Pubdate: Sun, 26 Apr 1998 Source: Oregonian, The Contact: http://www.oregonlive.com/ Author: Patrick O'Neill of The Oregonian staff STATE'S PHYSICIANS DEBATE MEDICAL VALUE OF MARIJUANA * The Oregon Medical Association considers whether to take sides on proposed ballot measures allowing medical use of the drug and restricting abortion GLENEDEN BEACH -- Oregon physicians are deciding whether to weigh in on two controversial issues headed for voters this fall. One proposed ballot measure would legalize the use of marijuana for medical purposes; the other would ban abortions after the first 12 weeks of pregnancy. On Saturday, the governing body of the Oregon Medical Association, which represents 5,800 of the state's 8,300 physicians, wrestled with whether to lend the association's weight in political battles on the two issues. The association's governing body, the house of delegates, will vote on those and other issues this morning. On Saturday, in sometimes-heated debate, doctors offered widely differing opinions on the wisdom of legalizing the smoking of marijuana in medical therapies. Dr. Charles E. Hofmann of Baker, past president of the OMA, urged the group to adopt an American Medical Association report recommending a ban on medical use of smoked marijuana until experiments have proved its usefulness. But Dr. Richard Bayer, a Portland internist and a chief petitioner for the marijuana initiative, told the group that plenty of evidence shows that smoking marijuana relieves nausea caused by chemotherapy and some symptoms of pain. He also said it is effective in fighting weight loss in AIDS patients. Bayer said he and other physicians have seen enough patients who have benefited from marijuana that he is convinced of its effectiveness. Bayer agreed that more study should be done. But the measure would "broker a peace of sorts while science continues its investigations," he said. Dr. Nancy Crumpacker, a Portland oncologist and Bayer's wife, echoed his sentiments. "I've seen medical marijuana work many times," she said. Some physicians oppose legalization of medical marijuana because they say it could open the door to unscientific practices in medicine. Dr. Kathleen Weaver, medical director for the Oregon Health Plan, said patients' desire for marijuana shouldn't be a factor in using it for medical purposes. "If demand dictates what we use, it will expand into other areas including alternative medicines," she said. She urged the members to wait until studies prove that marijuana is safe and effective. Dr. Esther M. Gwinnell, a Portland psychiatrist, chided opponents of medical marijuana for maintaining a "superstitious fear" of the drug. She said fears that using marijuana for medical treatments will foster abuse of the drug are wildly exaggerated. The most heavily abused drugs are prescription medications, she said. "Most of my patients will jump over 75 pounds of marijuana to get to four Dilaudid pills," she said. Dilaudid is a prescription pain medication. She reminded the group that the potential for abuse doesn't automatically mean there are no beneficial uses for a drug. Some doctors oppose using marijuana because a synthetic drug, Marinol, which contains one of marijuana's active ingredients, is effective for reducing nausea in cancer patients. Dr. Lonnie Bristow, past president of the American Medical Association and now a consultant for the manufacturer of Marinol, told the group that Marinol does work for "a substantial number of cases." He said smoking marijuana has too many unknowns for it to be considered safe. Bristow said he is donating his consulting fees from Roxane Laboratories, the maker of Marinol, to medical and nursing schools. Doctors also spent time discussing the battle about abortion in the general election. Dr. Leigh Dolin, a Portland internist and a member of the steering committee of Pro-Choice Oregon, asked the group to support a resolution to oppose efforts by Lon Mabon and the Oregon Cititens Alliance to ban abortions after the first 12 weeks of pregnancy. Dolin called the proposed measure "an unprecedented attack on the physician-patient relationship." The choice to terminate a pregnancy should be made by "the woman herself, possibly in consultation with her physician - -- not by Lon Mabon and the OCA." Dr. Zena I.P. Monji, a Eugene obstetrician-gynecologist, warned that the proposed abortion ban would make it virtually impossible to terminate pregnancies in cases where tests indicated birth defects, such as Down syndrome. As older women choose to have children, she said, tests such as amniocentesis become increasingly important. Amniocentesis cannot be performed until after the 12-week cutoff. The risk of having a child with Down syndrome is one in 350 after age 35, she said.