Pubdate: Sat, 25 Oct 2008
Source: Detroit Free Press (MI)
Copyright: 2008 Detroit Free Press
Author: Megha Satyanarayana, Free Press Staff Writer
Cited: Proposal 1
Bookmark: (Marijuana - Medicinal)


Proposal to legalize it for patients finds strong support and strong fears

For many voters, the decision to back or reject a proposal to give 
people with severe and terminal illnesses legal access to marijuana 
will come down to their thoughts on compassion for sick and dying 
people versus those on preventing drug abuse.

It's a debate that has divided the medical community, with each side 
pledging it is concerned with protecting Michiganders' health.

Supporters have campaigned for months, saying medical marijuana is 
the only thing that gives relief to some patients, mitigating the 
worst side effects of the best medical treatments. And the measure -- 
Proposal 1 -- has strong early support, boasting a 66%-25% lead in 
the most recent Detroit Free Press-Local 4 Michigan Poll.

But an opposition group of law enforcement, business and medical 
community members has campaigned hard in recent weeks against 
Proposal 1. It warns of a dystopia of strip-mall pot shops, teens 
with easy access to a so-called gateway drug, and crimes unpunished 
because of a medical marijuana defense.

There are many unanswered questions in the text of the proposal. It's 
not clear where users would buy seeds to grow their plants, and crime 
statistics are mixed in the 12 states with legalized medical 
marijuana. And, as federal law would still supersede state law, could 
agents rain down on Michigan as they have in California, busting pot shops?

One Patient's Relief

For the family of Caprice Wagner of Birmingham, who died in July at 
24 after a four-month battle with T-cell lymphoma, there is no 
question about the drug's benefits. The Vicodin she was prescribed 
barely touched the hallucination-causing pain -- so intense that her 
nurse described it to Wagner's mother, Robin O'Grady, as "like a Mack 
truck hit you."

But Wagner found relief when she started using marijuana for the pain 
on the advice of a medical professional.

"It helped suppress the nausea, eased the cramps, helped her sleep. 
It was good to see her relax, having a little bit of her life force 
back," said O'Grady, who is fighting for Proposal 1.

The proposal would give patients with pain, nausea and wasting -- 
common with HIV/AIDS, cancer and neurodegenerative diseases -- 
prosecution-free access to smoked or ingested marijuana, per a 
doctor's letter of recommendation. Users and their caregivers would 
have to carry a state identification card, registered through the 
Department of Community Health.

They could grow their own supply of 12 plants and could carry 2.5 
ounces at a time. It still would be illegal to use marijuana in a 
public place or operate a car under the influence.

By law, the Department of Community Health would administer the 
program and report to the Legislature. It is preparing its guidelines 
in case the measure becomes law.

While the department takes no stand on the proposal, Donald Allen, 
director of the Office of Drug Control and Policy, said, "These 
people certainly deserve our empathy, but ... it's not in the public 
health interest to see people smoke. Period."

The Michigan Medical Association agrees, said Dr. Dan Michael, a 
member of the MMA House of Delegates and Citizens Protecting 
Michigan's Kids, the leading opponents of the measure.

There is no way to deliver measured doses, and the association cannot 
promote smoking of any sort. He also said there isn't enough evidence 
for efficacy, making medical marijuana "bad medicine."

Nurses say otherwise. Joyce Stein of the Michigan Nurses 
Association's Congress on Public Policy, said nurses on the front 
line of end-of-life and cancer care see what medical marijuana can do.

"Doctors are looking for cures, and nurses are looking for comfort in 
pain," she said. "This is one more comfort measure they can offer."

Proponents Have Money Edge

Medical marijuana was once legal in Michigan. But the program created 
under a 1979 law was dependent on the federal government and a 
reluctant state health department, said Stephen V. Monsma, the state 
legislator who authored the bill. It came up for review in the 1980s 
and wasn't renewed.

Proposal 1 is sponsored by the Marijuana Policy Project, a 
Washington-based group, through the Michigan Coalition for 
Compassionate Care, made up of patients, medical personnel and 
marijuana law reform proponents. And campaign finance documents filed 
Friday showed it with a significant fund-raising edge, reporting the 
group raised more than $1.5 million and spent nearly $1.3 million

By comparison, Citizens Protecting Michigan's Kids reported raising 
$125,500 and spending a little more than $96,000.

The proposal smacks of the "law of unintended consequences," said 
William Schuette, a Michigan Court of Appeals judge and a leader of 
Citizens Protecting Michigan's Kids. He points to issues in 
California, including reports of increased crime and federal 
crackdowns on pot shops. Not explicitly outlawing pot shops 
implicitly allows them, he said.

"We're sensitive to the problems associated with pain management," he 
said, "but this is not a Michigan proposal."

He points to studies from the Substance Abuse and Mental Health 
Services Administration, showing increases in marijuana use in states 
with medical marijuana laws as evidence it would be more available to teens.

Diane Byrum, spokeswoman for Proposal 1, disputes that, saying a 
study by the Marijuana Policy Project and the State University of New 
York, Albany, shows teens in states with the laws are using pot less. 
The Centers for Disease Control and Prevention's Youth Risk Behavior 
Surveillance System survey shows mixed results for the states with 
medical marijuana laws that participated.

Byrum noted that the Michigan proposal wouldn't permit the type of 
cooperative growing that allows pot shops to exist in California. 
Those kinds of operations are what have faced federal crackdowns.

Loophole Concerns

Ferndale is among a handful of Michigan communities with largely 
symbolic ordinances allowing medical marijuana, although police Capt. 
Timothy Collins said it is not enforced because those users are still 
subject to prohibitive state and federal laws.

Collins said that marijuana is not a big issue in Ferndale schools. 
But he has problems with the state proposal, which he said doesn't 
have enough controls and is poorly written.

"If you look at the legislation, it allows people to grow it in their 
house for legal use. Bad guys are going to figure out how to skirt 
the law," he said.

There are loopholes, said Sheila Maxwell, a Michigan State University 
assistant professor of criminal justice. It's hard to regulate 
something you can't dose or study the side effects of, she said. 
Enforcing the section on growing plants in locked rooms would be 
extra work for law enforcement, she said. As with the 1979 law, she 
said this proposal should have suggested a temporary law, to best 
study the effects.

Lance Gable, a Wayne State University associate professor of law and 
a health law specialist, said the proposal is narrow. Pot shops are a 
nonissue, since a caregiver can have only five patients in his or her care.

"That would alleviate some of the concerns about creating an 
infrastructure for marijuana sales," he said.

And where the drugs would come from is the major question about 
Proposal 1. O'Grady, the woman whose daughter died of T-cell 
lymphoma, is lending her support to help lift the stigma of 
criminality, so people who need access to the drug can have it.

Many proponents stay mum on whether patients would have to break the 
law to buy the seeds. Getting seeds wasn't outlined in other states' 
proposals, said Bruce Merkin, spokesman for the Marijuana Policy Project.

Deb Brink of Kentwood was a 19-year-old leukemia patient struggling 
through chemotherapy and a bone marrow transplant in 1978 when she 
started using medical marijuana. She said people in her hometown 
would save pot for her when supplies went dry.

Now a four-time cancer survivor and registered nurse fighting for 
Proposal 1, she still remembers how smoking the drug and drinking tea 
brewed from its leaves was the only relief from the vomiting that 
came from her chemo.

"It was four hours of sick, eight hours of relief, and then I would 
start over," Brink said.



Proposal 1 would legalize marijuana use for select people with 
illnesses such as HIV/AIDS, Lou Gehrig's disease and Alzheimer's 
disease, and for symptoms such as chronic pain and nausea, which are 
common for cancer patients.

. Prescriptions cannot be written to get the drug in pharmacies. 
Instead, doctors would write a letter recommending marijuana use. 
Users and caregivers would register with the state and get an 
identification card. The card would preclude arrest for users and 
their doctors.

. Users or their caregivers would be allowed to grow 12 plants in a 
private, secure area, and caregivers could not carry more than 2.5 
ounces at a time. Sale to a non-registered person would be illegal.

. The Department of Community Health would administer the program and 
report on it to the Legislature. Privacy policies would apply to registrants.

Marijuana Use Drops Among Teens in State

According to the Michigan Youth Risk Behavior Survey, which quizzes 
thousands of Michigan teens about drug, tobacco and alcohol use, 
marijuana use in teens statewide has fallen in the last 10 years. In 
1997, 48% of teens said they had used marijuana during their 
lifetime; in 2007, it was 35%.

According to the Michigan Profile for Healthy Youth in 2007, the 
first year of the survey, 40.6% of Macomb County 11th-graders had 
tried marijuana, 44.6% of Wayne County 11th-graders had and 40.4% of 
Oakland County 11th-graders had.

"This is a new system and opportunity for local communities to be 
able to obtain data comparable to the Michigan Youth Risk Behavior 
Survey," said Kim Kovalchick of the Michigan Department of Education.

How Marijuana Works With Pain

Marijuana's effect on pain and nausea is through its main chemical 
component, delta-9-tetrahydrocannabinol, or THC. THC attaches to 
receptors on cells in the brain, causing the release or uptake of 
naturally produced chemicals that dampen pain, said Dr. Daniel Clauw, 
a rheumatologist and pain researcher at the University of Michigan, 
who is not part of Proposal 1.

Pain is genetic, said Clauw, and there may be 30 to 40 genes that 
encode pain sensitivity.

"Different people have different volume control settings for how 
susceptible to pain they are," he said. "There is no single class of 
drugs that works well for everyone. Cannabinoids work reasonably 
well. They might be the only class that works on some people."

There are two FDA-approved drugs for nausea and vomiting in HIV/AIDS 
patients that are derived from marijuana: Marinol and Cesamet. 
Proponents say swallowing a pill for nausea is difficult and that it 
takes longer to work than smoked marijuana. Canadians have access to 
Sativex, a mouth spray for multiple sclerosis symptoms.

There is little research being done on marijuana because it is 
difficult to get permission to grow the plant.



Five Michigan cities have medical marijuana ordinances: Detroit, 
Ferndale, Flint, Ann Arbor and Traverse City. The ordinances 
decriminalize medical use but do not provide for distribution. Canada 
allows medical marijuana for terminally ill people, with restrictions 
on the amount of marijuana allowed.

The city ordinances are symbolic, as both state and federal law 
outlawing marijuana use and possession supersede city ordinances.

"You could try to say ... 'You can't prosecute me through the city 
ordinance,' and we'd say, 'Fine, we'll prosecute you under the state 
law,' " said Ferndale Police Capt. Timothy Collins. He added that he 
doesn't believe there has been any change in crime due to the city ordinance.

Ferndale has a question on the November ballot to allow the 
distribution of medical marijuana, which would be unprecedented in 
the state but still symbolic.

"We've not had an incidence where marijuana was confiscated where it 
may have been used in a medical way," Detroit Police spokesman James 
Tate said. In the past, Detroit Police officials have said they will 
not arrest medicinal marijuana users but leave it to state and 
federal officers.



Michigan is no stranger to medical marijuana.

In 1979, after moving testimony from Deb Negen of Kentwood on how 
marijuana spared her the vomiting and nausea of chemotherapy, the 
state House of Representatives passed the Michigan Marijuana as 
Medicine Act by a vote of 100-0. The Senate followed with a strong 
vote in favor of the bill, 33-1. The bill was signed into law Oct. 22, 1979.

That same morning, Keith Nutt of Beaverton, a cancer patient who also 
had testified to the Legislature, died.

But what happened after is a mystery. The Michigan branch of the 
National Organization to Reform Marijuana Laws claims the goodwill of 
the bill foundered because the federal government, which at that time 
supplied the drug under a short-lived federal program, stalled and 
sent poor-quality supplies. The law lapsed in 1987, and in 1994, 
proponents walked up to 100 miles to Lansing in favor of reinstating 
it, or at least having medical use exempt from tougher drug laws on 
the books. Their efforts failed.

Negen, now Deb Brink, is an advocate for this year's Proposal 1.
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