The plant's use in China and India, both to heal and to intoxicate,
dates back thousands of years. Greek and Roman physicians recommended
cannabis for various ailments. Western doctors routinely prescribed
the drug for nearly a century before it was effectively banned in the
United States in 1937.

Yet as it makes a medical comeback in the 21st century, marijuana
poses a vexing dilemma for physicians.

Many doctors are uneasy advising patients to use a drug that has no
recommended dosage, widely varying potency and is most often delivered
not by a neat little pill but by sucking carcinogen-laden smoke into
the lungs.

And many doctors remain fearful of running afoul of the Drug
Enforcement Agency, which has the career-killing power to pull
doctors' licenses to prescribe federally controlled drugs.

Though nine states now have laws permitting medical marijuana use,
federal law classifies marijuana strictly as an illicit drug with no
legitimate medical use, on par with heroin and LSD. As a result,
doctors found to "aid or abet" patients in using marijuana could lose
their license to prescribe federally controlled drugs.

After California voters passed Proposition 215 in 1996, the Clinton
administration called a news conference. Gen. Barry McCaffrey,
director of the White House Office of National Drug Control Policy,
dismissed medical marijuana as "a Cheech and Chong show." Then
Attorney General Janet Reno announced that doctors who recommended
marijuana would be subject to investigation by the DEA, and as a
result could lose their federal drug license and be excluded from
participating in Medicare and Medicaid programs.

A group of California doctors and their patients sued the Clinton
administration, and in September a federal judge issued a permanent
injunction that barred federal authorities from penalizing doctors who
recommend marijuana. Despite the ruling, many doctors remain nervous
about recommending marijuana.

Law "Often Gets In The Way"

The White House Office of National Drug Control Policy continues to
take a dim view of the state medical marijuana laws. Its 2001 Drug
Control Strategy report said the state laws "undermine the scientific
process for establishing safe and effective medicines," and
"contradict federal law and are potential vehicles for the
legalization of recreational marijuana use." In part due to the threat
of federal intervention, some physicians simply won't recommend
marijuana under any circumstances. Others won't sign the form created
by the state Health Division, in which doctors confirm their patients
have one of the qualifying medical conditions and that marijuana may
help treat symptoms.

"I'm not prepared to write those notes," said Eugene physician Douglas
Bovee. "The DEA does not understand medicine. They are law enforcement
people, and law enforcement often gets in the way of the good practice
of medicine."

If Bovee does talk to a patient about marijuana and its potential medical
benefits, he follows the legal advice of the Oregon Medical Association:
Rather than signing the form, he makes a chart note - that is, documenting
the conversation in the patient's chart, as doctors routinely do after
every patient visit.

The patient can then use a copy of the chart note to obtain a medical
marijuana card from the state Health Division. That gives doctors what
might be called "plausible deniability" if they ever come under scrutiny.

"What the patient does with the medical record is the patient's
business," said Paul Frisch, the state medical association's legal
counsel. "The doctor can legitimately say, 'We had a conversation, I
documented it. That's as much as I know.' "

In 1999, after Oregon voters passed a medical marijuana law, the state
medical association wrote a letter to the DEA, asking for guidance
about what kind of legal exposure Oregon doctors faced if they
recommended marijuana.

The OMA is still waiting for an answer.

Treating A Broad Range

An Irish doctor named William O'Shaughnessy is credited with
introducing marijuana to the West in 1839. A professor at the Medical
College of Calcutta, he had observed Indians using cannabis for
various disorders, and began administering the drug to treat patients
for pain, muscle spasms and the often-fatal vomiting and diarrhea
associated with cholera.

His findings generated tremendous interest from Western doctors, who
began using cannabis (the word "marijuana" wasn't coined until the
20th century) to treat a broad range of ailments, including cramps,
headache, asthma, impotence, diabetes and pain.

By the 1930s, marijuana tinctures were being manufactured by major
drug companies such as Parke-Davis and Ely Lilly. At the same time,
physicians were turning to new synthetic drugs, such as aspirin and
barbiturates, instead of herbal remedies.

As recreational marijuana use became more popular among jazz musicians
and artists, the Federal Bureau of Narcotics waged a campaign to
discredit the drug, inspiring the 1936 B-movie "Reefer Madness." In
1937, Congress passed the Marijuana Tax Act, making prescription of
cannabis so cumbersome that physicians abandoned it.

It wasn't until the 1970s that marijuana-as-medicine began a revival,
its benefits spread by word of mouth. Cancer patients found it
relieved nausea and vomiting caused by chemotherapy. Glaucoma patients
found it lowered pressure in the eye. In the 1980s, AIDS patients
unable to keep food down found marijuana stimulated their appetite.

Today, though thousands of patients swear by it and many doctors will
recommend its use, marijuana's effectiveness as medicine hasn't been
proven in clinical trials or scientifically valid tests using human
subjects.

A British company, GW Pharmaceuticals, is in Phase II of clinical
trials involving cannabis in England and hopes to begin clinical
trials in Canada and the United States this year, according to an
interview its CEO, Dr. Geoffrey Guy, gave to High Times magazine.

Anecdotal evidence simply doesn't bear the same credibility as
clinical evidence, said Dr. John Benson, a former dean of the School
of Medicine at Oregon Health Sciences University and a co-author of
the most authoritative report on medical marijuana to date.

"If you talk to people who started using marijuana recreationally and
then continued using it medically, you'll find a lot of advocacy," he
said. "What you hear is from people who think it works. What you don't
hear is from people who found it disagreeable."

Benson was the co-principal investigator in a 1999 study conducted by
the Institute of Medicine, a branch of the National Academy of
Sciences that is viewed as a credible, impartial authority.

The White House Office of National Drug Control Policy asked the
Institute of Medicine to review the scientific evidence to assess the
potential health benefits and risks of marijuana and its active
ingredients.

Its report found that marijuana does hold "potential therapeutic
value" for pain, vomiting, nausea and loss of appetite, making it
"moderately well-suited" for cancer and AIDS patients, who often
suffer from those symptoms simultaneously.

"At the same time," Benson said, "we've got better medicine in each
case."

The study said smoking was a crude method for delivering medicine,
because marijuana smoke has the same kinds of tars and carcinogens as
tobacco smoke. It recommended more clinical trials be conducted aimed
at devising a better delivery system.

"It's hard to know what dose you're delivering" in smoke, Benson
said.

Marijuana's active ingredients could perhaps be delivered more
effectively through an inhaler, or nebulizer, like those used by
asthma patients.

Dr. James Morris, past president of the Lane County Pain Society,
shares Benson's skepticism about the medical use of smoked marijuana.

"I've not found compelling evidence that it's superior to other
treatments we have available," he said.

About a dozen patients have asked him to recommend marijuana, and in
only one case did he determine it was appropriate.

"Strictly from a medical perspective, there are a lot of disadvantages
to inhaling a burning substance," he said. "We restrict making this
recommendation only to people who have some kind of terminal condition
or severely debilitating condition that's likely to cause their demise."

More Research Needed

Not all doctors are convinced that pharmaceuticals are always superior
to marijuana, nor that smoking is always a bad way to deliver drugs
into the body.

Bovee, the Eugene physician, said he's convinced of marijuana's
therapeutic value for a variety of conditions.

"I have seen enough patients, who were honorable, decent, careful,
observing patients, who identified improvements in the way they felt,"
he said, either with Marinol, the pill form of marijuana, or by smoking.

"I don't have any doubt in my mind that if we had good research, some
benefit would be shown for a variety of conditions," he said.

And he's convinced that in some cases, smoking is a superior way to
deliver the drug.

"For nausea, the smoked route has a lot of benefit," he said,
particularly for patients unable to keep pills down.

Smoke gets the drug's active chemicals into the bloodstream within
seconds, so patients gain almost immediate relief, he said.

And if one or two puffs isn't enough to provide relief, the patient
can take one or two more as needed, he said.

But Bovee, like others, said there needs to be more clinical
research.

Dr. Richard Bayer, a co-petitioner of the medical marijuana ballot
measure in Oregon, doesn't think marijuana smoking is as harmful as
tobacco smoking, simply because patients don't smoke nearly the same
volume as do cigarette smokers.

Patients can reduce their risk of smoking marijuana by using a
vaporizer, a device that heats the marijuana enough to ignite the
cannabinoids - marijuana's active ingredients - but not enough to burn
the leaf. It reduces the particulates and toxins inhaled without
decreasing the quantity of cannabinoids.

"The most obvious form of harm reduction is to get the most potent
cannabis you can get," he said, because the patient doesn't need to
smoke as much to get the desired effects.

Bayer, a Lake Oswego physician, first encountered patients medicating
themselves with marijuana when he was a young doctor making rounds at
the Veterans Affairs Hospital in Portland in the 1970s.

During the years he practiced medicine, he shied away from
recommending marijuana when patients asked because he didn't want to
lose his license or risk being investigated by the Board of Medical
Examiners.

"I'd say, whatever works," he said. "It might help, but we don't know
a lot about the toxicology."

After Bayer quit practicing medicine in 1996 because of a physical
disability, he felt freer to get politically active.

Bayer helped draft medical marijuana legislation that went nowhere in
the Legislature. Then Bayer decided to talk with as many sick people
as he could find who were using marijuana to treat their symptoms.

He became convinced "these were people just trying to get well with
ancient herbal medicine," then decided to become the co-chief
petitioner for the medical marijuana ballot issue, Measure 67.

And he's used medical marijuana himself while going through physical
rehabilitation.

"I found it was great at giving some additional nausea control and
pain control," he said.

Bayer views marijuana as a logical weapon in the doctor's arsenal for
treating pain.

Doctors are trained to treat pain progressively: First they recommend
something such as Tylenol (acetaminophen). If that doesn't work, they
recommend an anti-inflammatory such as aspirin or Advil (ibuprofen).
If that doesn't work, they might prescribe a narcotic, such as Vicodin
or codeine.

In Bayer's view, the next logical step in that progression is
marijuana. It's a far less dangerous drug than many drugs doctors
prescribe all the time, he said.


Newshawk: Terry Liittschwager
Pubdate: Sun, 04 Feb 2001
Source: Register-Guard, The (OR)
Copyright: 2001 The Register-Guard
Contact: rgletters@http://www.registerguard.com/
Address: PO Box 10188, Eugene, OR 97440-2188
Website: http://www.registerguard.com/
Author: Tim Christie, The Register-Guard
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)