LEGALIZED MARIJUANA STIRS QUESTIONS, CONCERNS

The day after Michigan voters approved marijuana for medical use, Dr.
Robert Shurmur posted a sign on the door of his office, in
psychedelic colors, that read, "I do not prescribe medical marijuana.
Please do not ask!!"

The local rheumatologist called it a form of protest against what he
thinks is legislation that will allow greater abuse of the drug.

The Michigan Medical Marijuana Act went into effect Thursday, but its
enactment has produced more questions than answers for several local
health care providers. Physicians say they are unsure how to proceed.

The Michigan Department of Community Health has until April 4 to set
up a program for medical marijuana's administration and use. It
posted proposed rules to a new Web site announced Monday at
www.michigan.gov/mmp and plans to hold a public hearing on Jan. 5 to
receive comments.

Several local physicians do not think marijuana is better than
conventional medications and fear its legalization for medical use
opens it to greater abuse.

"Basically, it creates so many more problems than the potential
benefits of the medication," Shurmur said.

Jokingly, he said M.D. does not stand for marijuana distributor. But
patients who want it badly enough will eventually find a doctor who
will prescribe it.

"I went into medicine to help and heal patients," he said. "Now we've
got more of this crap to deal with and I don't get it."

Patients who have a cancer, glaucoma, HIV, AIDS and other
debilitating conditions as defined by the MDCH are eligible for
medical marijuana.

After the rules are decided, qualifying patients can register with
the state and receive ID cards allowing them to legally acquire,
possess, grow, transport and use a limited amount -- no more than 2.5
ounces and 12 plants -- of marijuana. They also can designate a
primary caregiver to receive similar protection.

Dr. Corbett Amburgey, an optometrist at Sears Optical, said for many
years he has seen patients claiming to have glaucoma, trying to
justify their marijuana use.

Glaucoma patients usually have no symptoms and feel no pain, but if
left untreated the condition can lead to peripheral blindness, he
said. There are prescription eye drops available that reduce pressure
in the eye by allowing the fluid inside to drain properly, preventing
vision loss.

All marijuana does is relax the muscles around the eye. A person
would have to smoke it 24 hours a day to get the same effect as one
drop in each eye once a day, he said.

"You probably wouldn't be able to drive or hold down a job if you had
to smoke all day and all night," Amburgey said.

Besides that, smoking marijuana long term has been associated with
the same diseases as cigarette smoking, he said.

Shurmur, however, said he thought marijuana might be useful in
treating terminally ill cancer patients when all other options have
been explored.

Getting to that point seemed unlikely since there are so many
federally approved medicines already available to alleviate the pain
and nausea often associated with cancer treatments.

Dr. Stephen Smiley, Battle Creek Health System director of medical
oncology, said his sister-in-law, who died of cancer more than 20
years ago, used marijuana obtained legally to ease her terminal condition.

Now doctors have Marinol, a synthetic copy of the active ingredient
in marijuana, which Smiley said he has prescribed on occasion, in
addition to other more powerful painkillers for cancer patients.

"So I think that has been my reason that you didn't hear me being a
big vocal advocate," he said. "What worries me is how is this going
to get distributed and what is the abuse potential."

Smiley is waiting for the state to finalize its rules on medical
marijuana before deciding if he will prescribe it.

"I'm going to want to know what my potential liability is, how this
is going to be procured, and what safeguards are in place," he said.

Perhaps the strongest argument for its legal use stems from the
growing number of unemployed and uninsured individuals who might not
be able to afford conventional medicines, but who could grow
marijuana plants for personal use.

"That doesn't hold water for me. Good God, there's a lot of things we
can do in life, but I don't think that's one of the reasons I would
prescribe it," Smiley said, noting pharmaceutical companies offer
their drugs free to low-income patients who qualify. "I'm all for
helping people that need help, but I just don't think that is the answer."