Medical Marijuana: What's It All About?
[Ed. Note: Additional reporting by Paul Armentano, NORML Publications Director and Carl Olsen, Director of Iowa NORML.]FINALLY IN THE SPOTLIGHTThe debate that has ensued as a result of California and Arizona voters passing initiatives (in California, Proposition 215; in Arizona, proposition 200) allowing for the legal use of marijuana for medicinal purposes, has finally put the spotlight on the issue of medical marijuana. So much so that now Americans can judge for themselves as to the real or contrived legitimacy of cannabis for relief of symptoms brought on by such serious illnesses as cancer, multiple sclerosis, cerebral palsy, and AIDS.California Proposition 215 states that, "Patients or defined caregivers, who possess or cultivate marijuana for medical treatment recommended by a physician, are exempt from the general provisions of law which otherwise prohibit possession or cultivation of marijuana." It further provides that, "Physicians will not be punished or denied any right or privilege for recommending marijuana to a patient for medical purposes."Arizona Proposition 200 is broader than California's measure and would essentially "medicalize" Arizona's drug policy. The Act calls for mandatory, court supervised treatment and probation as an alternative to incarceration for non-violent drug users and provides expanded drug treatment programs. It also permits doctors to prescribe controlled drugs such as marijuana to patients suffering from serious illnesses, such as glaucoma, multiple sclerosis, cancer and AIDS.While a majority of voters in the two states have declared their wishes, opposition among certain factions in Congress, as well as state officials, is strong against the recent initiatives. A Senate Judicial Hearing, under the direction of Senator Orrin Hatch (R-UT) is in progress to circumvent the state's referendum. Legal research into the ramifications of prosecuting doctors, who prescribe marijuana to their patients, under federal laws is actively being pursued. In Arizona, Governor Fife Symington is considering vetoing the ballot results, in direct contradiction to the people's will on the matter (Arizona citizens passed the initiative 65% to 35%, a distinct margin with little room for interpretation. California passed theirs with a margin of 56% to 44%). Prosecutors and law-enforcement officials from California and Arizona are meeting with officials from the Drug Enforcement Administration, the departments of Justice, Education and Health and Human Resources to get direction on how to proceed against the new legislation.CALIFORNIA AND ARIZONA VOTERS DUPED?Those who oppose the initiatives view the legalization of medical marijuana as a smokescreen for the re-legalization of marijuana overall (it was legal prior to 1937) and are determined to prevent the issue from reaching other state ballots. "The California proposition was a wolf in sheep's clothing," said James E. Copple, president of Community Anti-Drug Coalitions of America in a New York Times article (November 17, 1996). They're using the AIDS victims and terminally ill as props to promote the use of marijuana." Ethan Nadelmann, director of the Lindesmith Center (a policy center in New York that promotes more tolerant drug policies) and proponent of the propositions, rebutted saying that legalizing marijuana was not an immediate goal because, of those voters who voted in favor of marijuana for medical use, 50% also said they did not favor its outright legalization.Opponents, on a national level, believe voters were duped, especially in Arizona with respect to Proposition 200, into believing that the initiatives were in response to a critical medical need amongst its citizenry, when, in reality, the propositions were well orchestrated, highly-disguised maneuvers to legalize dope. "[This ballot measure] begins a road to destruction of people's lives in this country," said Senator Jon Kyl (R-AZ), one of only three Senators that attended Senator Hatch's hearings. Kyl called the California and Arizona drug-law campaigns classic examples of "bait and switch" tactics and alleged that the voters in those states were "deceived" by proponents. "The contention that the public was duped is absolutely absurd," countered Marvin S. Cohen, who testified on behalf of Arizonans for Drug Policy Reform. "Voters knew exactly what they were doing on November 5."Other opponents of Proposition 215 and 200, such as California Attorney General Dan Lungren, criticize the language of the bills claiming they are written so loosely as to encourage abuses. One of Senator Hatch's overriding concerns is that Arizona's bill would allow doctors to prescribe any Schedule I drug, which includes heroin, LSD, and, oddly enough, marijuana.Dave Gieringer of California NORML (National Organization for the Reform of Marijuana Laws) rebutted saying, "Proposition 215 was deliberately framed in general terms so that the state and federal governments could work out regulatory details of the distribution system. We want to work with local, state and federal authorities in ironing out any ambiguities in the law so as to prevent abuses." According to Dave Fratello, communications director of the California referendum campaign, "The first thing this [Proposition 215] does not do is create some sort of supply system. It gives a specific defense to a small group of people that is subject to scrutiny in court. That is why we feel it can't be easily abused."Regardless, even though the new state legislation permits the distribution and limited use of marijuana for medicinal purposes only, federal law supersedes state law, and federal law states that possession of marijuana is a felony. As such, General Barry McCaffrey, the Clinton Administration's Drug Czar, said that even if voters in California and Arizona make it legal for sick people to use marijuana for medical reasons, federal law enforcement officials will "absolutely" prosecute physicians who prescribe marijuana under the new laws. "A physician who tries to prescribe a "Schedule One" drug, with or without these referendum in California and Arizona, is subject to prosecution under federal law -- and we will uphold the law," McCaffrey said during an interview on Court TV's Washington Watch with Fred Graham.The federal law may be open to scrutiny. According to Rep. Barney Frank (D-MA) in a congressional record dated December 14, 1995, pg. E2365, marijuana prohibition began with the Marijuana Tax Act of 1937 under false claims despite testimony to the contrary from the AMA. The Controlled Substances Act of 1970 placed it in the most restrictive catagory of drugs, Schedule I, whereby drugs must meet three criteria: 1) have no therapeutic value, 2) are not safe for medicinal use, and 3) have a high abuse potential. In 1988, the Drug Enforcement Administration's law judge ruled that it should be removed from Schedule I and placed in Schedule II, where it would then be available to physicians to prescribe.OPINION POLLS REPORT AMERICA'S OVERWHELMING SUPPORT FOR MEDICAL MARIJUANAStatistically significant opinion polls, consistently point in favor of legalization of medical marijuana. Last year, a Gallop Poll showed that 85% of the respondents [of the poll] favored the legalization of marijuana for medical use. In Iowa, a recent survey by the Drug Policy Forum of Iowa reported support among Iowa legislative candidates at 44%, with 28% opposed and 26% undecided. Included in the Iowa weekly paper City View's report on the issue were the following comments by Iowa legislators: "I'm not convinced this is something the medical community wants," says Rep. Jeff Lamberti (R-Ankeny). "I don't see them saying this is something they need, and some are saying it does more harm than good." Rep. Robert Brunkhorst (R-Waverly) agrees, "I don't favor it. I think there are alternative drugs out there that are better suited than marijuana." Republican Senator Gene Maddox of Clive, while by no means endorsing marijuana, hasn't closed the door. "I'd be open to it on a restricted basis. But I have a lot of questions that need answered before I can make up my mind."THE FEDERAL GOVERNMENT ALREADY DISPENSES MEDICAL MARIJUANAOne confusing aspect of the debate surrounding the legalization of medicinal marijuana lies in what appears to be a hypocritical stance by the federal government. Research back in the 1980s caused the federal government to permit the use of medicinal marijuana for "compassionate relief", through a US Food and Drug Administration's Investigational New Drug Program, for patients who qualified and, in fact, provided them with the marijuana they needed. The program was been closed in 1991 by the Secretary of Health and Human Services. Today, however, the government still provides medicinal marijuana to eight patients, two of whom live in Iowa.In 1988, Barbara Douglass of Storm Lake, IA, began using marijuana supplied by the government to relieve her pain due to multiple sclerosis. George McMahon of Bode, IA, has Nailpattla Syndrome, which causes everything from pain and spasms to nausea, according to an article in Des Moines' City View (November 13). "All these generals and cops keep coming out and saying that there's no evidence that this [marijuana] works, but then why am I in this program? I'm evidence. There's people out there like me who need this," said McMahon.Obviously, cannabis had proved its efficacy enough to cause the government to act as a distributor. And this is not the first time our government has recognized the benefits of cannabis. Thirty-six states have passed legislation recognizing marijuana's therapeutic value.SCIENTIFIC RESEARCH ENDORSES MEDICAL BENEFITSMarijuana has been used for thousands of years to treat a wide variety of ailments. Marijuana was legal in the United States and prominent in the pharmacopoeia until 1937. Today, however, eight patients receive marijuana legally from the government; but for all other Americans who could benefit from its therapeutic value, it remains a forbidden medicine - until now. The passage of Proposition 215 in California, the Medical Marijuana Initiative, and proposition 200 in Arizona, the Drug Medicalization, Prevention and Control Act, are the first steps in amending this inequity.Contrary to popular belief, there have been hundreds of studies on the medical uses of cannabis since its introduction to western medicine in the mid-nineteenth century. The best established medical use of smoked marijuana is as an anti-nauseant for cancer chemotherapy. During the 1980s, smoked marijuana was shown to be an effective anti-emetic in six different state-sponsored clinical studies involving nearly 1,000 patients. For the majority of these patients, smoked marijuana proved more effective than both conventional prescription anti-nauseants and oral THC (marketed today as the synthetic pill, Marinol). For example, in a 1988 study by Dr. Vincent Vinciguerra published in the New York State Journal of Medicine, 78 percent of patients who had shown no improvement with standard anti-emetics responded favorably to marijuana. In addition, 29 percent of those patients who did not respond to oral THC did respond to smoked marijuana. Vinciguerra concluded that the results of the pilot study "demonstrate that inhalation of marijuana is an effective therapy for the treatment of nausea and vomiting due to cancer chemotherapy."Cheryl Miller, Jersey City, NJ, was diagnosed with Multiple Sclerosis in 1971 and has not been able to walk for over a dozen years. Her physician has prescribed numerous medications, including Merinol, with limited results. For Cheryl, smoking marijuana provides her with the most relief and allows her to live more comfortably. The same holds true for Douglass. She took Merinol and found it far too strong. "You took Merinol and Merinol took you," she said in an editorial in the Des Moines Register (December 5, 1996). Douglass claims the advantage to smoked marijuana is that she can regulate the dosage herself. Similar findings were noted in state-sponsored studies in New Mexico, Georgia, Tennessee, Michigan, and California. Currently, many oncologists are recommending marijuana to their patients despite its prohibition.In addition to its usefulness as an anti-emetic, there exists evidence - both scientific and anecdotal -- that marijuana is a valuable aid in reducing pain and suffering for patients with a variety of other serious ailments, and that it is less toxic and costly than the conventional (manufactured) medicines for which it may be substituted. For example, marijuana alleviates the nausea, vomiting, and the loss of appetite caused by the AIDS wasting syndrome and by treatment with AZT and other drugs without accelerating the rate at which HIV positive individuals develop clinical AIDS or other illnesses.This is not to say that all characteristics of AIDS respond favorably during marijuana therapy. According to a report in the LA Times (November 10, 1996), "studies indicate that for some HIV-positive patients, smoking pot can significantly worsen bacterial pneumonia. Even in a healthy person, short-term use can impair anti-bacterial defenses, while long term use has been known to cause neurological impairment." However, the legislation is specifically targeted for people with serious and/or terminal illnesses in order to provide some relief.It is generally accepted -- by the National Academy of Sciences (NAS) and others -- that marijuana reduces intraocular pressure (IOP) in patients suffering from glaucoma, the leading cause of blindness in the United States. This was first shown in a series of experiments by Robert S. Hepler of UCLA, stemming from research aimed at finding out whether marijuana dilated pupils. Hepler found a "statistically significant" drop in IOP in 429 subjects treated with marijuana or THC, 29 of which showed continued benefits during 94 days of treatment with no signs of tolerance. Currently, three of the eight patients who receive medicinal marijuana legally use it to treat glaucoma.There also exists historical evidence that marijuana is effective in treating a variety of spastic conditions such as multiple sclerosis, paraplegia, epilepsy, and quadriplegia. In the book, Marijuana: The Forbidden Medicine, Dr. Lester Grinspoon of Harvard Medical School describes several case histories of patients suffering from multiple sclerosis and other disorders, whose condition improved while they smoked marijuana and deteriorated after they stopped smoking. In addition, a number of animal studies have supported marijuana's ability to suppress convulsions. These studies specifically indicate cannabidiol, a non-psychoactive ingredient of marijuana unavailable in Marinol, to be a potent anti-convulsant. This latter fact was recently reaffirmed by the government's premiere marijuana expert, Dr. Mahmoud ElSohly of the Marijuana Project at the University of Mississippi, who stated during an interview with the Journal of the International Hemp Association that, "CBD [cannabidiol] is famous for [its] anti-convulsant activity." ElSohly concluded that, "There is no question about the use of cannabis for certain conditions. It does have a history. It does have utility."Marijuana is also used to treat those who seek relief from chronic pain. Historically, marijuana was used as an analgesic from ancient times through the nineteenth century. This usage declined with the introduction of faster acting and more potent, yet sometimes addicting, opiates such as morphine. However, anecdotal reports demonstrate that some patients currently receive their most effective pain relief from using marijuana. Limited scientific studies on nearly 100 patients have shown marijuana to be a potent analgesic.KILLER PAIN KILLERSIn Waterloo, IA, Allen Hemers uses marijuana on a daily basis to relieve chronic pain, the result of two accidents, the second due to a drunk driver who was given seven days in jail and eighteen months probation. The combined accidents caused Hemers a broken back (in five places), fourteen fractures in one leg, sixteen surgeries to enable him to walk, but leaving him with one leg significantly shorter than the other, which further aggravates his back condition, and Fibromyalgia, a condition that causes as much pain as Rheumatoid Arthritis. Traditional pain therapy would dictate that he use pain killers inevitably leading to addiction and high levels of toxicity that could eventually kill him.The natural side effects of these pain remedies are stomach bleeding and ulcerations, memory loss, impotence, to name only a few. Marijuana gives him more relief than the pain killers, and does not expose him to lethal levels of toxins. Yet, because of his efforts to relieve his pain, Hemers has experienced arrests, jail, probation, monetary fines and constant stress over his future. Thoughts of suicide are not uncommon for people like Hemers, who have no options inside the law and face incarceration, where no relief would be forthcoming for their ailments. Pain and nausea are the two most dreaded symptoms of illness because of the severe discomfort and debilitating effects.FACE THE FACTSEvidence in support of marijuana's medical value has existed for centuries and has been validated by numerous studies, researchers, committees, health organizations, and even the Drug Enforcement Agency's Chief Administrative Law Judge, Francis L. Young, who in 1988 declared marijuana to be "one of the safest therapeutically active substances known to man."In California alone, and contrary to claims by the opposition that no medical authorities endorse the legislation, two medical associations, The San Francisco Medical Society and the California Academy of Family Physicians, representing over 10,000 doctors have announced their support of the initiative for medical marijuana as useful and appropriate for various treatments. Also of great significance because it further validates the claims that marijuana has medicinal value, is the American Public Health Association's adoption of a resolution (7014) on Marijuana and the Law, which urges the federal and state drug laws to exclude marijuana from classification as a narcotic drug.Other Interesting Resources Concerning The Debate On Medical Marijuana: NORML's national web site: http://www.natlnorml.org/ Carl Olsen, Director of Iowa NORML, has put together one of the most comprehensive resources on the web concerning medical marijuana, legal cases and precedents, drug policies and more:http://www.commonlink.com/~olsen/ The 104th Congressional Record search page, where one can enter any subject, name or title and see what debates, statements, speeches and documents have been entered into the Congressional Record: http://thomas.loc.gov/home/r104query.html This is the full text of Rep. Frank's remarks to the Congress on December 14, 1995. In it he cites the American Public Health Association's stance on medical marijuana and places the criminalization of marijuana in its historical context: http://rs9.loc.gov/cgi-bin/query/1?r104:./temp/~r104b4iKThe home page and extensive resource of the Marijuana Policy Project, the only D.C. based marijuana law-reform movement with full-time, organized lobbying on the federal level:http://www.mpp.org