MEDICATION ... OR DRUG?

Marijuana Can Be Easier On Patients, But It Still Has Its Problems, Doctors Say

The pain was gone, but his heart was pounding. It felt like it might beat
through his chest. He couldn't sleep, struggled to eat and, according to
friends, wasn't pleasant to be around.

Such was James MacMinn's life on the painkiller Vicodin. The Modesto man
used the prescription drug to relieve pain in his wrists, shattered in a
workplace accident five years ago.

So when a friend offered a mellower alternative, MacMinn took the baggie.

Smoking marijuana eased the pain and "smoothed that edge," said MacMinn,
38, a former crane operator and lumberjack whose wrists now are a patchwork
of plates, pins and bone. He's on disability, but is going to school for a
degree in business administration.

MacMinn, who has a doctor's recommendation for medical marijuana and gets
it from an Oakland cooperative, said he takes several hits a day. Without
it, simple tasks such as cleaning, mowing the lawn or typing a letter would
"knock me out for hours."

MacMinn is among about 10,000 Californians who smoke marijuana as a medical
treatment. State voters approved the practice by passing Proposition 215 in
1996.

But more than eight years later, the debate over marijuana continues.

The U.S. Supreme Court will soon weigh in on California's law. The court is
grappling with whether the federal government has the right to impose
national drug laws on state-sanctioned medical cannabis.

Meanwhile, Modesto is having its own deliberations. The City Council passed
an ordinance last week that created a 45-day ban on any medical marijuana
dispensary from opening.

The measure passed amid concern over the opening of California Healthcare
Collective, Modesto's first marijuana dispensary.

The store, unaffected by the measure, has served a steady flow of patients
since it moved into a McHenry Avenue strip mall two weeks ago from its
first spot near Five Points. Nearby businesses have complained about
parking, loitering and patients firing up in the parking lot.

City staff is to present the council a report in about a month outlining
the city's options for zoning, regulating and permitting such stores.

While medical marijuana has many critics, including those who say it
exacerbates crime and sends the wrong message about drug use, people who
smoke it tell a different story.

One is MacMinn. Another is 48-year-old Modestan Bob Lawrence, who says he
was shedding pounds far too fast before pot came to his rescue.

Nauseous from the medicines he took to treat an inflamed pancreas, Lawrence
couldn't keep anything down. He didn't want to eat. He lost 60 pounds and,
because of the vomiting, some of his tooth enamel.

After trying an array of medicines, including Marinol, the prescription
pill made partly from marijuana ingredients, Lawrence found a doctor who
wrote him a recom-mendation for medical cannabis.

Lawrence said it worked for him.

"My appetite came back and so did the weight," said Lawrence, who has made
strides in fighting his illness and no longer uses the drug.

Dr. Tom O'Connell, an Oakland physician who has recommended medical
cannabis, said it has several advantages.

"Number one, it's safe. number two, it's effective. And number three, it's
well-tolerated over a period of time," he said. And since most patients who
seek marijuana as a treatment have experience with the drug, they know if
it works for them, "which is something doctors can't say about other
medications."

To obtain medical marijuana, patients must get a doctor's recommendation
and present an identification card at a dispensary. Few Northern San
Joaquin Valley doctors recommend marijuana, so many patients turn to Bay
Area physicians.

There is considerable debate in the medical community about whether
marijuana is a legitimate treatment.

Ron Lopp is spokesman for the California Medical Association, which opposed
Proposition 215. He said the medical benefits of marijuana haven't been
sufficiently evaluated.

"There's some anecdotal evidence, but there needs to be more study and
research before we go forward," said Lopp.

Like any drug, medical cannabis has downsides, too, said Dr. Frank Lucido,
a Berkeley physician who has recommended it.

It's most often smoked, which isn't healthy, he said. Plus, the euphoria it
causes can make it dangerous to drive or operate heavy equipment. Some
strains of pot make people sleepy. And "if you need alertness, marijuana is
not a good idea," Lucido said.

Then there is the issue of the law. Despite the legalization of medical
cannabis in California and 10 other states, the federal government
considers the drug an illegal narcotic -- whatever its purpose. Federal
agents have made numerous drug arrests of growers, patients and vendors of
medical marijuana.

MacMinn, who dabbled in marijuana use as a youth and has smoked medical pot
on and off for five years, is the first to admit that the drug is no panacea.

He said it clouds his thinking and has at times wilted his ambition. He
said he tries to smoke only when he truly needs it.

"It can be habit-forming if you use it for the wrong reasons," he said.

MacMinn said Proposition 215 has several shortcomings, and the state needs
to do a better job of regulation.

For instance, "with other drugs, you get a prescription from a doctor who
tells you how much to take, how long to take it," he said. With marijuana,
"they give you a piece of paper and you can smoke it all you want.

"Some people take advantage of that."

Under state law, purchases are limited to a maximum of 8 ounces. A
California Healthcare Collective employee who would not give his name said
the average cost is $15 per gram.

MacMinn said he's worried that those who abuse the system will undermine
public support for medical marijuana, harming the people who need it most.

"I'll admit: there are people who get their card just so they can get high
every day," said MacMinn, before taking a couple of hits to ease the pain
of yard work. "But if you really get out there and meet the people who use
it, you realize, 'Wow, for them this really makes a difference.'"