SUPREME COURT RULING UNDERMINES MEDICAL USE OF MARIJUANA

Some physicians applaud while others bemoan the recent ruling, but
all agree: More research is needed.

Washington -- There's no question that the U.S. Supreme Court's May
14 decision on certain legal questions related to the medical uses of
marijuana represents a setback for the drug's proponents, who believe
its use helps ease some of the distress of seriously ill people.

Although the ruling didn't strike down the nine state laws that allow
medically needy patients to obtain the drug without fear of state
prosecution, it did set up other obstacles.

For instance, patients in California will have to find other ways to
obtain their marijuana than from the cannabis buyers' clubs shut down
by the court's ruling.

The California Medical Assn., which supports its state law, was
disappointed with the decision. "CMA's interest in this issue is
rooted in the core belief that patients should not suffer
unnecessarily when other options fail," said Frank E. Staggers, MD,
president of CMA.

Physicians will have to continue to be very watchful when advising
seriously ill patients of their treatment options that they don't run
afoul of federal drug laws.

"We had hoped that, at least for a small subset of patients [for whom
marijuana use is a medical necessity], physicians could feel freer
with their discussion," said Alice P. Mead, a consulting attorney for
CMA.

As it stands now, there is a gray area, she said. Physicians can't be
sure when they have gone beyond the area of protected speech and into
the realm of what is illegally aiding and abetting a patient to get
marijuana.

"Some physicians understandably want to keep well clear of the gray
area and the sanctions that could result," she said. Among the
sanctions are loss of a license to prescribe controlled substances
and exclusion from the Medicare and Medicaid programs.

Although the AMA did not take a position in the Supreme Court case,
the AMA's Council on Scientific Affairs has submitted a report on the
medical uses of marijuana for this month's Annual Meeting in Chicago.

The report will update the AMA's 1997 report, which was written
before the state measures were passed and an Institute of Medicine
report on the subject was released. The AMA report will examine those
recent activities and will also re-examine the issue of the
compassionate use of the drug, according to council staff.

The Ruling

In United States v. Oakland Cannabis Buyers' Cooperative et al., the
Supreme Court unanimously upheld the federal government's right to
close an Oakland, Calif. buyers' cooperative. The cooperative was
established under the state's Proposition 215 to supply marijuana to
more than 8,000 patients who use the substance for a range of medical
reasons.

The drug has been credited with relieving pain and muscle spasms,
stemming the nausea that can accompany chemotherapy and stimulating
patients' appetites.

However, the Supreme Court found that the federal Controlled
Substances Act, which classifies marijuana as a Schedule I drug,
contains no exception that would allow patients to use the drug after
exhausting all other remedies. And although the passage of related
state laws removed the threat of state prosecution for patients who
use the drug, the threat of federal prosecution continued to exist.

It is unlikely that the U.S. government will begin to prosecute sick
individuals who use small amounts of the drug. However, cannabis
clubs, which were started all over California as a distribution point
for the drug, represent a larger target.

What the court's ruling means in the other eight states that do not
rely on clubs to distribute the drug is unclear. Some of those states
allow patients to grow a few marijuana plants for their own use while
shielding them from state prosecution.

That's the case in Oregon. John Benson, MD, dean and professor
emeritus of medicine at Oregon Health and Science University in
Portland, said he would like very much to know how the court's
decision affects his state. More than 2,000 patients in Oregon carry
cards issued by the state health department on the recommendation of
their physicians. The cards protect them from state arrest for
growing and using a small amount of marijuana.

Maine voters also passed a ballot initiative as well as an amendment
to the law that would establish a state-sanctioned distribution
system for patients to obtain the marijuana, said Gordon Smith,
executive vice president of the Maine Medical Assn.

The Supreme Court decision is likely to cause Maine officials to have
second thoughts about the wisdom of establishing a state-run
distribution center, said Smith. "While the Supreme Court decision
doesn't technically strike down the state law, I think it will
clearly have a chilling effect on the willingness of physicians and
law enforcement agencies to take our law any further than it goes
now," he said.

Unlike the California Medical Assn., the Maine Medical Assn. had
opposed passage of its state marijuana initiative. "We are lawyers up
here," said Smith, "and we said all along that this won't work
without the federal government being a player at the table; obviously
the court decision bears us out."

Research Needed

Many physicians, however, worry that the legalization of marijuana
for medical reasons could represent the camel's nose under the tent
and would soon be followed by the legalization of the drug for
everyone.

Eric Voth, MD, chair of the Institute on Global Drug Policy,
applauded the Supreme Court's decision. "The ballot initiative is a
scam that seeks to legalize marijuana by popular vote, rather than
through scientific research," he said.

Melvyn Sterling, MD, who directs a California hospice, thinks the
decision will have a dampening effect on the already scant research
under way on the medical uses of marijuana.

Although anecdotal evidence suggests that marijuana is helpful to
patients, the science-based evidence is not available, he said.

The 1999 IOM report on marijuana's therapeutic possibilities, on
which Dr. Benson served as the co-principal investigator, also
concluded that clinical research was lacking. The study found
excellent research at the basic science level, said Dr. Benson, but
not on the clinical level.

There are several legal drugs in use that work for some patients.
One, Marinol, manufactured by Unimed Pharmaceutical Inc., contains a
synthetic version of an active ingredient in marijuana.

In addition, there are a scattering of researchers searching for an
effective delivery mechanism for marijuana that doesn't involve
smoking the drug. British researchers are now conducting clinical
trials on extracts from the whole marijuana plant packaged as a
pharmaceutical. GW Pharmaceuticals is hoping to gain approval for its
drug in 2004.