by glaucoma.  Oral or intravenous THC has the same effect, which seems to be
specific to cannabis derivatives rather than simply a result of sedation.
Cannabis does not cure the disease, but it can retard the progressive loss
of sight when conventional medication fails and surgery is too dangerous.7
Seizures
        About 20% of epileptic patients do not get much relief from
conventional anticonvulsant medications.  Cannabis has been explored as an
alternative at least since 1975 when a case was reported in which marihuana
smoking, together with the standard anticonvulsants phenobarbital and
diphenylhydantoin, was apparently necessary to control seizures in a young
epileptic man.8   The cannabis derivative that is most promising as an
anticonvulsant is cannabidiol.   In one controlled study, cannabidiol in
addition to prescribed anticonvulsants produced improvement in seven
patients with grand mal convulsions; three showed great improvement.  Of
eight patients who received a placebo instead, only one improved.9  There
are patients suffering from both grand mal and partial seizure disorders who
find that smoked marihuana allows them to lower the doses of conventional
anticonvulsant medications or dispense with them altogether.2
Pain
        There are many case reports of marihuana smokers using the drug to
reduce pain: post-surgery pain, headache, migraine, menstrual cramps, and so
on.  Ironically, the best alternative analgesics are the potentially
addictive and lethal opioids.  In particular, marihuana is becoming
increasingly recognized as a drug of choice for the pain that accompanies
muscle spasm, which is often chronic and debilitating, especially in
paraplegics, quadriplegics, other victims of traumatic nerve injury, and
people suffering from multiple sclerosis or cerebral palsy.   Many of them
have discovered that cannabis not only allows them to avoid the risks of
other drugs, but also reduces muscle spasms and tremors; sometimes they are
even able to leave their wheelchairs.10
        One of the most common causes of chronic pain is osteoarthritis,
which is usually treated with synthetic analgesics.  The most widely used of
these drugs -- aspirin, acetaminophen (Tylenol), and nonsteroidal
antiinflammatory drugs (NSAIDs) like ibuprofen and naproxen -- are not
addictive, but they are often insufficiently powerful.  Furthermore, they
have serious side effects.   Stomach bleeding and ulcer induced by aspirin
and NSAIDs are the most common serious adverse drug reactions reported in
the United States, causing an estimated 7,000 deaths each year.
Acetaminophen can cause liver damage or kidney failure when used regularly
for long periods of time; a recent study suggests it may account for 10% of
all cases of end-stage renal disease, a condition that requires dialysis or
a kidney transplant.11,12  Marihuana, as I pointed out earlier, has never
been shown to cause death or serious illness.
AIDS
        More than 300,000 Americans have died of AIDS.   Nearly a million
are infected with HIV, and at least a quarter of a million have AIDS.
Although the spread of AIDS has slowed among homosexual men, the reservoir
is so huge that the number of cases is sure to grow.  Women and children as
well as both heterosexual and homosexual men are now being affected; the
disease is spreading most rapidly among intravenous drug abusers and their
sexual partners.  The disease can be attacked with anti-viral drugs, of
which the best known are zidovudine (AZT) and protease inhibitors.
Unfortunately, these drugs sometimes cause severe nausea that heightens the
danger of semi-starvation for patients who are already suffering from nausea
and losing weight because of the illness -- a condition sometimes called the
AIDS wasting syndrome.
        Marihuana is particularly useful for patients who suffer from AIDS
because it not only relieves the nausea but retards weight loss by enhancing
appetite.  When it helps patients regain lost weight, it can prolong life.
Marinol has been shown to relieve nausea and retard or reverse weight loss
in patients with HIV infection, but most patients prefer smoked cannabis for
the same reasons that cancer chemotherapy patients prefer it: it is more
effective and has fewer unpleasant side effects, and the dosage is easier to
adjust.
        These are the symptoms and syndromes for which cannabis is most
commonly used today, but there are others for which clinical experience
provides compelling evidence.  It is distressing to consider how many lives
might have been saved if penicillin had been developed as a medicine
immediately after Fleming's discovery.  It is equally frustrating to
consider how much suffering might have been avoided if cannabis had been
available as a medicine for the last 60 years.  Initial enthusiasm for drugs
is often disappointed after further investigation, but this is hardly likely
in the case of cannabis, since it is not a new medicine at all.  Its long
medical history began 5,000 years ago in China and extended well into the
twentieth century.  Between 1840 and 1900, more than one hundred papers on
its therapeutic uses were published in American and European medical
journals.  It was recommended as an appetite stimulant, muscle relaxant,
analgesic, sedative, anticonvulsant, and treatment for opium addiction.  As
late as 1913, the great Sir William Osler cited it as the best remedy for
migraine in a standard medical textbook.
        In the United States, what remained of marihuana's medical use was
effectively eliminated by the Marihuana Tax Act of 1937, which was
ostensibly designed to prevent nonmedical use but made cannabis so difficult
to obtain that it was removed from standard pharmaceutical references.  When
the present comprehensive federal drug law was passed in 1970, marihuana was
officially classified as a Schedule I drug: a high potential for abuse, no
accepted medical use, and lack of safety for use under medical supervision.
        But in the 1970s the public began to rediscover its medical value,
as letters appeared in lay publications from people who had learned that it
could relieve their asthma, nausea, muscle spasms, or pain and wanted to
shared that knowledge with readers who were familiar with the drug.  The
most effective spur to the movement for medical marihuana came from the
discovery that it could prevent the AIDS wasting syndrome.  It is not
surprising that the Physicians Association for AIDS Care was one of the
medical organizations that endorsed the California initiative prohibiting
criminal prosecution of medical marihuana users.  The mid-1980s had already
seen the establishment, often by people with AIDS, of cannabis buyers'
clubs, organizations that distribute medical marihuana in open defiance of
the law.  These clubs buy marihuana wholesale and provide it to patients at
or near cost, usually on the written recommendation of a physician.
Although a few of the clubs have been raided and closed, most are still
flourishing, and new ones are being organized.  Some of them may gain legal
status as a result of the initiative.
        Until the recent vote in California, efforts to change the laws had
been futile.  In 1972 the National Organization for the Reform of Marijuana
Laws (NORML) entered a petition to move marihuana out of Schedule I under
federal law so that it could become a prescription drug.  It was not until
1986 that the Drug Enforcement Administration (DEA) finally agreed to the
public hearings required by law.  During two years of hearings, many
--- 
---------------