== Forwarded Message Follows =========================================
From: "Carl E. Olsen" 
Subject: New England Journal of Medicine
>New England Journal of Medicine
>January 30, 1997, Vol. 336, no. 5, pp. 366-367
>
>Editorials
>
>                Federal Foolishness and Marijuana
>
>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 quantity 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 (tetra-hydrocannabinol), 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 accept ed 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.
>
>References
>
>1. Young FL.  Opinion and recommended ruling, marijuana    rescheduling
>petition.  Department of Justice, Drug    Enforcement Administration.
>Docket 86-22.  Washington, D.C.:     Drug Enforcement Administration,
>September 6, 1988.
>
>2. Department of Justice, Drug Enforcement Administration,    Marijuana
>scheduling petition:  denial of petition:  remand.     (Docket No. 86-22.)
>Fed Regist 1992;57(59):10489-508.  Copyright 1997, Massachusetts Medical
>Society.
>
>
Sylvia
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