Lighting Up a Controversy

Debate Over Medical Marijuana Heats Up

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Science Feature -- September 2004  

By  Ken Ortolon
Senior Editor  

For 25 years, Austinite Jay Gotschall suffered from grand mal seizures and a rare form of muscular dystrophy that wasted his nerves, deformed his arms and legs, and caused painful muscle spasms.

Medication helped control his grand mal seizures, but not the painful partial seizures that constricted muscles in his fingers, arm, and shoulder.

Mr. Gotschall , 45, says he constantly feared having a seizure for 25 years. Then he tried smoking marijuana. He says it ended the partial seizures and gave him back control of his life.

"I've found it nothing short of miraculous."

Mr. Gotschall's doctor, Austin family physician Elliot Trester, MD, agrees that marijuana has helped his patient.

"I have one patient who has done very well with marijuana used for medicinal purposes," Dr. Trester wrote in a May 7 letter supporting the right of physicians to counsel patients about marijuana. "He has found relief for symptoms that we have not been able to obtain with any other treatments."

Mr. Gotschall is one of thousands of Americans who suffer from diseases such as AIDS, cancer, and multiple sclerosis who smoke marijuana to relieve pain and nausea or to boost appetite. But they risk arrest.

Even in the nine states where medical marijuana is legal, federal officials have prosecuted patients and harassed physicians who recommend the drug.

That, however, could be changing. In October 2003, the U.S. Supreme Court refused to hear the government's appeal of a case in which a California appeals court declared that federal regulators cannot investigate, threaten, or punish physicians for recommending marijuana as a medical treatment.

And, it is expected to rule this winter on a second California case in which the same appellate court said medical marijuana users cannot be prosecuted under federal law if they do not sell marijuana, transport it across state lines, or use it for nonmedicinal purposes.

Meanwhile, several states are debating medical marijuana laws, and a new Austin-based group called Texans for Medical Marijuana (TMM) hopes to take the issue to the Texas Legislature in 2005.

Protecting Patient Communications  

The Texas Medical Association House of Delegates weighed in on the issue in May. It adopted a policy recommended by the Council on Scientific Affairs that physicians be allowed to discuss any and all treatment options, including medical marijuana, with their patients without fear of regulatory, disciplinary, or criminal sanctions.

The council report says anecdotal evidence and limited clinical research suggest that smoking marijuana may help treat nausea, intractable pain, and loss of appetite in AIDS patients or cancer patients undergoing chemotherapy or radiation therapy. It also calls for further well-controlled studies on medicinal uses of marijuana.

"Some physicians see medicinal marijuana as a 'last ditch' effort to manage a patient's symptoms so they can endure further treatment," the report said. "Physicians have at their disposal a modest array of weapons to manage symptoms resulting from chemotherapy or cancer itself, but some patients' symptoms are unaffected by other methods. Others are unable to ingest pharmaceutical versions (i.e., Marinol ) of the active component of marijuana, delta-9 tetrahydrocannabinol , otherwise known as THC."

Council Chair Leonides G. Cigarroa Jr., MD, of Laredo, says the primary concern is protecting a physician's ability to counsel patients. "We should be able to talk about anything that we know to be of benefit to the patient." Houston neonatalogist and former council Chair Michael E. Speer, MD, did some of the council's preliminary research on the marijuana issue. He says police shouldn't butt into the physician-patient relationship.

"Issues between physicians and patients ought to be issues between physicians and patients," he said.

The U.S. Drug Enforcement Agency (DEA), however, feels differently. After California enacted its medical marijuana law, Clinton administration officials warned physicians that the DEA would seek to revoke the prescribing authority of anyone recommending marijuana. The Bush administration continued that policy.

But in its ruling, the 9th U.S. Circuit Court of Appeals said the federal policy violated physicians' free speech rights. As a result, doctors in California and six other Western states with medical marijuana laws now may freely discuss marijuana use with their patients. 

Where's the Science?  

But the debate continues on how well smoking marijuana eases patients' pain or nausea. Dr. Speer says there is enough anecdotal evidence to "pique a researcher's interest" but little hard clinical data.

Dr. Cigarroa says the evidence thus far indicates that inhaled marijuana is beneficial, but those benefits may be outweighed by damage to a smoker's lungs.

"First, we have to prove that it does help, and then there has to be some way to get it into your system without inhaling," he said.

But federal officials have thrown up barriers to marijuana research here, says TMM Executive Director Noelle Davis.

"The Food and Drug Administration and the DEA make it very hard for anyone to study marijuana other than the federal government," she said. "Many people have been trying to get access to marijuana through the federal government for years and they keep being blocked or no one answers their request for two or three years."

In fact, researchers at the Medicinal Plant Program at the University of Massachusetts, Amherst, filed a lawsuit in July charging DEA and several other agencies with obstructing medical marijuana research.

They applied for DEA approval to establish a facility to produce marijuana for FDA-approved research in June 2001. DEA has not acted on that application.

DEA, however, says it is allowing research on marijuana. Information on the agency's Web site contends it facilitated research on Marinol in the 1980s and has registered seven initiatives to continue examining smoked marijuana's medicinal effects.

DEA says neither the medical nor scientific community has found sufficient data "to conclude that smoked marijuana is the best approach to dealing with these important medical issues." It added that medical marijuana already exists in the form of Marinol, which has been available since 1985.

But Ms. Davis says Marinol doesn't work for all patients and has harmful side effects. Mr. Gotschall tried Marinol, but suffered trembling, inability to think clearly, and general malaise.

Ms. Davis says the legalized medical marijuana movement seems to be gaining support despite federal opposition. Legislation legalizing medical marijuana was filed in Illinois this year, and Montana voters will vote on the issue in November. Supporters in Arkansas also are pushing for a similar ballot initiative, and up to 10 U.S. cities may have referenda this year.  

Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at Ken Ortolon.  


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