ARIZONA DOCTORS MAY FACE MARIJUANA DILEMMA

As debate over Arizona's medical-marijuana proposition heats up,
physicians across the state say the proposition is a double-edged sword.

Physicians agree that marijuana can provide relief for patients with
serious illnesses, but they also find ethical dilemmas in recommending
a drug that is not federally approved. Others warn against the
potential for abuse similar to prescription pills.

If voters approve Proposition 203 on Nov. 2, licensed physicians would
be able to recommend medical marijuana to patients with debilitating
medical conditions, including cancer, glaucoma, HIV/AIDS, hepatitis C
and Alzheimer's disease.

Patients would register for identification cards with the Arizona
Department of Health Services. They could receive up to 2 1/2 ounces
of marijuana every two weeks from dispensaries or cultivate up to 12
marijuana plants if they live 25 miles or farther from a dispensary.

There would be about 120 dispensaries.

In addition to the state health department, several drug-addiction and
- -prevention organizations have spoken out against the proposition,
including Arizona Addiction Treatment Programs Inc., Arizona Students
Against Destructive Decisions and the Yavapai County Methamphetamine
Advisory Task Force.

No medical organization in Arizona has publicly endorsed Prop.
203.

The Republic interviewed doctors whose patients could qualify for
medical marijuana about what impact the measure might have on their
patients.

Even physicians who staunchly oppose the proposition said marijuana
can provide medicinal relief for patients.

Dr. Lesley Meng, an oncologist who runs Desert Springs Cancer Care in
Scottsdale, said 5 to 10 percent of her patients have told her they
use marijuana for medicinal reasons. The clinic sees about 50 to 60
patients a day, she said.

Patients who lose their appetite or experience severe nausea after
chemotherapy become too weak to keep up with their treatments, Meng
said.

Dr. Sue Sisley, who has a private practice in Scottsdale and
specializes in internal medicine and psychiatry, said she has seen
patients' quality of life improve after using marijuana to cope with
chemotherapy or AIDS side effects.

Heather Torgerson, 29, was diagnosed with stage 4 brain cancer in
2007. She lost 20 pounds in four weeks of chemo and radiation and
became too weak to continue the treatments.

Torgerson's cousin suggested marijuana. Within five minutes of smoking
it, she said, she regained her appetite. She returned to chemo after
gaining back some weight.

Torgerson said she smokes once or twice during the week following her
monthly chemo treatments.

"Without it, I wouldn't be here," she said.

Tom Maza, 46, a Tucson resident who was diagnosed with AIDS in 1985,
said he wants to see this measure pass so that he can access the type
of marijuana that relieves pains from his peripheral neuropathy, a
common condition among AIDS patients that affects nerves in fingers,
toes and limbs.

Lack of federal approval

Although physicians agree that marijuana can bring some relief, one of
the main concerns they say they have about using marijuana as medicine
is the lack of U.S. Food and Drug Administration approval. The FDA
conducts clinical trials to determine which drugs are safe for public
use and over-the-counter sale. The FDA bases its approval on two
criteria: safety and efficacy.

Marijuana is classified as a schedule-1 drug by the U.S. Drug
Enforcement Administration, meaning it has a "high potential for
abuse," no accepted medical use and "lack of accepted safety."

The lack of FDA approval raises ethical concerns for physicians, said
Dr. Kenneth Fisher, a family practitioner in Phoenix who has worked
with AIDS patients for decades.

He prescribes Marinol to patients, but he said he is not comfortable
recommending marijuana because it lacks the federal regulation,
oversight and quality control that other medications go through.

Marinol, a synthetic THC pill approved by the FDA, is available by
prescription. It is commonly used to treat weight and appetite loss
and relieve nausea for cancer and AIDS patients. THC is the active
ingredient in marijuana.

If the proposition passes, all parts of a marijuana plant and its
seeds would be legal to use. This includes smoking marijuana,
ingesting it by food or brewing it as tea.

According to the National Institute on Drug Abuse, studies have found
that marijuana contains carcinogens, which irritate the lungs. Several
physicians, including those who support the proposition, said they are
worried their patients would smoke the marijuana.

Dr. Carol Peairs, an anesthesiologist in Phoenix who specializes in
pain management, said she does not support Prop. 203 because "anecdote
and emotion are not the way to prove a new medicine."

But to proponents of the measure, getting marijuana approved by the
FDA is a catch-22. Because marijuana is classified as a schedule-1
drug, it is difficult to secure enough funding to conduct the
extensive research necessary to get it approved by the FDA, said
Andrew Myers, campaign manager of the Arizona Medical Marijuana Policy
Project, which is largely funded by the Washington, D.C.-based
lobbying group backing the Arizona effort.

Safer than painkillers?

A disputed point among doctors is whether legalizing medical marijuana
would alleviate or augment problems with prescription medication, such
as abuse.

Proponents of the measure said marijuana would provide a safer and
more effective substitute for painkillers, such as Vicodin, Oxycontin
and Demerol, commonly prescribed to patients with serious illnesses.

Long-term use of these opioids can lead to addiction and physical
dependence, according to the National Institute on Drug Abuse. And
people can die from overdosing on prescription pills, but they can't
die from overdosing on marijuana, said Sisley, the private-practice
doctor in Scottsdale.

But doctors who oppose Prop. 203 said marijuana can be just as
sedating and addictive as prescription pills. Peairs said THC affects
multiple sites in the brain rather than just focusing on pain
receptors, she said. "Essentially, marijuana's activity in the brain
is like a bomb. What we need for pain relief is a sniper, targeting
the pain receptors only," she said.

Dr. Ed Gogek, a psychiatrist in Prescott who specializes in
addictions, said the medical community "absolutely recognizes" that
marijuana is an addictive drug. Marijuana is not as addictive as
tobacco or cocaine but about as addictive as alcohol, Gogek said.

Meng, the oncologist, who supports the measure, acknowledged that
regulation of medical marijuana would be challenging if it passes. But
she said she still thinks the positives outweigh the potential downsides.