Doctor No Way

By Dean Kuipers, LA CityBeat. Posted January 12, 2005.

Stuart Hoffman does not believe in the medical use of marijuana – at least, not the kind you grow in your backyard or buy off the street. And he'd feel that way, he says, even if he wasn't the chief medical review officer for the drug testing services at ChoicePoint, with clients ranging from the U.S. government to large national retail chains. Born and educated in Minnesota, he was a private oncologist with a thriving practice in Downey, Calif., for 35 years, and had plenty of patients who used pot to relieve symptoms. And while he agrees marijuana does relieve symptoms – dulling chronic pain, reducing seizures, stimulating the appetite, controlling nausea – he's seen it surpassed by better drugs.

And that, he says, is where the pro-medical marijuana people go wrong. It's not that the feds don't want to relieve suffering of people like Angel Raich, the 38-year-old with a plethora of chronic conditions who has taken her case to the U.S. Supreme Court. It's that the medical establishment has studied pot and found it lacking. "Angel Raich is being used by a group of people, in my opinion, who are struggling to make marijuana legal across the board," says Hoffman, "and they use all sorts of arguments that are sort of half-truths." He spoke not in his capacity as an officer of ChoicePoint – he cannot speak officially for the company – but as a doctor who couldn't let those "half-truths" lie.

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At ChoicePoint, do you test people who use medical marijuana?

Dr. Stuart Hoffman: Constantly. We do about four million drug tests a year here. Approximately five percent are positive for all sorts of things, and marijuana is probably 75-80 percent of those. A few people have prescriptions for Marinol, pure marijuana: perfectly legitimate, recognized by the federal government. People who are on medical marijuana present a very different problem for us because there are only about 10 or 11 states that currently accept medical marijuana. And it is the employer's individual policy which determines whether we make it a positive or negative.

So a Wal-Mart store in California will fire someone for using medical marijuana?

A Wal-Mart store anywhere in the world will not recognize medical marijuana, even though some states say that it's legal. It's their decision. It's title 49, part 40, U.S. Department of Transportation. [Hoffman pulls out thick printed book of regulations.] That's the bible for the federally regulated tests, and it's been challenged in court many times. Nobody's ever beaten this thing.

As an oncologist, you treated people who used marijuana. Have your attitudes about it changed?

No, my attitudes about it have always been the same. I treated many people with chemotherapy who became very nauseated, who were dying of cancer, losing weight and couldn't eat. Before it was legal, many of my patients would go out and get street marijuana. At the time, there were drugs called Compazine and Thorazine, which were also tranquilizers but had a fair anti-nausea effect. These drugs were on a par with marijuana, and none of them was very good, but they were better than nothing. About seven or eight years ago, a whole new class of drugs came in including things like Ondansetron and two-to-three others, which were anti-nausea medicines that just revolutionized chemotherapy. These were superb. There was no question, it was better. There were still a few people who would request marijuana because it was the mystique of the forbidden fruit.

Yes, but Ondansetron is expensive, and homegrown pot is free.

Sure. It's not cheap. But Ondansetron is given intravenously at the time of the chemotherapy, so insurance covers it 100 percent. Uninsured people don't get chemotherapy, because they can't afford it – so cost isn't really a factor.

What about appetite stimulation?

It's been known for years that marijuana will stimulate your appetite a little bit. But they've found that massive doses of progesterone, one of the female hormones – the substance is marketed under a trade name of Megestrol – is a superb appetite stimulant. Far better than marijuana.

Why not give seriously ill people whatever they want? Isn't it a societal goal to relieve suffering?

There's a lot of things that the general public does out of guilt or what they feel is compassion, but which really doesn't jive with reality for the people actually on the stuff. I had a huge cross-section of the population in my practice – they didn't want it. Any more than they wanted opium or opiates for pain relief. They fought it. But, nonetheless – if they did want it, that's fine. When it comes to pain relief, the right dose of morphine is enough. Whatever that is. The first goal is to prolong life. The next goal is to relieve suffering.

Sounds like you agree that marijuana could be good for that.

They can have Marinol. Now, there are many physicians in the state of California, particularly in Northern California, who have marijuana practices. We see the medical marijuana prescriptions coming in here. I called one of these physicians and talked to her at some length. She told me that she has limited her practice to the treatment of conditions that require marijuana. She has about 500-600 patients. I asked, "Well, what kind of diseases are you treating?" I thought: HIV, cancers, and things. [She said,] "I treat chronic anxiety, low back strains, tension headaches, degenerative arthritis." A bunch of things that the preponderance of physicians in this country would not treat with marijuana. I said, "Well, do you monitor them?" "Oh, yes. If these patients don't come in to see me once a month, I don't refill their prescription." This, to my mind, is immoral.

Why? She's relieving their suffering in some way.

But she could prescribe it for 90 days. She's doing this for the money.

Isn't that true of all doctors? People take drugs for arthritis or back pain or depression and never stop. Every time they go in to see the doctor, the doctor gets paid.

Sure, there are doctors who do that. Valium, Vicodin. But, in these areas, the state Medical Board of Quality Assurance does step in. I told them about this doctor, and they said she was doing nothing illegal. But there are people getting thrown out of the profession every single month for doing that.

You've given me a pile of photocopies showing that the government still allows research on the medical effects of marijuana. But the FDA and DEA have claimed for years that they cannot reschedule marijuana to allow for medical use because there's no research. Are they just ignoring it?

No. There's no research supporting street marijuana as medicine. If you listen to Americans for Safe Access, it says: These people are dying because they can't get access to marijuana. That's baloney. They can have Marinol. Your body can't tell the difference if you take it in that form or whether you smoke a joint. The federal government recognizes that there is a medical purpose for marijuana and a use. What they don't recognize is a medical purpose for marijuana grown in your backyard or bought off the street, because it conflicts with the societal objective of keeping the community safer by allowing less people to be impaired by it.

So you disagree with the idea that people ought to be able to medicate themselves.

That's true: That I disagree with, because you are taking a substance that can impair you and there's not some medical oversight. I'm not a policeman. I'm not a judge. I really believe that society is better off without medical marijuana. Sure, some people are going to benefit – poor people who cannot afford health insurance, for example. I have heard some very cogent arguments stating that we should completely decriminalize drug abuse and make it an illness. But sometimes when you get conflicting benefits and non-benefits to society, you say, OK, which is the greatest good for the greatest number?

              

Dean Kuipers is editor of LA CityBeat.

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