From: "Carl E. Olsen" 
Subject: Newsweek Articles
Can Marijuana Be Medicine?
The claims are unproven, but many patients say the drug helps them.
BY GEOFFREY COWLEY
SUSAN NELSON SPENT most of 1978 watching her husband, Don, retch almost
constantly. His body fought so hard to expel the chemicals used to treat
his testicular cancer that, after 18 months, his battered esophagus ripped,
causing tissue damage that has plagued him ever since. A decade later, it
was Susan's turn. She developed lymphoma in 1989, and she, too, underwent
chemotherapy. But in four months of treatment, she vomited only once.
Instead of heading for the bathroom when she felt a surge of nausea, she
took matters into her own hands: she fired up a joint.
Susan Nelson is no dopehead. She grew up in a military family, and never
even experimented with pot as a '60s teenager. But she wasn't about to
relive her husband's experience. The anti-nausea drug her doctor
prrescribed did wonders for her digestion, but it also lowered her
inhibitions, causing inexplicable urges to throw plates and roll burning
logs on the living-room floor. Smoking marijuana may have broken the .aw
(she bought it from fellow patients), but it didn't break her dishes. "When
I smoked it," she recalls, "you could still trust me."
Americans may frown on recreational pot smoking, but as recent votes in
California and Arizona make clear, a lot of people favor leaving folks like
the Nelsons alone. The states' initiatives won't have much practical effect
(they free doctors to recommend marijuana without creating legal supplies
of the drug). Still, the measures have revived an important and
long-neglected question: does pot ever make good medicine? Federal
drug-enforcement officials say the drug is both useless and dangerous.
They're challenging the new initutiatives in court and vow to punish
doctors who prescribe pot to their patients. But proponents claim marijuana
can help control glaucoma, forestall AIDS-related wasting, ease the nausea
brought on by cancer chemotherapy and counter the symptoms of epilepsy and
multiple sclerosis. The claims are largely unproven, but they warrant some
serious attention.
Marijuana's basic mode of action is well known. Several years ago,
researchers discovered that the body makes a chemical closely resembling
THC, the main active ingredient in cannabis, and that the brain has
receptors designed specifically to receive it. The receptors are
concentrated in the brain regions responsible for motor activity,
concentration and short-term memory. As anyone who ever inhaled will
attest, marijuana can disrupt all those functions.
The question is whether it can do anything else. For nearly three decades
the government has listed marijuana as a "schedule I" drug, a designation
reserved for substances with no apparent medical value and a high potential
for abuse. Barry McCaffrey, director of the Office of National Drug Control
Policy, stoutly defends that ruling, saying there is "no convincing
scientific evidence" that marijuana offers benefits that a person can't get
from approved prescription drugs.
Where glaucoma is concerned, McCaffrey has a point. It's well known that
smoking marijuana can reduce pressure within the eye, a hallmark of the
disease. But the drug may also reduce the blood supply to the optic
nerve-the last thing a glaucoma sufferer needs-and it doesn't seem to
prevent blindness. Even if marijuana could save eyes, smoking it enough
would take extraordinary effort. "In order to substantially reduce eye
pressure," says Dr. Harry Quigley of Johns Hopkins University's Wilmer Eye
Institute, "you'd have to be stoned all the time." When researchers tried
dissolving THC in eye drops, they succeeded only in irritating people's
eyes, but other compounds proved more useful. As a result, glaucoma
patients can now choose from a number of potent topical treatments. The
latest, a once-a-day eye drop called Xalatan, is virtually free of major
side effects.
Marijuana may not cure glaucoma, but it has other claims to respectability.
People have used it for centuries to stimulate appetite, and an unknown
number now use it to combat the wasting associated with AIDS. No one knows
how much good it's doing-the drug-control agencies have recently thwarted
studies intended to answer that question-but some experts suspect the
benefits are modest. The wasting syndrome doesn't stem solely from a lack
of appetite, says Dr. Donald Kotler, an immunologist at New York's St.
Luke's-Roosevelt Hospital. The patient may have an intestinal infection
that blocks the absorption of nutrients, or a neck tumor that interferes
with swallowing.
Skeptics also note that the FDA has already approved several effective
remedies for wasting. To stimulate appetite, patients can take Marinol, a
synthetic version of THC that comes in pill form, or Megace, a derivative
of the hormone progesterone. In premarketing studies, AIDS patients who
took Megace for 12 weeks gained an average of 11 pounds, while those
getting a placebo lost 21. Since AIDS takes a particular toll on muscle
tissue, the FDA has also approved several muscle-building steroids
(testosterone and its kin) as AIDS treatments. Patients with good insurance
can also get synthetic humangrowth hormone, a bone and muscle builder that
costs $1,000 a month.
Yet as many patients have discovered, plain old pot may stil1 have a
valuable role. Keith Vines, a 46-year-old San Francisco prosecutor,
considers himself a stalwart in the war on drugs. As an assistant district
attorney, he has spent years putting street dealers in jail. As an AIDS
patient, he has seen his body threaten to disintegrate. "Three years ago my
ribs were protruding," he says. "I was terrified to get on the scale." He
wanted to enroll in a study of human-growth hormone, but participants had
to eat three meals a day, and he could hardly force down one. He tried
several drugs-including Marinol, which often left him too blasted to
function-but nothing worked until he joined a local buyers' club and
started smoking pot. Once he took that leap, he qualified for the
humangrowth-hormone study, put on 45 pounds and managed to salvage his job.
"Without marijuana," he says earnestly, "I would be dead."
Like AIDS-related wasting, the nausea from cancer chemotherapy is readily
treated by prescription drugs. But those drugs are expensive, they don't
always work and they're not always harmless. Their warning labels are
littered with phrases like "hives," "impotence," "difficulty breathing,"
"tremors and rigidity" and "leukopenia" (a drop in white blood cells).
Marijuana isn't riskfree-its smoke contains a number of carcinogens-but
it's less toxic than many prescription drugs. There is no recorded instance
of a death from overdose. And because people consume it one puff at a time,
feeling the effects as they go, they can easily tailor their intake to
their needs.
That's a big advantage for people with chronic pain or with spastic
disorders such as multiple sclerosis. Whereas prescription drugs may zonk
them out for the whole day, marijuana lets them respond directly to their
symptoms. No one has conducted trials to gauge marijuana's genuine
therapeutic effect on pain and spasms. But that doesn't much concern 39
year-old Andrew Hasenfeld, who was diagnosed with multiple sclerosis in
1980. He tried the prescription drug bactofen, but it never relieved the
spasms, the stiffness, the sensation of "being all locked up." He resorted
to marijuana six months ago, at the urging of fellow sufferers in Amherst,
Mass., and the result was dramatic. "There's no comparison with any drug I
could buy in a pharmacy," he says. Few people would argue that Andrew
Hasenfeld, Keith Vines or Susan Nelson belongs behind bars. ("I'm already
in a wheelchair," says Hasenfeld. "Isn't that enough?") And though
recreational pot smokers can get involved with harder drugs, it's hard to
see how easing one's nausea, wasting or muscle spasms could cause what the
drug office describes as "a downward spiral of self-destruction." Still,
federal regulatory policy can't rest entirely on individual testimonials.
As McCaffrey argues in a forthcoming "myths and truth" position paper,
"drug policy must be based on science, not ideology." Approving marijuana
as a prescription drug would require organizing clinical trials,
identifying appropriate uses and finding ways to regulate its cultivation
and sale. Those aren't insurmountable obstacles; morphine has been used
medically for years. But federal policy has long discouraged clinical
research with marijuana. The drug-control office is now pledging that "any
serious marijuana research request will be considered." Perhaps that will
begin to clear the smoke.
With MARY HAGER in Washington, ADAM ROGERS in New York, CLAUDIA KALB in
Boston and PATRICIA KING in San Francisco
 ----------------
This Is Smart Medicine
A doctor argues that marijuana can ease patients' suffering in ways nothing
else can.
BY MARCUS CONANT
ANYONE WHO HAS EVER smoked marijuana will tell you he gets hungry
afterward. That kind of anecdotal evidence led doctors and patients to
experiment with marijuana as a treatment for extreme nausea, or wasting
syndrome. I have seen hundreds of AIDS and cancer patients who are losing
weight derive almost immediate relief from smoking marijuana, even after
other weight-gain treatments-such as hormone treatments or feeding
tubes-have failed. But it's not just individuals who have recognized the
medicinal benefits of marijuana. No less an authority than the FDA has
approved the use of Marinol, a drug that contains the active ingredient in
marijuana.
The problem with Marinol is that it doesn't always work as well as smoking
marijuana. Either you take too little, or 45 minutes later you fall asleep.
Even though insurance will pay for Marinol-which costs about $200 a
month-some patients spend their own money, and risk breaking the law, for
the more effective marijuana. That's fairly good evidence that smoking the
drug is superior to taking it orally. How would we keep patients from
giving their prescribed marijuana to friends? The same way we keep people
from abusing other prescription drugs: by making patients understand the
dangers of giving medication to other people. A physician who prescribes
marijuana without the proper diagnoses should be held up to peer review and
punished. There are drugs available at the local pharmacy-Valium, Xanax,
Percodan-that are far more mood-altering than marijuana. They aren't widely
abused. It's not important that a few zealots advocate the wholesale
legalization of marijuana. The federal government can't craft policy based
on what a few irrational people say. This is a democracy, and what the
people of California voted for was to make marijuana available for medical
use for seriously ill people.
For skeptics, a study devised at San Francisco General Hospital would test
the benefits of smoking marijuana once and for all. It, too, was endorsed
by the FDA-but the federal government won't provide the marijuana for the
study. Washington recently offered to fund a $1 million review of
literature on medical marijuana, but it refuses to allow a clinical trial,
which is what's really needed.
When citizens even speak up in favor of legalizing marijuana for medicinal
use, as happened this fall in California and Arizona, the government tries
to stop them. Gen. Barry McCaffrey and the Justice Department have
threatened to revoke the prescription-drug licenses of doctors who
prescribe marijuana. This is a truly dangerous step. The government has no
place in the examination room. Our society has long felt that certain
relationships require privileged communication, such as those between a
priest and a parishioner or a lawyer and a client. If a patient wants to
discuss marijuana, I don't want to have the responsibility of reporting
him, and I have to feel comfortable that the patient will not report me.
This is a First Amendment issue of freedom of speech between doctor and
pattient.
Perhaps the most persuasive argument for medicinal marijuana I've
encountered came two years ago, when the California Assembly was debating a
medical-marijuana bill. One GOP assemblyman said he had had a great deal of
trouble with the issue. But when a relative was dying a few years before,
the family had used marijuana to help her nausea. That story helped the
bill pass. Wouldn't it be awful if people changed their minds only after
someone close to them had died?
CONANT, a doctor at the University of California, San Francisco, has
treated more than 5,000 HIV-positive patients in his private practice.
 ---------- .
Comments by General McCafrey
WHY IS IT DANGEROUS  for Americans to use marijuana as medicine? The answer
is: it may not be. It may surprise you to hear the national drugpolicy
director say this, but I don't think we should automatically reject the
possibility that marijuana may have some medicinal benefits. In fact, a
synthetic version of THC, the main active ingredient in marijuana, is
already approved by the FDA and available with a doctor's prescription.
Called Marinol, it's used to ease nausea in cancer patients and help people
with AIDS keep up their appetites. Does that mean the new California law
legalizing marijuana as medicine is a good idea? Absolutely not.
The truth is, despite the insistence of legalization activists, there is no
proof that smoked marijuana is the most effective available treatment for
anything. Don't take my word for it. The National Institutes of Health
recently examined all ofthe existing clinical evidence about
smokedmarijuana. Its conclusion: "There is no scientifically sound evidence
that smoked marijuana is medically superior to currently available
therapies." This isn't an argument between advocates for legalizing
marijuana and the federal government. It's an argument between the
legalizers and the American Medical Association, and the American Cancer
Society, and the American Ophthalmological Society- all of which oppose the
California marijuana initiative.
It seems to me entirely sensible that before we go rushing to embrace the
medicinal use of marijuana-or LSD, heroin or any other illicit drug-we
ought to find out if it is safe and effective. Every other drug on the
market was required to undergo exhaustive testingby the FDA before it was
made available to the public. As far as I'm concerned, the door is wide
open to marijuana or any other substance-but first it has to pass
scientific scrutiny and be subject to peer-group review. (It surprises many
people to learn that methamphetamines and even cocaine have been approved
for specific medical purposes.)
We have made $1 million available to the Institute of Medicine at the
National Academy of Sciences to ask physicians and scientists for all that
is known about smoked pot, and what questions need to be asked about it.
And I have asked Dr. Harold Varmus, the Nobel laureate and head of the
National Institutes of Health, to examine the potential benefits of
marijuana. If researchers find there are compounds in marijuana that may
have medicinal benefits (cannabis is made up of more than 400 different
substances), we must immediately make them available to the American
medical community. If they can demonstrate that they are safe and
effective, then let's approve them.
Until then, though, it is inconceivable to allow anyone of any age to have
uncontrolled use of marijuana for any alleged illness -without a doctor's
examination or even prescription. But that is precisely what the California
law lets people do. Can you think of any other untested, homemade,
mind-altering medicine that you self-dose, and that uses a burning
carcinogen as adelivery vehicle? I think it's clear that a lot of the
people arguing for the Calif ornia proposition and others like it are
pushing the legalization of drugs, plain and simple. It sends a very mixed
and confusing message to the young. We've got 68 million kids age 18 and
below. They're using drugs in enormously increasing numbers. Drug use among
eighth graders alone has more than tripled in the last five years.
Pretending pot is just another choice makes their decision to stay off
drugs that much harder.
MCCAFFREY, a retired army general, is the director of the Office of
National Drug Control Policy.
                 B o o k s  b y  S t e v e  K u b b y:
    http://www.alpworld.com/HEALTH/Bio/Steve.html
--The Politics of Consciousness
    (foreword by Terence McKenna)
    http://www.alpworld.com/HEALTH/Bio/politics.html
--Why Marijuana Should be Legal
    (co-author Ed Rosenthal, illustrations by Garry Trudeau)
    http://www.alpworld.com/HEALTH/Prop_215/medical.html
        T H E   M E D I C A L   M A R I J U A N A   A R C H I V E S
                       http://www.alpworld.com/HEALTH
--UNDERSTANDING YOUR RIGHTS UNDER PROP. 215
    http://www.alpworld.com/HEALTH/Prop_215/Prop215Guidelines.html
--CANNABIS BUYERS' CLUBS PHONE NUMBERS
    http://www.alpworld.com/HEALTH/Prop_215/index.html#CBCs
--POLITICAL CARTOONS ABOUT MEDICAL MARIJUANA
    http://www.alpworld.com/HEALTH/Cartoons/Cartoons.html
--A NEW DECLARATION OF INDEPENDENCE
    http://www.alpworld.com/ken/Declaration.html
         A  l  p  i  n  e    W  o  r  l  d    O  n  l  i  n  e
           P.O. Box 2025, Olympic Valley, Ca 96146
                  URL: http://www.alpworld.com
                               (916) 581-1115
  
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