Denied a Liver Transplant for Using Medical Marijuana, and Dying for It -- The Heartlessness of Prohibition

The tragic fate of Norman B. Smith is all you need to know about to see how senseless it is to make consumption of marijuana a crime.

Photo Credit: Pablo Evans


After being diagnosed with liver cancer in 2009, Norman B. Smith applied to the liver transplant list at Cedar-Sinai hospital. While waiting for a transplant, Mr. Smith underwent chemotherapy in an attempt to destroy the cancer eating away at his liver. This caused severe side-effects, common to many cancer patients. In an attempt to curb the pain, and on the recommendation of his oncologist, Mr. Smith began using medical marijuana. Cannabis has become increasingly common as a medicine of choice for patients undergoing chemotherapy, since it increases appetite and reduces pain—minimizing the chance of a patient developing cancer related wasting syndrome. Finally, in September of 2010, Mr. Smith was notified that he was eligible for a liver transplant and was placed on the liver transplant list. Mr. Smith continued his treatment and submitted to drug testing per the hospital's transplant list policy. After testing positive for THC (one of the active chemicals in marijuana), Mr. Smith was taken off the transplant list and denied a life saving procedure. Mr. Smith died because of this. It did not matter to the hospital that Mr. Smith's marijuana use was non-recreational, and was approved by his oncologist as a way to treat his chemotherapy side effects.

This story is a more common than one might think. While working at NORML I received a call from a 19 year-old medical marijuana patient who had a rare liver cancer. This patient tried everything to control the pain and nausea that plagued her everyday. Pills, healthy foods,  acupuncture. . . nothing worked. In fact, many of the prescription drugs given to her by her doctor either worsened her nausea or caused other severe side-effects. Finally, she tried medical marijuana, which her oncologist said might be a good option if she could find a reliable source. She tried it, and it worked. After hearing about Mr. Smith, she became terrified that her marijuana use might jeopardize her chances of getting a new liver. How could this be possible? "I want my liver transplant, but I can't imagine living without my medicine, it would be too painful". Unfortunately, due to patient confidentiality laws, it is impossible to know how many people like Mr. Smith there are. But the number will continue to grow as marijuana continues to become an accepted treatment for cancer related pain and nausea. These are the human costs of the war on drugs.

Why do hospitals remove medical marijuana patients from their transplant list? One possibility is fear and ignorance. Cedar-Sinai claims that they remove marijuana users from transplant lists for two main reasons, that marijuana use may indicate a substance abuse problem (but taking high-powered and addictive pharmaceuticals does not?) and that marijuana may increase a user's chance of becoming infected with the aspergillus fungus, which may threaten the well-being of the transplanted organ. This theory is bunk and based on speculation, and a recent study featured in the American Journal of Tranplantation found that marijuana users are just as successful after a transplant as non-marijuana users. Another possibility is that hospitals are beholden to pharmaceutical companies who peddle dangerous drugs when there is a safe and affordable alternative; and marijuana remains illegal under federal law.

According to Dr. Lester Grinspoon, Professor Emeritus of Harvard Medical School, pharmaceutical companies oppose medical marijuana because "[they] cannot patent marijuana. . . [and] it will compete with their own products." And although marijuana has a long history of  medical use and thousands of years of validation, it is unable to win FDA approval because of the federal government's refusal to change the Controlled Substances Act, and reschedule marijuana out of its current Schedule I status. Schedule I drugs are defined as follows:

A) The drug or other substance has a high potential for abuse.

B) The drug or other substance has no currently accepted medical use in treatment in the United States.

C) There is a lack of accepted safety for use of the drug or other substance under medical supervision.

Any rational human being who has not been sleeping under a rock for the past 40 years recognizes the absurdity of classifying marijuana as a Schedule I substance, but efforts to reschedule it have been met with ignorance and special interest fueled political hacks who oppose anything that would re-think the fallacious state of drug policy in this country.

Even though several states have legalized the use of medical marijuana, the plant still remains illegal to possess for any reason under federal law. Doctor's who recommend the substance may also risk reprimand from the DEA, and although it has not happened, the revocation of a doctor's DEA license is a real possibility for those physicians that recommend cannabis to patients. The federal government's continued prohibition against cannabis is a hallmark example of capture by special interests.

Prohibition undermines the civil liberties of Americans, and creates an irrational and irresponsible environment. This environment causes hospitals to remove patients from transplant lists, causes employers to fire otherwise good employees, and has put tens of millions of Americans into the criminal justice system. This debate ended long ago. The real winner has already been declared. There is no rational reason for Marijuana to be listed as a Schedule I substance or to criminalize its possession, sale, or distribution. By upholding the status quo, politicians show where their true allegiance lies, with special interests and uninformed culture-warriors.

Matthew Donigian is a third year law student at the University of Illinois College of Law (graduating this May). Before starting this blog I interned as a student public defender for the Committee for Public Counsel Services in Boston, Massachusetts, and as a legal intern for the National Organization for the Reform of Marijuana Laws (“NORML”) where I wrote several articles for the NORML blog. My work has been cited in Reason and has been published in the Journal of Law, Technology and Policy’s “Timely Tech”. I am also the developer of the NORML Android application, and am learning more about web development at CodeacademyUdacity, and Coursera.

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