Source:  Playboy, August 1998 v45 n8 p41(1).
                                                                              
    Title:  PRESCRIBING THE FORBIDDEN MEDICINE a doctor challenges the
            feds.(marijuana)
   Author:  Lester Grinspoon
                                                                              

Full Text COPYRIGHT 1998 Playboy Enterprises Inc.

In my book Marihuana Reconsidered I recounted the history of medical cannabis.
But it was not until 1972, a year after the hook's publication, that what had
been an issue of public policy became a personal one. Early that spring I fell
into conversation at a dinner party with Dr. Emil Frei, who had recently
arrived from Texas to serve as head of cancer research at Boston's Children's
Hospital. Dr. Frei told me about an 18-year-old Hous-ton man who had become
increasing-ly reluctant to undergo chemother-apy for his leukemia because the
nausea and vomiting were unbear-able H is doctors and family were having
trouble persuad-ing him to take the drug he needed to survive. One day the
patient's attitude changed, and he no longer feared ehe-motherapy. It turned
out he was preventing nausea by tak-ing a few puffs of marijuana 20 minutes
before each ses-sion. On the way home my wife, Betsy. suggested some-thing
that had occurred to both of us: Marijuana might be what our son Danny needed.

Danny was diagnosed with acute lymphocytic leukemia in July 1967, when he was
en. For the first few years he willingly accepted his treat-ment at Children's
Hospital and even the occasional need for hospitalization. In 1971 he started
taking the first of the chemotherapy drugs that cause severe nausea and
vom-iting. In his case the standard treatments were ineffective. He started to
vomit shortly af-ter his chemotherapy sessions and continued retching for as
long as eight hours. He would vomit in the car as w e drove home and then lie
in bed with his face over a bucket on the floor. Still, I dismissed the idea
of using marijuana to ease his discom-fort. It was against the law and might
embarrass the hospital staff that had been so devoted to Danny's care. At that
point. I had been exposed to the medical benefits of marijuana on-ly through
text and testimony. Had I known how dramatically it would affect my son I
would never have objected.

The next chemotherapy session was two weeks after the conversation at the
dinner party. When I arrived at the hospital, Betsy and Danny were already
there, and I shall never for get my surprise. They were relaxed instead of
anxious, and they seemed almost to be playing a joke on me. On their way to
the clinic they had stopped near Wellesley High School and spoken with one of
Dan friends. After recovering from his shock at their request, the friend ran
off and reappeared a few minutes lat-er with a small amount of marijuana.
Danny and Betsy smoked it in the hospital parking lot before entering the
clinic. I was relieved and then de-lighted as I observed how comfort-able
Danny was. He didn't protest as he was given the treatment, and he felt no
nausea afterward. On the way hack we stopped to buy him a subma-rine sandwich.

The next day I called Dr. Not man Jaffe, the physician in charge of Dan-ny's
care, to explain what had hap pened. I said hat although I didn't want to
embarrass him or Iris staff had witnessed the effect of the drug and could not
stand in the was of fur-ther marijuana use. Dr. Jaffe suggest-ed Danny smoke
in his presence in the treatment room, next time Again Danny became completely
relaxed arid again he asked for a submar-sandwich afterward. During the
re-maining year of his life he used ma juana before each treatment, and I
cannot overstate how much it his dying and gave comfort to the whole family.
As Danny put it, "Pot turns bad things into good." Sometimes I won-dered
whether he ever asked himself why his father an au-thority on medicinal
marijua-na, had not suggested this possibility earlier.

How did marijuana become the forbidden medicine? In the 19th century,
physicians knew more about marijuana than contemporary doctors do. Between
1840 and 1900, medical journals published more than 100 papers on therapeutic
use of Indian hemp. It was recommended as an appetite stimulant, mus-cle
relaxant, analgesic seda-tive and anticonvulsant, and as a treatment for
opium, and diction and migraines. As it was chiefly administered oral-ly in an
alcohol solution, the potencey varied and the re-sponse was often unreliable.
Shortly after the turn of the century, synthetic alternatives became available
for insomnia and moderate pain. In the U.S., what remained of marijuana's
legitimate medical use was effectively eliminated by the Marijuana Tax Act of
1937 which was ostensibly designed to pre-vent nonmedical use. The law made
cannabis so difficult to obtain that it was removed from standard
pharma-ceutical references. In 1970, as I was completing Marihuana
Reconsidered, a new federal law classified marijuana as a Schedule I drug.
which means the government believes it has a high potential for abuse, has no
accepted medical use and is unsafe even under medical supervision.

That didn't stop sick people from experimenting. Letters about mari-juana's
medical uses began to appear in PLAYBOY and other publications in the early
Seventies. People who had learned that marijuana could relieve asthma, nausea,
muscle spasms and pain shared their knowledge. Thirty-five states passed
legislation that would have permitted the medical use of cannabis but for the
federal law. The most effective spur to the movement came from the AIDS
epidemic. People with AIDS learned that the drug could restore their appetites
and prevent what is known as the AIDS wast-ing syndrome.

In 1972 the National Organi-zation for the Reform of Marijua-na Laws entered a
petition to move marijuana out of Schedule I so that it could become a
pre-scription drug. It wasn't until 1986 that the Drug Enforcement
Administration agreed to the public hearings required by law. After two years
of testimony, the DEA's administrative law judge, Francis L. Young, declared
that marijuana fulfilled the require-ment for transfer to Schedule II. He
described it as "one of the safest therapeutically active sub-stances known to
man." His deci-sion was overruled by the DEA.

The Schedule I classification persists--politically entrenched but medically
absurd, legally questionable and morally wrong. After Danny's death, I began
to think about how many other people like him might enjoy sim-ilar physical
and emotional relief from marijuana. Maybe this medicine had advantages over
conventional drugs in more than one way. In the years since, I have been able
to pursue this question.

One patient, whom I will call John, was a 65-year-old retired college
pro-fessor from New York City. He said he had been depressed for 20 years and
had been in psychotherapy all that time. He had been treated with
electro-convulsive therapy and given prescrip-tions for one antidepressant
drug after another, always without success. John consulted me because of my
writings on marijuana. He had been hospital-ized several times, and on one of
those occasions a marijuana cigarette given to him by a fellow patient
produced "the first authentic depression-free mo-ment of my life." But
marijuana was difficult to obtain, and he was worried about going to jail. I
recommended and his doctor prescribed Marinol (a synthetic version of
delta-9-tetrahydro-cannabinol, the main active substance in cannabis). Marinol
has been avail-able in oral form for limited purposes as a Schedule II drug
since 1985. Al-though patients and physicians agree it is generally less
effective, with more uncomfortable side effects, than smoked marijuana, it is
the only legal alternative. It works fairly well for some patients--including,
fortunately, John. He is still taking Marinol, and his depression has not
recurred.

From this and other experiences in the past 30 years, I have become con-vinced
that marijuana is a strikingly versatile medicine for treating nausea and
vomiting caused by cancer chemo- therapy, weight-loss syndrome of AIDS,
glaucoma, epilepsy, muscle spasms, chronic pain, depression and other mood
disorders.

Marijuana is also remarkably safe, with fewer serious side effects than most
prescription medicines. Since it has little effect on the physiological
functions needed to sustain life, there have been no cases of death or serious
injury from an overdose. If you know anything about medicines, you will know
how extraordinary that is. A re- cent study estimated that adverse reac- tions
to prescription drugs kill more than 100,000 patients a year.

Some people find cannabis useful for relieving the pains of osteoarthritis.
The standard treatments are aspirin and other nonsteroidal anti-inflamma-tory
drugs, which cause more than 7600 deaths and 70,000 hospitaliza-tions each
year from gastrointestinal complications (mainly stomach bleed-ing). Another
standard treatment is acet-aminophen, which is one of the most common causes
of terminal kidney fail-ure. If some people with arthritis find marijuana to
be as effective as these drugs, they should be allowed to use it.

A familiar objection to marijuana as medicine is that the evidence is
anec-dotal-that supporters count apparent successes and ignore failures. It is
true that no efficacy studies have been done, chiefly because legal,
bureau-cratic and financial obstacles have been put in the way of such
testing. Yet so much research has been done on marijuana in un-successful
efforts to demonstrate its health hazards and addictive potential that we know
more about it than we do about most prescription drugs.

Besides, anecdotal evidence is the source of much of our knowl-edge of drugs.
Controlled exper-iments were not needed to rec-ognize the therapeutic
potential of barbiturates, aspirin, insu-lin, penicillin or lithium.
Anec-dotal evidence would be a seri-ous problem only if cannabis were a
dangerous drug. Even if just a few patients can get relief from cannabis, it
should be made available. The risks are so small. For example, many people
with multiple sclerosis find cannabis reduces muscle spasms and pain. The
standard treatments include baclofen, dantrolene and high doses of
diazepam--all potential-ly dangerous or addictive drugs. If cannabis were not
prohibited, it would cost less than most conventional medications. The price
would be $20 to $30 an ounce, or about 30 cents per cigarette. One cigarette
usually relieves the nausea and vomiting produced by chemotherapy. A standard
dose of on-dansetron (Zofran), the best legally available treatment, costs the
patient $30 to $40.

The many thousands of Americans who use marijuana as a medicine are, legally,
criminals. Sick people have to weigh the benefits against the risks of
financial ruin, loss of a career or forfei-ture of an automobile or home. A
few have been given absurdly long prison sentences.

One case I am familiar with involves Harvey Ginsburg, a professor of
psy-chology at Southwest Texas State Uni-versity. He suffers from glaucoma,
and since 1986 had been taking marijuana to treat the illness. He also has
taken prescription medicines, which his oph-thalmologist says are insufficient
to prevent progression of the disease. Af-ter he began using marijuana, his
eye-sight stopped deteriorating and his in-traocular pressure improved. On
June 24, 1994 he and his wife, Diana, were arrested for felony possession--six
plants (weighing two ounces each)and eight ounces of marijuana brownies. An
acquaintance of his son, responding to a flier that offered "a profitable,
ex-citing, guilt-free way to earn money," had placed a call to police for a
$1000 reward.

While Ginsburg prepared to present a defense of medical ne-cessity, a lien was
filed against his property and his assets were frozen to enforce payment of
the Texas Controlled Substanc-es tax. In July 1995 the district attorney
decided to dismiss all charges for the sake of judicial expedience. A week
later the lo-cal police chief wrote an angry letter to the town newspaper
ex-pressing his displeasure. The head of the narcotics division then contacted
the superinten-dent of the school system where Diana worked as a
special-edu-cation counselor. The superin-tendent threatened to fire her and
have her teaching license revoked on the grounds that she had violated the
district's zero-tolerance policy by living with an accused marijuana user.
Even-tually Diana decided to resign, though she later received a settlement.

Another case I have learned of involves Russ Hokanson, a 54-year-old
paraplegic who lives on a farm in New Hampshire. He has been using cannabis as
an analgesic for 30 years, because he found that marijuana re-lieved his
chronic pain, stimulated his appetite and reduced depression and anxiety. He
found it even helped him restore bladder control and achieve a normal
erection. He decided to start growing his own medicine. As a result, he was
arrested and the state of New Hampshire attempted to seize his house and land.

Pharmaceutical companies will not pursue the research needed to test
marijuana's therapeutic potential be-cause they cannot patent an ancient plant
medicine. The federal govern-ment, the other major source of fund-ing for
medical research, also has blocked the way. In 1994 an investi-gator at the
University of California at San Francisco sought approval for a privately
funded study comparing smoked marijuana with oral synthetic THC in the
treatment of AIDS wasting syndrome. Although this project was approved by the
FDA and several insti-tutional review boards and advisory committees, the
National Institute on Drug Abuse and the Drug Enforce-ment Administration
prevented the in-vestigator from receiving the marijua-na he needed. Maybe the
passage of the California initiative legalizing me-dicinal marijuana will
persuade federal authorities to relent. The Institute of Medicine, a branch of
the National Academy of Sciences, is now conduct-ing a review of marijuana's
medical us-es. But a research program designed to study dinical applications
of this drug will take years, and other ways must be found in the meantime to
accommo-date the needs of a rapidly increasing number of patients.

When medical use of marijuana in the U.S. was effectively outlawed in 1937,
the American Medical Associa-tion, to its credit, opposed the ban. Since then,
physicians have been both victims and agents in the spread of mis-information.
Ignorance, lack of inter-est and government obfuscation con-tinue to limit our
chances to recognize marijuana's medical potential.

In 1990, only 43 percent of those who responded to an American Society of
Clinical Oncology survey said that available legal anti-emetic drugs
(in-cluding oral synthetic THC) provided adequate relief for all or most of
their cancer patients. Forty-four percent had recommended the use of marijuana
to at least one patient, and half would legal. On average, they considered
smoked marijuana more effective than oral synthetic THC and about as safe.

When doctors confront the needs of their patients, they recognize the
fool-ishness of these laws. But most, so far, are either afraid to do more or
unable to provide further help because they know too little. To prescribe a
medicine responsibly, a physi-cian must balance risks and ben-efits. In most
cases a doctor re-lies on the knowledge that the FDA has already analyzed a
drug. A physician who recom-mends marijuana does not have that assurance.

I'm confident, because I know the balance of risk and benefit is powerfully
weighted by mari-juana's time-tested safety. If I didn't recommend it when it
is clearly in a patient's best inter-ests, I would be compromising my
physician's oath. After 30 years of study, I know more about this
substance--and about what is best for my patients--than any government
official or public relations person for the Partnership for a Drug-Free
America does.

I will continue to recommend marijuana when it appears to be the most
effective and least toxic choice. But under the present laws, neither I nor my
patients will be able to avoid anxiety. I could lose my license to practice
medi-cine and my patients could be arrested and have their property
confiscated. This makes me uncomfortable-but not nearly so uncomfortable as I
feel when I consider that if I avoid recom-mending marijuana, I may repeat the
mistake I made by not encouraging my son to use it earlier in the course of
his illness.
                                                                              
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