PRESCRIPTION POT

Proposals for Medicinal Marijuana Use Earn Mixed Reviews From the Medical
Community

Heather De Mian has vascular Ehlers-Danlos syndrome, a disorder that
weakens the body's collagen - what she calls the "rubber bands and glue
that hold the body together." She suffers from gastro-intestinal problems
and is prone to dislocated bones and bruises because of ligament weakness
and feeble blood vessels. Eventually, the disease may kill her.

De Mian takes seven prescription drugs, two of which, Zofran and Marinol,
are used specifically to treat the nausea and vomiting she experiences
regularly. Because she qualifies for Medicare and Medicaid, taxpayers pick
up the tab for her prescriptions; the Zofran and Marinol alone cost $32,000
per year.

But De Mian says she has a way to save that money.

"If I could grow my own marijuana, it would save taxpayers $30,000 for one
patient for one year," she says. "I use a wheelchair most of the time, and
if I'm lucky, I leave my house two times a week. If the money could be
spent on attendant services instead of drugs, it would benefit me greatly."

Eighteen months ago, in April 2003, Columbia voters turned down a proposal
to legalize the medical use of marijuana. This prompted Columbia Police
Chief Randy Boehm to declare the issue all but dead "for a while."

Since 1996, 11 states, most of them in the West, have passed laws
eliminating or reducing penalties for marijuana used for medical purposes.
It turned out to be a short while.

On Nov. 2, voters will once again weigh in on an issue that doctors,
patients, lawmakers and civil libertarians across the country have been
debating since the mid-1970s, when laws allowing the use of marijuana for
medicine were first passed.

Under city law, possession of 35 grams or less of marijuana is a Class A
misdemeanor, punishable by a maximum sentence of one year in jail and a
$1,000 fine.

Passage of Proposition 1 would allow for the dismissal of charges against
seriously ill people who obtain and use marijuana on a doctor's
recommendation. The new law would also protect physicians who prescribe
marijuana from arrest and prosecution.

This year's medical marijuana initiative is separate from a referendum,
also on the Nov. 2 ballot, on whether to send all misdemeanor marijuana
possession charges to Municipal Court. In 2003, when Proposition 1 was
rejected by 57.8 percent of voters, the two measures were combined.

"The original Proposition 1 was relatively successful," says Amanda Broz,
president of the MU chapter of the National Organization for the Reform of
Marijuana Laws. "It showed that a large majority of the town is open to
changing. This time, we separated the issues."

Eleven states -- Alaska, Arizona, California, Colorado, Hawaii, Maine,
Maryland, Nevada, Oregon, Vermont and Washington - and several
municipalities already have legalized medical marijuana. Several other
states and municipalities are also voting on the issue Nov. 2.

Results of Research

Three years ago, the American Medical Association issued a review of the
scientific research on the therapeutic value of marijuana. Studies have
found that marijuana has helped cancer patients and people with AIDS keep
food down and gain weight. Other studies have found that THC - marijuana's
active ingredient - helps post-operative patients deal with pain.

Clinical trial data and anecdotal evidence support the view that smoked
marijuana and oral THC, such as the brand-name drug Marinol, offers relief
from spasticity, pain and tremors in patients with multiple sclerosis,
according to the AMA.

"Lots of research is being done that shows the benefits of marijuana used
as medicine," says Columbia physician John Mruzik, an outspoken proponent
of medical marijuana.

In its report, however, the AMA stressed that more research is needed to
determine whether the benefits of marijuana outweigh its potential for
harm. The AMA concluded that the future of medical marijuana lies in its
"isolated components."

Smoking marijuana is a crude delivery system that also delivers harmful
substances, the AMA says: "Smoked marijuana should generally not be
recommended for medical use."

Mruzik concedes that marijuana has "some harmful effects." He does not
condone its use by patients with mental illness, and he acknowledges that
"no doctor alive is going to tell you that smoke is good for you."

But, Mruzik says vaporizers - machines that remove harmful carcinogens from
marijuana smoke but retain the psychoactive cannabinoids of the plant,
including THC - can reduce the lung damage caused by smoking marijuana.

In that case, Mruzik argues, "if it helps ease pain, what's the problem?"

Physicians Split on Use

Physicians are split on whether marijuana should be legalized for medical
purposes. The American Academy of Pediatrics, for example, says its members
"are not of one mind" regarding the legal status of marijuana. In 1995, the
academy asked its members their views on legalization. A minority - 18
percent - favored legalization, while just under a quarter said penalties
for personal possession of marijuana should be reduced.

As for the medical use of marijuana, 31 percent felt that the drug should
be available, by prescription, to certain patients. In June, the academy
made official its opposition to the legalization of marijuana and argued
that it would increase the already widespread availability of the drug to
adolescents. The policy approved by the academy's committees on substance
abuse and adolescents notes that in 1997, 23 percent of eighth graders
reported having used the drug at some time in their lives - an increase
from 10 percent in 1991.

"The abuse of marijuana among teenagers has increased as the perceived
harmfulness of regular use has decreased and the perception of peer
acceptance has increased," the statement says.

Moreover, the policy states that marijuana has "no currently accepted
medical use" in the United States and warns that it is classified by the
federal government as a Schedule I drug, which means it has a high
potential for abuse.

Still, the academy continues to support "rigorous scientific research" on
the use of cannabinoids - the various chemical constituents of marijuana -
for the relief of medical symptoms that are not alleviated by existing drugs.

On the other hand, a 1997 editorial in the New England Journal of Medicine
called policies that prohibit physicians from prescribing marijuana for
seriously ill patients "misguided, heavy-handed, and inhumane." While
acknowledging the drug's long-term adverse effects, including the
possibility that it could lead to serious addictions, the author, Jerome
Kassirer, a professor at Tufts University School of Medicine and an
associate research scientist at the Yale University School of Medicine,
argued that neither of those issues were relevant to the debate.

"It is hypocritical to forbid physicians to prescribe marijuana while
permitting them to use morphine and meperidine to relieve extreme dyspnea
(shortness of breath) and pain," Kassirer wrote. "With both these drugs the
difference between the dose that relieves symptoms and the dose that
hastens death is very narrow; by contrast, there is no risk of death from
smoking marijuana."

Kassirer also argued that, while oral THC has been available by
prescription for years, it is difficult to determine the proper dosage for
individual patients and is not often prescribed. By contrast, he said,
"smoking marijuana produces a rapid increase in the blood level of the
active ingredients and is thus more likely to be therapeutic."

Physicians who have the "courage" to prescribe marijuana for the sick will
eventually "force the courts to adjudicate between the rights of those at
death's door and the absolute power of bureaucrats whose decisions are
based more on reflexive ideology and political correctness than on
compassion," Kassirer concluded.

The realm of public opinion Indeed, referendums such as Proposition 1
signal a shift in the debate on medical marijuana from the medical arena to
the court of public opinion. Amanda Broz, the NORML president at MU, says
the medical marijuana movement suffers from a stigma.

Many doctors and teachers support Proposition 1, she says, but are fearful
of being associated with the controversy over an illegal substance.

"Some doctors aren't vocal because they could face punishment," she says.
"I 've encountered elementary school teachers supportive of the initiative,
but they were afraid to sign the initial petition out of fear of losing
their jobs.

"The word 'marijuana' is automatically a turnoff for some people. People
are afraid to have their name associated with this because of the
consequences, and I don't think those fears are necessarily unfounded, sadly."

Broz, whose group was instrumental in collecting the 2,276 petition
signatures required to put the issue on the Nov. 2 ballot in Columbia,
seemed surprised to find that support of, or opposition to, the referendum
isn't driven by conventional politics.

"You cannot stereotype anyone," she says. "I assumed most students would be
in favor of this but a lot of them aren't. At the same time, I've had
Republicans and Democrats sign the petition."

Caleb Lewis, president of MU College Democrats, says that the ballot
initiative has not garnered much discussion among his group -which has not
taken a position on Proposition 1 - nor among Democratic candidates for office.

"I don't think it will play a major role in any campaign," he says.

MU Campus Libertarians supports the initiative unequivocally. Libertarians
believe that laws should not limit options in terms of medical treatment,
group member Adam Shahid says.

"The government has no business interfering with matters between doctor and
patient when there is no fraud or malpractice involved," Shahid says.

Public opinion polls strongly suggest that many Americans feel the same
way. In October 2002, 80 percent of respondents to a Time Magazine/CNN poll
said they supported allowing adults to "legally use marijuana for medical
purposes." The Center for Substance Abuse Research reported in January 2002
that 70 percent of poll respondents agreed that the use of medical
marijuana should be allowed. And, in March 2001, when the Pew Research
Center asked 1,513 people if doctors should be allowed to prescribe
marijuana, 73 percent said yes.

"At some point, politicians will recognize that their constituents believe
in it," Mruzik says. "How can they oppose something so many people support?"

Columbia Voters to Decide

In August, the Columbia City Council, in a 3-3 tie, rejected an ordinance
that would have called for the dismissal of charges against people caught
with marijuana if their physicians approved its use. (Mayor Darwin Hindman
did not attend the meeting.) Council members, however, did agree
unanimously to put the issue on the Nov. 2 ballot.

Sixth Ward Councilman Brian Ash, who voted against the ordinance, says
passing the proposal would have sent the wrong signal.

"People might stretch the definition of a medical problem to be able to use
it," Ash says. "It just opens Pandora's Box."

Ash says those already using marijuana for medical purposes should not fear
prosecution. But Columbia Police Chief Randy Boehm says that, while he
knows of no cases in which medical users have been punished, they now face
the same criminal penalties as any other user if caught with marijuana.

Boehm says he opposes the initiative for several reasons. For one, he says,
the ballot language doesn't specifically address law enforcement's
responsibility.

"The wording of the petition is not quite clear," he says. "It seems
they're directing us to make it a low priority."

Boehm is also concerned about how patients would obtain the marijuana and
how law enforcement would verify that a doctor has approved its use.

"There are concerns legally that even if this were to pass, there's no way
to legally obtain it," he says. "There are complications with this on a
number of levels."

Are Drug Laws Unjust?

Clearly, many supporters of Proposition 1 seem as concerned with current
drug laws in the United States as they are about marijuana's therapeutic
effect on the sick. Chuck Thomas, executive director of the Interfaith Drug
Policy Initiative, a lobbyist organization established in 2003, calls
America's drug policy "completely backwards."

"Religions of the world all stress justice and compassion, and this drug
war is one of our government's most unjust and discompassionate policies,"
Thomas says. "This is largely a culture war, and that's another reason to
involve people of faith."

The Interfaith group's efforts to reform U.S. drug laws have the support of
other religious organizations, including the Unitarian Universalists, the
United Church of Christ, Evangelical Lutheran Church in America, and the
American Presbyterian Church. Interfaith has also garnered support from
progressive Jewish congregations.

"If somebody is using marijuana for medical purposes, it's clearly wrong to
punish somebody with no criminal intent who is only using it to treat a
medical condition and reduce pain and suffering," Thomas says.

Others say the prohibition against marijuana is hypocritical. The AAP
acknowledges that tobacco and alcohol, which are legal for 18- and
21-year-olds respectively, are more widely abused by adolescents than
marijuana. Right now, it's against the law for Heather De Mian to use
marijuana to ease the symptoms of her disease, but at the homeless shelter
where she works, "we've buried more alcoholics than I can count."

"There are plenty of more dangerous prescription drugs, such as Oxycontin,"
she says. "Even 7600 Americans die every year from aspirin, but there has
been no case of death from just marijuana itself.

"I don't understand how lawmakers have the gall to override a doctor," she
argues. "When all the politicians get their medical degrees, they can come
talk to me."

NORML's Broz says that barring marijuana from people who could be helped by
it doesn't make sense, and that the apparently widespread public support
for medical marijuana suggests that when it comes to pain and illness,
anything that brings relief should not be punishable by law.

"It's a quality of life issue," Broz says. "People who know someone with a
serious illness understand that it does help the pain. One of those
patients could be my mom, my sister, or me."