You
are in Research MARIJUANA
AS MEDICINE
A
Recent History (1976-1996) with Recommendations
By Robert C. Randall & Alice
M. O'Leary
Of The Alliance for Cannabis Therapeutics
ContentsI.
IntroductionII.
The Medical Prohibition Has No Public SupportIII.
Inheriting Bad PolicyIV.
Synthetic SolutionsV.
What Can Be Done?
I. Introduction This
document, originally published in January 1993 as Marijuana as Medicine: Initial
Steps, contained a series of recommendations for the incoming Clinton Administration.
Specifically it suggested: -
Immediate and full restoration of the FDA's Compassionate IND program for
medical marijuana,
- Encouragment
of aggressive medical research by rescheduling marijuana from Schedule I to Schedule
II of the Controlled Substances Act, and
-
Appointment of a Presidential Task Force to fully explore appropriate ways
to make marijuana legally available for use in legitimate therapeutic applications.
Without
such moderate actions the authors suggested the following: If
President Clinton takes no action . . . demands for reform will intensify. Some
elements within this broad coalition may cynically exploit seriously ill Americans
in a misguided attempt to promote reforms which have nothing to do with marijuana's
medical availability. The notion that ending the medical prohibition will automatically
lead to the backyard cultivation of marijuana may appeal to romantics in "the
movement." But such antic aspirations do not seriously address the legitimate
treatment needs of the ill.(See "On the Other
Hand" below) In
November 1996, voters in California and Arizona approved ballot initiatives which
legalized medical access to marijuana. The measures do not establish legitimate
means of supply for the drug nor are they specific in detailing which ailments
are responsive to the medication.
The political clamor which followed
these elections was loud and alarmist. Senate hearings were held and the Drug
Czar, retired Army general Barry McCaffrey, told the Judiciary Committee, "Both
measures are actually a quasi-legalization of dangerous drugs." Luminaries
such as former vice president Dan Quayle and former secretary of health Joe Califano
weighed in with newspaper columns denouncing the initiatives. Califano opined
that, "A moneyed, out-of-state elite mounted a cynical and deceptive campaign
to push its hidden agenda to legalize drugs."
Lost in the
flury and shuffle was the simple fact that marijuana has a long and distinguished
history of medical use. Moreover, efforts in the United States to ease research
restrictions and allow controlled, compassionate access to the drug have been
ongoing for more than twenty years. At every turn, however, federal officials
have thwarted the will of the people. Now federal authorities are faced with chaos
---- chaos of their own making.
In his post-election diatribe,
Mr. Califano notes, "Surely some obligation, moral if not legal, to speak
the truth goes along with the right to speak in support of any idea, however outrageous."
If Mr. Califano takes to time to review the history of this issue, briefly outlined
in this document, he will see that the American people have been demanding just
that obligation from the federal government for nearly a quarter of a century.
The federal government's position with respect to medical access to marijuana
is morally reprehensible, choosing prohibition over investigation and denial over
discovery.
Marijuana-as-medicine has NO political complexion. This
is NOT a liberal issue with well defined conservative opposition. Indeed, conservatives
believe doctors, not bureaucrats, should be in charge of medical care. The American
people know marijuana has legitimate medical uses, and they deeply resent bureaucratic
efforts to block marijuana's medical availability.
In 1993, President
Clinton had an opportunity to resolve this problem by embracing a moderate course
of action -- restore compassion, encourage research, and explore options. Instead
he chose to embrace the policies of the Bush Administration. This failure to rise
above the milieu of the so-called "War on Drugs" has created a climate
that will intensify cultural divisions and further blur the issue.
And while the drug reformers and the anti-drug forces rant and rave on the
public stage, the real story continues -- AIDS and cancer patients continue to
lose weight and experience bouts of nausea and vomiting that often prevent them
from using life-saving drugs; glaucoma patients go blind because conventional
medications fail; victims of multiple sclerosis, paralysis, and other conditions
experience intense and debilitating muscle spasms.
Lost in a swirl
of rhetoric are the patients.
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People
Are Suffering
Marijuana has unique therapeutic properties in
the treatment of several life- and sense-threatening diseases including glaucoma,
cancer, AIDS, and neurologic disorders resulting in muscle spasm and chronic pain.
Federal law, however, forbids marijuana's medical use. Licensed physicians
who routinely prescribe far more dangerous drugs are legally forbidden to provide
people who are dying, going blind or being crippled with licit, therapeutic access
to marijuana.(1)
This stark conflict between
urgent medical needs and prohibitory federal policies has created a perverse situation
in which physicians must send desperately ill Americans into the streets -- and
criminality -- to meet their legitimate medical needs.
Modern studies
have reconfirmed marijuana's historically recognized therapeutic value. This document
only concerns itself with marijuana's medical use in the treatment of several
life- and sense-threatening disorders. Glaucoma:
Glaucoma is the leading cause of blindness in the United States. In the 1970s
researchers discovered marijuana significantly lowers the elevated eye pressures
associated with glaucoma.(2) Between 2 and 4 million Americans
are afflicted with glaucoma and nearly 10,000 are blinded by the disease each
year.(3) This statistic indicates that standard treatments
and surgery are often ineffective. It is clear that, for some glaucoma patients,
the addition of marijuana can make a critically important difference in prolonging
sight. Cancer:
One million Americans are diagnosed with cancer each year. Many suffer from intractable
nausea and vomiting caused by highly toxic anti-cancer drugs.(4)The
debilitating effect of chemotherapeutic agents cause many patients to discontinue
potentially life-saving treatment. Medical studies consistently show marijuana
is one of the safest, most effective anti-nausea drugs known to man.(5)
In the mid-1970s cancer patients began smoking marijuana to control nausea and
vomiting, and stimulate appetite. Subsequent studies found marijuana helps up
to 90% of these patients control nausea and vomiting.(6)
AIDS:
HIV-positive (HIV+) people smoke marijuana for many of the same reasons as
cancer patients. Marijuana effectively reduces the intense nausea, vomiting and
rapid weight loss caused by advanced HIV-infection and the highly toxic drugs
used to treat AIDS. While it has only recently come to public attention the medical
use of marijuana, even though illegal, is already widespread among HIV+ people.
AIDS is now the nation's most rapidly increasing cause of death. More than 242,000
Americans have AIDS and more than 1 million Americans are now infected by the
deadly virus.(7) Muscle
Spasm: More than a million Americans suffer from neurologic conditions
like multiple sclerosis (MS), muscular dystrophy, spinal injury and arthritis
which cause severe muscle spasms and chronic pain. These conditions are not well
treated with conventional medications. Marijuana's illegality makes it impossible
to accurately estimate how widespread marijuana's medical use is among neurologically-impaired
Americans. It is clear marijuana's medical use among paralyzed Americans is now
widespread. As one neurologist testified during the recent DEA hearings, "You
cannot walk down a neurology ward in a VA hospital without smelling marijuana."(8)
Marijuana
does not cure any of these conditions. But rationally employed, under medical
supervision, marijuana can prolong sight in glaucoma, ease nausea and vomiting
caused by anti-cancer and AIDS therapies while helping patients maintain body
weight, reduce the crippling spasms common to neurologic disorders like multiple
sclerosis, muscular dystrophy and paralysis, and ease chronic pain.
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II. The
Medical Prohibition Has No Public Support Political
Analysis
It is difficult to find any other question which unites
so many of the American people in opposition to an existing federal policy.
Federal laws which prohibit marijuana's therapeutic availability are
not politically, socially or legally tenable. Federal agencies enforcing the medical
prohibition long ago lost the public debate for hearts and minds.
While
few people would identify medical marijuana as a "front-burner" issue,
there are emblematic aspects to the problem which can directly affect public perceptions
of an administration's candor, honesty and compassion.
All available
evidence suggests the medical prohibition of marijuana has no support among the
American people. Indeed, public repudiation of the medical prohibition is now
nearly universal. Despite two decades of bureaucratic disinformation the American
people view the medical prohibition as an irrational outgrowth of misdirected
War on Drugs zealotry.(9)
Public rejection of
the medical prohibition is evident in political actions, available polling data,
and recent election returns.
[Back to the Top]
Political Actions
In 1978, a young cancer patient,
Lynn Pierson, brought marijuana's medical value to the attention of the New Mexico
legislature. After public hearings in which cancer and glaucoma patients and their
physicians strongly endorsed marijuana's medical availability, the legislature
overwhelmingly enacted the nation's first law recognizing marijuana's medical
value.(10)
Patients in other states quickly
followed Lynn Pierson's lead and petitioned their legislatures for similar laws.
The result was an explosion of state legislation which has continued into this
decade.
On December 31, 1991, Massachusetts Governor William Weld
signed the nation's thirty-fourth state law recognizing marijuana's medical value.
In every instance these state laws gained broad bipartisan support and were enacted
by tremendous legislative margins.(11)
State
efforts to end the medical prohibition failed, however, because of entrenched
opposition from federal drug agencies.(12) This bureaucratic
opposition had very real human consequences. In New Mexico nine patients, including
Lynn Pierson, died "while waiting for promised supplies of federal marijuana
which never arrived. "(13)
Despite bureaucratic
hostility, six states finally managed to satisfy federal regulatory demands to
establish programs of patient access to medical marijuana.(14)
Angered by federal efforts to destroy the intent of their marijuana-as-medicine
statutes, the legislatures of New Mexico, Michigan and New Hampshire enacted Resolutions
to the U.S. Congress condemning federal efforts to block marijuana's medical use.
The Michigan Resolution bluntly states: "Federal
agencies have failed to meet this good faith effort, and have instead, through
regulatory ploys and obscure bureaucratic devices, resisted and obstructed the
intent of the Michigan legislature."(15) While
the state legislatures failed to overturn the negative effects of a federally-imposed
prohibition, there are several important political realities highlighted by the
enactment of so many state statute: 1)
Many of these state legislative actions were authored by conservatives. The first
four states to recognize marijuana's medical value -- New Mexico, Florida, Illinois
and Louisiana -- could hardly be characterized as "liberal." 2)
State laws recognizing marijuana's medical value consistently received exceptionally
broad bipartisan support. A cumulative 87% of the state legislators voting on
this question voted in favor of making marijuana medically available. 3)
These legislative actions were endorsed by the major media in these states and
received broad public support. Physicians, nurses, and patients appeared at legislative
hearings to express their support for marijuana's medical availability.
4)
Opposition to such legislation was muted, ill-organized and often dismissed as
hysterical. 5)
Finally, the profoundly bipartisan nature of these political actions indicates
medical marijuana is not a politically or culturally sensitive issue. Significantly,
no legislator who sponsored or supported marijuana-as-medicine legislation ever
lost an election because of such support. [Back
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Federal Legislation
This same pattern of broad
bipartisan political support was also evident in federal legislative efforts.
In September 1981, four Republican Congressmen -- Stewart McKinney (CT), Millicent
Fenwick (NJ), Hamilton Fish (NY) and Newt Gingrich (GA) -- introduced a federal
marijuana-as-medicine bill. This legislation, re-introduced in 1983 and 1985,
received broad bipartisan support in the House, attracting more than 110 co-sponsors.
It is difficult to find another legislative matter which could unite far-right
conservatives Gingrich, Fish, William Dannemeyer and Mickey Edwards with moderates
McKinney, Fenwick and William B. Hughes, and liberals Richard Gephardt and Barney
Frank. (16)
Despite the wide-range of political
support for meaningful federal legislation, Representative Henry Waxman (CA),
chairman of the House subcommittee on health, failed to hold public hearings on
this broadly sponsored legislation, preferring instead to concentrate attention
on his own poorly supported heroin-as-medicine measure.
In early
1987, Representative McKinney became the first Member of Congress to die of AIDS.
The legislation he sponsored died with him. There was no federal marijuana-as-medicine
bill until eight years later when Representative Barney Frank re-introduced the
McKinney legislation. Hoping to embarrass the new Speaker of the House Newt Gingrich
by pointing to Gingrich's former support of the bill, Frank rushed to embrace
the thirteen-year-old legislation and presented it with a small cadre of supporters,
all liberal Democrats. In the newly elected Republication Congress such political
shennigans had a predictable result. The bill was branded a "pro-drug"
measure and failed to gather much additional support over the next two years.
Moreover, the bill was no longer relevant. In a time of shrinking governmental
budgets and agencies, the bill calls for expasion of federal marijuana production
and the establishment of a new federal office to oversee distribution of the drug.
The future of legislative action on the federal level is unclear at this
writing. Efforts to counter the Arizona and California voter initiatives of 1996
with federal legislation have been discussed but nothing has been pursued as yet.
Opinion Samplings
Polling data of public attitudes
on this question mirrors the actions of the state legislatures and consistently
indicate a vast majority of the American people believe marijuana has medical
value and should be legally available, by prescription.
There is
a generalized public anger over increasingly intrusive bureaucratic controls on
the delivery of medical care. A poll conducted by The Wirthlin Group found 80%
of Americans believe patients should have a legal right to use promising, but
not yet approved, therapies for terminal illnesses such as AIDS or cancer.
Even in non-fatal diseases, 78-84% of the American people felt control
over the choice of medical treatment should be decided by patients and their physicians,
not remote bureaucrats or policemen. (17)
This
deep-seated public concern over who controls basic medical decisions is starkly
evident in the polling data available on the question of marijuana's medical availability.
[Back to the Top]
Polls & Surveys
The first reliable polling information on this question appeared in the
late 1970s from surveys conducted in Pennsylvania (18) and
Nebraska.(19) Both polls disclosed more than 80% of those
randomly questioned favored marijuana's prescriptive medical availability. A very
sizable majority of all those questioned -- whether segmented by age, party identification,
religion, education or income -- supported marijuana's medical use. Both polls,
conducted by different polling organizations, found opposition to marijuana's
medical use was limited to a scant 12% of the population.(20)
A telephone poll conducted by the Detroit Free Press on October
13, 1978, revealed 85.4% of those calling favored prescriptive access to marijuana.
In Washington, the State Medical Association conducted a poll in which
80% of the doctors favored the controlled medical availability of marijuana.(21)
A more recent polling of physicians was conducted in 1991 by Harvard
University's J.F.K. School of Public Policy. More than 2,000 cancer specialists
were surveyed about their attitudes towards marijuana's medical utility. An astonishing
89% of those physicians with an opinion said marijuana is an effective antiemetic
treatment.(22)
Unscientific radio-talk show
and newspaper samplings of public opinion consistently register a similarly high
range -- 75-85% -- of public support for medical marijuana.
For
example, a December 22, 1992 radio-talk poll conducted by Roanoke, Virginia station
WFIR is typical. The station reports that 96% of the listeners who phoned the
station vote-line endorsed marijuana's medical availability.(23)
The most recent scientific poll on this question was conducted for the
Drug Policy Foundation. In response to the one question relating to marijuana's
medical use 69% of those questioned favored prescriptive access to marijuana for
the treatment of glaucoma.(24)
[Back to the Top]
Public Elections
While polls provide a "snapshot"
of social attitudes, there is no more powerful, exacting or legitimate expression
of the electorate's mind than that afforded by an election.
In
November 1991, "liberal" San Francisco became the first political jurisdiction
in the United States to put this question on the ballot. An astonishing 79.5%
of the electorate rejected the federal prohibition to vote in favor of marijuana's
medical availability.
One year later, in November 1992, the voters
in "conservative" Santa Cruz County, south of San Francisco, voted to
end the medical prohibition by an equally astonishing 77.1%.
Significantly,
Proposition P in San Francisco and Measure A in Santa Cruz won by larger electoral
margins than any national candidate on the 1992 ballot or any previous voter initiatives
in California history.
These public expressions of support for
medical access to marijuana reached a zenith in November 1996 when the states
of Arizona and California passed state-wide voter initiatives.
[Back
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A Remarkable Consensus
There is no other issue
which unites so many of the American people in opposition to an existing federal
policy.
The American people know marijuana has medical value, and
they are clearly fed-up with bureaucratic efforts to block marijuana's therapeutic
availability. As noted above: -
87% of the legislators in thirty-four states voted to end the medical prohibition.
-
82% of the American people, when polled, reject the medical prohibition.
-
79.5% and 77.1% of the voters in two local public elections voted to end the medical
prohibition.
-
56% of voters in California and 65% of voters in Arizona supported state-wide
intitiatives recognizing marijuana's medical utility.
The
scale of the electoral victories reflects the bipartisan public consensus so evident
in the state legislatures, in the range of cosponsors attracted to Representative
McKinney's federal marijuana-as-medicine bill, and in the available polling data.
The most remarkable aspect of this vast public consensus is its constancy
over time, and its reach beyond mere party or ideological identifications. In
the purest political terms the net difference between multi-ethnic urban liberal
voters in San Francisco and predominately white, conservative voters in Santa
Cruz County was a mere 2.4%. In both elections, nearly eight out of ten voters
rejected the medical prohibition to vote in favor of a more rational and humane
policy directed at meeting legitimate medical needs.
[Back
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III. INHERITING
BAD POLICYCurrent
Federal Policy
Richard Nixon was president when marijuana was
made a Schedule I drug under the federal Controlled Substances Act. As such marijuana
is defined in law as a drug "with no accepted medical use in treatment in
the U.S."
For twenty-two years FDA, by erecting regulatory
barriers to cogent scientific and medical evaluations, has assisted DEA in maintaining
the medical prohibition. For example, FDA officially classifies marijuana, a natural
plant with an ancient medical heritage, as a New Drug.(25)
Gerald Ford was president when a federal court ruled a glaucoma patient's
use of marijuana was not criminal, but an act of "medical necessity."
In part, federal Judge James Washington ruled, "It is unlikely that [marijuana's]
slight, speculative and undemonstrable harm could be considered more important
than defendant's right to sight."(26) Concurrent with
the court's verdict, this man also became the first American to secure legal,
medical access to FDA-approved supplies of pre-rolled marijuana cigarettes.
Jimmy Carter was president when FDA, in the wake of a lawsuit by this
glaucoma patient, created the Compassionate IND system for medical marijuana.(27)
Demands for Change
For twenty years the medical
prohibition has been under sustained scientific, medical, legal, social and political
challenge. In the course of this protracted debate the courts, a majority of the
state legislatures, the press and the American people have rejected the medical
prohibition. (See Political Analysis above.)
Eroding societal support for the medical prohibition reached its zenith
in 1988 when DEA's chief administrative law Judge Francis L. Young condemned the
federal prohibition as "unreasonable, arbitrary and capricious." After
two years of Court-ordered public hearings, Judge Young ruled DEA should immediately
reschedule marijuana to Schedule II, and recommended marijuana be made prescriptively
available for the medical treatment of persons afflicted by life- or sense-threatening
disorders.
Anticipating the bureaucratic response, Judge Young
noted: "There
are those who, in all sincerity, argue that the transfer of marijuana to Schedule
II will `send a signal' that marijuana is `Ok' generally for recreational use.
This argument is specious.... The fear of sending such a signal cannot be permitted
to override the legitimate need ... of countless sufferers for the relief marijuana
can provide when prescribed by a physician. . . ." (28)
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Medical Prohibition Under Pressure
Judge Young's
historic verdict fractured the bureaucratic facade of unqualified resistance and
greatly accelerated patient demands for access to care. These demands took on
even greater urgency in the early 1990s when FDA was compelled to expand the nation's
Compassionate IND program for medical marijuana to include HIV+ people and Americans
afflicted by neurologic disorders like paralysis, multiple sclerosis, and muscular
dystrophy. (29)
Federal drug agencies were
whipsawed by these accelerating demands for care. DEA steadfastly maintained marijuana
has no medical value even as FDA authorized marijuana's compassionate medical
use for the treatment of an expanding number of life- and sense-threatening diseases.
By April 1991, this profound contradiction in federal policy brought the medical
prohibition into crisis.
The
Collapse of Compassion
This crisis in policy reached critical
mass in April 1991, when the U.S. Court of Appeals rejected DEA's standards for
scheduling marijuana.(30) In so ruling the Court focused on
the central contradiction in federal policy: how could DEA argue marijuana is
medically useless if FDA routinely authorized marijuana's therapeutic availability
in compassionate programs of medical care?
Bush Blunders
The Bush Administration foolishly sharpened
public awareness of this long unresolved problem in June 1991, when PHS Chief
James O. Mason abruptly and arbitrarily terminated the nation's fourteen year-old
Compassionate IND program for medical marijuana.
Confronted by
a rising tide of demands for licit access to medical marijuana, alarmed by DEA's
rapidly eroding legal position, and under escalating bureaucratic pressure to
"do something," the Bush Administration panicked. PHS Chief Mason initially
cited the "surge in new applications" as his reason for terminating
the long-standing program. (31)
Mason's announcement
caught policy-makers in the White House off-guard. It also triggered intense,
universally negative editorial reaction. People with glaucoma, AIDS and other
serious illnesses besieged the White House, Congress and the bureaucracy. This
fierce, sustained public reaction stunned the Bush White House. (32)
For the next nine months, while desperately ill Americans suffered, the
Bush Administration was torn by protracted inter-bureaucratic debate.
Events in the real world only deepened the Bush Administration's confusion.
-
October 8, 1991: The Florida Supreme Court ruled marijuana can be a drug of "medical
necessity" in the treatment of AIDS. (33)
-
November 6, 1991: Nearly 80% of the voters in San Francisco rejected the medical
prohibition. By some estimates, more than 65% of the city's conservative voters
favored marijuana's medical availability.
-
December 1, 1991: The popular CBS News magazine program Sixty Minutes highlights
the question of marijuana's medical availability in a segment titled "Smoking
to Live."
-
December 31, 1991: Conservative Massachusetts Governor William Weld signed the
nation's thirty-fourth state law recognizing marijuana's medical utility.
- February
1992: The National Association of People With AIDS (NAPWA) endorsed marijuana's
medical availability in AIDS care and called on the White House to maintain the
Compassionate IND program.
-
February 1992: The nation's ten legal marijuana smokers blasted the Bush Administration
for "turning the promise of compassionate care into a cruel bureaucratic
con game played against desperately ill Americans." The patients accused
PHS Chief James O. Mason of "medical terrorism." (34)
Administration
officials, traumatized by these external events, wandered through indecisive policy
debates marked by months of private meetings attended only by bureaucrats and
political appointees. The obvious chaos solidified public impressions that federal
drug policy was being driven by ideology and not by concern for the needs of seriously
ill Americans.
In a futile attempt to escape this public censure
the White House Office of National Drug Control Policy actually joined the chorus
of outrage. In January 1992, White House officials called PHS Chief Mason's actions
"unconscionable" and bluntly told PHS "people are suffering"
because of bureaucratic delays in the delivery of FDA-promised supplies of medical
marijuana. The White House promptly leaked this scathing letter. (35)
[Back to the Top]
Bush Blunders, II
It was too late. In March 1992,
War on Drugs hardliners in the bureaucracy won. Bush killed FDA's Compassionate
IND program for medical marijuana.(36) FDA dumped hundreds
of Compassionate IND applications into the trash and scores of patients were arbitrarily
denied promised access to medical care. Only a handful of patients -- those already
receiving medical marijuana -- were spared.
Editorial and news
reaction to the March 1992 announcement was even harsher and more sustained than
in June - September 1991.(37) PHS efforts to justify the policy
shift were subjected to outright ridicule. To make matters worse, high officials
in PHS, FDA, NIDA and the White House -- in off-the-record comments -- routinely
told reporters they strongly opposed the Bush Administration's decision to terminate
the Compassionate IND program for medical marijuana.
The most scathing
comments, however, came from the seriously ill. One Minneapolis AIDS patient,
Tim Braun, captured the public mood when he told the Associated Press,
"I
think it's a decision. . . made by some bozos that don't get their fat duffs out
of the office and ask the doctors who work with patients like this, talk to the
patients who are using it, talk to the families and the friends that see the difference."
(38) Braun
received FDA approval for marijuana therapy in December 1990. For nearly eighteen
months, while bureaucrats bickered, Tim Braun waited for his FDA-promised marijuana.
Often he could not obtain enough marijuana off the streets to meet his medical
needs. During these times Braun always lost weight. At one point he lost 60 pounds.
When an AP reporter told Tim Braun about the PHS decision to kill the
Compassionate IND program Tim prophetically said, "They're giving me a death
sentence."(39) Tim Braun, 44, died two months later without
ever receiving the compassionate care his government had promised to provide.
Critics charge Bush killed the program in a craven attempt to appease
War on Drugs hardliners and homophobic elements of the religious right.(40)
Destroying the nation's marijuana-as-medicine program may have appealed to a few
cultural zealots in Bush's narrow base, but "killing compassion" fueled
the already wide-spread public perception Bush was "out of touch," "uncaring,"
and "too ideological" to remain in office. (41)
Aftermath
Bush's politically maladroit move to
kill the Compassionate IND program has galvanized patients, physicians and drug
law reform advocates. As a result, the incoming administration faces an active,
aggressive and broad-based coalition ready to amplify deep-seated public demands
for an end to the medical prohibition.
By far the most legitimate
and powerful voices in this emerging coalition belong to seriously ill Americans
who can command media attention. A review of media from June 1991 through June
1992 underscores just how decisively a few well-spoken patients "won"
the public debate against George Bush. Significantly, editorial and press reaction
to Bush's medical prohibition was universally negative, often hostile.(42)
[Back
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IV. Synthetic SolutionsRather
than respond to public and political demands for marijuana's medical availability,
federal drug agencies are instead promoting bureaucratically sanctioned alternatives
which are synthetic, expensive and often ineffective. It is ironic that after
decades of pretending marijuana is medically useless, federal drug agencies are
now aggressively pushing synthetic Marinol, the so-called "pot pill,"
by arguing it is as safe and effective as marijuana.(43)
Patients familiar with the synthetic "pot pill" have strongly
condemned the bureaucrats for "pushing" an inferior substitute. One
AIDS patient recently told a reporter, "I
tried [Marinol]. I went through five pills before I was able to keep one down....When
I did manage to keep one down it took a long while to take effect, and only worked
about half a day. Two or three tokes on a joint helps me immediately."(44)
Let'em Eat THC
Delta-9-tetrahydrocannabinol (THC)
is the most powerful psycho-active chemical in marijuana. Synthetic THC
was developed for drug abuse research on rats and other animal subjects. The synthetic
"pot pill" was never intended for human use in a routine of medical
care. In the early 1980s, however, federal agencies were overwhelmed by demands
for legal access to government supplies of marijuana cigarettes for use in legislatively
authorized, state programs of patient care. FDA and DEA, unable to meet these
state requests for natural marijuana, began promoting synthetic THC pills as a
therapeutic substitute for marijuana.
In September 1980, federal
agencies released THC through the National Cancer Institute's Group C Treatment
Program. Then federal agencies frantically searched for a private-sector pharmaceutical
company to sponsor a New Drug Application (NDA) for the federally-developed THC
pill. In exchange, federal agencies promised the company exclusive control over
the medical market for synthetic THC.
This promotion of synthetic
THC was not designed to meet legitimate human needs. It had only one objective:
to maintain the medical prohibition against marijuana.
The public
was told "Pot Pill Approved." Federal drug agencies assisted in a disinformation
campaign by saying marijuana was no longer medically needed because the modern,
synthetic "pot pill" had arrived. Federal agencies knew this was a lie.
[Back to the Top]
Marinol Isn't Marijuana
The problem with this synthetic
strategy was most quickly evident to patients. Marinol isn't marijuana. The synthetic
solution failed because Marinol is only marginally effective.
The
difference between marijuana and THC was apparent from the outset. Cancer patients
quickly discovered smoking marijuana is far more effective than swallowing oral
THC pills.(45) During the DEA hearings before Judge Young,
one researcher, Norman Zinberg, M.D., testified that during his 1974 research
nearly half the patients quit his legal, THC-based study in order to obtain illegal,
but more effective, marijuana.(46)
Zinberg's
observations were amplified in an internal National Cancer Institute (NCI) memo
from mid-1978. Synthetic THC is described as "erratic," "unpredictable,"
and finally dismissed as "unfit" for human use. Marijuana cigarettes,
by contrast, are described as "reliable" and "highly predictable."
After reviewing the available evidence the cancer specialists at NCI concluded,
"All in all the [marijuana] cigarette may be the best means of delivering
the drug."(47)
After reviewing the available
evidence DEA Judge Francis L. Young concluded Marinol is not an adequate substitute
for marijuana.(48)
Some will argue these are
"old" conclusions. Yet as recently as 1992 , Dr. Robert Gorter, a primary
researcher of synthetic Marinol's use in AIDS therapy, echoed Zinberg's testimony:
"Again
and again patients have testified that they preferred marijuana above dronabinol
[Marinol] for its appetite stimulating effect. Therefore, it is hoped that marijuana
will stay an option for the medical treatment of [wasting syndrome] in AIDS patients."(49)
Why
is inhaled marijuana superior to synthetic THC? Speed
of delivery: When inhaled, marijuana reduces nausea and vomiting in five to
ten minutes.(50) Marinol, when ingested, takes 1 to 4 hours
to start working. This gives patients plenty of time to throw-up the pill.
Control
of Dose: Marijuana, when inhaled, works so quickly patients can exercise very
fine control over their dose. Once relief is achieved they simply stop smoking.
Inversely, a patient exercises NO control over an oral dose; once the pill is
swallowed all further control is lost. Moreover, because oral THC takes so long
to work, and works so erratically and unpredictably, patients may take a second
oral dose. Little wonder adverse psychological effects are far more common among
people employing oral Marinol than among those smoking marijuana. Chemical
Composition: Marijuana, like all naturally occurring substances, is chemically
complex. Marijuana has more than 400 chemical ingredients. Little is known about
which chemical ingredients -- or what combinations of ingredients -- are responsible
for the plant's multiple therapeutic actions. Federal
agencies did not approve Marinol because of evidence indicating delta-9 THC is
marijuana's most therapeutically-active ingredient. Delta-9 THC was synthesized
to facilitate drug abuse research on marijuana's psychoactive effects. Trapped
by their legal fixation on psychoactive effects, federal agencies simply assumed,
despite ample evidence to the contrary, that what gets you "high" makes
you well.
The irony, of course, is that to avoid making marijuana
medically available, federal agencies are now aggressively promoting a synthetic
alternative which contains pure THC which is profoundly more psycho-active than
marijuana in its natural form.(51)
Pills are
medically familiar. Smoking is not. Opponents of marijuana's medical use often
argue inhalation is not compatible with modern medical practice. In the name of
science such opponents would deprive those who are now ill of care while researchers
endeavor to create a perfect "marijuana-like pill."
Advocates
of marijuana's medical availability do not contend marijuana is "perfect"
or object to research into synthetic alternatives. Such research must continue
and, in some cases, begin.(52)But it is medically unethical
to use an elusive search for pharmaceutical perfection as an excuse to deprive
millions of currently ill Americans of therapeutic access to an effective, albeit
imperfect, treatment. This is particularly true when one considers the long and
distinguished history of marijuana's medical use.
To put it simply;
how can the government criminalize seriously ill citizens who choose to medically
use a God-given plant?
[Back to the Top]
The Great White Drug
When bureaucratic attempts
to push synthetic Marinol as a substitute for marijuana fail, federal drug agencies
fall back on another old standard: there are "new" drugs which make
marijuana medically unnecessary.
In the early 1980s, for example,
federal agencies promoted Torecan (Reglan) as an antiemetic substitute for marijuana.
Health care workers like Torecan because patients are well-controlled. Indeed,
Torecan renders patients nearly comatose. Many still vomit, but they are not conscious
enough to care.
Michigan tested the Torecan alternative in their
state authorized marijuana program. Researchers allowed patients to begin on Torecan
or marijuana. Patients could, at any time, elect to switch to the alternative
drug. Significantly, 90% of the patients who started on marijuana stayed on marijuana.
Even more significantly, 90% of the patients who received Torecan elected to switch
to marijuana. (53)
The most recent "new"
drug receiving bureaucratic praise as a marijuana alternative is Zofran which
costs $600 per dose and requires hospitalization at a cost of $500 - 1,500
per day. Zofran is said to be effective 75% of the time in helping patients
vomit six times or less per chemotherapy treatment.
By contrast,
marijuana costs a penny per dose, patients can safely use it at home, and marijuana
helps 90% of cancer patients unable to obtain relief using prescriptive antiemetic
agents.(54)
There is a final important difference.
Zofran is not an appetite stimulant. Marijuana is. A patient employing marijuana
at home can sit down to eat dinner with the family. This is not a matter of insignificant
benefit.(55)
As Kenny Jenks, Chairman of the
Marijuana/AIDS Research Service (MARS) has noted, "To the unintentionally
anorexic the munchies can be a life-saver."(56)
Let The Market Decide
No one is advocating that
all patients with marijuana-responsive disorders be forced to use marijuana. Ultimately
the decision to employ any medication is a profoundly personal decision which
is best left to the patient and physician. In a more rationale world natural marijuana
and synthetic Marinol would both be medically available and patients and physicians
would determine which drug was most appropriate for a particular treatment need.
The market would decide.
For nearly two decades, federal agencies
have used the medical prohibition to prevent such a market-based determination.
They have compounded this error by granting an exclusive monopoly to the manufacturer
of Marinol. In doing so FDA has ensured that the American people will be forced
to pay exorbitant prices to obtain a demonstrably inferior synthetic substitute
developed and researched almost exclusively at tax-payers' expense.
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V. What Can Be Done?[Author's
Note: The following is theoriginal text from the 1993 publication of this document.
It has been left in tact to demonstrate the strong, but predictable, political
forces which guide this issue. It is not too late for restoration of compassion
but time is running out. The Clinton Administration must accept the strong demand
for change, demonstrated by the 1996 votes in Arizona and California. Sadly the
early indications are that Clinton will attempt to maintain the status quo. The
result will be political, scientific, and cultural chaos. ---- 12/31/96 ]
One thing is certain, inaction is not an option. The Clinton Administration
will be publicly compelled, early on, to take steps to resolve this problem. Fierce
bureaucratic resistance is likely.
Presidents Come & Go
Federal drug agencies will
conspire to enmesh President Clinton in a foolhardy defense of their publicly
unpopular medical prohibition.
The bureaucrats will use pending
legal actions against DEA to draw the new administration into the issue on their
side.(57) It is also possible federal agencies could initiate
actions designed to embarrass the new administration.(58)
These bureaucratic pressures can be considerable. The nine months of
policy chaos triggered by PHS Chief Mason's impromptu attempt to kill the Compassionate
IND program in June 1991 was an outgrowth of the deeper struggle between ideologues
in the bureaucracy and political realists in the Bush White House.
By January 1992, White House realists, alarmed by the corrosive political
effects of the medical prohibition, publicly called bureaucratic efforts to kill
the Compassionate IND program "unconscionable." Yet, in March 1992,
War on Drugs ideologues won. The program was terminated. FDA dumped hundreds of
Compassionate IND applications into the trash and scores of patients were arbitrarily
denied promised access to medical care. Only a handful of patients -- those already
receiving medical marijuana -- were spared.
In the end the bureaucrats
got their (nearly) absolute prohibition. But at what price? President Bush was
subjected to months of negative news stories and scathing editorial comment which
reinforced the already widespread public apprehension that zealots had taken over
his administration -- as indeed they had.
Bureaucratic resistance
to marijuana's medical use is deeply ingrained. Entrenched and terrified of change,
federal drug bureaucrats do not have to live with the political consequences of
their publicly discredited prohibition. Politicians, as Mr, Bush recently learned,
are not so easily forgiven.
On
The Other Hand
If President Clinton fails to decisively address
this problem, seriously ill Americans, backed by an articulate, broad-based coalition
of drug law reform, legal, libertarian, medical and patient-advocacy groups will
focus this same powerfully corrosive media energy on the incoming administration.
Seriously ill Americans who medically need marijuana are increasingly
well-organized and have ample access to national media. Events from June, 1991
through June, 1992 suggest the tremendous influence such patients can exercise.
A review of media during this period shows just how decisively these patients
thrashed Bush and the bureaucrats who sought to block marijuana's medical availability.
If President Clinton takes no action these demands for reform will intensify.
Some elements within this broad coalition may cynically exploit seriously ill
Americans in a misguided attempt to promote reforms which have nothing to do with
marijuana's medical availability. The notion that ending the medical prohibition
will automatically lead to the backyard cultivation of marijuana may appeal to
romantics in "the movement." But such antic aspirations do not seriously
address the legitimate treatment needs of the ill.
The American
people -- in particular those who are seriously ill -- will not be well served
by a Punch 'n Judy culture clash between ultra-prohibitionists on the far right
and utopian reformers on the far left. The Clinton Administration cannot meet
the needs of seriously ill Americans by responding to pressure from "ideologues"
and "activists" operating on the political margin; left or right.
[Back to the Top]
Beyond Cultural Warfare
By advancing a decisive,
yet moderate plan to resolve the problem of marijuana's medical availability the
Clinton Administration can: -
avoid public identification with the extremely unpopular Bush policy,
-
seize the initiative in crafting a credible solution, and effectively demonstrate
a willingness to cut through decades of ideological crap and bureaucratic stonewalling
to deliver the kind of "change" the American people expect.
The
nation is ready to resolve this problem as two recent editorials illustrate.
On January 4, 1993, the Albany Times Union, noted, "We
are somewhat incredulous . . . that the federal law of the land still bars marijuana
for any medical use...." In keeping with public opinion, the editors in Albany
conclude, "There's no good reason to forbid such use."(59)
The
following day, a continent away, the Oakland Tribune echoed the comments
of the Albany Times Union when it observed that the medical prohibition
is "wrong-headed because it denies reality." The Tribune noted
that morphine and cocaine "highly addictive drugs, are available for doctors
to prescribe. Their use is successfully controlled through extra-stringent prescriptions."
The paper concluded with a call for "clear-headed and compassionate policy
that allows the medical use of marijuana."(60)
The recommendations outlined in this document (See "Introduction"
above) will not satisfy libertarians and those on the left who advocate sweeping
changes in U.S. drug law. Nor will these recommendations appeal to ultra-prohibitionists
in the bureaucracy and on the right. In short, the recommendations advanced here
are not designed to satisfy those with a merely political agenda.
These
recommendations instead appeal to the broad American middle. They focus on three
simple objectives: 1) meeting the legitimate treatment needs of those who are
currently ill, 2) increasing marijuana's availability for research, and 3) exploring
pragmatic ways to resolve the regulatory problems created by five decades of irrational
federal policy.
The American people know marijuana has important
medical benefits. What is now needed is a rational plan to make marijuana legally
available, under medical supervision, to those with legitimate medical needs.
Conclusion
Seriously ill Americans are suffering
because of federal policies which prohibit marijuana's prescriptive medical use.
To maintain this irrational prohibition, federal drug agencies have ignored the
will of the people and the needs of seriously ill Americans, retarded research,
obstructed the intent of state legislatures and refused to abide by administrative
and judicial rulings.
In March 1992, President Bush, under pressure
from War on Drugs ideologues in the bureaucracy, arbitrarily terminated the nation's
long-standing marijuana-as-medicine program. People are dying, going blind, and
being crippled by this cynical policy.
Based on polling data, election
returns and the actions of their elected political representatives, the American
people do not support the medical prohibition. Indeed, it is difficult to find
any other question which unites so many of the American people in opposition to
an existing federal policy. A vast majority of Americans view the medical prohibition
as a regulatory fraud; an irrational outgrown of War on Drugs zealotry.
President Clinton has two options. He can commit his political credibility
to a foolhardy defense of the medical prohibition or he can move to end that prohibition.
By taking moderate steps to meet the medical needs of seriously ill Americans,
President Clinton can win broad public and political support for a rational system
of prescriptive access to marijuana. Failure to resolve this problem will leave
the new President exposed to attacks from ultra-prohibitionists on the right and
utopian reformers on the left. These attacks will have a very corrosive effect
on President Clinton's evolving relationship with the American people.
Federal drug agencies will, of course, strongly resistance efforts to end
the medical prohibition. It is likely these agencies will agitate their clients
in politics, law enforcement and the pharmaceutical sector to oppose such action.
It is less likely, but possible, that medical marijuana could be exploited by
some as a cultural "wedge" issue. However, there is precious little
political profit to be gained opposing compassion. All available data indicates
such arguments have very limited public appeal. Moreover, true conservatives are
strongly opposed to bureaucratic interference in personal medical decisions. Conservatives
supported state legislation recognizing marijuana's medical value. In Congress
many conservatives sponsored a federal marijuana-as-medicine measure.
The American people know marijuana has medical value, they are fed-up with
bureaucratic efforts to block marijuana's medical use, and they are weary of being
victimized by those on the political margins - left and right - who advocate the
cult of cultural warfare.
The American people did not elect President
Clinton merely hoping for change. They voted for Mr. Clinton to initiate change.
We hope the pragmatic and moderate recommendations advanced in this document help
those in the new Administration to secure such change for the benefit of all Americans.
[Back
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Citations1.)
"Marijuana, in its natural form, is one of the safest therapeutically active
substances known to man. By any measure of rational analysis marijuana can be
safely used within a supervised routine of medical care." Ruling of Drug
Enforcement Administration Administrative Law Judge Francis L. Young, "In
the Matter of Marijuana Rescheduling," See Marijuana, Medicine & The
Law, Volume II, R.C. Randall, ed., (Galen Press: Washington, D.C.), 1989,
p. 440.
2.) Robert S. Hepler, M.D. and Ira Frank,
"Marijuana Smoking and Intraocular Pressure," JAMA. 217 (September
6, 1971) p. 1392.
3.) "Fact Sheet: Marijuana
& Glaucoma," Statement from the National Eye Institute, August 16, 1978.
4.) Malin Dollinger, M.D., Ernest H. Rosenbaum, M.D., and Greg Cable.
Everyone's Guide to Cancer Therapy, (Andrews and McMeel: New York), 1991,
pp. 119-121.
5.) Decision of Judge Francis L.
Young, See Marijuana, Medicine & The Law, Vol. II, pp. 413-421.
6.) Decision of Judge Francis L. Young, See Marijuana, Medicine &
The Law, Vol. II, p. 416 at 21.
7.) Center
for Disease Control, AIDS Quarterly Surveillance Report, December 31, 1992.
8.) Decision of Judge Francis L. Young, See Marijuana, Medicine &
The Law, Vol. II, p. 437 at 44.
9.) "Out
of Joint: The Case for Medicinal Marijuana," by Brian Hecht, The New Republic
(July 15 & 22, 1991), pp 8-9. "Voices from Across the USA, Question:
Should The Use of Marijuana For Medical Purposes Be Permitted?," USA Today,
(March 12, 1992).
10.) H.B. 329, later renamed
The Lynn Pierson Marijuana Treatment & Research Act, was enacted by
a vote of 53-9 in the New Mexico House and 33-1 in the Senate. The bill was signed
by Governor Jerry Apodaca in February 1978.
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11.) See "Legislative Tallies
for State Statutes Recognizing Marijuana's Medical Value."
12.) [W]e encountered severe difficulties with FDA, the Drug Enforcement
Administration (DEA), and the National Institute on Drug Abuse (NIDA). To say
that these federal agencies were uncooperative would be an understatement."
Direct Testimony of George Goldstein, Ph.D., former Secretary of Health for the
State of New Mexico. See Marijuana, Medicine & The Law, Volume I, R.C.
Randall, ed., (Galen Press: Washington, D.C.) 1989, p. 118, at 28.
13.) Ibid., p. 120 at 42.
14.)
New Mexico, New York, Michigan, Georgia, Tennessee, and California established
programs of medical access in the 1980s. Only one state, New York, formally published
the results of their study. See "Inhalation Marijuana as an Antiemetic of
Cancer Chemotherapy," New York State Journal of Medicine, Vincent
Vinciguerra, M.D., (October 1988), pp. 525-527. Data from the other state studies
was routinely submitted to FDA and various state agencies. This data is summarized
in the ACT Brief in Support of Findings of Fact and Conclusions of Law, See Marijuana,
Medicine & The Law, Vol. II, pp. 33-63.
15.) Senate Concurrent Resolution 473, Michigan legislature, 1983.
16.) Under intense pressure from War on Drugs hard-liners
in the Reagan Administration, Gingrich withdrew his sponsorship in late 1982.
Other conservatives, however, did not follow Gingrich's example.
17.)
"Poll: Unapproved Drugs Should Be Available," by David E. Anderson,
UPI Newswire, September 24, 1991.
18.) Survey
conducted by the National Center for Telephone Research, Princeton, NJ, December
1978.
19.) Survey conducted by Joe B. Williams,
Research Consultant, Elmwood, Nebraska, April 1979.
20.)
Ibid.
[Back to the Top]
21.)
Washington State Medical Association, February 28, 1979.
22.)
"Marijuana as Antiemetic Medicine:A Survey of Oncologists Experiences and
Attitudes," by Richard E. Doblin and Mark A.R. Kleiman, Journal of Clinical
Oncology, Vol. 9, No. 7 (July 1991) , p. 1316.
23.)
Charlene Cochran, program host WFIR, January 4, 1993.
24.)
"The America People Talk About Drugs: A Nationwide Survey," conducted
by Targeting Systems, Arlington, Virginia. April 1990. Distributed by the Drug
Policy Foundation, Washington, D.C.
25.) DEA
Judge Francis L. Young ridiculed FDA's definition of marijuana as a New Drug.
"The marijuana plant is anything but a new drug. Uncontroverted evidence
in this record indicates that marijuana was being therapeutically used by mankind
2000 years before the Birth of Christ." Decision of Judge Francis L. Young.
See Marijuana, Medicine & The Law, Vol. II, p. 426.
26.)
U.S. v Randall, D.C. Superior Court, D.C. Crim. No. 65923-75, "Criminal
Law & Procedure: Medical Necessity," The Daily Washington Law Reporter,
Vol. 104, No. 250, (December 28, 1976), p. 2253.
27.)
Randall v. U.S., 1978.
28.) Decision
of Judge Francis L. Young, See Marijuana, Medicine & the Law, Vol II,
p. 445.
29.) "Couple Urges Medicinal Use
of Marijuana," Chicago Sun-Times, March 1, 1991. "Marijuana Helps
Soothe MS Victims," Cape Cod Times, March 19, 1991. "Paraplegic
Lauds Marijuana's Benefits," The Tampa Tribune, April 20, 1991.
[Back to the Top]
30.)
ACT v DEA, U.S. Court of Appeals (DC Circuit). April 26, 1991, No. 90-1019.
See also "DEA Told to Reevaluate Marijuana's Medical Value," The
Washington Post, April 27, 1991.
31.) "HHS
to Phase Out Marijuana Program," by Michael Isikoff, The Washington Post,
June 22, 1991.
32.) "Medical Quandry Pushing
Husband On Illegal Path", by Cory Farley, Reno Gazette-Journal, (Reno,
Nevada), June 18, 1991; "Feds Withhold AIDS Couple's Marijuana," by
Phil Davis, News Herald (Panama City, Florida), June 21, 1991; "US
Curbs Marijuana Distribution for Ill," Chicago Tribune, June 23, 1991;
"Pot Better For Chemotherapy," Tampa Tribune, June 27, 1991;
"Patients Blast Decision To Ax Marijuana Medicine Program," Sioux
City Journal (Sioux City, Iowa), June 28, 1991; "Woman Pleads For Marijuana
To Ease Glaucoma," Fremont Tribune(Fremont, Nebraska), June 29, 1991;
"Stoned Cold Justice," Boston Globe, July 7, 1991; "Medical
Marijuana," Orange County Register, September 11, 1991; "Paralyzed
Push For Right To Medical Marijuana," St. Petersburg Times, October 2, 1991;
"Forbidden Relief," Dallas Morning News, November 10, 1991.
33.) State of Florida v. Kenneth & Barbra
Jenks
34.) "Medical Marijuana Chief Should
Resign, Patients Say," Saint Paul Pioneer Press (St. Paul, Minnesota),
February, 5, 1992. "Official Accused of Medical Terrorism," Orlando
Sentinel(Orlando, Florida), February 5, 1992.
35.) "Delay in Lifting Ban on Pot for Ill Is Assailed," by Ronald
J. Ostrow, Los Angeles Times, January 31, 1992; "Drug Office Blasts
Delay on Medical Use of Pot," San Francisco Chronicle, January 31,
1992.
36.) "The Last Smoke," The
Economist, March 28, 1992. "Marijuana Still A Drug, Not a Medicine,"
by Katherine Bishop, The New York Times, March 22, 1992.
37.) See "What the Press Says."
38.) "Government Limits Marijuana Medical Use," Houston Chronicle,
March 11, 1992, p. 6A.
39.) Ibid.
[Back to the Top]
40.)
"The Sick Who Need Pot Say Anti-Drug Era Hurts," by Cory Jo Lancaster,
Orlando Sentinel, March 4, 1992.
41.)
"Pot as Medicine: Unfair Decision," The Ann Arbor News, as reprinted
in The Bay City Times, March 23, 1992. "Medicinal Use of Marijuana
Inconsistent," by Ken Fuson, Des Moines Sunday Register, March 22,
1992. "Marijuana Ban Sparks Outrage," by Alfredo Azula, The Phoenix
Gazette, March 16, 1992.
42.) "The
Drug War Claims More Innocent Victims," by Stephen Chapman, Chicago Tribune,
March 12, 1992, p.29. "War on Drugs Heaps Suffering on Sufferers," The
News Herald (Panama City, Florida), March 13, 1992. "Medical Use of Marijuana:
Let Doctors Decide," The Star Tribune (Minneapolis), March 23, 1992.
43.) "One alternative is the use of the oral dosage form of the
major active ingredient in marijuana, delta-9 THC.... Its trade name is Marinol....
Marinol may be as effective and even less likely to cause adverse effects than
smoking marijuana cigarettes in controlling your patient's symptoms." Information
for the Physician on the Use of Marijuana Cigarettes Provided by the National
Institute on Drug Abuse, Fact Sheet prepared by NIDA, August 1991.
44.) "They Smoke Pot, But Not to Get High," by Sylvia Rubin,
San Francisco Chronicle, March 13, 1992.
45.) "Theoretically, smoking might be the preferable route since it results
in less variability of absorption through the gastro-intestinal route. Moreover,
smoking provides greater opportunity for individual patient control by permitting
the patient to regulate and maintain the `high'." S. Sallan, M.D., N. Zinberg,
M.D., & E.I. Frei III, M.D. "Antiemetic Effect of Delta-9-Tetrahydrocannabinol
in Patients Receiving Cancer Chemotherapy," New England Journal of Medicine,
Vol. 293, No. 16, (October 15, 1975), pp. 795-797.
46.) Direct Testimony of Norman Zinberg, M.D., Marijuana, Medicine &
The Law, Vol. I, p. 416.
47.) National Cancer
Institute, internal memo dated May 15, 1978. Minutes of a May 9, 1978 meeting,
pages 1 & 4.
48.) "Marijuana cigarettes
in many cases are superior to synthetic THC capsules in reducing chemotherapy-induced
nausea and vomiting. Marijuana has an important, clear advantage over synthetic
THC capsules in that natural marijuana is inhaled and generally takes effect more
quickly than the synthetic capsule which is ingested and must be processed through
the digestive system before it takes effect." Decision of Judge Francis L.
Young, Marijuana, Medicine & The Law, Vol. II, p. 413 at 3.
49.) Robert Gorter, M.D. "Management of Anorexia-Cachexia in Advanced
HIV Disease," PAACNOTES, Vol. 3, No. 5, 1992.
[Back to the Top]
50.) "Marijuana
cigarettes have been used to treat chemotherapy-induced nausea and vomiting and
research has shown that the active ingredient THC is more readily and quickly
absorbed from marijuana smoke than from an oral preparation of the substance."
From Marijuana For Chemotherapy-Induced Nausea and Vomiting, Fact Sheet
Prepared by the National Cancer Institute, February 12, 1992.
51.) According to a Harvard University survey of oncologists, 44% of
cancer specialists believe marijuana is more effective than Marinol and 47% stated
Marinol caused negative side effects. "Marijuana as Antiemetic Medicine:
A Survey of Oncologists Experiences and Attitudes," Journal of Clinical
Oncology, (July 1991), p. 1316.
52.) "Many
of the therapeutic properties of cannabis have been verified with pure natural
or synthetic cannabinoids. In several fields, however, no modern work exists.
The most blatant examples are the anthelmintic, antimigraine, and oxytocic effects.
Are we missing something?" Raphael Mechoulam, Ph.D., Cannabinoids as Therapeutic
Agents, (Boca Raton, Florida: CRC Press, Inc.) 1986, p.16.
53.) Marijuana Therapeutic Research Project: Trial A 1980-1981,"
Department of Social Oncology - Evaluations Unit, Michigan Cancer Society,
March 18, 1992, Table 9 at pg 10. See Marijuana, Medicine & the Law, Vol.
II, p. 45.
54.) Ibid. See Chang/NCI &
New Mexico studies, Marijuana, Medicine & The Law, Vol. II, pp. 34-38.
55.) Mae Nutt testified that when her son Keith, a cancer patient, had
access to marijuana, "He would join the family for dinner, where he would
eat more than his share. He became outgoing and talkative. Keith became part of
our family again because [of] marijuana...." Marijuana, Medicine &
The Law, Vol. I, p. 91 at 42.
56.) Press
Conference to announce creation of the MARS Project, February 28, 1991,
Chicago, Ill.
57.) The Alliance for Cannabis
Therapeutics, joined by the Physicians Association for AIDS Care and The Lymphoma
Foundation of America, has appealed DEA's March 1992 rejection of Judge Young's
1988 ruling that marijuana should be rescheduled. ACT v DEA, U.S. Court
of Appeals (DC Circuit Case No. 92-1168).
58.)
Federal agencies could sabotaged scheduled shipments of medical marijuana to the
ten seriously ill Americans still receiving Compassionate IND care. War on Drugs
hardliners in the bureaucracy would exploit such supply disruptions to provoke
a confrontation which publicly pits incoming Clinton appointees against these
seriously ill Americans. The bureaucracy would, of course, use the resulting confusion
to solidify control over future drug policy.
59.)
"Let Doctors Prescribe Pot," Albany Times Union, editorial, January
4, 1993.
[Back to the Top]
60.) "Marijuana Therapy Should Be Approved," The Oakland
Tribune, January 5, 1993.
61.) PHS Chief
Mason's order terminating the Compassionate IND program for medical marijuana,
March 4, 1992. From FOIA materials obtained by the Drug Policy Foundation, Washington,
D.C.
62.) "The Administrative law judge
recommends the marijuana plant considered as a whole has a currently accepted
medical use in treatment in the United States, that there is no lack of accepted
safety for use of it under medical supervision and that it may lawfully be transferred
from Schedule I to Schedule II." Decision of Judge Francis L. Young, See
Marijuana, Medicine & the Law, Vol II. pp. 445-446.
63.) DEA agents have routinely conducted extensive face-to-face interviews
with physicians who requested Compassionate IND access to medical marijuana. During
such encounters law enforcement officers demand that licensed physicians justify
treatment decisions. The intent of these interviews is to harass, coerce, and
intimidate the physician.
[Back
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About
the Authors
Robert Randall is president of the Alliance
for Cannabis Therapeutics (ACT), a Washington-based patient rights group. A glaucoma
patient, Mr. Randall was the first American to secure legal, medical access to
marijuana and is the nation's leading advocate for marijuana's medical availability.
He has authored numerous articles, books, and is a frequent lecturer on the topic
of marijuana's medical uses.
In November 1994, Mr. Randall was
diagnosed with AIDS. He was critically ill during all of 1995 and most of 1996.
He has now recovered and is continuing his efforts on behalf of medical access
to marijuana.
Alice O'Leary is publisher at Galen Press.
Ms. O'Leary formerly worked for the Marijuana Reclassification Project, the National
Women's Health Network, and for nearly a decade as administrative officer of the
Society for Scholarly Publishing. She is secretary-treasurer for the Alliance
for Cannabis Therapeutics. Her publishing company, Galen Press, is the nation's
leading source of information on marijuana's medical uses.
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