A VIRGINIA NURSE TAKES ON A TOUGH ISSUE: MEDICAL MARIJUANA

It has been reported to relieve muscle spasms in people with spinal cord
injuries, stave off blindness in glaucoma patients and prevent wasting in
those living with cancer and AIDS.

It might be a highly touted, widely used wonder drug, if it wasn't for one
significant drawback: In most states, it's illegal.

The branding of marijuana as an illegal substance, according to Mary Lynn
Mathre, is causing many people with chronic diseases to suffer needlessly
or secretly use the drug and live with the fear that they could lose their
job, home or freedom at any time. And that's why she's at the forefront of
a movement promoting patients' access to medical marijuana.

The Virginia Nurses Association member is calling on her health care
colleagues to convince policy-makers that marijuana can be the key to
enhancing certain patients' quality of life. But first she must convince
many of those same colleagues that marijuana should be viewed as an
acceptable palliative and preventive medication and not as a "gateway" drug
D one that leads to hard-core drugs like cocaine and heroin.

So far, only a handful of states have laws allowing the medical use of
marijuana, and only eight people still benefit from a now-defunct federal
program, called Compassionate IND, which gives them access to federally
supplied medical marijuana. (Seven of the original 15 program participants
have died from their illnesses.)

But times could be changing.

Mathre, MSN, RN, CARN, and Iowa Nurses Association member Melanie Dreher,
PhD, RN, FAAN, recently co-directed a historic national conference on the
medical use of marijuana attended by about 250 patients, physicians, nurses
and attorneys held at the University of Iowa and telecast to seven medical
centers in the United States and Canada. In addition, through Patients Out
of Time, an organization she started with her husband in 1995, Mathre has
won the support of several dozen health care organizations, including 10
state nurses associations and the American Public Health Association, which
endorsed position statements promoting the therapeutic use of marijuana.

And in a March 1999 report, the Institute of Medicine found that marijuana
has medical value and is not addictive nor a gateway drug, Mathre said.
There's even an oral prescription drug, Marinol, currently on the market
that uses the marijuana component "THC" in its formula, although many
people with severe nausea and vomiting prefer natural marijuana.

But the politics surrounding marijuana, which used to be prescribed as
"tincture of cannabis" six decades ago for a number of maladies, remains.

"There are sick people out there for whom marijuana has made a world of
difference, and a number are being monitored by physicians who are aware of
the use," Mathre said. Through her role in Patients Out of Time, she can
offer numerous examples of people who have benefitted from taking the drug
covertly or who are in government-sanctioned programs.

She recalled the case of a young mother who fractured her back after being
pinned between her car and a tree. "Her activities were limited because she
couldn't stand the pain, even though she was taking large doses of
narcotics," Mathre said.

Her only hope was further surgery. But before it was scheduled, the woman
began using marijuana medicinally -- only a few inhalations a day. When her
orthopedic surgeon and her pain management doctor saw her again, they were
impressed with her new-found mobility.

"Her quality of life was clearly different,' Mathre said. "She could do the
dishes and take long walks. She reduced her use of narcotics and was able
to do flexibility exercises to improve her back to the point where she no
longer needed surgery."

Another case involved a spinal cord injury patient with severe pressure
ulcers who needed skin grafts but suffered from severe spasticity, which
could compromise healing of the grafts. The only remedy he found that
controlled his spasticity was marijuana. One day, staff discovered him
smoking marijuana in the hospital parking lot, and their initial reaction
was to have him discharged. But their ultimate decision was to look the
other way if it meant the skin grafting would be successful.

For Mathre, health care professionals' continuing silence is the crime.

"We give meds that can kill people, or ruin their liver. We put in feeding
tubes for people who can't eat," she said. "We should be advocating for the
rights of a patient to use this medication if it's helping them."

Some may view Mathre's cause and her role as an addictions consult nurse at
the University of Virginia in Charlottesville as incongruous. But it's her
background -- first as a med-surg and critical care nurse and then as a
certified addictions specialist -- that has helped her understand the
connection between diseases and symptom relief, and the distinct difference
between dependence on a medication and addiction.

"People using marijuana to ease their symptoms generally don't become
addicted to it -- meaning that the drug isn't controlling every aspect of
their lives," she said. "Rather, medical marijuana use allows people to
live their lives more fully.

"Morphine, a highly addictive drug, is an excellent painkiller and is
successfully administered to patients without causing addiction. Marijuana,
on the other hand, is far less addictive, yet is prohibited. This is not
right."

Mathre is equally as passionate about her work in substance abuse
prevention and treatment.

Marion Kyner, MSN, RN, CS, describes her friend and former co-worker as
"fighting for people who can't fight for themselves -- poor people and
people who have addictions."

"Addiction is a brain disease," Mathre said. "In America, we've made
substance abuse a moral issue, a legal issue. In Europe, it is treated as a
public health problem."

In her role as an addictions consult nurse, Mathre sees anywhere from 15 to
20 patients a week who are referred to her by physicians, nurses and other
hospital staff.

"I would describe what I do as 'harm-reduction,'" Mathre said. "When
patients come into the hospital with pancreatitis, or trauma or a heart
attack, what the staff focuses on is the admitting diagnosis and not the
underlying cause." Mathre's job is to look beyond the diagnosis and help
patients see the connection between their unhealthy practices -- be it
smoking, alcohol abuse or narcotics addictions -- and their overall health.
Her job is a mix of roles: medical manager, social worker, psychosocial
therapist, patient educator.

With the bulk of referrals, she assesses for abuse, dependency and
addiction and then makes recommendations, which can include further
follow-ups on her part or referrals for treatment in the community.

For example, she might assess patients to see if they are "med-seeking." If
they are, she'll try to determine if the behavior is the result of
substance abuse or pain that hasn't been adequately addressed by health
care professionals.

She also helps other health care professionals better work with patients
who have addictions and are considered "difficult" and non-complying.

"Addiction and alcoholism have such a negative social stigma, and doctors
and nurses treating these patients are often influenced by the stigma,"
said Kyner. "Mary Lynn has confidence in herself. She knows her area of
expertise, but she's willing to listen to all sides before she says
anything. She's willing to understand the difficulties of the patient, and
she helps staff understand where the patient is.

"I also think she is one of the easiest people to work with, and she's a
very down-to-earth, flexible and empathetic person," Kyner said. "There
aren't many people out there doing what she does, and patients often don't
realize all that she does for them."

According to Marlene Bond, MSN, RN, chief clinical officer at the
University of Virginia, "Nursing staff know they can call on her at any
time, and they rely on her. Because of their own lack of knowledge or
biases, staff can have difficulty working with alcoholics and drug addicts.
Mary Lynn is a true patient advocate who educates house staff, physicians
and nursing staff in empathetic detox, and teaches them to regard these
patients as worthy individuals.

"She's very compassionate, but minces no words about what the disease is
and what the outcomes are when she's working with patients and their
families." Both Bond and Kyner are aware of Mathre's work in the area of
medical marijuana, but it's not common knowledge around the university.

"Mary Lynn doesn't talk about it (medical marijuana use) around patients.
You wouldn't even know this was her position," Kyner said. "She's an
activist, but not the type you'd see marching on Washington. She's an
activist on a personal level. She's gone to court to testify on the behalf
of people who use medical marijuana, and many of them have become her
friends. And she's respectful of other people's opinions on this issue."

Mathre, however, is known as an expert in the medical benefits of marijuana
in certain circles. She edited a book, "Cannabis in Medical Practice: A
Legal, Historical, and Pharmacological Overview of Therapeutic Marijuana,"
which was referenced in the 1999 IOM report and brings together other
experts in various fields and countries to tackle this subject.

"I think Mary Lynn is a role model for nurses in political action," said
Dreher, dean of the College of Nursing at the University of Iowa and a
long-time colleague of Mathre. "She's fighting a battle all the way on the
issue of medical marijuana, but she stays upbeat and undaunted. She's
definitely one of my heroes."

Dreher also has nothing but the best to say of Mathre as a person.

"When my son was graduating from the University of Virginia, we found it
impossible to find a hotel room. I remembered that Mary Lynn and her
husband ran a bed and breakfast, so I gave her a call. I also invited lots
of family and friends to stay with us -- and they all had to be in separate
rooms."

It wasn't until Mathre was giving her "guests" a tour of the house that
Dreher made a surprising discovery.

Said Dreher, "I mentioned to her that I thought running a bed and breakfast
was a great idea, and Mary Lynn said to me, 'Oh, we haven't done that in
years.' "She was so gracious about letting all these people stay at her
house. That's the kind of person she is."

Although Mathre can talk about the history and the politics of marijuana,
the main points she tries to get across hinge on patients' rights.

It goes to the reason behind the name of her organization "Patients Out of
Time."

"Patients don't have time to wait," Mathre said. "They need to be able to
use medical marijuana right now."

END NOTES

Working Toward A Better Night's Sleep

University of Florida College of Nursing Associate Professor Helene J.
Krouse, PhD, ARNP, RNCS, is leading a group of researchers to determine why
hay fever and allergic rhinitis symptoms worsen at night.

The Florida Nurses Association member specifically wants to see if there is
a connection between sleep cycles, allergy symptoms and cytokine levels
produced during sleep. Cytokines are hormone-like proteins produced by
various cells to help regulate the intensity and duration of the body's
immune response to allergens. They also help cells communicate with each other.

To help her in her research, she and her team received a $36,000 grant from
the American Academy of Otolaryngic Allergy Foundation.

"We know that asthma patients and people with allergies wake up at night,
because they can't breathe well," said Krouse, a certified otolaryngology
nurse practitioner and the first nurse to receive a grant from the
foundation. "It is not well understood why the nighttime swelling occurs."

Further, she said, "Allergic rhinitis affects about 40 million people each
year. It results in about $4.5 billion per year in estimated total direct
health care costs and 3.8 million missed work and school days annually."

Did You Know...that eight states have medical marijuana laws? Hawaii became
the first state to use legislation to decriminalize the use of medical
marijuana in June. The other seven states D Alaska, Arizona, California,
Maine, Nevada, Oregon and Washington D gained their medical marijuana laws
through ballot measures.