This OpEd piece was published 4/25/98 in The Oregonian
newspaper of Portland, Oregon as:
Initiative a reaction to draconian laws:
Doctors should be able to prescribe marijuana
[Authors' note: Emphasis added by the authors and the
areas in the italics were edited out of the final piece that actually
appeared in The Oregonian on Saturday, April 25, 1998.]
In two recent columns, Robert Landauer has
tackled the issue of marijuana's medical uses, and how public policy should
react to evidence of its benefits. Oregon voters are likely to face this issue
this fall as a result of the Oregon Medical Marijuana Act [, for which one of
us (RB) is a chief petitioner].
Landauer concludes that the scientific
evidence to date is too weak or unreliable for marijuana to become a
prescription medication. He rightly chides the federal government's knee-jerk
anti-marijuana policies for blocking research that could have solved the
question before now.
Still, his position -- increasingly common
among medical professionals as well -- begs the question: What do we do with
patients who benefit from marijuana now, but must break the law to use it? Our
initiative asks voters to end the risk of state criminal penalties faced by
these seriously and terminally ill patients in a sensible, regulated way,
brokering a peace of sorts while science continues its investigations.
To reach a do-nothing position, Landauer and
others tend to rely on an understatement of the knowledge that exists about
marijuana's medical value. Wait for more research, they argue. Many share
Landauer's fear that "personal anecdotes will dominate the public
discussion" of this year's ballot initiative. In fact, there's more value
to these much-derided "anecdotes" than he implies, and there's more
scientific support for marijuana's value than most people know.
Good clinical doctors seek anecdotal
evidence from patients to help with diagnosis and treatment. This is especially
true when managing problems such as nausea and pain, which are almost totally
subjective. In fact, it would be impossible to evaluate any anti-nausea or
anti-pain medicine without the use of important anecdotal evidence. And, when
thousands of patients come forward, all describing the same phenomena, it is
time to put politics aside and accept the obvious truth that some patients
benefit from the medical use of marijuana.
Scientific data collected in studies of
marijuana in the 1970s and early 1980s are also stronger than most people
realize. The American Medical Association's Council on Scientific Affairs
summarized those findings in a December 1997 report that Landauer quoted mainly
for its more ambivalent passages about marijuana's value. The report states:
·
[B]oth survey and
data derived from placebo-controlled single dose studies indicate that smoked
marijuana stimulates appetite in normal subjects.
·
Smoked marijuana was
comparable to or more effective than oral THC . . . in reducing nausea and
emesis [vomiting].
·
Anecdotal, survey,
and clinical data support the view that smoked marijuana and oral THC provide
symptomatic relief in some patients with spasticity associated with multiple
sclerosis (MS) or trauma.
·
Smoked marijuana may
allow individual patients to self-titrate their dosage to the point of
therapeutic benefit, while minimizing undesirable psychoactive effects. It also
provides a method of more rapid onset and offset than oral THC.
Even with such evidence supporting
natural marijuana, we are aware that some prominent physicians prefer the THC
pill (Marinol), a synthetic version of the main active chemical in marijuana.
(THC may or may not be the most important ingredient in marijuana, depending on
the condition and the patient, but THC is certainly the most psychoactive
ingredient.) Marinol is very expensive, can cost over $11 per pill, and
patients frequently spend $600-$1200 per month when using it regularly. Many
patients we have seen, however, complain of Marinol's slow onset and
undesirable mental effects. It's certainly not the solution for every patient
who benefits from marijuana.
The existence of Marinol, an imperfect substitute,
and a tangle of federal regulations and political opposition all get in the way
of proving, finally, whether and how marijuana works for some kinds of
patients. Currently, marijuana is classified federally as a Schedule I drug,
meaning doctors cannot prescribe it, even to dying and suffering patients. It
is time that the federal government moved marijuana to Schedule II, both
to expedite research into its medical uses and to allow patients to have access
to marijuana under medical supervision, just like morphine.
In the end, the debate over medical
marijuana is about dying and suffering patients. It's about providing these patients with effective
means to control the disabling symptoms they often face with terminal or
chronic debilitating illnesses. We say, let us hear from the patients. If
marijuana helps them, then they should have access to it, under strict
regulations, such as those in the Oregon Medical Marijuana Act. There is
plenty of justification available already to make a compassionate exception to
Oregon criminal laws on marijuana for those patients who can benefit from this
misunderstood drug
Richard Bayer, MD
Board Certified, Internal Medicine
Chief Petitioner, Oregon Medical Marijuana
Act
Nancy Crumpacker, MD
Board Certified, Internal Medicine
Board Certified, Medical Oncology