LEGAL DRUGS WORK AS WELL FOR PAIN AS MARIJUANA, HEROIN

People keep asking why marijuana and heroin can't be approved for
intractable pain in cancer patients. Today's guest columnist is Dr. Dean
Gesme, a Cedar Rapids oncologist, a physician trained in the diagnosis,
treatment and care of cancer patients. A former president of the Iowa
division of the American Cancer Society, he tells his perspective of this
controversial topic -- Cancer Update columnist Shirley Ruedy.

The medicinal use of marijuana and heroin has been discussed in the print
and electronic media for the past 10 years. These drugs are principally
known in our society because of their potential for abuse. The government
has been reluctant to authorize use of these drugs by physicians because of
this abuse potential.

Though these drugs can provide benefits for symptoms experienced by cancer
patients, the focus of concern should not be the legalization of marijuana
and heroin, but rather the appropriate use of existing drugs to control
cancer pain and nausea.

Radiation and chemotherapy can sometimes produce mild, or less frequently,
severe nausea. Marijuana has been shown in some cases to significantly
reduce this nausea. A chemical derived from the active ingredient in
marijuana is used in a drug called Marinol, and is currently licensed and
marketed for use in cancer patients with nausea.

This drug is not widely utilized because many patients find the side
effects unpleasant. Older patients in particular often report a feeling of
dizziness, jitteriness, or apprehension with the use of Marinol.

The issue, therefore, is not whether marijuana is effective in reducing
nausea, but rather, whether marijuana is the best drug to accomplish the
relief of these symptoms. Among cancer specialists, very few would consider
marijuana their first, second, or even third, choice in treating nausea.

The medical use of heroin is also a subject of hot debate among consumers.
Heroin can effectively treat many types of pain. It is, however, no better
than any of the other forms of the narcotic morphine, forms which are
already widely used for cancer patients.

Morphine-related products are available as pills, injections,
suppositories, and even in patches that can be absorbed through the skin,
similar to nicotene (used for patients who wish to stop smoking). Morphine
can also be given as a liquid, or as a tablet that rapidly dissolves under
the tongue. Some morphine preparations are absorbed almost immediately,
while other forms will be slowly absorbed over a period of many hours.

In my opinion, there is no need for heroin in the treatment of pain, since
morphine is equally effective and comes in a variety of forms that will
equal or surpass any of the benefits of heroin.

Cancer patients have a real and reasonable right to expect pain to be
substantially controlled with currently available treatments. They should
not be reluctant to let the doctor know the location and severity of any
persistent pain.

The goal of manageable pain requires good communication between the patient
and the health care team. Separating the components of anxiety, anguish, or
depression related to cancer from the actual pain can lead to more
effective control of these symptoms that may not respond to narcotic pain
medications.

But -- what should a patient do when his or her pain is ignored after
repeated requests for help? My advice: The patient should politely and
firmly request to see a pain or cancer specialist.

Looking through the prism of my experience with thousands of cancer
patients, I find that the argument that heroin and marijuana should be made
available for terminal pain is simply not appropriate. I see that patients
can receive alternative therapies that offer equal or better treatment
results with drugs that are already available -- drugs that do not carry
the reputation for abuse for which marijuana and heroin are known.

The push to approve marijuana and heroin for medicinal use usually comes
from individuals or groups who are also sympathetic to liberalizing drug
laws. Even those oncologists who agree with a liberal social policy toward
drug use will agree that there are few, if any, situations in which
marijuana or heroin could not be completely replaced with existing
alternative drugs.

Final note: I have received queries from people being pelted for donations
from cancer organizations they have never heard of. That's your tip-off:
You've never heard of them. To put it succinctly: If you want your money to
be put to the best use against cancer, go with an organization who has a
proven track record. That's what I do -- Cancer Update columnist Shirley
Ruedy.