SUPPORTERS OF MEDICAL MARIJUANA BILL CONCEDE PROBLEMS

The Law Doesn't Say Where the Marijuana Will Come From, but It's
Understood That It Will Be Obtained Illegally From Drug Dealers, or
Grown From Seeds Obtained Illegally.

The medical marijuana law that passed yesterday allows doctors to
recommend that patients obtain from illegal sources a drug of unknown
potency and unknown purity.

This is not how doctors normally prescribe treatment.

But if the longstanding support of the Rhode Island Medical Society
is any indication, many are willing to go this route -- because of
the potential benefits to patients who can't get relief from pain,
nausea, muscle spasms and other problems.

Even supporters of the concept, however, admit that it's "weird."

Under the new law, a doctor, a nurse practitioner or anyone else
permitted to write prescriptions can sign a statement attesting that
"the potential benefits of the medical use of marijuana would likely
outweigh the health risks" for a patient with a "debilitating medical
condition."

With this certification, the patient can apply for a card from the
Health Department that prohibits prosecution by state authorities for
growing or possessing marijuana. (Under a U.S. Supreme Court decision
earlier this year, however, the federal government can prosecute.)

The law doesn't say where the marijuana will come from, but it's
understood that patients or their caregivers will get it illegally
from drug dealers, or grow it from seeds obtained illegally.

"It's a weird concept, isn't it?" said Dr. Margaret A. Sun, president
of the Rhode Island Academy of Family Physicians, who testified in
favor of the law before the General Assembly. "I'll give them a
letter that it's OK for them to use medically, and then they're going
to some alleyway and buy it on the street."

Before the law is put to use, the Health Department must write
regulations. Sun hopes the regulations will provide some safeguards.
Sun also is concerned about not knowing the strength or purity of the
marijuana that patients may obtain. But she calls the law "a step in
the right direction" for those who don't have an alternative.

Dr. Robert S. Crausman, chief administrative officer of the state
Board of Medical Licensure and Discipline, disagrees. "It raises a
world of issues for us," he said. "Our statute says it's
unprofessional conduct to violate federal law. To create another law
that allows doctors to violate federal law . . . puts our board in a
very awkward circumstance.

"What other medications do doctors prescribe in this fashion?" said
Crausman, who practices medicine part-time, specializing in lung diseases.

If a patient of his requested a medical certification to obtain
marijuana, Crausman says he would probably decline because he
wouldn't know where they were getting the marijuana plants. "I don't
tell my patients on digoxin to take foxglove tea. . . . Aspirin comes
from bark. When was the last time you took bark for a headache?"

In a 1999 review of medical marijuana, the Institute of Medicine of
the National Academy of Sciences concluded that the active
ingredients in marijuana had "potential therapeutic value" for pain
relief, control of nausea and vomiting, and appetite stimulation. But
it called smoking marijuana a crude way to deliver the medication,
and one that also delivers harmful substances. Other than the hazards
of smoking, the institute concluded, the side effects of marijuana
are no worse than those of other medicines.

The new Rhode Island law allows marijuana use for cancer, glaucoma,
HIV infection, AIDS, hepatitis C, or any condition causing wasting,
chronic pain, severe nausea, seizures or muscle spasms.

Crausman acknowledged that marijuana contains "wonderful active
ingredients," but he wishes they were available through pharmacies in
a purified, regulated form. Meanwhile, he said, effective drugs are
available for every condition and symptom that marijuana is said to
treat -- including a pill containing the chief active ingredient in the plant.

But that pill often doesn't work because the drug isn't well-absorbed
through the stomach. And many doctors and patients say that the
existing medications don't work for everyone.

Sun, the family physician, said that her sister, who suffers from
multiple sclerosis, smokes marijuana to relieve the muscle rigidity
that sometimes makes her fall. "She'll take a puff or two of pot,
wait 15 minutes, and get her muscles able to move more easily," Sun said.

"She's on a lot of medications, including muscle relaxers," Sun said.
"They're very sedating. They work well, and eventually you become
tolerant so you don't fall asleep. Then they don't work as well. . .
. She finds that this is something that works well, works quickly and
doesn't sedate her."

Among the patients in her East Providence practice, Sun said she
doesn't have anyone she believes would benefit from smoking
marijuana. "I'm sure there'll be people asking me for it," she added
with a laugh. But doctors already face drug-seeking patients who want
prescriptions for legal narcotics, she said.

Dr. Thomas A. Bledsoe, an internist who is interim director of Brown
Medical School's Center for Biomedical Ethics, called the new law "an
unsatisfactory solution." But he said he might make use of it for
certain patients, after explaining the risks and unknowns. "Patients
who are competent have decision-making capacity," Bledsoe said. "I
see my job as giving them advice and giving them information."

In terminal cancer patients, Bledsoe said, "The symptoms that
[marijuana] can help with can be very nasty, very interfering with
normal life. We're talking about the rest of their life, and it's
short. Quality of life is very important."

Diane Lipscombe, a professor of neuroscience at Brown Medical School
who studies the biology behind chronic pain, said that the classic
drugs for pain relief simply don't work for millions of people.

Marijuana contains substances called cannabinoids that are also
produced naturally in the body, just as the body produces natural
opiates, she explained. The two substances work together in the brain
to numb pain. Cannabinoids may enhance the effect of opiates, and
they are of particular interest because they also affect peripheral
nerves, not just the brain, she said.

"There are millions of people who have no effective treatment for
pain," said Lipscombe. "All I can say is, anything that can help
people who are in constant pain is a good thing."