Forbidden Medicine

Laws and medicine clash over medicinal marijuana use.

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Feb. 21, 2000 (WASHINGTON) -- If it weren?t for his few daily tokes from marijuana cigarettes, Kiyoshi Kuromiya believes he would no longer be alive.

The Philadelphia AIDS patient and activist had lost 40 pounds over a four-month period and spent most days nauseated before he began smoking pot in 1995 to boost an appetite suppressed by his disease.

"Marijuana saved my life," says Kuromiya, 57, who was diagnosed with AIDS in 1988. "It?s a great irony to me that I can buy cigarettes, which will kill me, anywhere. But marijuana, which has kept me breathing, is illegal."

Kuromiya and others with debilitating ailments have long argued that marijuana should be legally available when standard medical treatment can't relieve a patient?s suffering and pain. They're now finding hope in the measured support that idea has received from some presidential candidates, including Vice President Al Gore. And some believe the November elections, which some political observers say could give control of the House back to the Democrats, may bring a change in attitude on the subject to Capitol Hill.

Voters in six states -- Maine, California, Alaska, Arizona, Oregon, and Washington -- have passed measures supporting medical marijuana use, and proposals in two other states -- Colorado and Nevada -- are pending. But under federal law the drug remains illegal. And while the government has rarely stepped in to prosecute medical users, the Clinton administration maintains that any change in marijuana?s legal status should be based not on state politics, but scientific data.

In March the Institute of Medicine, an independent organization chartered by the National Academy of Sciences, issued a report examining just that topic. After a two-year review of the clinical research and literature available, the report concluded that marijuana cigarettes could help cancer and AIDS patients control nausea and pain, though there?s still only rudimentary understanding of how the drug works. Findings were only "moderately promising" for treatment of spasticity diseases like multiple sclerosis, and less conclusive for glaucoma and seizure disorders like epilepsy. But the authors warned that smoking marijuana poses its own health hazards -- including possible lung damage and weakening of the immune system from impurities in plant material -- and should be recommended only as a last resort.

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"Marijuana's future as a medicine does not involve smoking," says Stanley Watson, a neuroscientist and substance-abuse expert from the University of Michigan who cowrote the report. "It involves exploiting the potential in cannabinoids" (chemical compounds that are the active ingredients in marijuana).

The best-known substance, THC, is already legally available as an oral prescription drug sold under the trade name Marinol -- a fact that those staunchly against medical marijuana use are quick to emphasize. "We already have good medicines out there for every ailment that marijuana is reported to help relieve the symptoms for, including cancer and AIDS," says Robert Maginnis, a senior director at the Family Research Council in Washington, DC. Maginnis and other opponents say legalizing marijuana for medical use sends the public the message that the drug is safe -- a sure prescription for increased illegal use by teenagers.

Still, the Institute of Medicine report acknowledged problems with some legal drugs. Both oral THC and megestrol acetate, a synthetic derivative of progesterone sold as Megace, can stimulate appetite in AIDS patients, but they can also cause dizziness, lethargy, and other more serious side effects. In addition, some patients say inhaling marijuana smoke gives them more control over the effects than a pill containing THC. Yet, even if researchers eventually do develop safer forms of the drug such as inhalers, the authors observed, terminally ill patients currently in severe pain "will find little comfort in a promise of a better drug ten years from now."

On that last point many Americans would seem to agree: In a nationwide Gallup poll conducted after the report was issued, 73% of respondents favored making it legal for doctors to prescribe marijuana to suffering patients. The issue has also been cropping up repeatedly on the campaign trail. In an October debate in Hanover, NH, Republican presidential contender John McCain was asked how he reconciles society's tolerance for alcohol with the obstacles to medicinal marijuana. "That is an excellent question," said McCain. "Which I'd prefer to duck." GOP front-runner George W. Bush has said that while he personally does not support medical marijuana use, states should have the right to allow it.

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Gore, responding to questions from a December town hall audience in Derry, NH, recalled his late sister's struggle with cancer in the mid-1980s and said some people "ought to have the option" of marijuana use: "We have not given doctors enough flexibility to help patients who are going through acute pain." In another New Hampshire forum his chief Democratic rival, Bill Bradley, said he opposes medical marijuana use for now, but believes it is "something we have to study more."

So far the federal government has approved a handful of studies. In one, researchers at the University of California-San Francisco are looking at the effects of the drug for patients with HIV. But even if scientists eventually establish such safety, ultimately factors besides science are bound to come into play. As the Institute of Medicine report concluded, this debate "presents a policy issue that must weigh -- at least temporarily -- the needs of individual patients against broader social issues."

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