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When
Barbara Douglass of Lakeside, Iowa, came to the University of Iowa last
April, she spent much of her time in a hotel room smoking marijuana.
She wasn't in town to have a good time, however; marijuana is Douglass'
medicine, and she was in Iowa City to speak at "Medical Marijuana: Science-Based
Clinical Applications," one of the first national scientific conferences
about medical uses of marijuana.
Douglass,
who has multiple sclerosis, was joined at the UI conference by George
McMahon, a Livermore, Iowa, resident who smokes marijuana for nail-patella
syndrome, a genetic disorder involving skeletal deformities, joint problems,
kidney problems, and sometimes glaucoma. Two of the eight legal users
of marijuana in the United States, they were at the conference to give
firsthand accounts of their experiences.
They
belong to the federal research study known as the Compassionate Investigational
New Drug program, which closed in 1992 after  admitting
14 people around the country. Six of the patients have since died. Douglass
and McMahon receive their marijuana free from the government and both
smoke about ten marijuana cigarettes a day to ease the pain from their
diseases.
Douglass,
McMahon, and the other six patients are at the center of a national debate
about whether or not marijuana should be used medically and whether or
not it should be legalized, period. Advocates for its medical use note
that marijuana has been shown to ease nausea and increase the appetite
of cancer patients undergoing chemotherapy, and they say its effects—mood
enhancement, anxiety reduction, and mild sedation—can be beneficial
for patients suffering pain and anxiety associated with their illnesses.
Opponents,
on the other hand, claim that marijuana has negative physiological effects,
including lung cancer, cardiovascular problems, and infertility. They
also fear that marijuana is a "gateway" drug that will lead to the use
of more harmful drugs like heroin and cocaine, that allowing marijuana
to be used as a medicinal drug will send a message to young people that
marijuana use is safe, and that approving marijuana for medical use will
open the doors to widespread legalization.
In
recent years, the debate has grown more heated as several states have
passed voter initiatives to allow the medical use of marijuana. Hawaii
was the first state to pass such legislation in 2000. Even in states
allowing the medical use of marijuana, however, it is still illegal
for a doctor to prescribe marijuana or for a patient to use it. Regardless
of state law, the federal government considers marijuana a prohibited
drug.
|
Medical History
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| The idea of using marijuana
medicinally is not new. Cannabis, the plant marijuana comes from,
was a staple crop of ancient China and was used not only for food,
fiber, oil, and paper, but to treat more than 100 ailments, including
leprosy, diarrhea, infections, and loss of appetite. |
| In the United States, cannabis
was valued as medicine during the 19th century, and during the early
part of the 20th century, marijuana was prescribed as a sedative
and an analgesic, to improve appetite and digestion, and for other
disorders. As synthetic drugs replaced it in the 1930s, medical
use of cannabis began to decline but recreational use increased.
|
| By 1931, 29 states had
outlawed marijuana, and the 1937 Marijuana Tax Act made it expensive
and inconvenient to obtain. In 1942, marijuana was removed from
the U.S. Pharmacopoeia because it was believed to be harmful and
addictive, causing psychoses, mental deterioration, and violent
behavior. |
| A sharp increase in recreational
marijuana use in the 1960s led to the Controlled Substances Act,
established in 1970. It divided drugs into five schedules and placed
marijuana in Schedule I, the category for drugs considered unsafe,
having a high potential for abuse, and having no accepted medical
use. |
Marijuana's
status today as a Schedule I substance means it is available for research
only after special application to federal agencies. The legal status
of the drug, and public perception of it as harmful, has hindered research
efforts, says Dr. Melanie Dreher, dean of the UI College of Nursing.
"There
are clinical observations that show marijuana increases the appetite,
and it has been shown to be quite effective to reduce wasting in AIDS
patients," Dreher says. "Exploration of marijuana should be supported.
Instead, it becomes increasingly difficult. The stigma attached to marijuana
compromises the interest in research on this multi-dimensional and fascinating
substance."
For
over 30 years, Dreher has investigated marijuana use in Jamaica, a country
that has a long tradition of using marijuana medically. There, Dreher
says, marijuana is smoked, made into a tonic with white rum, or brewed
in a tea, and it is used to treat a number of ailments, including teething
and colic in babies, asthma, fevers, and nausea in pregnant women. It
is also given to children to encourage a good appetite and help them do
well in school.
Dreher
feels more research on marijuana is warranted, and she hopes to continue
her own research by exploring the use of marijuana as an aid in rehabilitation
from cocaine use.
"I
think it will require a cultural change of attitude to get more research
done on this subject," Dreher says. "It's going to require at least temporarily
setting aside culturally generated feelings about this subject so we can
look at it in a more scientific way."
That
was the impetus for the University of Iowa conference, held April 6-8.
Dreher came up with the idea, approached the UI College of Medicine, which
co-sponsored the event, and then called upon Patients Out of Time, a nonprofit
organization working to legalize medical marijuana use, to organize it.
The conference featured speakers and panels presenting information on
clinical and basic science research on marijuana, the history of its medical
use, and case presentations of patients legally receiving marijuana. About
250 people attended the conference, which was simultaneously telecast
to six other institutions around the nation. Toll-free phone numbers allowed
individuals at the various sites to call in with questions and comments.
"Iowa
did a great job," says Al Byrne, co-founder of Patients Out of Time. "We
took information that is reinforced in every respect, with bona fide scientists
and peer-reviewed material. That it was at the University of Iowa gave
the conference national standing. The University of Iowa was not seen
as a fringe institution, but as a major university that was willing to
have a legitimate, open discussion."
Bruce
Upchurch, drug policy coordinator for the State of Iowa and director of
the Governor's Office of Drug Control Policy, says he isn't convinced
that the UI conference offered such a discussion, although he did not
attend.
"I'm
not sure I would classify what happened there as a scientific conference,"
he says. "I think a lot of the people there already had their minds made
up and had an agenda in mind. A lot of people who want to do good and
relieve pain and suffering get caught up in this. There should be continued
research on this subject, but unfortunately, some people would like to
shortcut this research. Instead of relying on science to see if there
are beneficial uses for some of the chemicals in marijuana, they are trying
to get the use of marijuana in general legalized."
Researchers
at the UI have been looking at marijuana in different ways for several
years. On the whole, however, there is not much scientific work being
done in this area. "There are about 30 people in the world who study this,"
says Byrne. "Twenty-eight of them were at the UI conference."
Research
has led to the development of at least one drug that attempts to harness
the benefits of marijuana while avoiding the harmful side effects that
come from smoking it. Upchurch supports efforts to identify beneficial
components of marijuana and to find safer methods of delivery, but he
feels more testing is necessary before marijuana can be considered medicine.
"We
don't smoke our medicine in this country," he says. "If research develops
a delivery system that's safe and can isolate the chemicals that are beneficial,
if it's tested and approved, then yes, it should be available. But there
are substances out there now, other than marijuana, that can be used to
relieve pain and suffering."
Patients
like Douglass and McMahon, however, aren't able or willing to use approved
drugs they feel are ineffective or to wait for a legal, socially acceptable
form of marijuana. For them, the debate comes down to one thing: if marijuana
helps patients with debilitating diseases, it should be available to them.
"When
I started smoking marijuana, I was in a hospital bed and wasn't supposed
to live long enough to make it home," recalls McMahon. "I hadn't eaten
in 20 days. I did not expect to get better. Now I'm walking, sleeping,
riding my bike.... The difference to me is from dead to alive."
When
Douglass began smoking marijuana, she also found dramatic relief from
the muscle spasms and pain, sight problems, and weight loss brought on
by multiple sclerosis. "I wanted anything that would help," she says.
Douglass
picks up her prescription—300 marijuana cigarettes—each month
when she visits her doctor, who monitors her condition and reports to
the study leaders. She says she can tell when she needs to smoke by how
her body becomes tense. She likes managing her own medicine and taking
the amount she feels is right for her. She doesn't agree with those who
feel that smoked marijuana is too harmful to be used therapeutically.
"The
side effect of my marijuana is that I can sleep, and I don't know any
person with multiple sclerosis who would argue with that," she says. Douglass
feels marijuana should not be legalized for recreational use, but should
be administered like any other prescription drug.
McMahon,
on the other hand, feels marijuana should be legalized across the board
for individuals to use as they see fit.
"Some people will abuse it, but I think the real danger of marijuana is
that people who are caught with it are sent to prison, and prison ruins
lives," he says. "I think it should be legal. I want to be able to go
to any doctor and talk about it freely. It's good medicine."
Susan
L. Green is an associate editor at the UI Office of Health Sciences
and a freelance writer in Iowa City.
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