerated medicines."

Both sides have declared the reports a victory and added them to their list 
of cited materials. NORML claims the studies verify the drug's utility as a 
treatment. The IOM could not be reached for clarification.

Although he stresses that his role is as a patient telling his story, 
McMahon agrees with NORML's interpretation. "It is good medicine and the 
IOM says it is."

By sharp contrast, the White House, citing the IOM report, is promoting the 
concept marijuana has no future as a medicine. "I'm not sure where the 
legalizers are getting this information out of this report," said White 
House spokeswoman Jennifer de Vallance. "The report concluded marijuana has 
harmful toxins and does not meet dosage requirements." Furthermore, the 
availability of Marinol(R), a synthetic formulation of THC, makes arguments 
over smoked marijuana irrelevant.

Marinol marks another battleground. Marinol, marketed by Unimed 
Pharmaceuticals, has been touted by a number of anti-marijuana groups as a 
perfect treatment. The drug has received FDA approval as an appetite 
stimulant for HIV/AIDS patients and as an antiemetic to stem nausea and 
vomiting associated with cancer chemotherapy (See sidebar).

As on other issues, the sides divide evenly about Marinol. The FDA and the 
White House tout it as a middle ground, a safer solution than outright 
legalization. However, marijuana advocates do not agree.


Grinspoon feels, while it can help, Marinol pales when compared to its 
natural predecessor. "Marinol is not nearly as useful as whole, smoked 
marijuana," he said.

Some, like McMahon, have concerns about its origin as well. "I do not 
believe it is even part of the answer," he said. "It is a synthetic drug. 
Some people get no effect; some are completely disoriented. It is just not 
the same."

Chiming in on the side of continued scientific exploration, the American 
Medical Association (AMA) does not currently advocate legalization. In a 
position statement on the topic, the organization notes one key component 
to patient care is the free exchange of information, including that about 
alternative treatment options, without the threat of criminal sanctions.

"Adequate and well-controlled studies of smoked marijuana must be conducted 
in patients who have serious conditions for which pre-clinical, anecdotal, 
or controlled evidence suggests possible efficacy," noted the AMA paper.

AMA officials have urged the National Institutes of Health to spearhead the 
effort, by facilitating grant applications and conducting well-designed 
clinical research. Studies should focus on the creation of a smokeless 
delivery system to reduce the health hazards involved.

The AMA plans to discuss the issue further at its annual meeting in June.


Medical marijuana's future remains uncertain. The federal government will 
likely continue on its opposition path unless or until the Supreme Court 
ruling countermands the current regulations. Similarly, legalization 
supporters will explore every angle of attack, hoping for a breakthrough.

Marijuana patches, pills or inhalers could signal a compromise between full 
or medical legalization and absolute denial of the drug to patients who 
claim its benefits far outweigh its health risks.

Grinspoon, in a Boston Globe OP-ED piece, foresaw one possible future 
outcome. He proposed a system where the pill and patches and other 
alternative delivery devices will be available. However, for patients who 
need it, he would still like to see the actual cannabis plant be made 
available, free of legal ties.

"Medical marijuana is here to stay. The question is what form it might 
take," Grinspoon said.

Shawn M. Proctor is an ADVANCE editorial assistant.
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MAP posted-by: Larry Stevens