EXPERTS: MEDICAL MARIJUANA BEST AS PILL

Smoking Might Benefit Small Number of Patients

There's a lot of talk lately about giving Michiganders the right to
take a toke.

A state House bill legalizing medical marijuana is going nowhere this
month, but already there is a petition drive out of Eaton Rapids and
talk of a second to allow Michigan voters to legally light up.

It's fascinating politics, but is it good medicine?

Yes and no.

There is strong evidence that marijuana's main psychoactive
ingredient has a place in the modern arsenal of medicines. Smoking
it, though, hardly appears to be the best way to administer that
drug, experts say.

In fact, smoking delta-9-tetrahydrocannabinol, commonly called THC,
might be appropriate only for a few chronically ill patients who meet
specific criteria.

Local oncologist Dr. Anas Al-Janadi called smoking marijuana "a very
bad way to administer good medicine."

Al-Janadi, who treats cancer patients through the Michigan State
University Breslin Cancer Center, said he would never advocate
smoking weed for medicinal reasons.

"Even if the patient is terminal," he said.

Smoking, after all, is not the only way to medicate with THC. It is
available by prescription in pill form.

THC Helps Some

THC has been proven to reduce pain in some patients and to ease
vomiting in about 25 percent of those in chemotherapy, according to a
1999 report by the Washington, D.C.-based Institute of Medicine of
the National Academies. THC also shows promise in treating wasting
syndrome in AIDS patients.

But some other health claims are just that - claims.

Marijuana, for example, has been shown to reduce pressure in the eyes
of glaucoma patients, but the effect is short-lived and not worth the
drug's side effects, according to the institute report. THC, for
example, alters mood and can actually add to patient distress.

The debate shows no sign of waning.

Tim Beck is an insurance sales executive from Detroit who smokes
marijuana to relieve pain. It's legal in Detroit, Ferndale, Ann Arbor
and Traverse City, as long as the marijuana is smoked for medicinal
purposes and the user has proof his physician approves. In Detroit,
for example, police said they won't charge such a user even though
state law prohibits marijuana possession.

Beck wouldn't divulge the details of his illness, but he noted that
pharmaceutical-grade THC doesn't work for everyone.

"Everybody's metabolism is different," he said.

Available in Capsules

Synthetic THC is marketed in capsule form under the trade name
Marinol and comes in only three dosages, according to the U.S. Food
and Drug Administration.

It's approved for the treatment of severe weight loss in AIDS
patients, and nausea and vomiting associated with chemotherapy.

Its limited approval is cited as a civil liberties issue.

"Who should make decisions about medical health - the patients and
their doctors or government officials?" asked state Rep. Leon Drolet,
R-Macomb County.

His answer: patients and doctors.

As a doctor, though, Al-Janadi sees little point in advocating the
smoking of a substance that can lead to dependence and has been
proven to contain cancer-causing compounds.

"I had one patient who just swore that the only thing that helped him
was smoking marijuana," Al-Janadi said. "The guy was doing great with Marinol."

[sidebar]

MARIJUANA AND MEDICINE

. Active ingredient: The main psychoactive ingredient in marijuana is
delta-9-tetrahydrocannabinol, commonly called THC.

. Pharmaceutical grade: Synthetic THC is marketed under the trade
name Marinol. The U.S. Food and Drug Administration has approved
Marinol for the treatment of severe weight loss in AIDS patients, and
nausea and vomiting associated with chemotherapy.

. Benefits: THC has been shown to ease pain, stimulate appetite, and
control nausea and vomiting in some people. Its health benefits for
glaucoma patients, however, are too short-lived to make it an
effective treatment.

. Side effects: Like most any drug, THC has a list of possible side
effects, including temporary cognitive impairment, euphoria, anxiety,
paranoia, panic, depression, discontent, depersonalization,
delusions, and changes in heart rate and blood pressure. Some people
can develop drug dependence.

. Cancer link: There is no hard evidence that smoking marijuana
causes cancer. That doesn't mean there isn't cause for concern.
Certain phases of marijuana smoke contain more cancer-causing
compounds than regular tobacco smoke. Of note is the fact that when
people toke, they hold the smoke deep in their lungs for as long as
possible. That is one of the reasons many medical professionals
believe smoking THC is not the best way to deliver what can be a
useful medication.

Source - 1999 report by the Division of Neuroscience and Behavioral
Health with the Institute of Medicine of the National Academies in
Washington, D.C.