MEDICAL VIEWS MIXED ON MARIJUANA

Voters are faced with contradictory opinions on ballot initiative

Will marijuana, the unofficial poster child of the war on drugs, get
long-sought legal approval for some types of medical uses in Washington?

This is the issue voters will decide with Initiative 692, which would
allow doctors to recommend, not prescribe, marijuana to patients who
may benefit.

This includes patients with chemotherapy-related nausea and vomiting,
AIDS wasting syndrome due to lack of appetite, anyone with severe
muscle spasms associated with multiple sclerosis and other spasticity
disorders, epilepsy, acute or chronic glaucoma and some forms of
intractable pain.

Voters will have to sort through a tangle of emotional and often
contradictory arguments, with opponents arguing that more effective
medications are now available and proponents saying that although
marijuana may help only a small number of patients, those who can
benefit should have access.

The Washington ballot initiative is one of just several similar moves
across the nation this year to authorize use of marijuana in cigarette
form to combat medical problems.

Alaska, Oregon, Colorado, Nevada and voters in Washington, D.C., are
being asked to approve similar measures, said Allen St. Pierre,
executive director of the National Organization for the Reform of
Marijuana Laws.

Arizona voters are being asked to affirm more far-reaching
applications of what are now illegal drugs for medical uses if
prescribed by two physicians, he added.

St. Pierre and other proponents, including some area physicians, said
that smoked marijuana is a cheap alternative to a prescription drug,
Marinol, with one of the active ingredients of marijuana. Each pill
can cost about $8.50, he said, and patients typically take it three to
four times a day.

Smoking marijuana also delivers the marijuana's active ingredient to
the bloodstream more quickly, he said.

"For the person who is very sick, smoking is the premier way to get
relief," St. Pierre added.

Dr. Bill Robertson, a former president of the Washington State Medical
Association and the head of the Seattle Poison Center, said that
anti-nausea drugs have a success rate of 80 percent, meaning they
don't work for everyone.

Approval of the initiative would introduce more choice in the
treatment of terminally ill or chronically debilitated patients, he
said.

"If somebody wants to do this, why should we stand in their way?" he
asked.

Dr. Jeffrey Ward, an Edmonds oncologist, said he objects to the
initiative because it is not needed.

Physicians now rarely use Marinol to treat nausea in chemotherapy
patients because more effective medications are available, Ward said.

"I don't have a vested interest in keeping marijuana illegal or
legal," he added. "I don't think using the argument that you need to
legalize it for medical purposes holds water."

Dr. Jonathan Gavrin, an assistant professor of anesthesiology at the
University of Washington who works at the Fred Hutchinson Cancer
Research Center in Seattle, said that patients there are always
cautioned against using marijuana because of the aspergillus fungus
that grows in anything smokable.

All Hutchinson patients receive bone marrow transplants, which
requires patients' immune systems to be suppressed. Smoking marijuana
could allow the dangerous fungus to get into their sinuses or lungs
and spread to their blood and brain, he said.

But Gavrin said he could support its use for hospice patients "truly
at an end-of-life situation" to relieve symptoms.

Recent medical studies are mixed as areas doctors on the issue. Here's
a few examples:

A February 1997 article in the Southern Medical Journal included a
national survey of oncologists, or cancer specialists, on patient use
of marijuana. Thirty percent said they supported reclassification of
marijuana for medical purposes.

An article in the June 1998 edition of the Western Journal of Medicine
said that while many medical studies suggest the "the medical utility"
of marijuana for some conditions, "the scientific evidence is weak,"
urging more research on the medical effects of marijuana.

A May 1997 article in the Annals of Internal Medicine said that the
most promising uses of marijuana are for counteracting the nausea
associated with cancer chemotherapy and stimulating appetite, but
added, "The evidence does not support the reclassification of crude
marijuana as a prescribable medicine."

An article in the March-April 1998 issue of the American
Pharmaceutical Association said that marijuana "shows clinical promise
for glaucoma, nausea, and vomiting, analgesia, spasticity, multiple
sclerosis and AIDS wasting syndrome" and should be available for
patients "who do not Aadequately respond to currently available therapies."

Lawrence Halpern, an associate professor of pharmacology at the
University of Washington, reflected on the degree to which experts
disagree on the issue.

"There are (medical) papers considering the legitimate use of
marijuana as an adjunct medicine going back 30-40 years," he said.
"Others say it's a poison. Somewhere in the middle is the truth."

You may Herald reporter Sharon Salyer at 425-339-3486 or you can send
e-mail to her at salyer@heraldnet.com .

Checked-by: Matt Elrod