HTTP/1.0 200 OK Content-Type: text/html Drug Stigma Makes For Painful Deaths
Pubdate: Sat, 10 Jan 2004
Source: Vancouver Sun (CN BC)
Copyright: 2004 The Vancouver Sun
Author: Nicholas Read


Addiction, Legality Worry Patients: Study

Even when they're dying, some patients are hesitant to take medical 
marijuana because they fear getting into trouble with the law or becoming 
addicted, a study done by a palliative care expert at the University of 
B.C. has found.

Dr. Romayne Gallagher, a clinical professor at UBC's division of palliative 
care, surveyed 68 dying patients at palliative care facilities in Vancouver 
and Kelowna and found that participants also worried that smoking pot might 
damage their lungs and that second-hand smoke from it could harm family 

That discovery came on the heels of evidence from her own clinical practice 
that such patients may be even more reluctant to take morphine because of 
its enduring stigma as a "narcotic."

But while that may surprise some people, it didn't surprise Gallagher. 
"People who are dying are still living," she said in an interview Thursday.

"A person who's dying thinks of himself as living, so he doesn't want to do 
anything to harm himself. Just as we might say, 'What are the benefits and 
the risks [of smoking medical marijuana]?' so will he.

"But despite all that, people were quite willing to try it [marijuana]," 
she added. "So what does that tell you? It tells you that people who are 
suffering physically and emotionally are vulnerable people who are willing 
to try anything, whether it works of not."

Gallagher says studies still need to be done to determine how effective 
marijuana is in preventing acute pain, such as that experienced by terminal 
cancer patients. So far, she says, evidence points to it being more 
effective in treating nausea and reducing chronic pain in people suffering 
from strokes or multiple sclerosis.

Morphine and its cousins remain the most effective treatments for acute 
pain, she says. Yet her experience tells her that cancer patients, worried 
about taking "narcotics," may refuse to take morphine. In fact, they may be 
more reluctant to take it than they are marijuana.

"Because cannabis is perceived to be more natural than morphine, people 
perceive it as safer," Gallagher said. "When they look at [morphine] they 
see stories in the newspaper about people dying from a heroin overdose, but 
they never see people dying from smoking too much pot. So they perceive it 
as something safe.

"I'm trying to get people to use the pain medications that we already have 
because studies show that in theory, we can control almost all the pain 
people have, yet people are still dying in pain."

In fact, she says, morphine is just as "natural" as marijuana, given that 
opium is extracted naturally from the poppy plant. But in 1914, when the 
U.S. government forbade it from being sold over the counter, it assumed a 
stigma that persists even today.

"What happened is that physicians began to be accused of prescribing it to 
addicts, so they stopped prescribing it," she says. "That made it more 
difficult for people to get their morphine, so it went underground and 
became criminal."

Even today, she says, "health-care providers are not as comfortable as they 
should be with these medications.

"We've had a lot of misunderstandings about what addiction is and what it 
isn't. We used to think that if you took morphine for several weeks and 
stopped suddenly and got withdrawals, you must be addicted. We now know 
that anyone who takes it for several weeks and stops will get withdrawals. 
But that doesn't mean you're addicted."
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