In late February, CBC Radio's Mary
O'Connell took Sunday Morning listeners on
a trip-to the Cannabis Cultivators Club in
San Fransisco. Crowding the brownie bar
were cancer and AIDS patients,
manic-depressives, people in their 30s
mingling with others in their 80s-all
munching cookies, truffle and spice cake
laced with marijuana.
The patrons weren't there to get stoned.
They were eating or smoking marijuana on
their doctors' recommendations: 'Among
other users of medical marijuana, AIDS
patients report that it stops the wasting
syndrome by boosting appetite,' O'Connell
noted. 'Manic-depressives say it balances
severe mood swings, possibly preventing
suicide. Those who suffer from arthritis
or nerve damage say marijuana is more
effective and safer than morphine.'
Since Proposition 215, a California
referendum last November on the use of
medical marijuana, it's legal in that
state. Arizona followed suit, but neither
state's decision has changed the fact that
medical marijuana is still a hot political
issue. U.S. President Bill Clinton has
declared war on drugs, with marijuana a
prime target: According to his 'drug
czar,' Gen. Barry R. McCaffrey, 'The
National Institutes of Health recently
examined all of the existing clinical
evidence about smoked marijuana. Its
conclusion: 'There is no scientifically
sound evidence that smoked marijuana is
medically superior to currently available
therapies'.'
In his arguments against Proposition 215,
McCaffrey called the idea of permitting
uncontrolled access to marijuana for any
alleged illness inconceivable: 'Can you
think of any other untested, home-made,
mind-altering medicine that you self-dose,
and that uses a burning carcinogen as a
delivery vehicle?'
Sitting at his kitchen table in downtown
Toronto, Bill Budd (not his real name)
tamps down a pinch of weed in a tiny pipe,
lays a match to the bowl and inhales
deeply. The pungent smell of marijuana
smoke fills the room.
Budd, pushing 50, is also pushing his
luck: If a cop bursts into his house, he's
busted. Budd says it's worth the risk. A
child of the smokey '60s, he already knew
about marijuana, or pot, but one day he
decided to try it again-this time to ease
severe chronic back pain from progressive
arthritis. To his surprise and delight, he
found that it lessened his pain and helped
his 'proper' medication kick in a little
more quickly. After that, it was a regular
part of his medicine chest, easing a
little of his morning stiffness and
boosting his morning medication routine;
at bedtime, he says, it allowed him to
forgo 'at least one dose of codeine' so he
could sleep.
Constant painkillers, and codeine
especially, Budd says, are very
depressing; they leave him in 'a kind of a
fog.' The pot allows him to cut back on
the codeine and at the same time 'distract
myself from the pain much more easily-with
a book or a piece of music or anything.
And when the pain is flared up, there's no
great euphoria from smoking, but there's
certainly some relief.'
The pot doesn't interfere with Budd's
regimen of anti-inflammatories, which he
takes to keep his condition under control,
only the 'as-needed' painkillers with
codeine. It's one of a number of
pain-relief strategies he employs. 'Not
one of them by itself is sufficient,' he
says, 'and in fact even the whole
collective is never sufficient to remove
the pain. The pain is always there as a
constant presence.
'Pain is one of those things that's very
poorly understood, and not necessarily
terribly well understood by physicians. I
mean, physicians have some measures, but
they pretty well have to take on faith
that what you're describing is true, and
until you've actually lived with
unremitting pain, you really can't pass
judgement.'
Dr. Lester Grinspoon is a psychiatrist and
professor at Harvard Medical School in
Cambridge, Mass., and coauthor of
'Marijuana: The Forbidden Medicine.' In
the revised and expanded edition, due out
in July, he and his coauthors have what he
calls 'a fairly extensive discussion of
arthritis, because I believe that
marijuana may ultimately turn out to be a
very important medicine for people who
suffer from arthritis and other rheumatic
diseases.'
Why? Because 'it gives good relief to
these folks,' Grinspoon says, and, more
important, because 'ultimately, marijuana
may be safer than the Aspirin and
acetaminophen and other NSAIDs that so
many people with arthritis use.'
Indeed, thousands of North Americans
(including hundreds of Canadians) die each
year from the side effects of NSAIDs, a
number that's likely to rise as the
prevalence of arthritis increases (see the
story on Page 2). 'I don't know whether
anyone with osteoarthritis, for example,
will get good relief from [smoking
marijuana] or not,' Grinspoon says, 'but I
do know this: It isn't going to hurt
them.'
In fact, he says-disputing General
McCaffrey's contentions-'when marijuana
becomes an accepted part of the
pharmacopeia again-a place it lost in 1941
in this country after the passage of the
Marijuana Tax Act-it will be seen as one
of the least toxic drugs in that whole
compendium. If I had OA, boy, you can be
sure I'd prefer to use marijuana over the
drugs I mentioned before, which are so
commonly used.'
Dr. Jack Lewin, a family practitioner and
CEO of the California Medical Association,
squared off with Grinspoon in the March
'97 issue of Health magazine over the
issue of whether Americans should be
allowed to smoke marijuana as medicine. No
way, Lewin said. He worries about the
effect of the smoke on the lungs, as well
as its addictive potential. And, while he
conceded that 'marijuana probably has some
value' in certain conditions, overall, he
argued, 'there isn't enough known at this
point for doctors to safely recommend
marijuana to patients for anything other
than a life-threatening disease.'
Lewin has lots of support: The American
Medical Association, Cancer Society and
Ophthalmological Society all opposed the
California marijuana initiative. On the
other hand, Lewin accepts that the entire
issue has become so politicized that
'we've almost been afraid to find out if
[marijuana] has therapeutic benefits.
That's wrong. Most doctors favor limiting
use of medical marijuana to controlled
studies for patients with life-threatening
conditions. That's the scientific way to
move ahead.' A lot of people-on both sides
of the debate-agree proper clinical trials
to study marijuana's safety and efficacy
are overdue, but it won't be easy. As Dr.
Jerome P. Kassirer wrote in an editorial
in the Jan. 30 issue of the prestigious
New England Journal of Medicine (NEJM),
'The noxious sensations that patients
experience [from chemotherapy] are
extremely difficult to quantify in
controlled experiments. What really counts
for a therapy with this kind of safety
margin is whether a seriously ill patient
feels relief as a result of the
intervention, not whether a controlled
trial 'proves' its efficacy.'
The point is, Kassirer wrote, a government
policy 'that prohibits physicians from
alleviating suffering by prescribing
marijuana for seriously ill patients is
misguided, heavy-handed, and inhumane.'
And it's no good citing bogeymen like
addiction or long-term side effects; those
are irrelevant for such people, Kassirer
wrote. It's also hypocritical to forbid
doctors from prescribing marijuana while
allowing them to prescribe potent
painkillers like morphine, in which 'the
difference between the dose that relieves
symptoms and the dose that hastens death
is very narrow; by contrast, there is no
risk of death from smoking marijuana.'
The other roadblock to clinical trials is
money: It takes hundreds of millions of
dollars to mount a proper clinical trial,
which pharmaceutical companies are willing
to spend, Grinspoon says, when they can
get a patent, 'and more than recoup their
investment. However, no drug company can
get a patent on marijuana-it's a plant.
Therefore nobody is coming up with the
money to do these studies, even if the
government would let them.'
It's an opportunity missed: If marijuana
were legalized as medicine, it could
potentially replace any number of
conventional drugs, with their side
effects and high price tags. Grinspoon
points to an anti-nausea drug widely used
in cancer chemotherapy. Not only do many
people report that marijuana 'is more
useful' than the anti-nausea drug, it's
much, much cheaper: The pharmaceutical
product costs from $30 to $160 for a
single course of treatment, a price that
soars to more than $600 (U.S.) if the
patient has to have the drug
intravenously.
On the other hand, Grinspoon says, 'if
marijuana were available as a medicine, it
would cost about $20 to $30 an ounce.
That's about 30 cents a marijuana
cigarette, and most patients can get
complete relief from the nausea and
vomiting by smoking just a part of one of
those 30-cent marijuana cigarettes.' Not
only that, 'many people report that the
relief they get from that marijuana
cigarette is better than they can get from
[the pharmaceutical product], without the
nasty side effects.'
That's just one drug, to say nothing of
the health-care dollars that could be
saved because people don't have to be
treated for bleeding ulcers and more
serious problems leading to death from
NSAIDs. 'I mean,' Grinspoon says,
'sometime in the 21st century we're going
to look back on this business and say,
'How in the world could we have behaved
the way we did with respect to
cannabis?'-in a whole bunch of areas, not
the least of which is cannabis as a
medicine.'
