REBUTTAL OF H. RES 372 - A CASE OF MISTAKEN IDENTIDY

Introduction

H. Res.. 372 was introduced in the House of Representatives on February 26,
1998. It constitutes a "sense of the House of Representatives that
marijuana is a dangerous and addictive drug and should not be legalized for
medicinal use."

This paper is a rebuttal of H. res. 372 and an argument that marijuana has
several extensively documented applications and a high safety margin with
medically supervised use. In addition it refutes the rhetorical tool of of
connecting the issues of substance use and abuse to medically supervised
use as inconsistent with the accepted protocols which govern the medical
research process. It questions the underlying legal, moral and political
priorities which criminalize sick, suffering and dying people for their
medically supervised use of marijuana as fundamentally inconsistent with
basic tenets of nursing practice which strive to care for and support ill
people with compassion. Each rebuttal paragraph corresponds to the item
of the same number in the text.

The vote on H. Res.. 372 is tentatively scheduled for Tuesday, April 21'st,
1998.

1. The Controlled Substances Act was signed into Law in 1970 by President
Richard Nixon. It classifies certain drugs or substances with a high
potential for abuse into schedules. There are 5 schedules which represent
graded levels of control. Schedule one is for drugs which do not meet any
of the three basic requirements of listing:

1.No recognized medical value; 2. Toxic; 3. Highly dependence forming

Schedule one placement of marijuana is inappropriate on two of the three
parameters. Numerous scientific studies document five notable uses. (anti
seizure effects, anti nausea effects, appetite stimulant effects, analgesic
effects and intraocular pressure reduction effects.) In 1987 DEA Chief
Administrative Law Judge Francis Young conducted extensive and well
documented hearings into marijuanas placement into Schedule

1. He subsequently ruled that marijuana should be immediately reclassified
into schedule 2 His ruling was dismissed by DEA Administrator John Lawn
claiming the evidence was not scientific enough. In the intervening decade
documentation about the therapeutic uses of cannabinoids (the chemicals in
marijuana responsible for its effects) has increased including numerous
books, research papers and patient accounts.

2. Marijuana use is not associated with domestic violence when used alone.
Alcohol is. Marijuana is ranked as one of the least toxic drugs in
wide-spread use today. There is no documented mortality associated with
acute overdose of cannabis in the medical literature encompassing 5000
years of use. In contrast, four hundred-thousand Americans die each year
from diseases brought on by tobacco smoking. Research citing increases in
traffic accidents related to cannabis intoxication is ambiguous at best.
Some studies show that drivers intoxicated by marijuana actually compensate
for their impairment by driving more carefully. Alcohol use is clearly
associated with more aggressive driving patterns. Obvious wisdom would
dictate that driving while under the influence of ANY drug is foolish.

3. This paragraph in H. Res. 372 expands upon and repeats paragraph 1.
Research clearly shows that medical complications of Heroin, PCP, and
Cocaine use can be severe and life-threatening. Approximately twenty-five
thousand Americans die each year from complications of illegal drug use
such as heart attacks and strokes. Medical contraindications of marijuana
relate to a large extent on inhaling as the route of delivery. Pulmonary
complications such as bronchitis, and respiratory infections can and do
occur. Immune impairments are probably minimal, with some studies showing
enhanced immunity. Cognitive impairments can occur to some heavy conic
users-most notably reversible short-term memory deficits. Cannabis
Dependence Syndrome is listed in the Diagnostic and Statistical Manual of
Mental disorders (DSM-IV) as an affliction based upon inability to control
use. Reproductive research is far from conclusive, and has often been
based upon large doses of cannabinoids infused rapidly into rodents.
Research purporting to prove the existence of withdrawal symptoms also is
based upon wildly unrealistic research protocols in rodents. There is no
documented malignant pathology (cancer) associated with exposure to
marijuana in humans in spite of the fact that marijuana smoke contains many
of the same harmful combustion by-products as tobacco smoke. Large scale
mortality research has shown no increase in mortality associated with
marijuana use when confounding variables are considered. By far the
greatest contra-indication to marijuana is that associated with its illegal
status. These include arrest, prosecution, loss of home and employment,
fines, jail time and child protective service investigations.

4. Dronabinol, known by the trade name Marinol is a synthetic version of
the THC molecule-one of the major cannabinoids. It is approved for use by
the FDA as a schedule 2 drug for appetite stimulation related to AIDS
wasting syndrome and as an anitemetic in cancer chemotherapy. Marinol
costs $15 or more per capsule and is dispensed in 2.5 mg, 5 mg and 10 mg
doses in a sesame oil formulation. It is effective for some patients
however others prefer the ease and speed of the inhaled route. The lungs
deliver cannabinoids to the brain in 1-10 minutes allowing patients to
easily self regulate the dose and effect. Marinol may take 3 hours to
digest and patients complain of excessive sedation, dizziness. Patients
who are nauseated often cannot tolerate pills. Phase 3 clinical trials by
the FDA have not been conducted in spite of much evidence of efficacy. In
February 1997 The National Institute of Health conducted an inquiry about
medical uses of marijuana and concluded that several indications merit
further study.

5. Marijuana has an extensively documented history of medical use spanning
5000 years. Marijuana was widely prescribed by physicians in Europe and
America as a tincture (an alcohol based preparation) until its use was
effectively banned in 1937 by passage of the Marihuana Tax Act.

In western medical science drugs are evaluated primarily for efficacy. Many
obscure, dangerous and potent drugs exist and are used when necessasary by
physicians.

6. Numerous governmental and scientific commissions have publicly
positioned themselves in support of a medically supervised and regulated
supply of marijuana. These include The World Health Organization, and many
physician and nursing groups. Unfortunately, decades of Federal Government
obstruction has confused Americans.

7. In November of 1996 voters in the states of Arizona and California
approved initiatives which legalize marijuana for medical use. Shortly
thereafter, on December 30th 1996, HHS Secretary Donna Shalala, National
Drug Coordinator Barry McCaffery and Attorney General Janet Reno conducted
a press conference openly threatening to revoke the DEA license of doctors
who prescribe marijuana to their patients. Doctors filed suit and gained
an injunction forbidding Federal authorities from carrying through on their
threat.

8. Shortly after Arizona voters approved of the medical use of marijuana
legislators in Arizona passed legislation nullifying the vote. Voters
refiled another petition to bring the question to a vote. Arizonans will
again vote on the issue this November.

9. In the United States there are no laws which completely forbid citizens
of one state from financially supporting legislative or political efforts
underway in another state. Millions of dollars cross state lines each year
for many different issues.

10. Organizations like the National Organization for the Reform of
Marijuana Laws (NORML) have long supported compassionate use of marijuana
when governmental and health care agencies have not. Many other
pro-legalization groups have advocated for reform of laws surrounding the
war on drugs. Public support of medical marijuana may be a result of
widespread experience of loved ones, family members and friends who have
benefited by using marijuana. Americans overall oppose unregulated access
to marijuana but continue to support medically supervised access.

11., 12. Many children in the United States have drug abuse problems. Many
parents do also. Problems of addiction in the United States cost billions
of dollars annually and result in approximately half a million deaths.
Billions more dollars are spent in interdiction efforts. Drug availability
on the street remains high, prices for hard drugs have fallen and purity
has increased. Marijuana use in children has risen in recent years partly
because of a perception of safety. But many children appear confused about
the mixed messages they receive about substance use in our society. These
messages that connect legal drug use with prosperity, glamour and health
are pervasive. The DARE program, ostensibly a medical class taught by law
enforcement personnel, is in 80% of public schools. It has repeatedly
been shown as ineffective at teaching children the risks and benefits
associated with all drugs. There is simply no logical connection between
safe and effective drugs used under medical supervision and their potential
for abuse by others, a point repeatedly acknowledged by governmental
commissions.

13. References to statistical associations between marijuana use and hard
drugs are misleading and inconclusive. The 1997 National Drug Strategy
reports that some 80% of marijuana users do not use hard drugs. Increased
use of hard drugs by marijuana using teenagers can be explained by looking
at personality types which are more risk-taking. Troubled youths coming
from troubled homes are more likely to behave in anti-social or unhealthy
ways-including using marijuana. This does not make marijuana a causative
agent in the progression to more deadly substances. There is no biochemical
connection between marijuana use and the use of other substances. Marijuana
users are more likely to drink alcohol. It is absurd to assert that
marijuana use leads to alcohol use, or vice-versa. The gateway theory has
been repeatedly used as a pretext for marijuana prohibition. It has been
discredited by studies which describe it as faulty logic with no basis in
fact. There is a statistical association with alcohol use and violence.
Alcohol works on parts of the brain which affect self-control. This is a
biochemical explanation. Tobacco use over many years is statistically
associated with cancer. This also is a biochemical association. Cocaine,
Heroin, PCP and Methamphetamine use is statistically and causally related
to a variety of medical complications including death. IV injection of
drugs with contaminated syringes has a clear statistical association with
increases in the transmission of the AIDS virus. Use of marijuana by
children does not lead to hard drugs. Government interdiction efforts which
strive to end the massive flow of drugs into the United States however seem
to be statistically correlated with increases in hard drug use in this
country.

14. In US society children receive many ambiguous messages regarding
sexual activity, drug use, and money through practically all mass media but
particularly through television. But cultural messages which glamorize
drug use have nothing to do with medically supervised access to a valuable
medicine. Marijuana occupies a niche along with thousands of other plants
and drugs. Appropriate medical use of a drug does not glamorize
inappropriate use of it and is a spurious argument. On the other hand,
deceptive emotional laden rhetoric which persistently assigns moral
overtones to a medical or public health issue is a disservice to Americans
who depend on their government to be honest. Many other public health or
medical issues have been mischaracterized by politicians, mostly
republicans, as breakdowns in moral fabric, including passing out condoms,
sterile needles and elective abortion. Not only does this deceive
Americans, but it neglects to evaluate public health issues on a balanced
playing field.

There is widespread addiction , mortality, morbidity and suffering
associated with substance use. Legal behaviors kill half a million
Americans each year.

15. 16. Many Americans, particularly teenagers are distrustful of the
Federal Government. Poor quality politically motivated drug education
epitomized by the DARE program, serves to cultivate ignorance, apathy and
distrust of the Federal Government. Inequities in public health policy
abound. Children perceive an illogical association between the high rate of
legal tobacco related death and the non-existent death associated with
illegal marijuana. In addition, children have seen first hand how loved
ones have benefited from using marijuana, or watched them slowly die from
using tobacco. As such, the more Americans understand about the medical
use of marijuana, the more they approve of it. It is mostly conservative
politicians and Federal Government agencies which continue a long tradition
of misinforming the public about the beneficial uses of marijuana. As a
result, large numbers of patients endure arrest, and prosecution because of
their use of it.

CONCLUSION

H. Res. 372 represents an attempt to maintain polarization in the debate
about medical marijuana and illegal drug use by disregarding a large body
of evidence which supports medically justified use. Many of the assertions
made in H. Res. 372 are either demonstrably false, or casually unrelated to
the risk/benefit assessment that governs drug research and use in this
country. It fails to place the relatively small issue of medical marijuana
into a balanced perspective of drug use and addiction in our society. By
deflecting attention away from public health behaviors which cause an
alarming degree of mortality and morbidity, like tobacco use, H. Res. 372
serves to misinform the public. Americans , and particularly children are
distrustful and cynical about government. Large numbers of sick and dying
patients are currently using marijuana for documented relief of several
conditions. Federal attempts to criminalize patients, and their health
care providers result in more pain and suffering, a more intrusive Federal
Government and a more cynical and uninformed public.

Within the medical framework of the United States compassion and knowledge
should be integrated. Disallowing a valuable medicine for poorly
documented and morally dubious reasons is inconsistent with the basic
cornerstones of medical care.

Edward Glick, RN