MEDICAL USE OF MARIJUANA IGNITES DEBATE

While working as a hospital resident in 1978, a young doctor named Rick
Bayer detected the pungent smell of marijuana smoke wafting from a
patient's room. The sick man in the hospital bed confided to Bayer that
marijuana eased the nausea and vomiting brought on by cancer chemotherapy.

Intrigued, Bayer kept an eye open for other instances of marijuana
"self-medicating" among the combat veterans he treated at the Portland
Veterans Affairs Medical Center.

One patient swore by marijuana as a treatment for the severe muscle spasms
and pain arising from a crippling spinal cord injury.

A former soldier recovering from a land mine explosion and leg amputation
said he found marijuana easier to tolerate than the morphine painkillers
prescribed by a doctor, which left him groggy and constipated.

Bayer wondered if this notorious plant might be the wellspring of new
pharmaceuticals. Twenty years later, he says, "We as scientists have not
really tapped all the potential."

The 43-year-old Portland doctor is now leading a campaign to legalize the
medical use of marijuana in Oregon. Measure 67, he says, would allow
people with cancer, AIDS, multiple sclerosis and other conditions to smoke
marijuana without fear of going to jail or losing their homes.

And doctors could talk with patients about the possible benefits of
marijuana without risking their licenses to prescribe controlled
substances.

But can the law allow compassionate use without worsening the problem of
abuse? Some legal experts and law enforcement associations say absolutely
not.

"The loopholes are there for everybody to get through if you want to smoke
dope," says Mike Cahill, president of Oregon Police Chiefs for Safer
Communities. "You can pretty much bet that it will basically eliminate the
ability to enforce laws against the illegal use, delivery and cultivation
of marijuana."

Under Measure 67, patients with written permission from a licensed
physician can obtain a registry card from the state Health Division to grow
marijuana for treating "debilitating" medical conditions. Registered users
could grow up to three mature marijuana plants and four immature plants.
They could carry an ounce of marijuana with them and keep one ounce per
mature plant at home.

Carrying out the measure would cost the state an estimated $140,000 to
$295,000 per year, depending on the level of oversight. The estimates
assume that about 500 people at any given time will be registered.

Bayer drafted the measure with backing from Americans for Medical Rights,
the group that persuaded Californians to legalize medical marijuana in 1996.

Billionaire financier George Soros of New York, Cleveland insurance
executive Peter Lewis and University of Phoenix founder John Sperling are
all contributors to the national organization, based in Santa Monica,
Calif., which is pouring money into medical marijuana campaigns in Oregon,
Alaska, Colorado and Maine.

Unlike California, the Oregon proposal explicitly forbids medical users to
smoke in public, and it prohibits the selling of marijuana under any
circumstances.

Cahill says the measure still poses a threat. "You could count on a major
increase in marijuana use by our youth if it passes," he says. "What's to
prevent someone's 9-year-old daughter or son going to the family plant,
taking off a bud, and smoking a little before they go to school? It's
nicely available, and if Mom or Dad uses it then it must be OK."

A critique by Multnomah County District Attorney Michael Schrunk points out
several possible loopholes. Schrunk objects that the requirement for having
a "debilitating medical condition" would allow almost anyone who can find a
willing doctor to gain access to medical pot.

Users could get around the limits on quantity by arguing in court that a
greater amount was "medically necessary" for their medical condition.
Similarly, the law gives those without permits a legal foundation for
arguing a medical use defense.

Measure 67 also prohibits police from destroying seized property,
presumably including live marijuana plants. Schrunk argues that this means
that law enforcement agencies would have to maintain live plants in
greenhouses until court cases are resolved.

"These exceptions cancel out the rules and limits, thereby making
enforcement of any marijuana laws not only impractical but virtually
impossible," Schrunk wrote.

Backers of the law disagree with this interpretation. They insist that it
does not loosen or change any other laws against the recreational use of
marijuana.

"We all know that useful drugs can be abused," Bayer says. "We recognize
there is a difference between drug abuse and appropriate drug use. We don't
think patients should be penalized because some people abuse marijuana. I
really think that's inhumane."

Cahill and other critics suspect that medical use initiatives are really
just Trojan Horses to advance the cause of complete legalization. "I am
referring to the move by NORML and other pro-marijuana groups to find a
long-term nationwide way to drug legalization," Cahill says.

Bayer says he opposes complete legalization, saying his long-term goal is
to persuade the Drug Enforcement Agency to reclassify marijuana so that it
could be prescribed as a controlled substance like morphine.

The DEA considers marijuana a Schedule 1 drug - addictive but having no
medical use. Schedule 2 drugs such as cocaine and morphine are considered
addictive but with some medical use.

"I can tell you that if marijuana was changed to Schedule 2 by the federal
government and became available on pharmacy shelves, we could call this
campaign off," Bayer says.

Critics are correct when they say the medical usefulness of marijuana has
not been firmly established. But the possibility is not just a fantasy.
Experts convened by the National Institutes of Health last February pointed
out that smoking marijuana has significantly different effects on the body
than when the active ingredient delta-9-THC is taken in the pill form
called Marinol.

Inhaled marijuana smoke delivers drugs more quickly, for instance, and
contains substances other than delta-9-THC that might have pharmaceutical
value.

Still, while it's not possible to die from an overdose - like it is with
aspirin, for example - the drug is not risk-free. Smoking it may damage the
lungs, and evidence suggests that long-term use weakens the immune system,
according to the NIH panel.

Bayer doesn't disagree but says current laws have to be changed, or the
potential benefits of medical marijuana will never be known. He believes
that the benefits will outweigh the risks for selected patients.

"I look at the class of cannabinoid drugs as an area that needs to be
explored so we can have more tools for caring for patients," he says. "I
think there should be one standard: what helps the patient."

Cahill emphasizes a different risk-benefit equation. He believes that the
potential harm to society, particularly young people who become abusers,
outweighs the potential benefit to individual patients.

"That's the crux," he says.

MEASURE 67: PROS & CONS

The measure would legalize possession and cultivation of marijuana for
treating debilitating medical conditions. Requires written permission from
a licensed physician to obtain a registry card from the state Health
Division. Registered users could legally carry an ounce of marijuana and
grow no more than three mature marijuana plants and four immature plants.

THE PROS

Patients with cancer, AIDS, multiple sclerosis and other conditions who
have found relief using marijuana would not have to fear prosecution.

Doctors would be allowed to talk with patients about possible benefits of
marijuana.

The measure does not allow medical users to smoke in public, drive under
the influence or sell marijuana under any circumstances.

Contact: Oregonians for Medical Rights, 189 N.E. Liberty St., Suite 205,
Salem, OR 97301, (503) 371-4711; Internet: www.teleport.com/~OMR

THE CONS

Marijuana may have long-term adverse effects and it can be addictive, while
its medical benefits remain poorly documented.

Legalization for medical uses could make it harder to enforce laws against
recreational users and dealers.

The measure risks sending a message to youths that society considers
marijuana use acceptable.

Contact:Oregonians Against Dangerous Drugs, 5285 S.W. Meadows Road, Suite
340, Lake Oswego, OR 97035, (503) 598-7343

FACTS ABOUT MEDICAL MARIJUANA

Although marijuana may be no better than available drugs for certain
conditions, not all patients respond to or can tolerate standard drugs.
Experts convened by the National Institutes of Health last year concluded
that inhaled marijuana looks promising enough to merit full-scale clinical
trials for these indications:

Pain: Marijuana's active ingredient, THC, works by a different mechanism
than available pain medications, making it potentially useful for people
who don't respond well to morphine-type drugs. Marinol, a synthetic THC in
pill form, eases pain but has a narrow margin between useful doses and
those producing unacceptable side effects.

Nerve and movement disorders: Anecdotal reports suggest marijuana can
relieve the severe muscle spasticity caused by multiple sclerosis and
spinal cord injury. Preliminary findings suggest a possible role for
marijuana in treating epileptic seizure disorders.

Nausea and vomiting: Inhaled marijuana has the potential to improve
chemotherapy-related nausea and vomiting.

Glaucoma: Smoked marijuana can lower pressure within the eyeball for three
to four hours. The mechanism is unknown, but if it's unique to marijuana,
it could prove a useful alternative treatment.

Wasting syndromes: Smoking marijuana has been shown to increase frequency
and amount of eating. Smoking the drug increases the risk of pneumonia in
HIV patients, while Marinol may be less effective.

- - Source: NIH Workshop on the Medical Utility of Marijuana, Feb. 19-20, 1997

Copyright (c) 1998 The Register-Guard