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Medical Marijuana: Regulations Clash

Doctors are facing a dilemma: risk breaking the law or withhold a potential treatment.

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McCaffrey's threats also inspired organizers in 10 states to begin gathering signatures for ballot measures similar to California's medical marijuana initiative. And in May of 1997 the Florida Medical Association called on the federal government to reopen clinical trials on marijuana. The author of the initiative, internist Mark Antony LaPorta, M.D., of Miami Beach, says he was so "pissed" by McCaffrey's comments that he sat down and wrote the successful resolution. "I have never prescribed marijuana, and I can't say that I've ever recommended it," he says. "But I need to be able to discuss it so that my patients have all the information they need."

Several months earlier, federal officials had tried to make amends in an open letter, dated February 27, that said that nothing prevents a physician "from merely discussing with a patient the risks and alleged benefits of the use of marijuana." But the letter confused the issue by repeating the threat of criminal prosecution if doctors provide "oral or written statements in order to enable [patients] to obtain controlled substances." And many local law enforcement officials leave no doubt as to their leanings. "I would investigate any doctor that prescribes this illicit drug, and I'd turn [the case] over to the federal government and ask them to investigate and possibly prosecute," says county attorney Richard Romley of Maricopa County, Arizona. "I don't know if marijuana is good or bad. I don't really care. If the scientific community says it has some beneficial properties, we will support it 100 percent. But it's not up to the voter community."

Given the legal hazards, why do many doctors continue to suggest marijuana? The answer is that it can stop the nausea and retching that torments patients after chemotherapy, as well as halt the disastrous weight slide of the AIDS wasting syndrome. Smoking marijuana is also believed to possibly help lower eye pressure in glaucoma patients, control spasms due to multiple sclerosis, and relieve chronic pain, according to Lester Grinspoon, an associate clinical professor of medicine at Harvard Medical School who has written two books on the medicinal use of marijuana.

For patients wracked by nausea and vomiting, some doctors prescribe Marinol, a legal synthetic version of delts-9 THC (an active ingredient in marijuana). But patients often complain of being disoriented on Marinol, and many doctors say that smoked marijuana acts more quickly and its dosage is easier to adjust. "If you take too much Marinol, you nod off; a patient with AIDS dementia might fall down the stairs," Conant says.

Many doctors say that the best solution would be for the federal government both to allow physicians to advise cannabis use without fear of penalty and to supply marijuana for clinical research, as it did during the 1970s.

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