ELDERLY PATIENTS CHANGE FACE OF MARIJUANA USERS

In the Medical Pot Debate, It's More Difficult for Doubters to Write Off
Older People As Dopers.

SEATTLE -- Betty Hiatt's morning wake-up call comes with the purr and
persistent kneading of the cat atop her bedspread.

Reaching for a cane, the frail grandmother pads with uncertain steps to the
tiny alcove kitchen in her two-room flat.

She is, at 81, a medical train wreck and a miracle, surviving cancer,
Crohn's disease and the onset of Parkinson's. Each morning Hiatt takes more
than a dozen pills. But first she turns to a translucent orange
prescription bottle stuffed with a drug not found on her pharmacist's shelf
- -- marijuana.

Peering through owlish glasses, Hiatt fires up a cannabis cigarette with a
wood-stem match. She inhales. The little apartment -- a cozy place of
knickknacks and needlepoint -- takes on the odor of a rock concert.

"It's like any other medicine for me," Hiatt says, blowing out a cumulus of
unmistakable fragrance. "But I don't know that I'd be alive without it."

With the U.S. Supreme Court poised to soon rule on whether medical
marijuana laws in California and nine other states are subject to federal
prohibitions, elderly patients such as Hiatt are emerging as a potentially
potent force in the roiling debate over health, personal choice and states'
rights.

No one knows exactly how many old people use cannabis to address their
ills, but activists and doctors say they probably number in the thousands.
And unlike medical marijuana's younger and more militant true believers,
the elderly are difficult for doubters to castigate as stoners.

Conflicting Beliefs

Patients contend cannabis helps ease the effects of multiple sclerosis,
glaucoma and rheumatoid arthritis. It can calm nausea during chemotherapy.
Research has found that cannabinoids, marijuana's active components, show
promise for treating symptoms of Parkinson's disease and Alzheimer's,
perhaps even as anti-cancer agents.

A recent AARP poll found that 72 percent of people age 45 or older believed
adults should be allowed to use cannabis with a doctor's recommendation.
(The poll found a similar proportion staunchly opposed to legalizing
recreational pot.) Even conservative elders such as commentator William F.
Buckley and former Secretary of State George Shultz have supported
marijuana as medicine.

Hiatt and those like her are "more and more the face of the marijuana
smoker," said Ethan Nadelmann of the Drug Policy Alliance, which advocates
treating cannabis like alcohol: regulated, taxed and off-limits to teens.

"There's this sense that when you get old enough, you've earned the right
to live your own life," Nadelmann said. "The mantra of the drug war has
been to protect our kids. But the notion of a drug war to protect the
elderly? That's ludicrous."

Stories of suffering elders are not lost on John Walters, President Bush's
point man for the war on illegal narcotics. But as he beats the drum for
psychotropic abstinence, the drug czar doesn't mince words.

"The standard of simply feeling different or feeling better" does not make
pot safe and effective medicine, said Walters, director of the White House
Office of National Drug Control Policy. People who abuse illegal drugs such
as crack cocaine feel a similar burst of euphoria, he noted, "but that
doesn't make crack medicine."

Congress and federal drug regulators have repeatedly rebuffed pleas to
legalize medical use of cannabis, which is classified as a dangerous
Schedule I drug, along with heroin and LSD. Walters argues there is not a
whiff of clinical proof qualifying smoked pot as medicine.

Life or Death Choice

Pain drove Hal Margolin, 73, of Santa Cruz, Calif., to the drug. It began a
decade ago, as the cervical vertebrae at the top of Margolin's back
calcified, strangling a bundle of nerves and producing a searing sensation
in his extremities. His feet can feel as if scalded by boiling water.

Margolin tried to address the unrelenting agony the standard way, buying
maxi-packs of Advil and Aleve. An operation made things worse. He lost the
feeling in his fingers and the soles of his feet, and at times he was
reduced to crawling to the bathroom. Despite a prosperous retirement, a
good marriage and two happy grown children, Margolin contemplated suicide.

He tried pot at a friend's urging. A few tokes and the pain seemed to
recede to the background, Margolin said. "I was no longer obsessing" about it.

He gets his cannabis from a Santa Cruz dispensary serving 200 patients,
many terminally ill. In a decade of operation, the cannabis cooperative has
lost more than 150 clients to cancer, AIDS and other ills.

For Margolin, marijuana has been "the difference between clinical
depression from the pain, and carrying on with my life."

Other Forms on Horizon

Although it was part of the U.S. pharmacopeia early in the 20th century,
cannabis was outlawed during the Depression. In recent decades, advocates
have repeatedly failed to gain federal approval for doctors to prescribe
the herb.

An exhaustive 1999 study by the National Academy of Science's Institute of
Medicine concluded that marijuana can help curb pain, nausea and
AIDS-related weight loss. The study warned against the toxic effects of the
smoke, but said cannabis could be given under close doctor supervision to
patients who don't respond to other therapies.

Several drug companies are developing prescription forms of the drug, such
as the cannabis mouth spray that G.W. Pharmaceuticals of Britain is
expected to begin marketing in Canada.

During the buildup to prescription forms, the raw plant shouldn't be
ignored, said Dr. Raphael Mechoulam, a pioneer in cannabinoid chemistry at
Hebrew University of Jerusalem. If it helps the elderly fight pain until
prescription drugs are available, he said, "then why not?"