Pubdate: Sat, 25 Apr 1998 Source: Oregonian, The Section: OpEd - pg E9 Contact: http://www.oregonlive.com/ Authors: Richard Bayer, MD and Nancy Crumpacker, MD INITIATIVE A REACTION TO DRACONIAN LAWS Doctors Should Be Able To Prescribe Marijuana In two recent columns, Robert Landauer has tackled the issue of marijuana's medical uses, and how public policy should react to evidence of its benefits. Oregon voters are likely to face this issue this fall as a result of the Oregon Medical Marijuana Act. Landauer concludes that the scientific evidence to date is too weak or unreliable for marijuana to become a prescription medication. He rightly chides the federal government's knee-jerk anti-marijuana policies for blocking research that could have solved the question before now. Still, his position -- increasingly common among medical professionals as well -- begs the question: What do we do with patients who benefit from marijuana now, but must break the law to use it? Our initiative asks voters to end the risk of state criminal penalties faced by these seriously and terminally ill patients in a sensible, regulated way, brokering a peace of sorts while science continues its investigations. To reach a do-nothing position, Landauer and others tend to rely on an understatement of the knowledge that exists about marijuana's medical value. Wait for more research, they argue. Many share Landauer's fear that "personal anecdotes will dominate the public discussion" of this year's ballot initiative. In fact, there's more value to these much-derided "anecdotes" than he implies, and there's more scientific support for marijuana's value than most people know. Good clinical doctors seek anecdotal evidence from patients to help with diagnosis and treatment. This is especially true when managing problems such as nausea and pain, which are almost totally subjective. In fact, it would be impossible to evaluate any anti-nausea or anti-pain medicine without the use of important anecdotal evidence. And, when thousands of patients come forward, all describing the same phenomena, it is time to put politics aside and accept the obvious truth that some patients benefit from the medical use of marijuana. Scientific data collected in studies of marijuana in the 1970s and early 1980s are also stronger than most people realize. The American Medical Association's Council on Scientific Affairs summarized those findings in a December 1997 report that Landauer quoted mainly for its more ambivalent passages about marijuana's value. The report states: [Both survey and data derived from placebo-controlled single dose studies indicate that smoked marijuana stimulates appetite in normal subjects. Smoked marijuana was comparable to or more effective than oral THC . . . in reducing nausea and emesis (vomiting). Anecdotal, survey, and clinical data support the view that smoked marijuana and oral THC provide symptomatic relief in some patients with spasticity associated with multiple sclerosis (MS) or trauma. Smoked marijuana may allow individual patients to self-titrate their dosage to the point of therapeutic benefit, while minimizing undesirable psychoactive effects. It also provides a method of more rapid onset and offset than oral THC. The existence of Marinol, an imperfect substitute, and a tangle of federal regulations and political opposition all get in the way of proving, finally, whether and how marijuana works for some kinds of patients. Currently, marijuana is classified federally as a Schedule I drug, meaning doctors cannot prescribe it, even to dying and suffering patients. It is time that the federal government moved marijuana to Schedule II, both to expedite research into its medical uses and to allow patients to have access to marijuana under medical supervision, just like morphine. In the end, the debate over medical marijuana is about dying and suffering patients. It's about providing these patients with effective means to control the disabling symptoms they often face with terminal or chronic debilitating illnesses. We say, let us hear from the patients. If marijuana helps them, then they should have access to it, under strict regulations, such as those in the Oregon Medical Marijuana Act. - ---- Rick Bayer, MD Chief Petitioner, Oregon Medical Marijuana Act 6800 SW Canyon Drive Portland, OR - 97225 503-292-1035 (voice) - 503-297-0754 (fax) - (email)