Pubdate: Wed, 21 Apr 2004 Source: Rutland Herald (VT) Copyright: 2004 Rutland Herald Contact: http://rutlandherald.nybor.com/ Details: http://www.mapinc.org/media/892 Author: Paul E. Jarris Note: Paul E. Jarris, M.D., M.B.A., is Vermont's commissioner of health. http://www.healthyvermonters.info/admin/jarrisbio.shtml Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal) Bookmark: http://www.mapinc.org/opinion.htm (Opinion) LEGISLATURE ASKED TO PLAY DOCTOR As a family physician caring for patients for over 20 years, I have had the unfortunate experience of prescribing medicine that later turned out to have unintended consequences, to have actually caused harm to my patient. This can and does happen, even when doctors are careful to stay up-to-date on the latest scientific developments, and even when they are fully informed about their patient's symptoms and conditions. Good doctors take care to minimize the risks of bad effects. Together with our patients, we carefully consider the benefits and risks of a medication based on the individual's needs, history, health condition and possible interactions with other medications. We learn to prescribe doses conservatively, and to monitor reactions closely - increasing or decreasing dosages or discontinuing drugs according to the effect they are having. Any doctor who made a habit of prescribing a drug for a patient without specifying the strength of the drug, or the amount or frequency of the dosage, could expect to be brought before the Medical Practice Board on charges of unprofessional conduct. Yet the Vermont Legislature is being asked to approve a bill that would require me, as the commissioner of health, to approve the use of marijuana by severely ill and debilitated patients. There is no legal source from which to obtain this marijuana, and there could be no control whatsoever over the quality or potency of the drug or the size or frequency of the dosage. In this compassionate attempt to ease the suffering of Vermonters, we are likely to cause harm. While little is known about the effects of over 400 chemicals in the leaves, sticks and flowers that are part of smoked marijuana, severely ill or debilitated patients may be particularly vulnerable to adverse consequences. Potentially life-threatening effects known to be caused by the chemicals in marijuana include elevated heart rate, sudden fall in blood pressure when standing up, and a diminished ability to fight off lung infections. How many heart attacks, strokes, falls and pneumonia would I cause my patients to suffer if I were to advise them to consume marijuana? The fact is that neither the Legislature nor I know. Some have argued that our compassion for the suffering of the patient should outweigh concern over the harmful effects of these poorly studied chemicals. Such a notion implies that severely ill individuals are not deserving of both compassionate care and the best possible treatment that medical science and dedicated clinicians have to offer. I reject that notion. The bill is called S.76, "An Act Relating to the Medical Use of Marijuana." Here's what it would do: * A patient with a debilitating medical condition who is experiencing chronic pain could get approval from his or her attending physician for the medical use of marijuana. * The paperwork would then come to the Health Department, where we would be required to verify the accuracy of the medical records and the appropriateness of the approval. * The patient and his or her caregivers would then get a piece of paper authorizing them to grow up to seven plants and possess two ounces of marijuana, and for the patient to consume it. As commissioner of health, I find aspects of this proposal unacceptable - even before we get to important questions of whether administering marijuana to patients is good medicine or makes sense as public policy: * The Health Department is not equipped to offer what would amount to second opinions on the long list of diseases and conditions enumerated in the bill. Nor, in good conscience, could we simply rubber stamp the requests that came in. * But even more importantly, this bill calls for the state of Vermont to approve and enable the administering of a drug to a vulnerable population with no controls over potency, dosage or efficacy whatsoever. This isn't just a matter of the Legislature playing doctor; this bill asks the Legislature to play negligent doctor. * Finally, S.76 would put me and any subsequent health commissioner in a legal bind. The law requires that the Vermont health commissioner be a physician, and yet this bill would require me to commit two acts that could be viewed as unprofessional in the eyes of the Medical Practice Board: It would require me to routinely approve medication without the controls mentioned above, and it would require me to participate in the routine violation of federal law, which prohibits the medical use of marijuana. Much as I respect the laws of Vermont and the Legislature that makes them, I find S.76 both legally and ethically untenable. - --- MAP posted-by: Richard Lake