DOC SAYS POT PILL NO GOOD

There's a key reason why some groups want to make it legal for some
seriously ill patients to smoke marijuana to ease vomiting and nausea.

Although there is a pharmaceutical version of marijuana called
Marinol that comes in pill form, it doesn't work, according to Dr.
Elaine Chottiner. She serves as section head of hematology and
oncology at Saint Joseph Mercy Health System, which runs the Saint
Joseph Mercy Woodland Center in Genoa Township.

"If Marinol worked, nobody would care about legalizing marijuana,"
Chottiner said.

On Nov. 4, Michigan voters will decide the fate of the medical use of
marijuana ballot question. Under Proposal 1, there would be specific
guidelines to using marijuana. A physician would need to approve
marijuana use for a patient with a debilitating medical condition,
and patients would receive an identification card. Patients would
only have protected use in their home and could not smoke it in public places.

Chottiner said Marinol was approved because it was shown in clinical
trials to alleviate vomiting and nausea caused by certain kinds of
chemotherapy. It contains a synthetic form of THC, the major active
substance in marijuana, which helps relieve nausea and vomiting from
chemotherapy and stimulates appetite for AIDS patients.

However, Chottiner said few patients have found the pill to be
effective and usually don't seek refills. She said absorption is
probably one reason the drug doesn't work as well, since it takes
longer to digest something than smoke it. Also, Marinol contains only
one of marijuana's 66 compounds.

Chottiner said a few people have asked her about smoking marijuana to
ease their symptoms, and a few patients have told her they're smoking
marijuana to ease their nausea and vomiting. In general, Chottiner
said only a very small percentage of patients have chronic nausea and
vomiting from chemotherapy. She said most chemotherapy does not cause
those symptoms. She also said there are excellent medications
available -- and that work -- to prevent those symptoms.

Chottiner, who indicated she was neutral on the ballot question, said
there are pros and cons with the proposal.

She said the most important issue is helping patients.

"We want to do everything we can for our patients and alleviate their
suffering," she said. "If this is something that can be used for this
purpose, it would be helpful to find a way to provide it."

However, Chottiner said she feels much more comfortable prescribing
drugs that have gone through the U.S. Food and Drug Administration
approval process. She said the FDA conducts rigorous clinical trials
so doctors know what's in a drug, a proper schedule and dosage for a
particular drug. She said it would be difficult to prescribe
marijuana because there are no standards.

Chottiner said she doesn't prescribe herbs because "you never know
what you're getting."