IS MARIJUANA GOOD MEDICINE?

Proposal to legalize it for patients finds strong support and strong fears

For many voters, the decision to back or reject a proposal to give
people with severe and terminal illnesses legal access to marijuana
will come down to their thoughts on compassion for sick and dying
people versus those on preventing drug abuse.

It's a debate that has divided the medical community, with each side
pledging it is concerned with protecting Michiganders' health.

Supporters have campaigned for months, saying medical marijuana is
the only thing that gives relief to some patients, mitigating the
worst side effects of the best medical treatments. And the measure --
Proposal 1 -- has strong early support, boasting a 66%-25% lead in
the most recent Detroit Free Press-Local 4 Michigan Poll.

But an opposition group of law enforcement, business and medical
community members has campaigned hard in recent weeks against
Proposal 1. It warns of a dystopia of strip-mall pot shops, teens
with easy access to a so-called gateway drug, and crimes unpunished
because of a medical marijuana defense.

There are many unanswered questions in the text of the proposal. It's
not clear where users would buy seeds to grow their plants, and crime
statistics are mixed in the 12 states with legalized medical
marijuana. And, as federal law would still supersede state law, could
agents rain down on Michigan as they have in California, busting pot shops?

One Patient's Relief

For the family of Caprice Wagner of Birmingham, who died in July at
24 after a four-month battle with T-cell lymphoma, there is no
question about the drug's benefits. The Vicodin she was prescribed
barely touched the hallucination-causing pain -- so intense that her
nurse described it to Wagner's mother, Robin O'Grady, as "like a Mack
truck hit you."

But Wagner found relief when she started using marijuana for the pain
on the advice of a medical professional.

"It helped suppress the nausea, eased the cramps, helped her sleep.
It was good to see her relax, having a little bit of her life force
back," said O'Grady, who is fighting for Proposal 1.

The proposal would give patients with pain, nausea and wasting --
common with HIV/AIDS, cancer and neurodegenerative diseases --
prosecution-free access to smoked or ingested marijuana, per a
doctor's letter of recommendation. Users and their caregivers would
have to carry a state identification card, registered through the
Department of Community Health.

They could grow their own supply of 12 plants and could carry 2.5
ounces at a time. It still would be illegal to use marijuana in a
public place or operate a car under the influence.

By law, the Department of Community Health would administer the
program and report to the Legislature. It is preparing its guidelines
in case the measure becomes law.

While the department takes no stand on the proposal, Donald Allen,
director of the Office of Drug Control and Policy, said, "These
people certainly deserve our empathy, but ... it's not in the public
health interest to see people smoke. Period."

The Michigan Medical Association agrees, said Dr. Dan Michael, a
member of the MMA House of Delegates and Citizens Protecting
Michigan's Kids, the leading opponents of the measure.

There is no way to deliver measured doses, and the association cannot
promote smoking of any sort. He also said there isn't enough evidence
for efficacy, making medical marijuana "bad medicine."

Nurses say otherwise. Joyce Stein of the Michigan Nurses
Association's Congress on Public Policy, said nurses on the front
line of end-of-life and cancer care see what medical marijuana can do.

"Doctors are looking for cures, and nurses are looking for comfort in
pain," she said. "This is one more comfort measure they can offer."

Proponents Have Money Edge

Medical marijuana was once legal in Michigan. But the program created
under a 1979 law was dependent on the federal government and a
reluctant state health department, said Stephen V. Monsma, the state
legislator who authored the bill. It came up for review in the 1980s
and wasn't renewed.

Proposal 1 is sponsored by the Marijuana Policy Project, a
Washington-based group, through the Michigan Coalition for
Compassionate Care, made up of patients, medical personnel and
marijuana law reform proponents. And campaign finance documents filed
Friday showed it with a significant fund-raising edge, reporting the
group raised more than $1.5 million and spent nearly $1.3 million

By comparison, Citizens Protecting Michigan's Kids reported raising
$125,500 and spending a little more than $96,000.

The proposal smacks of the "law of unintended consequences," said
William Schuette, a Michigan Court of Appeals judge and a leader of
Citizens Protecting Michigan's Kids. He points to issues in
California, including reports of increased crime and federal
crackdowns on pot shops. Not explicitly outlawing pot shops
implicitly allows them, he said.

"We're sensitive to the problems associated with pain management," he
said, "but this is not a Michigan proposal."

He points to studies from the Substance Abuse and Mental Health
Services Administration, showing increases in marijuana use in states
with medical marijuana laws as evidence it would be more available to teens.

Diane Byrum, spokeswoman for Proposal 1, disputes that, saying a
study by the Marijuana Policy Project and the State University of New
York, Albany, shows teens in states with the laws are using pot less.
The Centers for Disease Control and Prevention's Youth Risk Behavior
Surveillance System survey shows mixed results for the states with
medical marijuana laws that participated.

Byrum noted that the Michigan proposal wouldn't permit the type of
cooperative growing that allows pot shops to exist in California.
Those kinds of operations are what have faced federal crackdowns.

Loophole Concerns

Ferndale is among a handful of Michigan communities with largely
symbolic ordinances allowing medical marijuana, although police Capt.
Timothy Collins said it is not enforced because those users are still
subject to prohibitive state and federal laws.

Collins said that marijuana is not a big issue in Ferndale schools.
But he has problems with the state proposal, which he said doesn't
have enough controls and is poorly written.

"If you look at the legislation, it allows people to grow it in their
house for legal use. Bad guys are going to figure out how to skirt
the law," he said.

There are loopholes, said Sheila Maxwell, a Michigan State University
assistant professor of criminal justice. It's hard to regulate
something you can't dose or study the side effects of, she said.
Enforcing the section on growing plants in locked rooms would be
extra work for law enforcement, she said. As with the 1979 law, she
said this proposal should have suggested a temporary law, to best
study the effects.

Lance Gable, a Wayne State University associate professor of law and
a health law specialist, said the proposal is narrow. Pot shops are a
nonissue, since a caregiver can have only five patients in his or her care.

"That would alleviate some of the concerns about creating an
infrastructure for marijuana sales," he said.

And where the drugs would come from is the major question about
Proposal 1. O'Grady, the woman whose daughter died of T-cell
lymphoma, is lending her support to help lift the stigma of
criminality, so people who need access to the drug can have it.

Many proponents stay mum on whether patients would have to break the
law to buy the seeds. Getting seeds wasn't outlined in other states'
proposals, said Bruce Merkin, spokesman for the Marijuana Policy Project.

Deb Brink of Kentwood was a 19-year-old leukemia patient struggling
through chemotherapy and a bone marrow transplant in 1978 when she
started using medical marijuana. She said people in her hometown
would save pot for her when supplies went dry.

Now a four-time cancer survivor and registered nurse fighting for
Proposal 1, she still remembers how smoking the drug and drinking tea
brewed from its leaves was the only relief from the vomiting that
came from her chemo.

"It was four hours of sick, eight hours of relief, and then I would
start over," Brink said.

[sidebar]

HOW PROPOSAL 1 WOULD WORK

Proposal 1 would legalize marijuana use for select people with
illnesses such as HIV/AIDS, Lou Gehrig's disease and Alzheimer's
disease, and for symptoms such as chronic pain and nausea, which are
common for cancer patients.

. Prescriptions cannot be written to get the drug in pharmacies.
Instead, doctors would write a letter recommending marijuana use.
Users and caregivers would register with the state and get an
identification card. The card would preclude arrest for users and
their doctors.

. Users or their caregivers would be allowed to grow 12 plants in a
private, secure area, and caregivers could not carry more than 2.5
ounces at a time. Sale to a non-registered person would be illegal.

. The Department of Community Health would administer the program and
report on it to the Legislature. Privacy policies would apply to registrants.

Marijuana Use Drops Among Teens in State

According to the Michigan Youth Risk Behavior Survey, which quizzes
thousands of Michigan teens about drug, tobacco and alcohol use,
marijuana use in teens statewide has fallen in the last 10 years. In
1997, 48% of teens said they had used marijuana during their
lifetime; in 2007, it was 35%.

According to the Michigan Profile for Healthy Youth in 2007, the
first year of the survey, 40.6% of Macomb County 11th-graders had
tried marijuana, 44.6% of Wayne County 11th-graders had and 40.4% of
Oakland County 11th-graders had.

"This is a new system and opportunity for local communities to be
able to obtain data comparable to the Michigan Youth Risk Behavior
Survey," said Kim Kovalchick of the Michigan Department of Education.

How Marijuana Works With Pain

Marijuana's effect on pain and nausea is through its main chemical
component, delta-9-tetrahydrocannabinol, or THC. THC attaches to
receptors on cells in the brain, causing the release or uptake of
naturally produced chemicals that dampen pain, said Dr. Daniel Clauw,
a rheumatologist and pain researcher at the University of Michigan,
who is not part of Proposal 1.

Pain is genetic, said Clauw, and there may be 30 to 40 genes that
encode pain sensitivity.

"Different people have different volume control settings for how
susceptible to pain they are," he said. "There is no single class of
drugs that works well for everyone. Cannabinoids work reasonably
well. They might be the only class that works on some people."

There are two FDA-approved drugs for nausea and vomiting in HIV/AIDS
patients that are derived from marijuana: Marinol and Cesamet.
Proponents say swallowing a pill for nausea is difficult and that it
takes longer to work than smoked marijuana. Canadians have access to
Sativex, a mouth spray for multiple sclerosis symptoms.

There is little research being done on marijuana because it is
difficult to get permission to grow the plant.

[sidebar]

5 CITIES OK WITH MEDICAL POT, BUT IT'S JUST SYMBOLIC

Five Michigan cities have medical marijuana ordinances: Detroit,
Ferndale, Flint, Ann Arbor and Traverse City. The ordinances
decriminalize medical use but do not provide for distribution. Canada
allows medical marijuana for terminally ill people, with restrictions
on the amount of marijuana allowed.

The city ordinances are symbolic, as both state and federal law
outlawing marijuana use and possession supersede city ordinances.

"You could try to say ... 'You can't prosecute me through the city
ordinance,' and we'd say, 'Fine, we'll prosecute you under the state
law,' " said Ferndale Police Capt. Timothy Collins. He added that he
doesn't believe there has been any change in crime due to the city ordinance.

Ferndale has a question on the November ballot to allow the
distribution of medical marijuana, which would be unprecedented in
the state but still symbolic.

"We've not had an incidence where marijuana was confiscated where it
may have been used in a medical way," Detroit Police spokesman James
Tate said. In the past, Detroit Police officials have said they will
not arrest medicinal marijuana users but leave it to state and
federal officers.

[sidebar]

PATIENT'S STORY LED STATE TO OK MEDICAL POT IN '79

Michigan is no stranger to medical marijuana.

In 1979, after moving testimony from Deb Negen of Kentwood on how
marijuana spared her the vomiting and nausea of chemotherapy, the
state House of Representatives passed the Michigan Marijuana as
Medicine Act by a vote of 100-0. The Senate followed with a strong
vote in favor of the bill, 33-1. The bill was signed into law Oct. 22, 1979.

That same morning, Keith Nutt of Beaverton, a cancer patient who also
had testified to the Legislature, died.

But what happened after is a mystery. The Michigan branch of the
National Organization to Reform Marijuana Laws claims the goodwill of
the bill foundered because the federal government, which at that time
supplied the drug under a short-lived federal program, stalled and
sent poor-quality supplies. The law lapsed in 1987, and in 1994,
proponents walked up to 100 miles to Lansing in favor of reinstating
it, or at least having medical use exempt from tougher drug laws on
the books. Their efforts failed.

Negen, now Deb Brink, is an advocate for this year's Proposal 1.