cannabisnews.com: Law Leaves Doctors Uneasy





Law Leaves Doctors Uneasy
Posted by FoM on February 04, 2001 at 12:26:59 PT
By Tim Christie, The Register-Guard 
Source: Register-Guard
Hemp is ancient medicine.The plant's use in China and India, both to heal and to intoxicate, dates back thousands of years. Greek and Roman physicians recommended cannabis for various ailments. Western doctors routinely prescribed the drug for nearly a century before it was effectively banned in the United States in 1937.
Yet as it makes a medical comeback in the 21st century, marijuana poses a vexing dilemma for physicians.Many doctors are uneasy advising patients to use a drug that has no recommended dosage, widely varying potency and is most often delivered not by a neat little pill but by sucking carcinogen-laden smoke into the lungs.And many doctors remain fearful of running afoul of the Drug Enforcement Agency, which has the career-killing power to pull doctors' licenses to prescribe federally controlled drugs.Though nine states now have laws permitting medical marijuana use, federal law classifies marijuana strictly as an illicit drug with no legitimate medical use, on par with heroin and LSD. As a result, doctors found to "aid or abet" patients in using marijuana could lose their license to prescribe federally controlled drugs.After California voters passed Proposition 215 in 1996, the Clinton administration called a news conference. Gen. Barry McCaffrey, director of the White House Office of National Drug Control Policy, dismissed medical marijuana as "a Cheech and Chong show." Then Attorney General Janet Reno announced that doctors who recommended marijuana would be subject to investigation by the DEA, and as a result could lose their federal drug license and be excluded from participating in Medicare and Medicaid programs. A group of California doctors and their patients sued the Clinton administration, and in September a federal judge issued a permanent injunction that barred federal authorities from penalizing doctors who recommend marijuana. Despite the ruling, many doctors remain nervous about recommending marijuana.Law ``Often Gets In The Way''The White House Office of National Drug Control Policy continues to take a dim view of the state medical marijuana laws. Its 2001 Drug Control Strategy report said the state laws "undermine the scientific process for establishing safe and effective medicines," and "contradict federal law and are potential vehicles for the legalization of recreational marijuana use." In part due to the threat of federal intervention, some physicians simply won't recommend marijuana under any circumstances. Others won't sign the form created by the state Health Division, in which doctors confirm their patients have one of the qualifying medical conditions and that marijuana may help treat symptoms."I'm not prepared to write those notes," said Eugene physician Douglas Bovee. "The DEA does not understand medicine. They are law enforcement people, and law enforcement often gets in the way of the good practice of medicine."If Bovee does talk to a patient about marijuana and its potential medical benefits, he follows the legal advice of the Oregon Medical Association: Rather than signing the form, he makes a chart note - that is, documenting the conversation in the patient's chart, as doctors routinely do after every patient visit.The patient can then use a copy of the chart note to obtain a medical marijuana card from the state Health Division. That gives doctors what might be called "plausible deniability" if they ever come under scrutiny."What the patient does with the medical record is the patient's business," said Paul Frisch, the state medical association's legal counsel. "The doctor can legitimately say, `We had a conversation, I documented it. That's as much as I know.' "In 1999, after Oregon voters passed a medical marijuana law, the state medical association wrote a letter to the DEA, asking for guidance about what kind of legal exposure Oregon doctors faced if they recommended marijuana.The OMA is still waiting for an answer.Treating a Broad Range:An Irish doctor named William O'Shaughnessy is credited with introducing marijuana to the West in 1839. A professor at the Medical College of Calcutta, he had observed Indians using cannabis for various disorders, and began administering the drug to treat patients for pain, muscle spasms and the often-fatal vomiting and diarrhea associated with cholera.His findings generated tremendous interest from Western doctors, who began using cannabis (the word "marijuana" wasn't coined until the 20th century) to treat a broad range of ailments, including cramps, headache, asthma, impotence, diabetes and pain.By the 1930s, marijuana tinctures were being manufactured by major drug companies such as Parke-Davis and Ely Lilly. At the same time, physicians were turning to new synthetic drugs, such as aspirin and barbiturates, instead of herbal remedies.As recreational marijuana use became more popular among jazz musicians and artists, the Federal Bureau of Narcotics waged a campaign to discredit the drug, inspiring the 1936 B-movie "Reefer Madness." In 1937, Congress passed the Marijuana Tax Act, making prescription of cannabis so cumbersome that physicians abandoned it.It wasn't until the 1970s that marijuana-as-medicine began a revival, its benefits spread by word of mouth. Cancer patients found it relieved nausea and vomiting caused by chemotherapy. Glaucoma patients found it lowered pressure in the eye. In the 1980s, AIDS patients unable to keep food down found marijuana stimulated their appetite.Today, though thousands of patients swear by it and many doctors will recommend its use, marijuana's effectiveness as medicine hasn't been proven in clinical trials or scientifically valid tests using human subjects.A British company, GW Pharmaceuticals, is in Phase II of clinical trials involving cannabis in England and hopes to begin clinical trials in Canada and the United States this year, according to an interview its CEO, Dr. Geoffrey Guy, gave to High Times magazine.Anecdotal evidence simply doesn't bear the same credibility as clinical evidence, said Dr. John Benson, a former dean of the School of Medicine at Oregon Health Sciences University and a co-author of the most authoritative report on medical marijuana to date."If you talk to people who started using marijuana recreationally and then continued using it medically, you'll find a lot of advocacy," he said. "What you hear is from people who think it works. What you don't hear is from people who found it disagreeable."Benson was the co-principal investigator in a 1999 study conducted by the Institute of Medicine, a branch of the National Academy of Sciences that is viewed as a credible, impartial authority.The White House Office of National Drug Control Policy asked the Institute of Medicine to review the scientific evidence to assess the potential health benefits and risks of marijuana and its active ingredients.Its report found that marijuana does hold "potential therapeutic value" for pain, vomiting, nausea and loss of appetite, making it "moderately well-suited" for cancer and AIDS patients, who often suffer from those symptoms simultaneously. "At the same time," Benson said, "we've got better medicine in each case."The study said smoking was a crude method for delivering medicine, because marijuana smoke has the same kinds of tars and carcinogens as tobacco smoke. It recommended more clinical trials be conducted aimed at devising a better delivery system. "It's hard to know what dose you're delivering" in smoke, Benson said.Marijuana's active ingredients could perhaps be delivered more effectively through an inhaler, or nebulizer, like those used by asthma patients.Dr. James Morris, past president of the Lane County Pain Society, shares Benson's skepticism about the medical use of smoked marijuana. "I've not found compelling evidence that it's superior to other treatments we have available," he said.About a dozen patients have asked him to recommend marijuana, and in only one case did he determine it was appropriate."Strictly from a medical perspective, there are a lot of disadvantages to inhaling a burning substance," he said. "We restrict making this recommendation only to people who have some kind of terminal condition or severely debilitating condition that's likely to cause their demise."More Research Needed:Not all doctors are convinced that pharmaceuticals are always superior to marijuana, nor that smoking is always a bad way to deliver drugs into the body.Bovee, the Eugene physician, said he's convinced of marijuana's therapeutic value for a variety of conditions."I have seen enough patients, who were honorable, decent, careful, observing patients, who identified improvements in the way they felt," he said, either with Marinol, the pill form of marijuana, or by smoking. "I don't have any doubt in my mind that if we had good research, some benefit would be shown for a variety of conditions," he said.And he's convinced that in some cases, smoking is a superior way to deliver the drug."For nausea, the smoked route has a lot of benefit," he said, particularly for patients unable to keep pills down.Smoke gets the drug's active chemicals into the bloodstream within seconds, so patients gain almost immediate relief, he said. And if one or two puffs isn't enough to provide relief, the patient can take one or two more as needed, he said.But Bovee, like others, said there needs to be more clinical research.Dr. Richard Bayer, a co-petitioner of the medical marijuana ballot measure in Oregon, doesn't think marijuana smoking is as harmful as tobacco smoking, simply because patients don't smoke nearly the same volume as do cigarette smokers. Patients can reduce their risk of smoking marijuana by using a vaporizer, a device that heats the marijuana enough to ignite the cannabinoids - marijuana's active ingredients - but not enough to burn the leaf. It reduces the particulates and toxins inhaled without decreasing the quantity of cannabinoids."The most obvious form of harm reduction is to get the most potent cannabis you can get," he said, because the patient doesn't need to smoke as much to get the desired effects.Bayer, a Lake Oswego physician, first encountered patients medicating themselves with marijuana when he was a young doctor making rounds at the Veterans Affairs Hospital in Portland in the 1970s.During the years he practiced medicine, he shied away from recommending marijuana when patients asked because he didn't want to lose his license or risk being investigated by the Board of Medical Examiners."I'd say, whatever works," he said. "It might help, but we don't know a lot about the toxicology."After Bayer quit practicing medicine in 1996 because of a physical disability, he felt freer to get politically active.Bayer helped draft medical marijuana legislation that went nowhere in the Legislature. Then Bayer decided to talk with as many sick people as he could find who were using marijuana to treat their symptoms.He became convinced "these were people just trying to get well with ancient herbal medicine," then decided to become the co-chief petitioner for the medical marijuana ballot issue, Measure 67.And he's used medical marijuana himself while going through physical rehabilitation."I found it was great at giving some additional nausea control and pain control," he said.Bayer views marijuana as a logical weapon in the doctor's arsenal for treating pain.Doctors are trained to treat pain progressively: First they recommend something such as Tylenol (acetaminophen). If that doesn't work, they recommend an anti-inflammatory such as aspirin or Advil (ibuprofen). If that doesn't work, they might prescribe a narcotic, such as Vicodin or codeine.In Bayer's view, the next logical step in that progression is marijuana. It's a far less dangerous drug than many drugs doctors prescribe all the time, he said.Background on the history of medical marijuana in this story comes from several sources, including "Marijuana as Medicine? The Science Beyond the Controversy" (National Academy Press), and from Dr. Lester Grinspoon's Web site: http://www.rxmarihuana.com/Source: Register-Guard, The (OR) Author: Tim Christie, The Register-GuardPublished: February 4, 2001Copyright: 2001 The Register-Guard Address: PO Box 10188, Eugene, OR 97440-2188 Contact: rgletters guardnet.com Website: http://www.registerguard.com/ Related Article & Web Site:Oregon Medical Marijuana Acthttp://www.ohd.hr.state.or.us/hclc/mm/Home-Grown Medicine http://cannabisnews.com/news/thread8564.shtmlReluctant Advocates Say it's the Best Optionhttp://cannabisnews.com/news/thread8563.shtmlCannabisNews Medical Marijuana Archiveshttp://cannabisnews.com/news/list/medical.shtml 
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Comment #5 posted by sapp on July 14, 2001 at 10:45:18 PT:
pot
ii sometimes smoke pot and i will contiue to smoke pot.law in force and the laws are as stupid as it comes.i would rather see people smoking pot than going out drivingunder the efeks of booze. i not the smartit one in the world be i grsudated high school and didnt drop out andi find my way around the internet i went to college and madeA's in all my subject at thw age of 41
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Comment #4 posted by FoM on February 05, 2001 at 13:07:38 PT
Dr. Russo
I just got The Journal of Cannabis Therapeutics delivered today. We only ordered it about a week ago. We are looking forward to reading it. I'll take it to the VA Hospital when we go and I took The Handbook of Psychotropic Herbs to the VA clinic and told him a little about herbs but he made my husband stop taking any herbs for the time being. He said they could be making him sick. I disagree but I won't argue the point. Thanks for all your hard work Dr. Russo.
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Comment #3 posted by Ethan Russo, MD on February 05, 2001 at 07:49:40 PT:
IOM Report
The IOM Report was okay up to a point, but it is hardly the last word, most authoritative, or even best done review of the subject. Additionally, the information on cannabis and cannabinoids has exploded since its release 2 years ago. Cannabisnews.com junkies owe it to themselves to keep up to date on the literature. Keep perusing PubMed for new articles on cannabis and cannabinoids. We will keep publishing new journal articles and books on the subject, and hope that the information becomes part of the debate.
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Comment #2 posted by Mari on February 05, 2001 at 07:24:02 PT
Act of 1937
The act you are refering to is the Harrison Tax Act.It has already been struck down by the Supreme Court in 1971!The govt. turned around and invented the Controlled Substance Act and created the schedule that is used today.No scientific basis for determining scheduling was used.By the way,heroin is used in medicine today.It is part of a Bromptom's Cocktail,a mixture of drugs used for intractable pain in terminal cases.Cannabis is medicine for the body and the soul!
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Comment #1 posted by meagain on February 04, 2001 at 17:53:47 PT
Wake up call
I would rather smoke it as medicine than take some of these man made synthetics.Its time to wake up to the truth marijuana has been used for centuries until 1937 it wasn't a problem.Because of some jaerk-offs greed many have suffered cruel and unusual punishment ...jail .It is time to repeal that act passed in 1937 .
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