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US: Opinion: Smoke Screen
Robert K. Kubena, Ph.D. Pittsburgh Post-Gazette (PA)
Tuesday 28 Aug 2001 Hypocrisy About Addiction And Pain Control Keeps Medical Marijuana From Needy Patients This is a story about cancer. What is unusual are the parties involved. The cancer patient was a nurse, her daughter a toxicologist and her son-in-law a pharmacologist. Unfortunately, this combined body of medical experience could do nothing to alter the course of this fatal disease, which is the second-leading cause of death in this country. What it did do, however, was allow the three of us to understand better than most what the treatment, the side effects and inevitable conclusion would be. This story began when my mother-in-law, a robust 76-year-old who was still working as a head nurse in a nursing home near Washington D.C., was diagnosed with lung cancer. She was treated at Georgetown University Hospital by one of the country's pre-eminent oncologists. During surgery, doctors determined the cancer had spread, and she was given radiation and chemotherapy. The therapy took its usual toll. She lost her hair, her appetite and wasted away to 87 pounds. Because I had extensively researched THC (one of the active ingredients in marijuana), and related topics for my masters', doctoral and post-doctoral theses, I was acutely aware of the anecdotal reports that marijuana could stimulate appetite and reduce nausea. My six years of research convinced me that marijuana was the safest therapeutic agent known to man. Convinced of marijuana's safety, my wife and I suggested that my mother-in-law smoke some. She had no moral objection because she had smoked marijuana at Harlem jazz clubs in the 1920s while in nursing school. She was, however, reluctant, fearing it might interact unfavorably with the other drugs she was taking. Fortunately, her doctor was one of the 50 percent of oncologists who recommend marijuana to their patients. (Seventy percent say that they would recommend it if it was legal). When she smoked the marijuana, her spirits lifted immediately and she developed a ravenous appetite. There is no question that the drug enhanced her last weeks at home. Our only regret is that she did not use it sooner. The only drugs I have seen act as quickly and effectively are narcotic painkillers such as morphine and Demerol. But, at what cost? With prolonged use, a person might need higher and higher doses to get the same relief. Yet, too high a dose can cause a dangerous slowing of breathing or even coma. So the usefulness of these drugs is limited. This dilemma is usually put to the family in the form of a euphemism: "Do you want the patient to be pain-free?" In an attempt to accomplish this, the dose of morphine or Demerol is continually escalated. This practice is known in hospital circles as "snowing." The patient takes a higher and higher dose until she can no longer metabolize the drug. A less polite, but no less ethical term, is euthanasia. In my mother-in-law's case, the high doses of morphine were a far better end than drowning in her own fluids because of the lung cancer. While some right-to-life advocates might have a problem with this practice (until it is a member of their family), I see it as a compassionate course of action although it is technically illegal. If such compassionate acts occur in hospitals every day, why has the Supreme Court (which has successfully avoided the subject of this type of euthanasia) decided to prevent the medical use of marijuana by needy patients? The court's recent ruling was based on the Controlled Substance Act of 1970. The act classified marijuana as a Schedule I drug, which presumed that it had "no currently accepted medical use" and "a high potential of abuse." This is in spite of findings by the Institute of Medicine of "potential medical benefits in the active ingredients of marijuana." Nonetheless, the National Institute of Drug Abuse stopped all research on marijuana in 1980. It is impossible to determine marijuana's benefits if scientists cannot study it. Addiction researchers have long placed its addiction potential far below that of alcohol and nicotine, which are responsible for 500,000 deaths each year. In fact, the addiction potential of marijuana is most similar to that of caffeine. Implicit in the Supreme Court's decision was the assumption that federal laws concerning marijuana preclude its prescription by doctors. There are federal laws against the possession and/or manufacture of cocaine, methamphetamine and opium -- although all are available by prescription. It also fails to address the fact that after alcohol and cigarettes, cocaine and methamphetamine are two of the most dangerous and debilitating drugs abused in our society. Only those profiting from the war on drugs would categorize marijuana with them. Such a categorization is responsible for 600,000 arrests per year for marijuana violations. If the judiciary, law enforcement and most legislators are opposed to the medical use of marijuana, and scientists are prohibited from studying it, who is in favor of it? Only the people. Voter initiatives in seven states and legislators in two states have passed laws allowing doctors to prescribe it. Nationwide, 75 percent of those polled favor the medical use of marijuana. Some believe that medical use of marijuana is a moot point for debate now that THC is on the market in a synthetic marijuana called Marinol. They are mistaken. It was my dream to see this compound reach the marketplace. Now, however, I am ambivalent concerning this development. THC was first evaluated for appetite-stimulating and anti-nausea effects because of anecdotal reports of such effects among pot smokers. Equating THC with marijuana, as well as changing how it is consumed, is less than good science. This may account for the arguably meager clinical activity of Marinol. In controlled studies, patients given Marinol had an appetite improvement that was only 50 percent better than those given a placebo. With weight gain and nausea reduction, there were no significant differences between Marinol and a placebo. Better studies would have compared smoked marijuana with oral and/or smoked Marinol. A pharmaceutical company is unlikely to conduct such a study because there is no profit in marijuana because it is a natural product and can't be patented. Finally, one can only hope that, when cancer strikes the homes of those opposed to medical marijuana, they avail themselves of the 50 percent of oncologists who do not recommend it. Otherwise, they will become the worst kind of hypocrite -- those who would impose suffering on others while seeking solace for themselves. Of course, watching a loved one vomit to the point of causing a hernia might cause them to re-evaluate their unfounded opposition to medical use of marijuana.
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