MEDICAL MARIJUANA DEBATES LIGHT UP:

Patients, Physicians Draw Line In The Sand

Legalizing the use of marijuana for medical treatments has followers and
detractors. At this time, the issue is rife with tangled information, with
both sides using the same studies to prove their conflicting points. Even
as words fly, an upcoming U.S. Supreme Court decision due soon may finally
settle some of the dust.

Still, new drugs in the pipeline might have a big impact in the future.
Among them, an arm patch or inhaler might deliver marijuana's chief
ingredient medicinally.

If that sounds odd, then consider a typical pharmacy line. Today it is
common for patients to present prescriptions for Allegra or Viagra. If
pro-medical marijuana forces prevail in court, patients might be able to
hand over a script for marijuana cigarettes, commonly known as "joints" on
the street trade.

At least, that is the picture a growing community of patients, physicians
and pundits would paint.

POT HANDLES

Leading champion on the pro side of the issue is author Lester Grinspoon,
MD, professor of psychiatry emeritus at Harvard Medical School, and
chairman of the National Organization for Rational Marijuana Legislation
(NORML) Foundation. "The future of cannabis as a medicine is assured," he
said. Currently he maintains a web site, rxmarijuana.com, which contains
supporting data from patients and doctors.

Marijuana will eventually be considered a wonder drug, Grinspoon told
ADVANCE. "After three years of intensive study, I have come to conclusion
that smoked marijuana is less harmful than alcohol or tobacco."

Marijuana--known by a plethora of slang names like pot, weed, Buddha and
reefer-is a green-gray plant, which is often smoked. Experts believe the
active ingredient in marijuana, or cannabis as it is also known, is THC,
also known as delta-9-tetrahydrocannabinol. Marijuana induces a euphoric
high in a smoker and may have some health benefits to counteract any
perceived hazards.

Anecdotal evidence indicates cannabis may have the following medicinal values:

. Reduces nausea, . Stimulates appetite in wasting patients, . Reduces eye
pressure in glaucoma patients, . Reduces pain, . Steadies spastic muscles,
and . Helps prevent seizures.

However, there are dangers accompanying the smoking of the drug, according
to 1997 and 1999 studies by the Institute of Medicine (IOM). Perils include:

. Throat and lung cancer, . Disrupted short-term memory, and . Suppressed
immune defenses, causing chronic bronchitis.

IOM's studies concluded marijuana probably causes too many reactions in the
body to be prescribed safely. Marijuana is hazardous for long-term use and
its medical benefits are not entirely proven, IOM stresses.

JOINTS FOR AILING JOINTS

Grinspoon contests those allegations. "This drug is not nearly as toxic as
the U.S. government would have you believe," he said. "It is remarkably
non-toxic drug. There has never been a death recorded due to marijuana,"
Grinspoon asserted. "It will be an inexpensive medicine, possibly as low as
one dollar per marijuana cigarette. Lastly, it is versatile. Like
penicillin, it is able to treat a great many conditions."

George McMahon, a long-time medical marijuana patient, agrees with that
assessment. The Lake Palestine, Texas, man suffers from Nail Patella
Syndrome, a rare genetic disorder that causes joints to be malformed or
missing at birth and to degenerate prematurely.

McMahon was born without kneecaps, and medical marijuana allows him moments
of pain-free existence. "Without marijuana I wouldn't have a quality of
life," he said. For example, he can mows his small lawn over the course of
a couple days when he uses marijuana. "I talk to everyone and try to
explain this."

Currently, he smokes 300 marijuana cigarettes a month and claims the
treatment is legal. His doctor petitioned the federal government and
eventually won the right for him to receive a monthly dosage. He was the
fifth of 15 patients approved, and currently one of eight remaining. Since
patients in the program are considered terminal, many have died since their
enrollment.

"I believe marijuana is the drug needed by a large portion of people using
pharmaceuticals like synthetic THC and pain relievers," he said. "It is a
wonderful medicine."

Any discussion about legalizing cannabis brings challengers to the
foreground. Among the staunchest anti-legalization advocates are the
Partnership for a Drug-Free America and the White House.

HE DIDN'T INHALE

The Office of National Drug Control Policy in the White House advises the
President about drug-related concerns. Because marijuana has a high
potential for abuse and a lack of accepted medical use, the executive
branch opposes the use of "marijuana outside of authorized research,"
according to materials outlined in the 2001 national drug control strategic
report.

White House officials, under President Clinton, advised states considering
medical marijuana ballot initiatives to counter such moves on the basis
that legalizing marijuana would "undermine the scientific process for
establishing safe and effective medicines."

In a recent Rolling Stone interview, Clinton said he personally favored the
legalization of use and sale of small amounts of marijuana.

McMahon bristled at Clinton's public comment. His lack of interest in the
topic or action during his eight years in office is not easily wiped away,
he said. More people have been arrested for using marijuana under Clinton
administration than any other president, and words will not change the
past, he added.

Debate could come to a head in U.S. Supreme Court this summer, when the
case of the federal government versus an Oakland cannabis cooperative will
be heard. The issue is the California Proposition legalizing medical
marijuana against the current federal policy forbidding sale and use of the
drug.

WEED WAR

Another bone up for grabs is a definitive interpretation of the IOM reports
which note: "Until researchers develop a safe and effective delivery
system, caregivers must consider the health problems that can result from
smoking when deciding whether to recommend marijuana to patients."

Still, the reports concede: "The adverse effects of marijuana are within
the range of other tolerated medicines."

Both sides have declared the reports a victory and added them to their list
of cited materials. NORML claims the studies verify the drug's utility as a
treatment. The IOM could not be reached for clarification.

Although he stresses that his role is as a patient telling his story,
McMahon agrees with NORML's interpretation. "It is good medicine and the
IOM says it is."

By sharp contrast, the White House, citing the IOM report, is promoting the
concept marijuana has no future as a medicine. "I'm not sure where the
legalizers are getting this information out of this report," said White
House spokeswoman Jennifer de Vallance. "The report concluded marijuana has
harmful toxins and does not meet dosage requirements." Furthermore, the
availability of Marinol(R), a synthetic formulation of THC, makes arguments
over smoked marijuana irrelevant.

Marinol marks another battleground. Marinol, marketed by Unimed
Pharmaceuticals, has been touted by a number of anti-marijuana groups as a
perfect treatment. The drug has received FDA approval as an appetite
stimulant for HIV/AIDS patients and as an antiemetic to stem nausea and
vomiting associated with cancer chemotherapy (See sidebar).

As on other issues, the sides divide evenly about Marinol. The FDA and the
White House tout it as a middle ground, a safer solution than outright
legalization. However, marijuana advocates do not agree.

NO QUARTER GIVEN

Grinspoon feels, while it can help, Marinol pales when compared to its
natural predecessor. "Marinol is not nearly as useful as whole, smoked
marijuana," he said.

Some, like McMahon, have concerns about its origin as well. "I do not
believe it is even part of the answer," he said. "It is a synthetic drug.
Some people get no effect; some are completely disoriented. It is just not
the same."

Chiming in on the side of continued scientific exploration, the American
Medical Association (AMA) does not currently advocate legalization. In a
position statement on the topic, the organization notes one key component
to patient care is the free exchange of information, including that about
alternative treatment options, without the threat of criminal sanctions.

"Adequate and well-controlled studies of smoked marijuana must be conducted
in patients who have serious conditions for which pre-clinical, anecdotal,
or controlled evidence suggests possible efficacy," noted the AMA paper.

AMA officials have urged the National Institutes of Health to spearhead the
effort, by facilitating grant applications and conducting well-designed
clinical research. Studies should focus on the creation of a smokeless
delivery system to reduce the health hazards involved.

The AMA plans to discuss the issue further at its annual meeting in June.

FUTURE SHOCK

Medical marijuana's future remains uncertain. The federal government will
likely continue on its opposition path unless or until the Supreme Court
ruling countermands the current regulations. Similarly, legalization
supporters will explore every angle of attack, hoping for a breakthrough.

Marijuana patches, pills or inhalers could signal a compromise between full
or medical legalization and absolute denial of the drug to patients who
claim its benefits far outweigh its health risks.

Grinspoon, in a Boston Globe OP-ED piece, foresaw one possible future
outcome. He proposed a system where the pill and patches and other
alternative delivery devices will be available. However, for patients who
need it, he would still like to see the actual cannabis plant be made
available, free of legal ties.

"Medical marijuana is here to stay. The question is what form it might
take," Grinspoon said.

Shawn M. Proctor is an ADVANCE editorial assistant.