DEBATE SWIRLS OVER MARIJUANA AS MEDICINE

SPRINGFIELD - Brian Fitzgerald doesn't think the law wants to throw a
wheelchair-bound, half-blind father of three like him into jail, but he's
still wary about where or when he smokes his pot.

``Without this stuff, my limbs cramp up so much I can't roll myself to the
bathroom,'' said the 53-year-old multiple sclerosis sufferer, puffing on a
marijuana pipe made from a chicken's claw. ``So I risk being evicted or
busted just to be able to get to the john.''

Fitzgerald is one of thousands of Bay State residents who inhale marijuana
day upon day for what they insist are medicinal reasons.

Desperate to stave off the pain or sickness of MS, chemotherapy, glaucoma,
asthma, migraine headaches and other ailments, they cooperate in a vast
illicit network, risking prison and profession to acquire their
controversial ``herbal remedy'' - a substance the federal government
rejects as a prescription medicine and classifies as a narcotic on a par
with heroin.

This medicinal marijuana underground, the Sunday Herald has found, includes
grandparents and teenagers, old-line hippies and hardline Republicans,
caregivers and cops, folks who can't walk and folks who run marathons.

All insist that pot is a maligned miracle drug that allows the ailing to
eat, sleep and breathe, to get to work or just get through the day.

All are scorned by antidrug forces, ranging from the U.S. Justice
Department to neighborhood crime groups, as lawbreakers with illegitimate
claims to pot use.

And all are eager for March, when the U.S. Supreme Court will weigh for the
first time whether ``therapeutic smokers'' of marijuana can employ the
so-called medical-necessity defense to contest federal and state drug charges.

``Federal authorities must rescind their prohibition on medical usage of
marijuana for seriously ill patients, and allow physicians to decide which
patients to treat,'' said Dr. Jerome P. Kassirer of Weston, former editor
of the New England Journal of Medicine and one of many physicians who have
come to support marijuana's potential as a therapeutic drug.

``The government should grow it and oversee its distribution,'' said
Kassirer, who now teaches clinical medicine at Tufts, ``and doctors should
prescribe it, but only to the very sickest people.''

Yet even as the medical community begins to endorse marijuana's potential
as a pharmaceutical drug - in 1999, the conservative National Academy of
Sciences in Washington said ``marijuana's active components are potentially
effective in treating pain, chemotherapy-induced nausea, anorexia from AIDS
wasting syndrome, and the involuntary spasticity associated with MS'' -
opponents are firm in their determination to block the drug's
decriminalization for medical uses.

``All these attempts to legalize marijuana for medicinal purposes are part
of an indirect means of achieving total legalization of the drug,'' said
William T. Breault of the Main-South Alliance for Public Safety in
Worcester. Breault points to studies stating that regular use of marijuana
damages the human brain, immune system, reproductive organs and lungs.

``Even more important,'' Breault added, ``the message being spread
concerning the so-called medical use of marijuana is very effective
advertising to convince kids that marijuana is not harmful. This
advertising is many times more effective than those `Joe Camel' ads by the
tobacco companies, which lured children to smoke tobacco.''

Despite the passion of anti-pot forces, it has become clear that in
Massachusetts, as in many other states, an enormous amount of civil
disobedience is under way among citizens who have turned to pot out of
desperation and come to believe it has a bum rap.

These self-avowed lawbreakers include prominent liberals like Stephen Jay
Gould, the Harvard scientist and author, who used pot during abdominal
cancer treatment, and Kareem Abdul-Jabbar, the basketball legend, who says
pot helps him stave off migraines.

``Marijuana was the greatest boost I received in my treatment,'' Gould
said, ``and the most important effect on my eventual cure.''

Other illicit users include prominent conservatives like Lyn J. Nofziger,
the former Reagan administration aide, who says he obtained black-market
pot for a teen daughter with lymph cancer, and Richard Brookhiser, senior
editor of National Review, who ``had to become a criminal'' to find
marijuana while enduring harsh chemotherapy for testicular cancer.

``I am for law and order,'' said Brookhiser, who added that his doctors
knew many patients who used pot to subdue nausea or recover hunger during
cancer treatment. ``But crime must be fought intelligently. The law
disgraces itself when it harasses the sick.''

Although there has been little controlled testing of the medical efficacy
of marijuana in recent decades, advocates on both sides insist that some
formal studies and hard science bolster their views.

According to George Biernson of Woburn, a retired engineer and author of a
self-published treatise, ``Dispelling the Marijuana Myth,'' pot ``is more
dangerous than heroin, cocaine, alcohol or tobacco'' because its key
psychoactive ingredient, delta-9-tetrahydrocannabinol, or THC, stays
``stored in fat cells'' long after it is smoked.

``We have seen that marijuana badly damages immune systems,'' Biernson
said. ``How can we justify telling unfortunate AIDS patients they should
smoke marijuana to lessen their pain? Instead we should be shouting out:
`With your weakened immune systems, you should consider marijuana to be the
worst form of poison!' ''

And Gen. Barry McCaffrey, the drug czar under President Clinton, belittled
medical marijuana during his tenure, saying: ``The argument that this
chemical needs to be smoked doesn't make sense.''

But two Harvard professors, Lester Grinspoon and James B. Bakalar, an
associate professor and a lecturer in law, respectively, in the Department
of Psychiatry at Harvard Medical School, are among the outspoken backers of
marijuana's medical potential. In their 1997 book, ``Marijuana: Forbidden
Medicine,'' they write: ``After carefully monitoring the literature for
more than two decades, we have concluded that the only well-confirmed
deleterious physical effect of marijuana is harm to the pulmonary system.''

They add that weighed against ``the overwhelming anecdotal evidence''
suggesting that pot helps mitigate glaucoma, migraines, uncontrolled
spasticity and other tortuous conditions, it is wrong for the federal
government to disallow studies of a drug ``known to help sick people feel
better.''

``Driven by its harmful `war on drugs,' '' Grinspoon said, ``the government
evidently fears that as more people gain experience with cannabis as a
medicine, they will see for themselves that its toxicity is greatly
exaggerated and its medical utility badly undervalued.''

So far, the nationwide stirring of civil disobedience among furtive
medicinal pot users has led to a modest groundswell at U.S. ballot boxes.
Nine states - Alaska, Arizona, California, Colorado, Hawaii, Maine, Oregon,
Nevada and Washington - have laws that protect medicinal marijuana users
from state prosecutions.

Generally, state initiatives allow people with small amounts of pot, and a
doctor's letter stating that they benefit from its use, to cite ``medical
necessity'' if they are seized on local drug charges.

But none of the state laws can deter federal prosecution. Washington
refuses to let the states provide pot to residents unless the product comes
from the National Institute on Drug Abuse, and that agency has declined to
make medicinal pot available to local health officials since 1986.

The net result is that anyone growing or otherwise procuring marijuana for
medicinal use faces federal arrest and imprisonment. Any physicians who
formally prescribe it can be stripped of the federal licenses they need to
dispense legal pharmaceutical drugs.

This conflict between federal and state laws came to a head last fall in
California. A group called the Oakland Cannabis Buyers' Cooperative, which
was set up after the state approved the growth and distribution of
medicinal pot, was enjoined by the Clinton Justice Department from selling
the drug to users bearing doctors' notes, despite what the state law said.

The U.S. Court of Appeals for the 9th Circuit reversed, saying there ought
to be a common-law medical necessity defense. In addition, U.S. District
Judge William Alsup ruled physicians could ``recommend'' marijuana to
patients without fear that federal authorities would strip their licenses.

The Justice Department appealed to the U.S. Supreme Court, which will hear
arguments March 28. Proponents hope that the high court will reconcile the
fact that more and more states, including Massachusetts, want to make pot
available to sick people, while the federal government does not.

Just such a lawful prescription is the hope of Maureen Blake, 53, of
Webster, an avowed daily medical pot user who qualifies for federal
disability for arthritis, depression and eating disorders.

``I'm tired of being made into a criminal to get the only medicine that
works for me,'' she said. ``And I'm sick of being prescribed costly
narcotics that make me ill when a bit of cheap pot makes me well.''