SMOKE SCREEN

Hypocrisy About Addiction And Pain Control Keeps Medical Marijuana
From Needy Patients

This is a story about cancer. What is unusual are the parties
involved. The cancer patient was a nurse, her daughter a toxicologist
and her son-in-law a pharmacologist. Unfortunately, this combined
body of medical experience could do nothing to alter the course of
this fatal disease, which is the second-leading cause of death in
this country. What it did do, however, was allow the three of us to
understand better than most what the treatment, the side effects and
inevitable conclusion would be.

This story began when my mother-in-law, a robust 76-year-old who was
still working as a head nurse in a nursing home near Washington D.C.,
was diagnosed with lung cancer. She was treated at Georgetown
University Hospital by one of the country's pre-eminent oncologists.
During surgery, doctors determined the cancer had spread, and she was
given radiation and chemotherapy.

The therapy took its usual toll. She lost her hair, her appetite and
wasted away to 87 pounds. Because I had extensively researched THC
(one of the active ingredients in marijuana), and related topics for
my masters', doctoral and post-doctoral theses, I was acutely aware
of the anecdotal reports that marijuana could stimulate appetite and
reduce nausea. My six years of research convinced me that marijuana
was the safest therapeutic agent known to man.

Convinced of marijuana's safety, my wife and I suggested that my
mother-in-law smoke some. She had no moral objection because she had
smoked marijuana at Harlem jazz clubs in the 1920s while in nursing
school. She was, however, reluctant, fearing it might interact
unfavorably with the other drugs she was taking.

Fortunately, her doctor was one of the 50 percent of oncologists who
recommend marijuana to their patients. (Seventy percent say that they
would recommend it if it was legal).

When she smoked the marijuana, her spirits lifted immediately and she
developed a ravenous appetite. There is no question that the drug
enhanced her last weeks at home. Our only regret is that she did not
use it sooner.

The only drugs I have seen act as quickly and effectively are
narcotic painkillers such as morphine and Demerol. But, at what cost?
With prolonged use, a person might need higher and higher doses to
get the same relief. Yet, too high a dose can cause a dangerous
slowing of breathing or even coma.

So the usefulness of these drugs is limited. This dilemma is usually
put to the family in the form of a euphemism: "Do you want the
patient to be pain-free?" In an attempt to accomplish this, the dose
of morphine or Demerol is continually escalated.

This practice is known in hospital circles as "snowing." The patient
takes a higher and higher dose until she can no longer metabolize the
drug. A less polite, but no less ethical term, is euthanasia. In my
mother-in-law's case, the high doses of morphine were a far better
end than drowning in her own fluids because of the lung cancer.

While some right-to-life advocates might have a problem with this
practice (until it is a member of their family), I see it as a
compassionate course of action although it is technically illegal. If
such compassionate acts occur in hospitals every day, why has the
Supreme Court (which has successfully avoided the subject of this
type of euthanasia) decided to prevent the medical use of marijuana
by needy patients?

The court's recent ruling was based on the Controlled Substance Act
of 1970. The act classified marijuana as a Schedule I drug, which
presumed that it had "no currently accepted medical use" and "a high
potential of abuse." This is in spite of findings by the Institute of
Medicine of "potential medical benefits in the active ingredients of
marijuana." Nonetheless, the National Institute of Drug Abuse stopped
all research on marijuana in 1980.

It is impossible to determine marijuana's benefits if scientists
cannot study it. Addiction researchers have long placed its addiction
potential far below that of alcohol and nicotine, which are
responsible for 500,000 deaths each year. In fact, the addiction
potential of marijuana is most similar to that of caffeine.

Implicit in the Supreme Court's decision was the assumption that
federal laws concerning marijuana preclude its prescription by
doctors. There are federal laws against the possession and/or
manufacture of cocaine, methamphetamine and opium -- although all are
available by prescription. It also fails to address the fact that
after alcohol and cigarettes, cocaine and methamphetamine are two of
the most dangerous and debilitating drugs abused in our society. Only
those profiting from the war on drugs would categorize marijuana with
them. Such a categorization is responsible for 600,000 arrests per
year for marijuana violations.

If the judiciary, law enforcement and most legislators are opposed to
the medical use of marijuana, and scientists are prohibited from
studying it, who is in favor of it? Only the people. Voter
initiatives in seven states and legislators in two states have passed
laws allowing doctors to prescribe it. Nationwide, 75 percent of
those polled favor the medical use of marijuana.

Some believe that medical use of marijuana is a moot point for debate
now that THC is on the market in a synthetic marijuana called
Marinol. They are mistaken. It was my dream to see this compound
reach the marketplace. Now, however, I am ambivalent concerning this
development.

THC was first evaluated for appetite-stimulating and anti-nausea
effects because of anecdotal reports of such effects among pot
smokers. Equating THC with marijuana, as well as changing how it is
consumed, is less than good science. This may account for the
arguably meager clinical activity of Marinol. In controlled studies,
patients given Marinol had an appetite improvement that was only 50
percent better than those given a placebo. With weight gain and
nausea reduction, there were no significant differences between
Marinol and a placebo. Better studies would have compared smoked
marijuana with oral and/or smoked Marinol.

A pharmaceutical company is unlikely to conduct such a study because
there is no profit in marijuana because it is a natural product and
can't be patented.

Finally, one can only hope that, when cancer strikes the homes of
those opposed to medical marijuana, they avail themselves of the 50
percent of oncologists who do not recommend it. Otherwise, they will
become the worst kind of hypocrite -- those who would impose
suffering on others while seeking solace for themselves. Of course,
watching a loved one vomit to the point of causing a hernia might
cause them to re-evaluate their unfounded opposition to medical use
of marijuana.