Legalization of Marijuana for Medical Use

by Carol E. Rachal

The controversial issue of legalizing marijuana for medical use has found its way to Arkansas, and Arkansans may have the chance to vote on the issue in the 2000 general election. That's if The Alliance for the Reform of Drug Policy in Arkansas has its way. ARDPArk will have to get 56,000 signatures in order to get the initiative approved for the 2000 general election.

Denele Campbell, founder and president of ARDPArk, is determined to get the issue on the ballot. In an interview with Campbell, I asked what prompted her to start the group, which has only been in existence since July 1999. Campbell said the group grew out of conversations at social gatherings; the more they talked about the issue, the more they felt they had to take action.

"The outrageousness of the situation and a personal experience with a cancer patient is what prompted me to get involved; people risking arrest, dignity and the quality of life just to find comfort is outrageous," Campbell said. "Marijuana is a folk medicine that has been around for centuries; even as recently as 1937 it was listed in the United States' Pharmacopoeia as a treatment for various ailments.

I got Online and discovered a Listserv with a collection of newsletters posted bypeople from around the country and the world about their experiences with the drug. The more I read, the more I realized there was a movement going on. I was greatly empowered by this and encouraged that other people led the way, and I could get involved on a larger scale. I've always been somewhat of an activist, so this seemed natural to me."

The group began its activism by first mailing out brochures about ARKPArk and the issue of legalization to people they thought might be interested in their cause.

"We didn't get much of a response from that," Campbell said. "It was an Arkansas Times column written by Mara Leveritt about the group and our efforts toward reform that brought calls in from all over the state. We were able to reach more people through the article."

Campbell feels, as do many others involved in this issue, that the real issue here is compassion for the seriously ill. The bill, based on the one that has since passed in Oregon, would allow physicians to advise and recommend marijuana but not prescribe it. After the recommendation, the patient would bring a note to the Health Department for verification, in which case an identification card would be issued to the patient and a designated care-giver. The care-giver would be designated to grow the herb or get it from a producer for the patient. Both the patient and care-giver would be protected against prosecution.

Arkansas is not alone in the fight to legalize marijuana for medical use. In November 1996, California voters passed Proposition 215 by a comfortable 56 percent. Proposition 215 permits patients to possess and use marijuana for medical purposes with a physician's recommendation/prescription, particularly in cases of glaucoma, to combat AIDS wasting syndrome, and as an anti-nausea agent in the treatment of some cancers, AIDS and Multiple Sclerosis.

Arizona, Oregon, Nevada, Washington and Alaska have followed suit, but because federal law supercedes state law, and marijuana is illegal according to the federal government, those using marijuana for medical purposes are subject to prosecution, while doctors prescribing it run the risk of losing their licenses. California's state report on medical marijuana has recommended state officials set up a registry for medical marijuana patients to protect users from arrests.

House Bill 912 was introduced in 1999 by Rep. Barney Frank, D-Mass. The bill is a states' rights bill that would allow states to determine for themselves whether marijuana should be legal for medicinal use.

Public interest and support in this issue is growing. A 1997 ABC poll showed 67 percent of Americans supported making medical marijuana legal. In March 1999, a Gallop poll reported that 73 percent of Americans support making marijuana available to doctors so they may prescribe it to patients.

Many feel that people are being incarcerated needlessly. The so-called "War on Drugs," launched by President Ronald Reagan in 1982, began as an assault on marijuana and has resulted in the overcrowding of U.S. prisons with non-violent marijuana offenders. According to numbers put out by The Marijuana Policy Project, the number of marijuana arrests in 1997 was the largest in U.S. history with 695, 201 arrests, 87 percent of which were for the possession of marijuana, not the sale or manufacture. There have been more than 11 million marijuana arrests in the United States since 1965, according to a November 1998 report; and there are an estimated 15,668 people incarcerated in federal prisons for marijuana, 13,670 in state prisons, and 7, 222 in local jails.

In 1980 there were almost twice as many violent offenders in federal prison as drug offenders. Today, there are more people incarcerated in prisons for marijuana than for manslaughter or rape. In 1992, the average punishment for a violent offender was 43 months. The average punishment for a marijuana offender was about 50 months. Small-time marijuana dealers are being given life sentences in some cases, while violent offenders are being released early.

Drug offenses differ from most crimes in that they are subject to federal, state and local laws. In 1985, a Florida watermelon farmer was arrested for growing marijuana, convicted under state law and sentenced to five years probation. Five years later, the local U.S. attorney decided to prosecute him for the same crime, under federal law. He was found guilty and sentenced to life in prison without parole.

Under federal law, the death penalty can be imposed for growing or selling a large amount of marijuana, even if it is a first offense. A bill introduced in September of 1996 by former Speaker of the House Newt Gingrich demanded either a life sentence or the death penalty for anyone caught bringing more than two ounces of marijuana into the United States. Although the bill attracted 26 co-sponsors, it failed to reach the House floor.

Barry McCaffrey, the nation's drug czar, pressured by the growing public interest in marijuana as medicine, commissioned a report to evaluate the scientific validity of the benefits of medical marijuana. When he took office in 1996, he stated that there was " not a shred of scientific evidence" that smoking marijuana was useful or necessary. McCaffrey had to eat his words when the report, released in March 1999 by the National Academy of Sciences' Institute of Medicine, stated that there was evidence of the benefits of marijuana as medicine.

One of the principle investigators of the report, Dr. John Benson, said in an interview with ABC News that " We're coming down on the side that this is a powerful agent. There's just too much promise there to ignore it."

The legalization of marijuana has been an issue of controversy since the passing of the Marijuana Tax Act of 1937, which banned marijuana use in the United States. The law was passed in an attempt to curb recreational use of the drug, and it made cannabis so difficult to get, the drug was eventually removed from pharmaceutical references.

In 1970 marijuana was officially classified as a Schedule 1 narcotic under the Controlled Substances Act. A Schedule 1 narcotic is considered highly addictive, with no medicinal value and cannot be prescribed by a physician. Heroin and LSD are classified as Schedule I narcotics.

During the 1970s, the medical benefits of marijuana were rediscovered when, in the early '70s, some young cancer patients receiving chemotherapy found that smoking marijuana relieved the nausea and vomiting associated with the cancer treatment. In 1971, the National Organization for the Reform of Marijuana Laws entered a petition to reclassify marijuana to a Schedule II narcotic, which would allow physicians to prescribe it for their patients. It was another futile attempt at getting the US government to recognize the medicinal benefits of marijuana.

Pressure from proponents of medical marijuana forced the government into discussing the issue, and in 1975 a report by the federal government noted that "Cannabis is one of the most ancient healing drugs... One should not, however, summarily dismiss the possibility of therapeutic usefulness simply because the plant is the subject of current sociopolitical controversy."

In 1978 a treatment program was introduced, The Individual Treatment Investigational New Drug Program, referred to as the Compassionate IND or the "Compassionate Use" program.

The program was developed as a result of a lawsuit brought against the federal government by Robert Randall, a 51-year-old glaucoma patient, who was arrested for growing marijuana. Randall sued the federal government, contending that smoking marijuana was a medical necessity, as it eased the pressure on his eyes. In 1976, a judge agreed, and Randall began receiving marijuana under the supervision of a doctor. The arrangement began to unravel in 1978, and Randall sued again. The government settled the case through the "Compassionate Use" program, in which the FDA gives patients access to unapproved drugs if other therapies fail to help them.

The program provided marijuana, grown under government supervision at the University of Mississippi, to seriously ill patients if their physicians were willing to undergo the enormous amounts of paperwork needed to be accepted to the program. Approximately three dozen patients received 300 marijuana cigarettes per month, compliments of the federal government, for various ailments which included nausea and vomiting associated with chemotherapy, and relieving the intraocular pressure associated with glaucoma, the leading cause of blindness in the United States. The program was discontinued in 1992 by then President George Bush, however, eight surviving members of the program are still receiving marijuana monthly from the federal government.

The government's decision to keep the remaining survivors on the program has caused some controversy since the program's end, especially with people like Tom Brown, founder of Our Church, Inc., a church that supports the growing of marijuana for medical use.

"The issue here is, does the federal government have a justifiable reason to keep some Americans from accessing marijuana while providing it to others. Do they have the right to pick and choose?" said Brown, a resident of Northwest Arkansas, who spent five years in prison for growing marijuana. Released in the spring of 1999, he now spends his time and money participating in lawsuits against the federal government and their policy on medical marijuana.

The Drug Enforcement Administration agreed to public hearings on the issue in 1986, and for two years listened to the testimony of physicians and patients, and poured over thousands of pages of documents. An opinion by Judge Francis L. Young in 1988 declared that marijuana fulfilled the requirement for transfer to a Schedule II classification. Judge Young, in his opinion, described marijuana as "one of the safest therapeutically active substances known to man." He based his opinion on the investigation of the experiences of doctors and patients. Judge Young quoted an example about the mother of child with cancer; "When you're kid is riding a tricycle while his other buddies are hooked up to IV needles, their heads hung over vomiting buckets, you don't need a federal agency to tell you marijuana is effective. The evidence is in front of you, so stark it cannot be ignored." The DEA overruled his opinion.

Over the years scientific studies have shown that although legislators and law enforcement officials would have the public believe marijuana is a dangerously addictive drug with no medicinal value, it is in fact, neither. Marijuana as medicine has been documented throughout history in a number of cultures.

In 2800 B.C., Chinese Emperor Shen-Nung prescribed it to treat a variety of ailments such as beri-beri, constipation, gout, malaria, rheumatism, "female problems," and a host of others. In India, cannabis use was associated with the religious activities of Hinduism as well as the treatment of ailments, i.e., dysentery, sunstroke, indigestion, reduced appetite, alertness and so on. Aside from its use in religious activities and for medicinal purposes, hemp, a by-product of the plant, was also used in many products. By 500 A.D. marijuana was being used as medicine throughout most of Europe.

The introduction of marijuana as medicine to the United States came in a report in 1839 in the homeopathy journal American Provers' Union, which listed the drug's therapeutic properties. From the years 1850 to 1942, marijuana was listed in the United States' official list (Pharmacopoeia) of recognized medicinal drugs; between 1840 and 1860, more than 100 articles were published in American and European journals on the medicinal and therapeutic benefits of marijuana in the treatment of a number of ailments such as mania, whooping cough, asthma, chronic bronchitis, tetanus, epilepsy, withdrawal from alcohol, and as mentioned earlier, the nausea and vomiting associated with cancer treatment.

There is also evidence that marijuana is effective as a therapeutic agent in the treatment of muscle diseases and conditions such as multiple sclerosis, paraplegia and quadriplegia, and has even been successful in suppressing convulsions.

The National Academy of Sciences researchers found from both animal and human studies that the cannabinoids found in marijuana are capable of producing an analgesic effect, citing that many patients and older Americans are using marijuana to control chronic pain.

Research on animals and observation of the behavior of drug addicts have consistently proven that marijuana is not addictive. The neurotransmitter in the brain associated with pleasure is Dopamine. The neural systems associated with dopamine are involved with the limbic system, an area of the brain that controls emotions and behavior. Highly addictive drugs such as cocaine, amphetamines and opiates affect the pathways and cause an increase or decrease in the amount of dopamine in the brain, depending on the drug. Research and observation has shown that animals will forsake their own personal good, even at great risk to their health, in order to stimulate the pleasure center of the brain.

Studies done by the National Institute of Mental Health involving rats and THC, one of the active ingredients in marijuana, showed that animals will not self-administer THC in controlled studies ..., and that cannabinoids generally do not lower the threshold needed to get animals to self-stimulate the pleasure center of the brain, as do other drugs of abuse.

Another indication of a high potential for addiction and abuse is the drugs ability to induce tolerance. Tolerance is created by "wearing out" the dopamine receptors in the brain, thus forcing the consumer to progressively increase dosage to achieve the same affects. Drugs such as cocaine, amphetamines and opiates have this affect on the brain, whereas, THC does not.

Jean, a nurse for 22 years, an and oncology nurse for five years, works at a local Northwest Arkansas area hospital. In an interview, Jean described the difference between addiction and physical dependence.

"Anyone can become physically dependent on a drug and suffer withdrawal symptoms, but the difference between addiction and physical dependence is that with addiction, the person changes their social behavior to get the drug. The addict is focused on getting the drug."

Jean feels as do many other proponents of medical marijuana that despite all the hype surrounding the issue, the real issue is the patient and pain management.

"Seventy percent of cancer patients are dying in pain," said Jean. "Marijuana takes care of the pain , it does not make you high, you will become lethargic; this is not about pleasure, this is about pain. My concern is the patient and pain management."

A major boost to the medical marijuana issue came in the 1980s with the advent of AIDS, and the discovery that smoking marijuana could assist in preventing AIDS wasting syndrome by stimulating the patient's appetite. AIDS organizations have been at the forefront of the battle to legalize marijuana for medical use.

Jeff (not his real name), who has full-blown AIDS said he smokes marijuana to stimulate his appetite and attitude, and to help with nausea. A resident of the Northwest Arkansas area, Jeff tested positive for HIV in 1990 and has had full-blown AIDS since 1992; originally 225 pounds, by 1995 his weight had dropped to 142 pounds.

"For two years I would smoke, and eat at least 5,000 calories per day to gain the weight back," said Jeff. "I'm now 175 pounds. I smoke to relieve the nausea from the medication I take to stop the disease from replicating. Smoking also helps to relieve stress and it makes me feel rejuvenated. I feel like I want to do things, not just sit around."

When asked how he felt about the issue surrounding legalization of the drug, Jeff said, "I don't consider marijuana a drug, it's an herb; God gave it to us."

Leading the battle for legalization is Dr. Lester Grinspoon, a professor of psychiatry at the Harvard Medical School. Grinspoon has written two books on the subject, and testified before the Crime Subcommittee, Judiciary Committee and the U.S. House of Representatives in October 1997 on the medical benefits of marijuana as medicine. His most recent book, Marihuana, The Forbidden Medicine, addresses the benefits of smoked marijuana as opposed to dronabinol, trade name Marinol, which is the synthetic form of the active ingredient, delta-9-tetrahydrocannabinol, found in marijuana.

When the FDA approved the use of Marinol, in 1986, investigation by the federal government into the benefits of smoked marijuana came to an end, despite the fact that the data suggested that smoked marijuana was more useful than oral THC for some patients.

Charles (not his real name), suffering from a rare form of lung cancer, was prescribed Marinol for weight loss due to the effects of surgery, radiation and on-going chemotherapy. The combination of the three has been successful in nearly eradicating all of the cancer from his body, but Charles still has a long way to go. In an interview, he talked about his use of marijuana in combination with Marinol, and his reason for combining the two.

"The problem with Marinol is the THC isn't absorbed into the bloodstream as quickly as with smoked marijuana," Charles said. "It almost has a time-release effect. I take 20 mg. of Marinol in the morning with my cancer medication and by the time I'm hungry enough to feel like eating, it's about 5:00 p.m. After that I'm hungry until I go to bed. I don't want to have to wait that long for the full effects of the drug to kick in. When I smoke, I feel hungry right away." With the consent of his doctor, Charles has increased his dosage to 40 mg. per day; he takes one pill in the morning along with his cancer medication, then another pill before going to bed. "I thought that if I took the pill before going to bed, it would stimulate my appetite by the time I got up in the morning."

Charles also supplements Marinol with smoked marijuana to help with depression.

"I've suffered with depression ever since being diagnosed eight months ago," Charles said. "The depression combined with the effects of the cancer medication deplete me of energy, and I don't feel like doing anything. When I smoke, I feel motivated. It makes me want to get up and do things. It has helped my attitude tremendously."

Jeff, the AIDS patient, has taken Marinol, but said it didn't help stimulate his appetite nor make him feel rejuvenated as did the smoked marijuana. "All the Marinol did was put me to sleep," Jeff said, "so I stopped taking it."

Marinol is classified as an anti-nauseant in the Physician's Desk Reference. The dosage ranges from 2.5 mg. to 20 mg., and is only administered to patients who have not responded to other medications.

The issue of medical marijuana has drawn much opposition. Some people believe it is the smoking of marijuana that is the real issue. If the FDA approves the use of medical marijuana it will be the first and only drug approved by the FDA that is administered by smoking.

Barry McCaffrey told a House subcommittee that the idea of decriminalizing medical marijuana is "sheer buffoonery ...," and that medical marijuana referendums are merely a front for total legalization. McCaffrey stated that while "marijuana does have a 'potentially positive effect on some symptom management,' the drug 'doesn't cure anything."

In 1996, McCaffrey stated that sending teens the wrong message that marijuana is medicine will cause drug use to skyrocket. In October 1999, The Center for Substance Abuse Research, funded by grants from the University of Maryland and the Maryland Governor's Office of Crime Control and Prevention, published that "The percentage of California residents who reported using marijuana in the past month has remain unchanged at six percent." McCaffrey was proven wrong, and this wouldn't be the first time.

Data from a survey conducted in 1998 by the Substance Abuse and Mental Health Services Administration, a division of the U.S. Department of Health and Human Services, showed that in 1995, 5.2 percent of all Californians were current marijuana users. Three years later, 5.5 percent were listed as current users. These figures are consistent with the national level of 5 percent.

Officer Shannon Gabbard of the Fayetteville Police Department and D.A.R.E. coordinator for the fifth grade classes in the Fayetteville, West Fork and Greenland schools, agrees that legalizing marijuana would send kids a mixed message about drugs. The Drug Awareness Resistance Education program, or D.A.R.E., was developed to teach school children about the dangers of drug use.

"One of the issues that D.A.R.E. concentrates on is how drugs affect your body. Using it for medical purposes sends a mixed message, because we are telling kids that the use of marijuana has negative effects on the body," Gabbard said in an interview. "The effects on the brain cells, especially for young people, is critical. Their ability to concentrate and retain information is affected when they smoke marijuana."

While studies have shown that marijuana can have negative effects on young people and possibly even chronic smokers, its value as a medicine cannot be ignored. Still, marijuana is not completely harmless.

The greatest danger in smoking marijuana is potential lung damage. Marijuana is said to have higher tar levels than that of cigarettes, about twice as much. But marijuana smokers don't generally smoke as much marijuana as cigarette smokers smoke tobacco, so the danger isn't as high. Also, this is not of great concern to those suffering from diseases such as terminal cancer and AIDS. The benefits of smoked marijuana far outweigh the risks in such cases.

The issue is not about the risks to young people of smoking marijuana, the issue is about easing the suffering of the seriously ill. The irony of the situation is with the concern for the negative effects on young people, when both alcohol and cigarettes cause more harm than does marijuana. Also, although illegal for sale to minors, both alcohol and cigarettes are much more widely accessible and cheaper.

The argument that marijuana is a "gateway" drug has been proven to have no basis in fact. There is no evidence to prove that the use of marijuana, whether for pleasure or pain, prompts people on to more dangerous drugs.

The call for more research into the medical benefits of marijuana has prompted the Clinton Administration, a staunch opponent to legalization for medical use, to take action. In May 1999 the Clinton Administration announced that it will sell government-grown marijuana to scientists who want to study it. McCaffrey, a staunch opponent of medical marijuana, supported the decision. In October 1999, the FDA granted approval to Dr. Ethan Russo, a neurologist from Missoula, Mont., to study the effects of smoked cannabis as compared to oral dronabinol (Marinol) in the treatment of migraine. This is only the second clinical study of cannabis to be approved within the last 15 years.

The controversy continues, with some believing that the reasons behind the federal government's refusal to legalize marijuana for medical use are much more than the concern over the alleged dangers of the drug, especially to society.

When marijuana was banned in the United States in 1937, Harry J. Anslinger, the head of the Federal Bureau of Narcotics and Dangerous Drugs from 1931 to 1962, and his associate the famous William Randolph Hearst, used what is known as "yellow journalism" to spread the news of the many dangers associated with marijuana use such as addiction, psychosis, and induced violent behavior.

New Orleans District Attorney Eugene Stanley claimed that, "many of the crimes of the south were committed by criminals who relied on the effects of the drug to give them a false courage and freedom from restraint."

The idea that the passing of the Marijuana Tax Act was not a desire to keep people from becoming addicted to drugs, but rather an attempt by the oil and timber industries to stop the production of hemp, a potential threat to their livelihood. Industrial hemp was used in the manufacture of many products such as paper, and could easily replace the use of wood in the making of paper. The paper pulp made from industrial hemp requires less bleaching and fewer chemicals than paper made from wood pulp. Hemp was also used in personal cleansers and cosmetics as well as paint. Paints made from hemp oils have been found to penetrate wood better. Hemp oil was a major component in paints and varnishes. It was also used in glues and industrial lubricants as well.

Along with William Randolph Hearst, oil man and Treasury Secretary Andrew Mellon was a key player in creating the hysteria that resulted in the banning of marijuana including the use of hemp, a by-product of marijuana, in the United States. Today, studies are being done to examine the uses of industrial hemp. The potential to use it as a substitute for wood pulp in paper products and cotton fibers in textiles is being investigated.

Denele Campbell believes that is one of the major forces behind the government's refusal to legalize marijuana today.

"Today we can add the pharmaceutical companies to that list," Campbell said. "It costs between $350 and $625 monthly to use Marinol. People growing their own marijuana is a huge threat to the pharmaceutical industry."

Another issue surrounding the stigma of legalizing marijuana for medical use is the amount of assets seized under the guise of the "Drug War." With the passing of civil forfeiture statutes by Congress in the 1980s, the government has the right to seize real estate, vehicles, securities, cash, jewelry, and any other property connected to a marijuana offense. A farm can be seized if a single marijuana plant is found growing on the property, and the government is not required to prove whether the property was purchased with the proceeds of illegal drug sales. When the property is seized, the burden of proving "innocence" falls upon the owner. According to statistics, about $1.5 billion of assets were forfeited under state and federal laws in 1994. Monies from seizures are divided among law enforcement agencies involved in the case.

In newspaper interviews, former Justice Department officials admitted that many forfeitures are driven by the need to meet budget projections. The abuse of power also becomes an issue, when the guilt or innocence of the defendant becomes less important than the availability of his assets.

In a tragic incident in California, Donald Scott was killed when 31 state and federal drug agents raided his 200-acre Malibu ranch. Scott was alleged to have been marijuana growing there. No evidence of marijuana cultivation was discovered. An investigation by the Ventura County District Attorney's office found that drug agents had been partially motivated by a desire to seize the $5 million dollar ranch. With legalization, asset seizures would become a thing of the past, leaving police agencies clamoring to make up for lost funding.

There is no doubt that there are many issues surrounding the legalization of marijuana for medical use, but proponents argue that the issue is about compassion for the seriously ill; it is about improving the quality of life for many people who are suffering with seriously debilitating and terminal illnesses; it is about survival. The debate over marijuana as medicine continues ...