Legal marijuana may stop with Rosenfeld’s group of eight. In November voters in California and Arizona gave doctors the right to prescribe marijuana for some patients, but last week the federal government just said no. At a joint press conference, drug czar Barry McCaffrey, Health and Human Services Secretary Donna Shalala and Attorney General Janet Reno said that doctors who prescribed marijuana risked losing their licenses to prescribe drugs and might face prosecution. Few doctors think marijuana is the panacea that some advocacy groups argue it is, but many want to be able to give their patients the legal right to buy and possess it.
The case for medical marijuana has its merits, and a history. In their book, “Marihuana: The Forbidden Medicine,” Harvard psychiatrist Lester Grinspoon and his writing partner, James Bakalar, describe a dozen of marijuana’s possible benefits, which include easing nausea and vomiting from cancer chemotherapy, improving the appetite of people with AIDS and lowering pressure inside the eye due to glaucoma. Indeed, studies in the 1970s and 1980s began to confirm many of these effects in human beings. States were developing Compassionate Investigational New Drug programs (a federal one gave Rosenfeld his pot), but they largely fell victim to the War on Drugs in the early 1990s. Rigorous research is still lacking, but illicit clinical use continues. Many glaucoma and AIDS sufferers still rely on marijuana, and in a 1991 study of oncologists, 48 percent said they would prescribe it if they could and 44 percent said they had recommended it to patients. “Marijuana is not meant to replace all the medications that have been devised since the dawn of time,” says Richard Cohen, an oncologist in San Francisco. “It is for select groups of individuals.”
Those against legalization say marijuana shouldn’t be for anyone. The administration fears that any sanctioned use would lead to further liberalization of drug laws, which could in turn lead to increased drug use. Others argue that newer drugs and therapies have filled the niches marijuana once might have (chart). They point out that smoking marijuana is harmful to the lungs and may cause hormonal and reproductive problems. “These propositions are not about compassion,” McCaffrey said at the press conference. “They are about legalizing dangerous drugs.” Both the government and the American Medical Association say that there is no scientific evidence that marijuana is useful.
That evidence is not forthcoming. The plant is so cheap–it is, after all, a weed–that drug companies don’t have a financial incentive to fund its study. Marijuana has more than 460 different chemicals in it, making it hard to parse out active ingredients. A synthetic version of one main ingredient, tetrahydrocannabinol, is sold as the appetite stimulant and anti-nausea drug Marinol, but its value is not entirely proven.
So is there a medical role for marijuana? It’s cheap, probably nontoxic and–with chemotherapy patients, at least–anecdotally effective. But marijuana is still classified as a Schedule I drug with a high potential for abuse, like heroin and LSD. By stopping legalization, the government has eliminated any impetus for further study. “I don’t care what makes me survive,” says Irvin Rosenfeld. “I just want the best care.” To the very sick, neither politics nor science really matters.
Advocates support several medicinal uses for marijuana, all with some evidence to back them up. Below, some of the disorders and their conventional, legal treatments:
AIDS-Related Wasting Syndrome: Experimental therapies involving anabolic steroids may allow people with AIDS to regain muscle mass more effictively than appetite stimulants like Megase or marijuana.
Cancer Chemotherapy: Drugs like Zofran can reduce nausea and are administered intravenously, for patients who can’t eat. Smoked marijuana is also effective.
Glaucoma: Many drugs reduce pressure inside the eye, but with side effects like pain or dimming of vision. A new drug, Xalatan, is easier to use and won’t lower blood pressure like marijuana.
Pain and Muscle Spasm: Many different drugs and therapies work, but marijuana may also alleviate symptoms.
