Pubdate: Tue, 05 Dec 2000 Source: Akron Beacon-Journal (OH) Copyright: 2000 by the Beacon Journal Publishing Co. Contact: http://www.ohio.com/bj/ Forum: http://krwebx.infi.net/webxmulti/cgi-bin/WebX?abeacon Author: Cheryl Powell, and Katherine Spitz, Beacon Journal Medical Writers Cited: Oakland Cannabis Buyers' Cooperative http://www.rxcbc.org/ Northcoast NORML http://www.timesoft.com/ncnorml/ Bookmarks: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal) http://www.mapinc.org/mmjcn.htm (Cannabis - Medicinal - Canada) CANNABIS DEBATE Medicinal marijuana is illegal in Ohio, but some still use it to ease nausea, pain. For one 37-year-old Akron man who is HIV-positive, a daily regimen of 22 pills can be tough to swallow. The pills sap his appetite and often make him feel like vomiting, he says. But he has found an effective -- and illegal -- antidote that works wonders. The man, who asked not to be identified, smokes a marijuana joint about once a day -- roughly $50 worth per week -- to ease his nausea and keep his appetite strong. ``If I am nauseated, I can smoke a little bit and I want to eat,'' he says. ``It does the trick.'' Cases such as this Akron man's are at the heart of an ongoing debate about the appropriateness of using marijuana for medical purposes. In Ohio and all but eight states, it's against the law to use or possess marijuana, even if it's supposedly for medicinal use. The issue came to the national forefront last week, when the U.S. Supreme Court agreed to decide whether the drug can be used by patients with medical necessity, even though federal law makes its distribution a crime. The justices will hear the Clinton administration's effort to bar the Oakland Cannabis Buyers' Cooperative in California from providing the drug to seriously ill patients for pain and nausea relief. Physicians in California and the seven other states that allow medical use of marijuana can't prescribe the drug. Instead, doctors can write a letter recommending their patients use the drug, and the patients go to a state agency for approval to buy it. Even in Ohio and other states where it's illegal, an underground medicinal marijuana circuit exists -- often with the knowledge but not participation of physicians. ``My doctors know about it,'' says the Akron HIV patient who smokes marijuana daily. ``They have never discouraged me from doing it. I never had any negative reactions from any doctors.'' Two local physicians who are involved in end-of-life medical care say patients have talked about using street marijuana to relieve symptoms. However, neither physician helps patients obtain the drug. ``The question comes up,'' says Dr. Skip Radwany, an Akron internist who directs Hospice of SummaCare. ``There are patients who swear by it.` And the patients don't fit the stereotype of pot smokers. ``I have 80-year-old women who are using this to control the nausea related to their chemotherapy,'' says Dr. John Petrus, an Akron General Medical Center oncologist-hematologist who is also medical director for the Visiting Nurse Service hospice program in Akron. Among AIDS patients, illegal use of marijuana to help with side effects from medication is extremely common, says Marsha Michaels, a clinical counselor and a supervisor with Violet's Cupboard, a nonprofit agency in Akron that provides services for HIV and AIDS patients. ``They're not smoking to get high,'' she says. ``A significant number of my clients don't even really consider it a drug. They said, `I really consider this an herb that allows me to live healthy.' '' Supporters say marijuana can also be used as a relaxant or to ease pain. Additionally, investigators in England and the United States have found evidence that derivatives of marijuana called cannabinoids help control spasticity and tremor symptoms in mice with a disease similar to multiple sclerosis. But currently, the most common -- and most widely accepted -- medicinal use of marijuana is to combat nausea and stimulate appetite. Although nausea feels like one wretched sensation, it's actually a complicated series of events involving the brain and gastrointestinal system, Petrus says. There's an anxiety component to nausea. In other words, just thinking about being nauseated can make people feel more nauseated, he explains. Some theories exist that marijuana eases nausea by working on the thought processes that contribute to nausea. It might also affect the actual part of the brain that controls vomiting. Legal anti-nausea drugs have ``dramatically improved,'' in the past 10 years, but they don't work for everyone, Petrus says. Also, the active ingredient of marijuana is already available in a legal pill form with the trade name Marinol. But Petrus says even when he prescribes Marinol for some of his patients who have told him they have used marijuana medicinally, they say the legal drug is ``nowhere near as effective.'' And some people, such as migraine and seizure sufferer Eleanor Ahrens, complain they can't use the synthetic Marinol because of allergies. After years of suffering from health problems, the 47-year-old woman says she has used marijuana as medicine. When she had the visual disturbances or strange feeling that usually came before a migraine or seizure, she slipped some leaves into a cup of hot tea and slowly sipped her tension away. The American Academy of Neurology, which deals with the study of headache, seizures and other neurological problems, says it has taken no stand on marijuana use. But Ahrens says the marijuana-spiked tea helped her relax and relieve pain and anxiety during episodes. ``I thought, `It's organic, it's natural,' '' she says. However, her supply dried up considerably when she was arrested and eventually pleaded guilty to drug trafficking in 1996 after police found marijuana growing in the backyard of her Shalersville Township home. Ahrens now shares her story with others who come to visit her at the NORML Shop, a fund-raising store in downtown Ravenna that she manages for the Northcoast Chapter of the National Organization for the Reform of Marijuana Laws. The store doesn't sell drug supplies, but it does offer books about medical uses of marijuana. ``When you meet people who use marijuana as a medicine, it's usually as a last resort,'' she says. Northcoast NORML is working with state legislators to try to get a law passed allowing medical use of marijuana in Ohio, says chapter President John Hartman. For the most part, the mainstream medical community remains somewhat skeptical. Radwany, Hospice of SummaCare medical director, emphasized that more scientific research needs to be done on the medical uses of marijuana before it could be used with confidence by the medical profession. He compares it to the use of legal herbal supplements -- they're widely used and available, he says, even though there's not enough research backing their safety. Petrus predicts that if medicinal marijuana is approved, it will only have use on a limited basis. ``There might be a niche for it, but it's not going to be like Zantac or Tagamet,'' he says, referring to two popular drugs used for gastrointestinal upset. A recent report issued by the Institute of Medicine and funded by the federal Office of National Drug Control concluded that more research should be done on the medicinal effects of marijuana. The report advocated compassionate use of marijuana be allowed under certain, narrow circumstances. It also advised against the use of smoked marijuana for medical problems and called for the development of a medical inhaler for marijuana. The Akron HIV patient who regularly uses marijuana agrees the drug deserves more attention. ``Definitely, I think it's time the laws changed,'' he says. ``I think if they really looked into it, they would see more benefits. I do think it could be an alternative to a lot of the prescription drugs that are out there.'' - --- MAP posted-by: Doc-Hawk