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Mainers
for Medical Rights
44 Exchange Street
Suite 201
Portland, ME 04101
800.846.1039
207.780.0704
info@mainers.org
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January 30, 1997 |
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Foolishness and Marijuana |
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The
advanced stages of many illnesses and their treatments are often accompanied by
intractable nausea, vomiting, or pain. Thousands of patients with cancer, AIDS,
and other diseases report they have obtained striking relief from these devastating
symptoms by smoking marijuana. (1) The alleviation of distress can be so striking
that some patients and their families have been willing to risk a jail term to
obtain or grow the marijuana.
Despite the desperation of these patients, within weeks after voters in Arizona
and California approved propositions allowing physicians in their states to prescribe
marijuana for medical indications, federal officials, including the President,
the secretary of Health and Human Services, and the attorney general sprang into
action. At a news conference, Secretary Donna E. Shalala gave an organ recital
of the parts of the body that she asserted could be harmed by marijuana and warned
of the evils of its spreading use. Attorney General Janet Reno announced that
physicians in any state who prescribed the drug could lose the privilege of writing
prescriptions, be excluded from Medicare and Medicaid reimbursement, and even
be prosecuted for a federal crime. General Barry R. McCaffrey, director of the
Office of National Drug Control Policy, reiterated his agency's position that
marijuana is a dangerous drug and implied that voters in Arizona and California
had been duped into voting for these propositions. He indicated that it is always
possible to study the effects of any drug, including marijuana, but that the use
of marijuana by seriously ill patients would require, at the least, scientifically
valid research.
I believe that a federal policy that prohibits physicians from alleviating suffering
by prescribing marijuana for seriously ill patients is misguided, heavy-handed,
and inhumane. Marijuana may have long-term adverse effects and its use may presage
serious addictions, but neither long-term side effects nor addiction is a relevant
issue in such patients. It is also hypocritical to forbid physicians to prescribe
marijuana while permitting them to use morphine and meperidine to relieve extreme
dyspnea and pain. 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. To demand evidence of therapeutic efficacy
is equally hypocritical. The noxious sensations that patients experience are extremely
difficult to quantify in controlled experiments. What really counts for a therapy
with this kind of safety margin is whether a seriously ill patient feels relief
as a result of the intervention, not whether a controlled trial "proves" its efficacy.
Paradoxically, dronabinol, a drug that contains one of the active ingredients
in marijuana (tetrahydrocannabinol), has been available by prescription for more
than a decade. But it is difficult to titrate the therapeutic dose of this drug,
and it is not widely prescribed. By contrast, smoking marijuana produces a rapid
increase in the blood level of the active ingredients and is thus more likely
to be therapeutic. Needless to say, new drugs such as those that inhibit the nausea
associated with chemotherapy may well be more beneficial than smoking marijuana,
but their comparative efficacy has never been studied.
Whatever their reasons, federal officials are out of step with the public. Dozens
of states have passed laws that ease restrictions on the prescribing of marijuana
by physicians, and polls consistently show that the public favors the use of marijuana
for such purposes. (1) Federal authorities should rescind their prohibition of
the medicinal use of marijuana for seriously ill patients and allow physicians
to decide which patients to treat. The government should change marijuana's status
from that of a Schedule 1 drug (considered to be potentially addictive and with
no current medical use) to that of a Schedule 2 drug (potentially addictive but
with some accepted medical use) and regulate it accordingly. To ensure its proper
distribution and use, the government could declare itself the only agency sanctioned
to provide the marijuana. I believe that such a change in policy would have no
adverse effects. The argument that it would be a signal to the young that "marijuana
is OK" is, I believe, specious.
This proposal is not new. In 1986, after years of legal wrangling, the Drug Enforcement
Administration (DEA) held extensive hearings on the transfer of marijuana to Schedule
2. In 1988, the DEA's own administrative-law judge concluded, "It would be unreasonable,
arbitrary, and capricious for DEA to continue to stand between those sufferers
and the benefits of this substance in light of the evidence in this record." (1)
Nonetheless, the DEA overruled the judge's order to transfer marijuana to Schedule
2, and in 1992 it issued a final rejection of all requests for reclassification.
(2)
Some physicians will have the courage to challenge the continued proscription
of marijuana for the sick. Eventually, their actions will 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.
Jerome P. Kassirer, M.D. |
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