SHOULD SMOKING MARIJUANA BE A MEDICAL OPTION?

Rocky Hoveland of Greensboro suffers pain from spine, neck and back injuries.

For a long time, he took prescription painkillers. But the drugs
often left him dazed, if not null and void.

Then about 10 years ago, he began using marijuana to treat the pain.
He found that it didn't eradicate the pain, but it made it more manageable.

"It keeps me from being in that haze of wanting to sleep all day or
feeling hung over all day," he said. The prescription medications
"were making me lay down, and I ain't one to lay around."

Hoveland and others like him are pushing for North Carolina to
legalize cannabis for medical purposes. And they have become part of
a national trend.

In November, Michigan became the 13th state to legalize marijuana for
medical purposes.

That popular-vote referendum was just the most recent decision in a
long-running debate: whether it should be legal for people to use,
grow and sell marijuana for medicinal purposes.

On one side: sick, suffering patients, many of

whom are dying. For at least some of them, cannabis eases symptoms of
illness or side effects of treatment.

On the other: a federal government that believes marijuana's benefits
are too few and its side effects too risky for the drug to be
legalized, even to the highly restricted level of cocaine.

Billy, a Davidson County man who didn't want his full name used ,
once took the prescription painkiller Dilaudid every day after
lingering neck and wrist injuries, experiencing some of the same side
effects as Hoveland.

Dilaudid "didn't do much" for the pain, he said. "And I got hateful.
My family didn't want to be around me."

Marijuana has helped him, too, he said. "Now I'm up and around,
hiking and fishing," he said. "Marijuana focuses my mind away from
the pain. I'm still hurting, but it's not that important anymore."

Proponents of legalization in North Carolina are ramping up their efforts.

Representatives of the nonprofit N.C. Cannabis Patient Network have
toured the state this winter, meeting with politicians, clergy and
medical professionals and airing programs on local public-access TV stations.

On May 2, proponents are scheduled to march in Raleigh on behalf of
legalization as part of a global one-day protest called the Million
Marijuana March.

"We're looking forward to this becoming legal in this state so people
can quit living in fear," said Jean Marlowe, the network's executive
director. "We're returning dignity to these patients."

Marlowe, who lives in Polk County, has used marijuana since 1991 to
treat muscular dystrophy, rheumatoid arthritis, degenerative disk
disease, muscle spasticity and fibromyalgia. She says the authorities
leave her alone because she has a letter from her doctor saying she
needs medical cannabis.

Before using marijuana, she said, the side effects of her various
medications left her practically disabled.

"I spent my time throwing up, dizzy," she said. "I couldn't cognize.
I couldn't balance my checkbook. I spent my life in a chair, in the
corner, with a trash can."

State Rep. Earl Jones, D-Guilford, introduced a bill in the 2008
legislative session to create a study commission to look at
legalizing marijuana for medical purposes in North Carolina. Jones
plans to reintroduce his bill this year .

"I think the legislature will do the right thing once they see it
will benefit the public and they have been educated," Jones said.

But the U.S. Drug Enforcement Administration remains adamantly
opposed to legalizing cannabis even for medical purposes. It
continues to prosecute under federal law in some other states for
growing and distributing the plants.

The most comprehensive review of the possible medical benefits of
marijuana remains a book-length report, "Marijuana and Medicine,"
published in 1999 by the Institute of Medicine . The institute is
part of the National Academies, agencies that advise the government
on medicine and other sciences.

That report, co-authored by a researcher at Wake Forest University
Baptist Medical Center, examined marijuana use with respect to five areas:

* Pain, particularly nerve pain experienced by patients with AIDS and
other diseases. * Nausea and vomiting, often experienced by
chemotherapy patients. * Wasting syndrome and loss of appetite, often
experienced by AIDS and cancer patients. * Neurological symptoms,
including muscle spasticity and multiple sclerosis. * Glaucoma,
excessive pressure in the fluid inside the eye. The condition can
cause blindness.

In general, the report found that marijuana, though not a panacea,
could help relieve some of these symptoms in at least some patients.
In some cases, the report found, marijuana worked as well as or
better than accepted treatments.

It also found that smoking treats symptoms such as pain and nausea
more quickly and effectively than taking the medicine by mouth.

The report raised concerns about the long-term health effects of
smoking marijuana, which, like tobacco, is associated with an
increased risk of cancer. Such long-term risks probably don't matter
for patients who already are dying, the report noted.

A synthetic form of marijuana's most active ingredient, THC, is
available by prescription under the trade name Marinol. But it takes
longer to work than inhaled marijuana smoke.

Also, taking cannabis by mouth can get patients "higher" than smoked
cannabis - which many patients don't want. When THC is eaten, the
liver, which smoking bypasses, breaks the psychoactive elements down
into even more potent chemicals.

Another problem with synthetic oral cannabis is that it contains only
a few active ingredients, while smoked marijuana contains more than 60.

The combination of those ingredients, not just one, may provide the
most medical benefit, says Dr. Wilkie Wilson, director of the
DukeLEARN neurological-research program at Duke University, who notes
that drug companies are researching that question.

"What you need is something, maybe like an aspirator or an inhaler,
that can deliver the drug better than a pill would," said Dr. Steven
R. Childers, a professor of physiology and pharmacology at Wake
Forest University's Bowman Gray School of Medicine. Childers co-wrote
the 1999 Institute of Medicine report.

Wilson, co-author of "Buzzed: The Straight Facts About the Most Used
and Abused Drugs from Alcohol to Ecstasy," says some patients prefer
smoking because it gives them greater control over their dosage -
they can choose to stop, or continue, at any time depending on how
much relief they're getting.

Childers says the 1999 report's general conclusions remain accurate.
Researchers have made some incremental advances, particularly in
whether cannabis can ease some symptoms of multiple sclerosis. The
nonprofit National Multiple Sclerosis Society is paying for a 10-year
study, which began in March.

Also, Swiss researchers found in 2006 that cannabis taken orally can
ease muscle spasticity in people with spinal-cord injuries. And after
promising findings in rats and mice, Israeli researchers plan human
trials to determine whether cannabis may slow or halt memory loss in
people with Alzheimer's disease.

But U.S. government-sponsored studies since 1999 have been few and
far between. The government grows little marijuana for research and
tightly restricts its use. Currently, of 768 drug-related studies
sponsored by the National Institute for Drug Abuse and registered at
www.ClinicalTrials.gov, two pertain to medicinal marijuana.

Besides the possible direct benefits to patients, what are the
arguments for legalizing medicinal cannabis?

For one thing, it may help patients for whom other drugs are
ineffective or cause intolerable side effects. Its own side effects
are relatively minor, the long-term cancer risk aside.

Cannabis is safer than many drugs now on the market. There has never
been a documented death attributable to marijuana overdose, Wilson says.

And legalization would bring about standardized dosages and quality,
aiding both treatment and research.

Critics argue that the drug is psychologically habit-forming. It can
be, but it is less so than alcohol, tobacco and such drugs as heroin,
the institute report found.

Some research subjects have reported unpleasant feelings or
sensations after taking the drug. And some do not like the "high"
that comes with taking the drug. That condition also can make it
dangerous to drive or perform other skilled tasks and can hurt
judgment and short-term memory.

Wilson points out that these ill effects are particularly dangerous
in young people, whose growing brains must absorb not only academic
knowledge but also social skills.

There is some evidence the drug can hamper the immune system in some patients.

And marijuana is considered a "gateway" drug - one that could lead to
use of more potent and dangerous illegal drugs. The 1999 report found
little evidence to support that claim on a pharmacological basis. It
also observed that alcohol and tobacco are more widely used gateway
drugs, particularly among younger people.

For those reasons and others, federal law classifies marijuana as a
Schedule I controlled substance, the most restricted type. Such drugs
are defined as having no currently accepted medical use in the U.S.,
a high potential for abuse, and no accepted safe approaches for use
even under medical supervision.

Another Schedule I drug is LSD.

Proponents of medicinal marijuana want it reclassified at least as a
Schedule II drug, the most restrictive category for addictive drugs
with recognized medical uses. Examples include codeine, the active
ingredient in many cough medicines, and the painkiller Dilaudid.

The U.S. Drug Enforcement Administration maintains that marijuana's
risks are too great, and its medical benefits too few, to legalize
it. Even in some of the 13 states that have legalized medicinal
marijuana, DEA agents still arrest people on federal drug charges.

And the government can prosecute doctors who prescribe marijuana. To
avoid arrest, doctors often give their patients letters stating that
the patient needs marijuana, rather than a prescription.

Proponents of medicinal marijuana also argue that regulating the drug
should be a state and local matter, not a federal one.

In 2005, the U.S. Supreme Court ruled in a case called Gonzales v.
Raich that the federal government had the right to regulate marijuana
even within a single state, as opposed to in interstate commerce.

But a more recent Supreme Court decision suggests that the days of
such overarching federal regulation might be numbered.

On Dec. 1, the court refused to hear an appeal from the city of
Garden Grove, Calif. That city was defying a state court's order to
return marijuana it had seized from a man who had won dismissal of
drug charges after he provided a statement from his doctor that he
needed marijuana.

Proponents hope that these incremental steps will lead to a day on
which no one need fear legal punishment for using medicinal cannabis.

"I'd like us to be united in compassion," Marlowe said. "Living in
fear of the government is not what we want for people who are sick and dying."

Wilson says marijuana should be legally distributed through
pharmacies just as other drugs are.

"We control amphetamines - my God, we give them to kids for
attention-deficit disorder," Wilson said. "Just treat (marijuana)
like any other regulated pharmaceutical. I don't see any reason not
to do that. I just don't see the reason."

After her tour of the state, Marlowe said she is more hopeful than
ever about legal medical marijuana.

"I can smell the finish line," she said. "I'm not going to be a
criminal much longer."

[sidebar]

MEDICAL MARIJUANA USE

The most comprehensive review of the possible medical benefits of
marijuana is a book-length report, "Marijuana and Medicine,"
published in 1999 by the Institute of Medicine.

That report, co-written by a researcher at Wake Forest University
Baptist Medical Center, examined marijuana use with respect to five areas:

n Pain, particularly nerve pain experienced by patients with AIDS and
other diseases.

* Nausea and vomiting, often experienced by chemotherapy patients.

* Wasting syndrome and loss of appetite, often experienced by AIDS
and cancer patients.

* Neurological symptoms, including muscle spasticity and multiple sclerosis.

* Glaucoma, excessive pressure in the fluid inside the eye. The
condition can cause blindness.