cannabisnews.com: Smoking Gun 










  Smoking Gun 

Posted by FoM on February 28, 2001 at 19:20:03 PT
By Liz Scherer  
Source: Praxis M.D.  

One Wednesday in August 1999, California internist Molly Fry, MD, sat in church, quietly reflecting on her life and giving thanks for her health after losing both breasts in a fight with cancer. She worried, though, that another battle was beginning. The day before, a man came to her door asking if he could pick berries on her land. She told him no, but the man continued to hang around the property. 
Then a neighbor showed up to warn her that authorities—probably acting on a tip that Fry was growing marijuana—were setting up surveillance around her property in the Sierra foothills town of Greenwood. When she returned from church, her husband met her at the door. The police were already there. Fry had two choices: either produce a doctor’s statement authorizing her to use marijuana, or accompany them, in handcuffs, to jail.The showdown sparked her journey as an activist, advocate, and physician consultant. “At that moment, I realized that my pain and suffering from the cancer were nothing compared to the pain and suffering that would continue to be inflicted on me because of the use of marijuana.”Fry had tried marijuana during 4 months of chemotherapy, after conventional drugs failed to relieve her symptoms. Marinol, the pill form of THC (marijuana's main psychoactive substance), had made her feel “doped up.” At first her husband, attorney Dale Schafer, had bought marijuana for her on the street. Concerned about the risk involved, the couple began practicing horticulture.California is one of seven states that have passed initiatives on medicinal marijuana. In November 1996, voters approved Proposition 215, the Compassionate Use Act, which permits seriously ill citizens to obtain and use marijuana for medical purposes where “appropriate and recommended by a physician.” The law encourages state and federal governments to implement some sort of “plan to provide for safe and affordable distribution of marijuana.”Yet Molly Fry and other Californians—people living with such conditions as nausea, cachexia, glaucoma, epilepsy, or migraine—who want to take advantage of Prop 215 may only get in trouble because of it. More than 4 years later, the state has nothing more than disparate county guidelines on the numbers of plants that can be grown for personal medical use. Patients growing the plant have been prosecuted. It's like a country road with no speed limit, says Fry: “How do you know when you're going too fast?”Despite the Compassionate Use Act, suspicion of marijuana reigns in the medical establishment and in health maintenance organizations. Many of Fry's patients were denied certification by doctors in the University of California, Davis health system. Fry says that fear remains the prevailing attitude among physicians. Her sense was borne out in interviews with half a dozen doctors, all of whom asked to speak off the record. “The undercurrent of threats from the California Medical Board and other authorities was extensive,” Fry says. One colleague was forced to spend more than 3 hours in deposition with federal agents “breathing down his neck” for recommending marijuana to AIDS patients.Fry’s own run-in with the law was a close call. Producing a prescription for Marinol, she was able to convince police that she had a medical reason to grow marijuana. With Schafer’s legal counsel, the doctor decided to try putting up some signs on a treacherous road.Legalize It:Fry conducted a thorough review of the literature on medicinal cannabis and visited several doctors who were already recommending it, while Schafer studied the laws on marijuana. In November 1999 they opened the doors of the California Medical Research Center. The Center is an unusual combination of a medical practice (based on a psychiatric model involving detailed history taking, consultation, and assessment) and a legal-defense firm. The consultation takes time, 2 hours per patient. Half the visit is dedicated to thinking about preventing legal harassment and winning any court cases that may arise.Potential patients are required to complete a questionnaire and view two films. The first explains the evolution of the Center and the legal issues surrounding medicinal marijuana, and the second is a segment of Hooked: Illegal Drugs and How They Got That Way, the History Channel’s examination of drugs through the ages. The patient then sits down with Schafer, who explains federal and California laws on medicinal marijuana and tries to relate them to the patient’s rights in this particular case. The consultation also establishes attorney-client privilege in case patients face trial for possession.http://www.historychannel.com/Then Fry takes over. She reviews medical records, then administers a more detailed questionnaire and interview to determine whether marijuana would be effective, appropriate, and the least toxic alternative. Recently she has begun doing a complete physical examination. This helps guard against “patients” who think Prop 215 is a legal excuse to get high. Eligible patients then receive a certified physician statement notarized, embossed, and signed by Fry and her physician assistant. The document, which includes the patient's fingerprint, is good for 1 year.The hours, energy, and money expended on certifications could be better spent elsewhere, Fry believes. Her attention to detail leaves little time to publish the data she has collected on some 4,000 patients, or to learn more about the medicinal properties of marijuana and its cannabinoid constituents. “I seem to be going through incredible amounts of hoops so that my patients can get a nontoxic herb,” she says.Advocates cite the well-publicized 1999 Institute of Medicine report that supported the herb’s efficacy in treating chronic pain and muscle spasticity associated with multiple sclerosis, and in alleviating nausea, vomiting, and cachexia associated with chemotherapy and AIDS. But blinded, placebo-controlled trials are lacking, according to critics, who charge that marijuana has considerable toxicity that limits its usefulness. Anecdotal data, moreover, suggest that marijuana is no better than available pharmaceuticals. And Marinol is now easily available from drug stores.Marijuana’s primary mode of delivery is to inhale, with all the tar and residues in the smoke, making it an unacceptable therapeutic option for many physicians and patients. Consuming the drug—in teas, brownies, or butter—delays its action and has other side effects. The British firm GW Pharmaceuticals is working to develop alternative delivery systems such as vaporizers and sublingual tinctures.Researchers Aim To Develop Marijuana Without High: http://cannabisnews.com/news/thread8835.shtmlQuality and purity also vary between plants. Fungi, molds, and other plant toxins have the potential to compromise the weakened immune systems of AIDS and chemotherapy patients who might benefit. Fungal spores, for example, may increase the risk of aspergillosis in AIDS patients. The federal government tried to standardize the crop between 1975 to 1992, when the National Institute of Drug Abuse grew marijuana on a farm at the University of Mississippi; physicians could apply for the herb on behalf of their seriously ill patients. But the Public Health Service shut down the program, citing that it undercut the Bush administration’s policy on drugs.Today, a few controversial patient-run collectives work with pure strains and hybrids under close federal scrutiny, however, most patients must grow their own plants. But the lack of agreement among law enforcement officials on what constitutes a reasonable number of plants puts do-it-yourselfers at risk. Cannabis-buyers’ clubs that recycle street product are thinly disguised dealing operations, as marijuana advocates concede. It might be easier just to buy the product on the street from drug dealers.The claim that marijuana is a “gateway drug” for more addictive substances like heroin and cocaine is a roadblock to the acceptance of medicinal marijuana. This idea also helps keep it on the Controlled Substances Act's Schedule 1—the list of drugs with no proven medicinal value and a high abuse potential. Advocates, including several addiction specialists interviewed for this article, say that marijuana's small potential for dependence should not exclude it from medical use.While the battle over marijuana rages on, it appears that the Center’s procedural policies are protecting patients as well as physicians. The California Medical Board has left Fry alone, unlike two other Prop 215 consultants interviewed for this article who were subject to sanctions for authorizing marijuana. Local law enforcement officers now thank Fry—a far cry from spying on her. On average, she testifies in one case each month on behalf of her patients. Sometimes she doesn’t even need to show up in court. In December 2000, a patient with anxiety was arrested for possession of 2 g. The trial was dropped after the district attorney learned that Fry was planning to testify. January 2001 saw four cases, however, and Fry thinks the number will increase as her patient caseload grows. To Fry’s knowledge, not a single patient has been found guilty in a medicinal marijuana case since the Center opened its doors.While Fry meets with patients, Schafer has turned his attention to advocacy. He met with the state’s medical board, as well as with members of the state Attorney General’s office, to present the Center’s procedures as the basis for statewide guidelines to certify patients. His next step is to take the Center’s plan to the California Medical Association.This spring, the state legislature will take a second look at Proposition 215. Fry says she won't be satisfied until the burden of fear that her patients carry with them goes away. “The largest danger that marijuana poses is incarceration,” Fry says. “Regardless of whether or not you believe that marijuana has any medicinal properties, sick people don't belong in jail.”References:Joy JE, Watson SJ Jr., Benson JA Jr., eds.: Marijuana and medicine: assessing the science base. Institute of Medicine. 1999.National Academy of Sciences: Marijuana's components have potential as medicine; clinical trials, drug development should proceed. 1999 Mar 17. Accessed 2001 Feb 12: link.Sutton S, Lum BL, Torti FM: Possible risk of invasive pulmonary aspergillosis with marijuana use during chemotherapy for small cell lung cancer. Drug Intell Clin Pharm. 1986 Apr;20(4):289-91.Denning DW: Pulmonary aspergillosis in the acquired immunodeficiency syndrome. N Engl J Med. 1991;324:654-52. Grinspoon L, Bakalar JB: History of cannabis. The Forbidden Medicine. New Haven: Yale University Press; 1997.http://www.rxmarihuana.com/Hecht B: Out of joint: the case for medical marijuana. New Republic. 1991 Jul 15:7-10.Cermak TL: Addiction medicine perspective on the medicalization of marijuana. J Psychoactive Drugs. 1998 Apr/Jun;30(2):155-62.Endlinks:Link to the text and legislative analysis of Proposition 215, including a summary of arguments for and against the law. California Compassionate Use Act, Proposition 215. http://vote96.ss.ca.gov/Vote96/html/BP/215text.htmLindesmith, an independent drug policy institute, is geared toward building a drug policy reform movement. The website holds extensive bibliographies on every aspect of drug policy, including marijuana regulation and medicinal use, along with research briefs, news, legal affairs, and information on seminars and jobs.Lindesmith Center-Drug Policy Foundation: http://www.lindesmith.org/The first academic journal (subtitled Studies in Endogenous, Herbal, and Synthetic Cannabinoids) devoted to the study of clinical cannabis, endocannabinoids, and synthetic cannabinoids is published by Haworth Press. Click the journal title for subscription rates, abstract and indexing information, and the first issue’s contents (Spring 2001). Journal of Cannabis Therapeutics: http://www.haworthpressinc.com/store/Journal of Cannabis Therapeutics: http://cannabisnews.com/news/thread8466.shtmlSee our Best Practice of Medicine for more information on Generalized Anxiety Disorder, Oncology, Rheumatology, HIV Opportunistic Infections, HIV: Antiretroviral Therapy, Gastrointestinal Disease in Patients with AIDS, and Neurology.See our Best Health Guide for more information on Vertigo and Dizziness, Panic Disorder, HIV, Neurology, and Bronchitis.See our Praxis Links for more information on Management of Malnutrition and Cachexia, Chronic Diarrhea, and Hepatobiliary Disease in Patients with HIV Infection, Neurology, Oncology, Rheumatology, HIV/AIDS treatment information service (ATIS), National Institute of Drug and Alcohol Abuse, and JAMA Migraine Information Center.Liz Scherer’s articles have appeared in Postgraduate Medicine and the Journal of Epilepsy.Submitted By Ethan Russo M.D.Source: Praxis M.D.Author: Liz SchererPublished: February 21, 2001Copyright: 2001 Praxis Press Inc.Contact: info praxispress.com Website: http://www.praxismd.com/praxisgate.aspDL: http://www.praxismd.com/post/inperson/022101CannabisNews Medical Marijuana Archiveshttp://cannabisnews.com/news/list/medical.shtml 

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Comment #12 posted by kaptinemo on March 02, 2001 at 04:16:17 PT:
Why they didn't mention vaporizers
Some here have wondered why the IoM report made no mention of vaporizers. I would hazard a guess that they simply didn't want to appear to be favoring cannabis use under any circumstances.Consider: antis are always shaking in their boots in fear of 'sending the wrong message'. In this case, the 'wrong message' would be that cannabis use can be 'made safe' through the use of vaporizers. This would confer legitimacy upon medicinal cannabis. Legitimacy that the government has vociferously denied. How would it sound if the IoM report had indeed made such a recommendation? It would sound as if the government were admitting it had been lying for almost 7 decades. The anti positions regarding medicinal cannabis remind me of someone who puts brand-new vinyl siding on a house with termite-infested wood; it looks impregnible from outside, but the interior is so rotten one good kick would bring it down. To answer the vaporizer question honestly would be to open a window of vulnerability straight to the core of the anti position, laying it bare for attack. Sooner or later, the point would have been brought up; in a press conference, in a symposium among scientists, somewhere, the obvious question would have been raised. As as we all know, the antis adamantly refuse to give straight answers to certain questions, for the reasons I've mentioned. Why vaporizers weren't mentioned as safe cannabinoid delivery systems would be one such question.One more reason why antis are pee-their-pants scared of a knock-down, drag-out, no-holds-barred debate. Because they have no rational answer to give on that one...or any other.
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Comment #11 posted by Jeaneous on March 01, 2001 at 22:07:37 PT:
Dr. Russo
You hit the nail on the head regarding the relief cannabis brings for pain yet has little "stoned" effect. As you stated, you don't get high you just feel half way human. Thanks for your comments. 
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Comment #10 posted by DCP on March 01, 2001 at 20:29:11 PT
Greenwood
Fivepounder: Greenwood is in El Dorado county, not Placer.
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Comment #9 posted by Ethan Russo, MD on March 01, 2001 at 07:31:51 PT:
Once Again
It is truly shocking that the IOM did not address vaporizer technology. A big part of the problem for the current lack of publicity fo this technology is:1) Vaporizers are considered paraphernalia and, in and of themselves, are illegal in some areas. In others, they are legal until tainted with cannabinoids.2) Very little research has been published. This is due to lack of reimbursement by the usual underwriters (e.g., NIH, good luck!). We are trying to change this trend. The Journal of Cannabis Therapeutics 1(3-4) will contain a new article by Dale Gieringer of CANORML showing excellent results with a vaporizer. You can see preliminary details at www.maps.org3) The antis are desperate to avoid publicity about vaporizers, inasmuch as one of their favorite arguments against cannabis as medicine is deflated by the removal of pulmonary sequelae as an excuse for their Inquisitional zeal. Then what's left?: The quality of the cannabis is unknown? The patient might enjoy the treatment too much (be addicted)? Euphoria is forbidden in our society? 4) I suspect that any manufacturers are subjected to the full and not so subtle sanctions of the powers that be.I agree that the word "vaporizer" should be frequently interjected into any debate on clinical cannabis.
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Comment #8 posted by michael on March 01, 2001 at 07:13:33 PT:
VAPORIZERS!!!!!!!!!!!!!!!
  Oh sure, they get the occasional mention. As a legal med-mar user, it seems in our battle for natures herb we let the antis slide on some things. Maybe it's just me, but why aren't we ramming the vaporizer fact down their throats. I use a vaporizer and I'm here to say my lungs are smiling :-) When I see the vegatable matter that I didn't have to smoke, WOW. My lungs are clear for the first time in decades. So when the anti's casualy mention smoking damage and ( TESTING ) of vaporizers we should be cutting them off mid sentance. Truly, this issue is a microcosm of our battle. They keep repeating ingestion lies and denials, and we let them get away withit. Maybe it's just me. 
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Comment #7 posted by dddd on March 01, 2001 at 06:36:28 PT
It's True
Ethan....I appreciate your balanced view.It's quite true that not all of the people researching MMJ alternativesare entertaining bad intentions.......Thank You...Sincerely.........dddd
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Comment #6 posted by Ethan Russo, MD on March 01, 2001 at 05:31:36 PT:
Must Jump in Again
I understand all the previous comments. I have always maintained a stance of favoring legalization. I favor whole cannabis over isolated derivatives or synthetic analogues.However, please allow that profit is not the absolutely sole motivation for every person researching these modalities. Some do have altruistic tendencies of wishing to present improved therapies to the sick and dying. It definitely remains to be seen that any will present advantages over cannabis itself, even used in traditional fashion. Vaporization of whole cannabis, and extracts of whole cannabis present the greatest promise.Once again, it requires emphasis that many clinical cannabis users have excellent symptomatic control without attaining the dreaded high. Particularly in painful conditions, it is as if the pain soaks up as much cannabinoid as it needs and leaves little or no euphoria or high. Compared to the pain, however, feeling normal is an almost euphoric experience.
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Comment #5 posted by kaptinemo on March 01, 2001 at 05:11:29 PT:
Re-inventing the wheel...to patent it.
It's been said before, but could still stand repeating; the current efforts by antis to shut out natural cannabis usage therapies in favor of pharmaceutically-based ones is a paper-thin deceit of the worst order. It is nothing but callousely trying to make a buck off of the sick and dying - just to ensure that they can continue to turn a profit for their investors. Nothing more, and nothing less. All of these efforts by corporations seeking to develop non-psychoactive cannabis preparations reminds me of the nonsense that was endured by people during alcohol prohibition; that alcohol was to be used for 'medicinal purposes, only'. Yeah, right, whatever. It's still a lie, no matter how they justify it.If only those medicinal cannabis users who weren't so ill or so frightened of the eventual LEO 'visit' could stand up and give their elected representatives 'holy hell' for causing them to suffer, this idiocy would be over in a heartbeat.
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Comment #4 posted by meagain on March 01, 2001 at 04:30:23 PT
Gateway smaaightway
Urinalysis is the "Gateway" to other drugs the kind that are out of your system in hours.
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Comment #3 posted by mungojelly on February 28, 2001 at 21:47:10 PT:
more hogwash about vaporizers
Here's a real cheap way for GW to "develop" vaporizers: they can go ask the people who are already making & using them. "Developing" tinctures of cannabis? Hey, that's a novel idea. Fortunately they were already "developed" hundreds of years ago; they were available in pharmacies in the US (without a prescription) well before marijuana prohibition was "developed." Hey, here's a brilliant new idea for those big drug companies to "develop": cooking marijuana into brownies. Somebody could get a patent on that and make a mint. They're just tryin to weasel their way out of all that senseless propaganda that marijuana MUST be bad for you because it's smoked. Can't they ever admit it when they're wrong? 
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Comment #2 posted by fivepounder on February 28, 2001 at 21:41:25 PT
Slowly we win
Great to hear people are getting recommendations from other doctors around the state ESPECIALLY Placer County.
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Comment #1 posted by Duzt on February 28, 2001 at 20:38:40 PT
Two great people
I went through this office to receive my certification. They are very thorough and compassionate. they make sure their patients know about canabis and the laws around it and they protect us, it's a great set-up. Hopefully more doctors and lawyers will come foward to protect us. these people truly care, much more so than the politicians who "serve" us.
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