Medical marijuana: a boon & a challenge

When my sister Mimi found that marijuana could relieve her severe gastrointestinal distress, years ago, one joint after dinner was all it took. Unfortunately we couldn’t keep up the supply. After one foray into the rather scary realm of pot-dealing in a state (Georgia) where we could have wound up in jail very quickly, we decided that not even such clear relief was worth the risk.

Today, at least in California and 14 other states — with the District of Columbia possibly to be added soon — the risk is minimal but the dosage is fuzzy. The conundrum was outlined by writer Lena K. Sun in the San Francisco Chronicle:

On Tuesday, District of Columbia officials gave final approval to a bill establishing a legal medical marijuana program. If Congress signs off, D.C. doctors – like their counterparts in 14 states – will be allowed to add pot to therapies they can recommend to certain patients, who will then eat it, smoke it or vaporize it until they decide they are, well, high enough.

The exact dosage and means of delivery – as well as the sometimes perplexing process of obtaining a drug that remains illegal under federal law – will be left largely up to the patient. Doctors say that upends the way they are used to dispensing medication, giving the straitlaced medical establishment a whiff of the freewheeling world of weed.

Even in states where marijuana is allowed for medical use, doctors cannot write prescriptions because of the drug’s status as an illegal substance. Physicians can only recommend it, and have no control over the quality of the drug their patients acquire.

Because there are no uniform standards for medical marijuana, doctors have to rely on the experience of other doctors and their own judgment. That, they say, can lead to abuse.

California’s “quick-in, quick-out mills” that readily hand out recommendations have proliferated, worrying advocates. The state, the first to legalize medical marijuana 14 years ago, allows for a wider range of conditions, including anxiety.

To guard against abuse, some doctors say they recommend marijuana only after patients exhaust other remedies. Some doctors perform drug tests as part of pre-screenings.

Mimi died over a year ago. Her last decades, like almost all of her adult life, were spent in the State of Georgia, where medical marijuana is still against the law. I know what her required dosage was; legalization and proper oversight would allow doctors to learn dosages that work for their patients. It seems worse than cruel that thousands of other sick and dying citizens continue to be denied the potential relief that legalized medical marijuana could bring.

Dispensing medical pot a challenge for doctors.

Medical marijuana: a painful issue all around

Courtesy of http://prospect.rsc.org/blogs/cw/?p=655She is 46, a breast cancer survivor for four long years, a regular user of medical marijuana. She told me — as we were introduced by a mutual friend and she was updating the friend — a horror story too ridiculous even for an ‘Only in California’ tale. Her name is not Emily, but I’ll call her Emily to protect the innocent.

Emily has a solid career in social services with a California nonprofit. For years their funding has come partly through federal grants. This has been fine with Emily’s regular use of medical marijuana, which is legal in California and which keeps her chronic pain — a result of cancer and several other issues — under control. She smokes one joint in the morning, and four at night. (An editorial caveat here: I’ve not tried marijuana, which is wise since I’m addicted to anything that comes down the pike, so I know from nothing about dosages, etc. I’m just repeating what she explained.)

Not long ago, a new project was offered Emily’s organization and she was named as its head. Only problem? Everyone would have to take the federally-mandated drug test. Only solution? get Emily off of the weed for six weeks in order for her to pass the test. She had done that, finishing it all and passing the test and starting the project, a few months earlier. It was not fun.

“In order to get through all this,” she said, “I was prescribed a total of six different pain-relief drugs which I took every day. They were expensive, but the only way I could have made it. So for six weeks I poured six different toxins into my system at an obscene cost, both financially and physically. But hey, you do what you have to do.”

Emily is now back to growing, and smoking, her own.

California voters, thanks to a ballot issue certified yesterday by our secretary of state, will decide next November whether to legalize marijuana for any adult use. The issue is being rather hotly debated elsewhere on True/Slant and I frankly have no idea where I’ll come down when the dust settles and I read the whole business. Friends tell me it’s fine, others tell me it’s addictive, the state needs the money, who knows where legalization and regulation could lead? Neither does much to curb alcohol abuse, but then, I quit drinking years ago so it’s easy to be holy about alcohol abuse; some of us can handle the booze, some of us can’t.

But all of us need pain relief. Marijuana is a proven pain-relief drug. Why in the world it should be denied those who need it boggles this increasingly boggled mind.

Is marijuana a medicine?

Of course it is, to answer this rhetorical question posed by a January 18 headline in the Wall Street Journal. New Jersey is the most recent to recognize that fact, becoming the 14th state to legalize use of marijuana for medicinal purposes. The New Jersey law, signed this week by outgoing Governor Jon Corzine, limits use to patients with specific illnesses such as cancer, HIV/AIDS, multiple sclerosis and ALS (Lou Gehrig’s disease) and specifically forbids grow-it-yourself projects.

What’s needed now are serious studies of how good a medicine it really is, and these aren’t happening very fast. As outlined in a New York Times article this week, getting permission to study the weed is no easy task.

Despite the Obama administration’s tacit support of more liberal state medical marijuana laws, the federal government still discourages research into the medicinal uses of smoked marijuana. That may be one reason that — even though some patients swear by it — there is no good scientific evidence that legalizing marijuana’s use provides any benefits over current therapies.

Lyle E. Craker, a professor of plant sciences at the University of Massachusetts, has been trying to get permission from federal authorities for nearly nine years to grow a supply of the plant that he could study and provide to researchers for clinical trials.

But the Drug Enforcement Administration — more concerned about abuse than potential benefits — has refused, even after the agency’s own administrative law judge ruled in 2007 that Dr. Craker’s application should be approved, and even after Attorney General Eric H. Holder Jr. in March ended the Bush administration’s policy of raiding dispensers of medical marijuana that comply with state laws.

“All I want to be able to do is grow it so that it can be tested,” Dr. Craker said in comments echoed by other researchers.

Marijuana is the only major drug for which the federal government controls the only legal research supply and for which the government requires a special scientific review.

“The more it becomes clear to people that the federal government is blocking these studies, the more people are willing to defect by using politics instead of science to legalize medicinal uses at the state level,” said Rick Doblin, executive director of a nonprofit group dedicated to researching psychedelics for medical uses.

In California, where a mish-mash of laws and enforcement policies can bewilder all but the expert — (and there are many experts) — the Supreme Court ruled yesterday that lawmakers acted improperly in amending the voter-approved legalization of medicinal marijuana to limit the amount critically ill patients might have:

The high court ruled lawmakers improperly “amended” the voter-approved law that decriminalized possession of marijuana for “seriously ill Californians” with a doctor’s prescription by limiting patients to eight ounces (227 grams) of dried marijuana and six mature or 12 immature plants.

The Compassionate Use Act, passed by California voters in 1996, set no limits on how much marijuana patients could possess or grow, stating only that it be for personal use.

In 1997, the state’s Supreme Court defined a lawful amount as enough to be “reasonably related to the patient’s current medical needs.”

The state’s quantity limits were passed in 2003 as part of a voluntary identification card program designed to protect against both drug trafficking and wrongful arrest by allowing police to quickly verify a patient’s prescription.

The court on Thursday let stand the voluntary card program but found that the limits it imposes should not “burden” a person’s ability to argue under the Compassionate Use Act that the marijuana possessed or grown was for personal use.

California Attorney General Jerry Brown said in a statement the decision “confirms our position that the state’s possession limits are legal” as applied to medical marijuana cardholders.

While conceding that marijuana may have some just-for-fun attraction too, I can’t vouch for the recreational weed. Thankfully, since I am addicted to anything that comes down the pike and question the view that marijuana is non-addictive,  it hadn’t made its way to small-town Virginia when I was experimenting with other mood-altering substances. But I do know its medicinal value. My beloved now-deceased sister could have had much suffering relieved with legal pot. Countless friends I loved and worked with during the height of the AIDS pandemic would have suffered less with legal, easily-accessible marijuana.

We are past time to establish, through definitive studies, the medicinal benefits of this natural bounty, and make it legally available to those in desperate need.

Obama shifts justice department resources away from medical marijuana

A little ray of sanity from President Obama: the feds won’t be going after legitimate users of medical marijuana. This will be welcome news in San Francisco, where federal raids on legal suppliers during the Bush administration met with widespread protests; possibly unwelcome news in Los Angeles, which is cracking down on its over-supply of dispensaries; and interesting news in the U.K., where guardian.uk.com reported on it Monday.

The US justice department today told federal law enforcement officials to shift resources away from investigation and prosecution of medical marijuana users and suppliers.

In a memo sent this morning to federal prosecutors, officials at president Barack Obama’s justice department said that prosecutions of individuals who are clearly using or supplying marijuana for medical purposes are “unlikely to be an efficient use of limited federal resources” if the targets otherwise comply with state and federal laws.

Fourteen states allow some use of marijuana for medical purposes, though it remains banned under federal law. The Bush and Clinton administrations – the first to grapple with the conflict – essentially ignored the state laws, treating medical marijuana as illegal.

“The federal government is no longer at war with the 13 states that have chosen to allow patients to use marijuana for medical purposes,” said Bruce Mirken, spokesman for the Marijuana Policy Project, which favours decriminalisation of the drug.

“It’s going to provide relief to a lot of people who have been anxious about whether or not they’re going to be arrested for helping patients get their doctor-recommended medicine,” said Tom Angell, a spokesman for Law Enforcement Against Prohibition, which claims 1,500 former police, prosecutors, border patrol agents and other one-time fighters in the war on drugs among its membership.

This would’ve been good news for my sister, whose brief search for relief a few decades ago was mentioned in the post below. It would’ve made life a little easier for a lot of people with AIDS in recent decades.  Set aside the arguments pro or con recreational use; when a drug is known to help suffering people, and is legal in a particular city or state, wasting federal tax dollars to interfere seems to make very little sense.

The memo doesn’t legalize marijuana or end prosecution of illegal, for-profit sales etc. It does, though, leave these to local federal officials. And clarifies the federal government’s position.

It puts into writing remarks by attorney general Eric Holder, who in March said the federal government would end raids on legitimate medical marijuana dispensaries. Obama has indicated he is sympathetic to medical marijuana use, noting during the presidential campaign that his mother had died of cancer and that he saw no difference between morphine prescribed by doctors and marijuana used to relieve pain.

I don’t do pain very well. Given its prevalence in long, drawn-out illnesses today, I’m in favor of whatever palliative care and pain-relieving medicines there are. It is nice to have a president who understands.

via Obama justice department to shift from investigating medical marijuana cases | World news | guardian.co.uk.

The aches & pains of medical marijuana

An article in Sunday’s New York Times details the struggle in Los Angeles to regulate the cannabis dispensaries which have proliferated around the  city over the past six or eight years, raising the old medical marijuana questions about how to control, whether to tax and how useful it is in the first place. Reporter Solomon Moore cites Oakland, California’s Harborside Health Center as the place to which many are looking for a model.

‘Our No. 1 task is to show that we are worthy of the public’s trust in asking to distribute medical cannabis in a safe and secure manner,’ said Steve DeAngelo, the pig-tailed proprietor of Harborside, which has been in business for three years.

Harborside is one of four licensed dispensaries in Oakland run as nonprofit organizations. It is the largest, with 74 employees and revenues of about $20 million. Last summer, the Oakland City Council passed an ordinance to collect taxes from the sale of marijuana, a measure that Mr. DeAngelo supported.

Mr. DeAngelo designed Harborside to exude legitimacy, security and comfort. Visitors to the low-slung building are greeted by security guards who check the required physicians’ recommendations. Inside, the dispensary looks like a bank, except that the floor is covered with hemp carpeting and the eight tellers stand behind identical displays of marijuana and hashish.

There is a laboratory where technicians determine the potency of the marijuana and label it accordingly. (Harborside says it rejects 80 percent of the marijuana that arrives at its door for insufficient quality.) There is even a bank vault where the day’s cash is stored along with reserves of premium cannabis. An armored truck picks up deposits every evening.

City officials routinely audit the dispensary’s books. Surplus cash is rolled back into the center to pay for free counseling sessions and yoga for patients. “Oakland issued licenses and regulations, and Los Angeles did nothing and they are still unregulated,” Mr. DeAngelo said. “Cannabis is being distributed by inappropriate people.”

I don’t know where Los Angeles will go with all this, or how well Harborside will continue to operate for how long. What I do know is that marijuana serves a real medical purpose. Probably serves a real recreational purpose too, and there’s the rub; but since I missed the pot party — thank heavens, as I am addicted to anything that comes down the pike, and please don’t try to tell me one cannot get addicted to marijuana — I can’t address that issue. Everything I know is anecdotal, but convincing.

Decades ago my beloved sister was suffering acute gastro intestinal distress, much later identified as a symptom of celiac disease but this was before anybody really knew anything about celiac sprue. One day she said, “You know, everybody at X High School either smokes pot or knows where to get it. Could you get me some so I could at least try it?” Well, even though the statute of limitations would probably protect the surviving players I think I won’t go into details of this adventure. But what I learned was: buying and selling illegal pot is a little scary for the novice, but the deal was easy and nobody went to jail. It did indeed give relief to my suffering sister. Though both of us wished she could have that relief on an ongoing basis, we reached a mutual conclusion that the risk was not worth the reward, and that was the end of that.

Fast forward to the 1990s, when everyone I knew with AIDS knew how marijuana could relieve some symptoms of the disease, and most had a supply. I was in San Francisco by then, and celiac disease pales in comparison to AIDS. I don’t even recall how legal it was for this relief; too many other issues were more important. But again, I saw its usefulness.

The Times article quotes Christine Gasparac, a spokeswoman for California Attorney General Jerry Brown, as saying his office is getting calls from law officials and advocates around the state asking for clarity on medical marijuana laws. I know that’s tough, and that the answer will in many cases be left to the courts. I also know that legalizing marijuana, whether here in woo-hoo California or elsewhere, raises a multiplicity of sticky issues.

But still. It’s a useful drug. If Big Pharma were producing and marketing it, it would probably come in a little pill that costs a fortune and would be covered by expensive insurance policies. Every governmental body in the U.S. needs money. Taxes raise money. Are there not some dots that could be connected here?