REEFER MADNESS OR REEFER MEDICINE?

Aired March 17, 1999 - 11:30 a.m. ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY
BE UPDATED.

MARY TILLOTSON, HOST: Reefer madness or reefer medicine? A new study out
this morning on the medical use of marijuana.

Thanks for joining us. I'm Mary Tillotson.

About half an hour ago, an outfit called The Institute of Medicine, which
is part of the National Academy of Sciences, released a new study on using
marijuana as medicine. The study found that, yep, smoking marijuana can
help some patients more than it hurts them, that it's not particularly
addictive, that it does not lead users to try harder stuff like heroin, and
there's no particular reason to believe medical use of marijuana will lead
to more recreational use of the drug.

The report confirms smoking marijuana can relieve patients who are
nauseated and losing weight from AIDS or chemotherapy for cancer but the
new study does not conclude those folks should be able to just pick up pot
at the local drug store. Instead, the report wants doctors and
pharmaceutical researchers to come up with a new delivery system that works
as fast and effectively as smoking marijuana without the harmful side
effects of inhaling that smoke.

General Barry McCaffrey is head of the president's Office of National Drug
Control Policy. He commissioned the medical marijuana study a year and a
half ago. He's on the phone with us from Los Angeles.

General McCaffrey, thank you for joining us.

BARRY McCAFFREY, DRUG CONTROL POLICY DIRECTOR: Good to be here, Mary.

TILLOTSON: This report is not exactly what you might have wished for, is it?

McCAFFREY: We really think they've satisfied our requirements beautifully.
Dr. John Benson and Dr. Stanley Watson that did this study really have
moved this discussion where it belongs, back into the field of science and
medicine. So let me just say unequivocally we thank them for their work.
And they have contributed to a rational look at using canabanoids (ph) in
research to find out whether they have utility to control some symptoms of
certain diseases.

TILLOTSON: Since both you and the Clinton administration, General, have
been very much opposed to legalizing marijuana at the state level, which as
you know has certainly happened in several states, does this in any way
make you or do you think the administration in general rethink that position?

McCAFFREY: No. I think really we're where we need to be. The study
concludes there's little future on smoked marijuana as a medically approved
medication. I don't think that's where the field is going. What may well be
though, they've noted that advances in canabanoid science in the last 16
years opened a real wealth of new opportunities for development of some
medically useful canabanoid- based drug. So I think where we'll need to --
what we'll need to do is what the National Institute of Health, Dr. Harold
Varmis (ph), and people like Dr. Alan Leshner (ph) at NIDA (ph) look at
this and determine what we can do to advance research on these potential
symptom-controlling compounds.

TILLOTSON: And so you think the idea of this mention in the study of
finding a new delivery system such as an inhaler has some merit?

McCAFFREY: Sure, absolutely. And I think on top of that, what they're
really suggesting is that, you know, in the 1980s, THC, one of the most
active of the canabanoids in smoked marijuana, was isolated is now
available in pharmacies with a prescription from a doctor. And there may
well be more of these canabanoid compounds that can be isolated and also
could provide medical benefits. So the door should remain always open for
evidence-based research on this or any other compound.

TILLOTSON: General Barry McCaffrey, I understand out in Los Angeles you're
going to have your own news conference responding to this in about half an
hour, a little bit less?

McCAFFREY: Indeed, Mary.

TILLOTSON: We'll hear more from you then. Thank you, General McCaffrey.

Joining our conversation now from New York, Richard Brookhiser. He is an
author and senior editor at the "National Review." His latest book is
"Alexander Hamilton, American." He's also, by the way, a former cancer
patient and knows personally about the medical use of marijuana.

Betty Sembler started the Drug Free America Foundation nearly 25 years ago
in Florida. She's joining us from Miami this morning. And from Los Angeles,
Dr. Ann Mohrbacher, who teaches at the University of Southern California
and is in private practice as a cancer specialist. We are very glad to have
all three of you here.

Since you're the patient of the day, Richard, tell us about your own
experience. You got familiar with the debate about medical marijuana and
what it can or cannot do for chemotherapy patients when you were one of
those back in 1992?

RICHARD BROOKHISER, FORMER CANCER PATIENT: That's right. I was diagnosed
with testicular cancer in 1992, and I underwent a course of chemotherapy
that lasted over four months. And halfway through, I could tell that the
legal anti-nausea drugs I was getting, which were the newest thing at the
time, very good drugs, they were not going to continue to do the job. The
effects of the chemotherapy were cumulative.

So for the second half of my chemotherapy, I smoked marijuana. Now none of
my doctors and none of my nurses discouraged me from doing this, and they'd
all had experience with patients of theirs who had done this and who had
gotten good results. And I was being treated at NYU Hospital in New York,
and I had a consultation at Memorial Sloane Kettering (ph), so I was not
going to New Age faith healers for this advice.

TILLOTSON: Let me ask you this, Richard. I think a lot of people who are
undergoing chemo or have AIDS, even if it's legal in their state, as is the
case in California, the law is kind of murky, and they're scared to go out
and buy the stuff.

BROOKHISER: Well, and rightly so. I think one of the sad, sad aspects of
our situation is that I was not at much risk. I live in Manhattan. I'm a
journalist. I'm a lower rung of the media, a leat (ph) if you will. I'm not
the kind of person who gets in trouble, but people are in different lines
of work or live in different places, they can indeed get in trouble,
particularly if they have a chronic condition and try to get pot repeatedly.

TILLOTSON: I'm going to get back to you on the question of the oral pill
versus smoking the stuff.

Betty, it was your personal experience that got you involved in fighting
drugs, too, was it not? One of your kids you were worried about?

BETTY SEMBLER, DRUG FREE AMERICA FOUNDATION INC.: Absolutely.

TILLOTSON: Tell us about that.

SEMBLER: Well, it's been more than 25 years ago since I've entered the
field, and yes, it was through one of my sons who was smoking marijuana. Of
course, at the time, marijuana had much lower THC content than it does
today. Today, there's about ten times the amount of this hallucinogenic
drug in marijuana. So today, it's a much different drug than it was 25
years ago.

But what that alerted me to was the danger to our children. So I have
worked for the past 25 years teaching children and promoting the true
information not only about marijuana but of course about all hallucinogenic
and mind-altering drugs.

TILLOTSON: I would think any parent would have to share your worry, but the
report that's out this morning says there's no particular evidence that
marijuana is what they're calling a gateway drug to encourage kids to go
onto something else. And to be blunt with, Betty, when you've got an
emaciated AIDS patient or somebody undergoing chemotherapy, this is
scarcely the poster person for the kind of cool that teenagers want, is it?

SEMBLER: Well, I think that -- Of course, I haven't read the complete
report since it's only just been put out, but I have been able to read the
synopsis of it. The recommendations validate what our message has been all
along, that is Drug Free America Foundation. We have always supported
scientific research, peer reviewed research, and FDA approval, and this
report absolutely does not validate the smoking approved marijuana as
medicine. What it does say is that there is plenty of room for research,
something that we have always said.

TILLOTSON: No, it does not validate the prescription of marijuana but what
it does say is that it does not think that would lead to the sort of
increased recreational use which is one of the primary arguments, is it not
- -- and I'm going to go to Dr. Mohrbacher on this one -- against broadening
the medicinal use of marijuana. The worry is will kids who aren't sick will
somehow have broader access to it.

DR. ANN MOHRBACHER, ASSISTANT PROFESSOR OF MEDICINE, UNIVERSITY OF SOUTHERN
CALIFORNIA: Well, what is unorthodox about this situation is that this is a
drug that patients or families could grow at home in other cases of
legalizing medications based and provided by pharmaceutical companies or
government sponsored trials. And I think some concern is that everyone
would start growing a plot of marijuana and that other persons other than
the patient would have access to it, and would that allow proliferation of
use of the drug.

TILLOTSON: I want to get to how it actually works in California where there
is a state law that made it legal. But can we stick for just a moment --
and I'll start with Dr. Mohrbacher and then let Richard back in the
conversation -- the pros and cons of taking the oral pill form of the
effective agents in marijuana that supposedly suppress nausea form chemo or
AIDS? I keep hearing patients say it's not as effective as smoking dope.

MOHRBACHER: Well, that's the anecdotal information coming from the patients
who have had some experience with the recreational use of the drug. The
oral drug does work in some capacities. It is a rather modest anti-nausea
agent compared to current drugs that we have available today, and I was
curious whether Richard had one of the newer generation drugs that have
really only been public for the past...

TILLOTSON: Let's hear from him.

BROOKHISER: Yeah, the drug I had was, oh, gee, I'm blanking on the name,
but it was brand new in 1992, Zophran (ph).

MOHRBACHER: Gophran (ph), exactly.

BROOKHISER: I got Zophran which...

MOHRBACHER: And that wasn't completely effective for you?

BROOKHISER: No, it wasn't. It was effective at first, but then its
effectiveness wore off. And look, there may be some patients who get a
benefit from Marinol (ph). That's fine.

MOHRBACHER: That's exactly true.

BROOKHISER: That's fine. But then there are others who don't. And, you
know, my doctors had years of research. My oncologist was the head of
oncology at NYU Hospital. He'd seen lots of cancer patients, and a lot of
them had gone the route of smoking marijuana to relieve their symptoms of
nausea. Also, you know, I should say I wasn't a recreational smoker before,
and I certainly never smoked recreationally after. You know, if you want to
do aversion therapy for smoking marijuana, give everybody cancer, a course
of chemotherapy, and give them some joints and they'll never look at one
again.

TILLOTSON: You gave us a lovely place to take a break, which we have to,
unfortunately. We're going to be back, though, and talk about the
intersection between politics and pot and whether it's really about
medicine or about a political tug of war. Stay with us. Be right back.

(COMMERCIAL BREAK)

TILLOTSON: We're talking about a report that was put out this morning by a
branch of the American Academy of Science talking about the fact that there
is medical evidence now that smoking marijuana can help relieve the nausea
of some AIDS and chemotherapy patients, but prescribing what may take years
of research to come up with a new delivery system.

Dr. Mohrbacher, they say smoking, taking the smoke into your lungs is bad
for you in and of itself, so let's figure out how to do this with an
inhaler for the speed and effectiveness of smoking marijuana without the
bad side effects. How long could that sort of research take?

MOHRBACHER: Oh, many years. And the number of exposures to the smoke are
probably not very relevant from the medical point of view except in
patients who are taking drugs that have long toxicity. And paradoxically,
many of the patients who have asked me about whether it's OK to smoke
marijuana or that they've heard it might be better than what I can offer as
prescription drugs were younger patients. And those very patients are the
ones who have Hodgkin's disease and testicular cancer where a drug called
Liomycin (ph) is used which has intrinsic long toxicity.

So I generally discouraged the idea only for fear that the smoking would
somehow be interactive with the long toxicity of their drugs and ask them
if they were interested in that category of drug being effective in them if
they would please give a try to the prescription form of the active
ingredient instead. And in general, many patients have to try a series of
drugs on a trial and error basis to find out what works for them.

And Richard is correct in that although 90 percent of patients would find
relief from the more mainstream drugs, there will be a few patients who
seem to uniquely benefit from that category of drug, and we do have a
prescription form available. But I think many physicians don't doubt that
there may be other active ingredients in the natural form of the drug that
probably should be researched, but may be available in the smoked form of
the drug or at least in the natural form of the drug in some fashion.

BROOKHISER: That's right. And, you know, one thing I noticed in my own
experience, and this is borne out by the testimony of other people who have
used the smoke form of the drug, is that it's easier to titrate your own
dose. It's much easier to control how much you need versus taking a pill
because a pill is longer acting. You actually end up taking smaller amounts
of it if you're, you know, doing it yourself on a kind of half or quarter
joint basis per every wave of nausea that you feel.

And this gets to the political point of why it should be that the
government should be dictating these health decisions to doctors and
patients. And this is where I feel that I as a conservative am not making
not exception to my principles but I'm just following out their consequences.

We were the people who ranted and raved about Hillary Clinton's health care
plan, you know, because it was going to tell doctors and patients what they
had to do and on and on and on. So why should most conservatives be opposed
to this, which unfortunately they are? I just want to say to them, you
know, come on, wake up, follow out your true principles.

TILLOTSON: I want to let Betty back in real quickly because I want to
emphasize to everybody, Betty, that your concern is to reduce if possible
or at least not expand recreational use of illegal drugs. But why do you
fear that medicinal use, if it were properly controlled and users had some
kind of identification on them, would it encourage kids to use drugs?

SEMBLER: Well, I certainly do not oppose the medical use of marijuana. What
I do oppose and what the report certainly does point out is that the
smoking of crude marijuana is not medicine. We must understand that. The
peer review and scientific research is what I most heartily endorse. And I
think that that's what all of us must realize.

Naturally, if you call something a medicine and a child takes it, they can
grow it, they can buy it, there's no control on it, there's no dosage
recommendation, no quality control. That's not medicine. What medicine is
is scientifically tested. You don't test anecdotes. You test the science of
it. Once it is tested and properly tested, then...

BROOKHISER: But, but...

TILLOTSON: Richard, hang on to that. You're going to be first when we come
back. Got to take one more break but before we do, we're going to hear from
Rhonda Schaffler with an update from the New York Stock Exchange.

(COMMERCIAL BREAK) TILLOTSON: Welcome back. Before we went to that break, I
interrupted both Richard Brookhiser and Betty Sembler.

SEMBLER: Yes.

TILLOTSON: I'm going to start with you, Betty. You seem to be making the
point, no such thing as smoking marijuana for medicinal purposes?

SEMBLER: Well, I certainly don't believe so, especially crude marijuana. We
know from our research community that smoking of anything poses a grave
risk to the user. And marijuana, crude marijuana contains over 400
different chemicals that the user is inhaling.

TILLOTSON: Academic if the user is already dying of cancer, isn't it?

MOHRBACHER: Not always. Some of the patients are using this in curable
cancers such as testicular cancer and Hodgkin's disease.

BROOKHISER: Yeah, but look, medicines, lots of medicines that are
scientifically tested are very dangerous, and they can be overused.

SEMBLER: Yeah, I certainly do agree with that, Richard.

BROOKHISER: There is abuse of prescription medicines all the time, but that
doesn't mean we yank them off the shelves and it doesn't mean we don't let
doctors use them. And you always have to weigh the benefits against the
risks. I also think...

SEMBLER: But we also have to have scientific evidence.

BROOKHISER: I also think it was a little disingenuous, it was disingenuous
of the drug tsar to begin our segment by saying, "We need more research" as
if this IOM report was the first research that has ever been done. It's
only the first research that he signed off on. There have been studies of
various aspects of medical use of marijuana going back over 20 years. This
is not a new thing, this is not a brand new discovery. This is something
that patients -- This is something that...

TILLOTSON: And I want to let Dr. Mohrbacher in. You're nodding your head
yes. You're agreeing with Richard on that, right?

MOHRBACHER: Yes. There is a...

BROOKHISER: This is something that patients and doctors have known for a
long time, and we haven't made use of it because of an extreme fear of
marijuana as a maligned, magical substance that must not be used under any
circumstances.

(CROSSTALK)

TILLOTSON: Dr. Mohrbacher, for the sake of truth in advertising, I want to
say that it's been a long time now, but I watched my mother struggle
through cancer and chemotherapy, and at the time, they gave her something I
think I'm recalling correctly called the Brompton (ph) cocktail or a
combination of all kinds of stuff that the police would have me in the
slammer for buying on the street, and that was all right. But marijuana's
not?

MOHRBACHER: Well, I think the politicization of the issue is resting on the
fact that it is an illicit drug first not a drug that had a medical
indication first as in cocaine or other opiates that we would certainly
never deny a cancer patient and would not claim is being spread as a
recreational drug to a society just because it's made available for medical
use.

The other issue is it certainly has medical benefits. Whether any of those
are attributable to the actual smoked form of it or not is not yet known.
On the other hand, when we say further research needs to be done, how long
will that take? And if the patient has, for example...

TILLOTSON: And is that politicizing the discussion?

MOHRBACHER: I believe so, because I think that a terminally ill patient
with either AIDS or cancer isn't the going to wait five years until a
purified form of this is available.

On the other hand, it's relatively few cancer patients who are asking me
for this in the smokable form. In fact, most of them have such negative
associations with that that they wouldn't try it if they were pressed to.
Some of my colleagues in the HIV field say that they've had quite numerous
anecdotal reports of the smoke form working better than the pill form that
we routinely offer, and that they found that patients together often
encourage each other to try it, and that women patients in particular were
often reluctant to because of the illicit nature of it. But some who had
never used a recreational drug in their life did find the drug gave them
significant relief.

TILLOTSON: I think a quick answer...

MOHRBACHER: My feeling is ultimately that it will not be the smoked form of
it that's going to be recommended for medicinal use, but I have no idea how
long it will take to do the research and develop those drugs or whether
there's even any financial interest in developing these drugs. Remember,
the government isn't going to provide it long term...

TILLOTSON: You got votes coming up...

MOHRBACHER: Some patients, some patients can't wait.

TILLOTSON: You've got votes coming up in four more states and I'm curious
- -- We're almost out of time, but I want to get an opinion from each of you
since we got the report out today that in effect says, yes, there is some
utility, though we don't like the delivery method of smoking the stuff. Do
you think the report from the IOM, Richard -- and then I'm going to get
Betty in and Dr. Mohrbacher in -- is going to increase the chances there
will be more such state laws passed to allow the medicinal use of marijuana?

BROOKHISER: Well, definitely. I think the people of America and the states
have shown that they have a better sense of this issue than the politicians
in Washington. They'll continue to do so.

TILLOTSON: And Betty?

SEMBLER: Well, I certainly don't think that we should vote by medicine, you
know, these ballot initiatives. We've never voted on medicines in this
country. We have a device called the FDA.

TILLOTSON: I think we vote on what's bad though. I remember prohibition.
Wasn't that one?

SEMBLER: Well, that's of course a whole other program if you'd like to go
into it. But the recommendations from the IOM do not recommend a long-term
study. However, it does...

TILLOTSON: I'm so sorry, we needed more time always. Betty, next time. Yes,
we'll come back and discuss this and...

SEMBLER: Yes, I'll be happy to come back.

TILLOTSON: ... prohibition as well. Appreciate our guests coming in today.

SEMBLER: Thank you.

TILLOTSON: Dr. Ann Mohrbacher, Betty Sembler, Richard Brookhiser, good to
have the three of you. Glad as always everybody else was with us, too. Hope
to see you tomorrow. I'm Mary Tillotson.