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Medicinal Marijuana: A Patient-Driven Phenomenon
by RICHARD
KNOX
June 14th 2010
Fourteen
states and the District of Columbia have launched a
medical experiment that
doesn't follow any of the rules of
science. By approving the use of marijuana
as a medicine —
with varying kinds of restrictions — these jurisdictions
are
bypassing the federal government's elaborate processes for
approving
medicines.
That's
highly unusual. In fact, it's only happened once in recent memory: In the late
1970s, about half the states legalized the use of laetrile, an extract of
apricot pits, as a cancer treatment. At least 50,000 cancer patients took it
before it was exposed as totally useless.
Nobody
argues that marijuana is the new laetrile. For one thing, nobody's claiming it
cures any fatal diseases. But it is a departure from the usual rules of
evidence for drugs.
Struggling
With Chronic Illness
If
you want to understand why it's happening, you should spend some time with
Ellen Lenox Smith of suburban Rhode Island: a lively, petite, 60-year-old
grandmother, former schoolteacher and one-time master swimmer.
When
you meet Smith, you don't suspect anything's seriously wrong with her health.
But in fact, she has two incurable diseases: One, called sarcoidosis, is
ravaging her lungs. The other makes her tendons and ligaments loose and
fragile.
"My
knee tore, and two weeks later the other knee tore," Smith says.
"And the same thing with my shoulder. It was one shoulder and then the
other shoulder. So I was tearing like tissue paper, and no one knew why."
After
years of misdiagnosis and surgical repairs, Smith learned she has a rare
genetic disease of connective tissue called Ehlers-Danlos syndrome.
"My
condition causes pain throughout the entire body," Smith says. Most
people with Ehlors-Danlos "live on morphine and OxyContin," she
says, but she has bad reactions to these and nearly all other painkillers.
"I can't tolerate them."
An
Unlikely Prescription
Feeling
desperate with pain and suffering sleepless nights, Smith consulted pain
specialist Dr. Pradeep Chopra. This was about four years ago, just after Rhode
Island became the 11th state to legalize medical marijuana. Chopra had never
recommended marijuana to a patient, and he never imagined he would.
But
in Smith's case, he says, "she had absolutely no other option. So very,
very hesitantly, I said, 'Listen, why don't you try medicinal marijuana?'
"
Smith
says, "I can remember laughing and thinking, 'I wish my parents were
alive to hear this conversation!' You spend your life being told to stay away
from certain things, and here I have a doctor suggesting it could help
me."
Smith
appealed to one of her adult sons, who scrounged some pot from a friend.
Because of her lung condition, she couldn't smoke it, so she soaked it in oil
and stirred the oil into applesauce.
"I
tried it that night — scared to death! I mean, I had no idea what to
expect," she says. "The only time I'd ever tried marijuana was once
in college, and it was so horrible. So I was really nervous about it.
"But
it was so amazing! I took this oil, went to bed, and the next thing I know, it
was morning," Smith says. "I had literally slept through the entire
night for the first time in months."
Patient:
Marijuana Saved My Life
She's
used marijuana ever since — sometimes during the daytime, too — and says
she's never gotten high from it.
"I
wake up in the morning, my head is clear, I read the papers, do my Sudoku
puzzles, and my mind is fine," she says. "Somehow this drug attacks
pain, and I get pain relief but I don't get stoned."
This
point is controversial. Some researchers believe patients who use marijuana
medically do have psychoactive effects, but they have the effect of shifting
patients' attention away from their pain, perhaps in addition to a direct
pain-relieving effect. JoAnne Leppanen of the Rhode Island Patient Advocacy
Coalition says: "What pain patients tell me is, 'Cannabis does not get
rid of my pain. It's still there. But I don't care so much.' So it's affecting
their mental attitude."
For
Smith, relief is far from total, but she can deal with her pain now,
especially since she sleeps well. Smith says marijuana has saved her life.
"My
husband says it, too," she says. "I don't think I'd be here. I think
I probably would have passed away if I didn't have this drug. There was
nothing — nothing left to help me."
A
Slippery Slope?
Smith
is exactly the kind of patient legislators have in mind when they allow
marijuana to be used as a medicine. But some think legalization is dangerous.
"Approving
medical use of marijuana by political referendum is a slippery slope,"
says Joseph Califano, director of the National Center on Addiction and
Substance Abuse at Columbia University. "What's the next substance we'll
approve by political referendum?"
Califano
was U.S. Secretary of Health, Education and Welfare during the laetrile
period.
"We
have the best system in the world for clearing drugs in the Food and Drug
Administration, and that's the system we should follow," he says.
There
was a time when Califano's view was the prevailing opinion, but that may not
be the case any more. It seems that many in the medical world who once were
dead set against medical marijuana are now not so sure.
The
FDA specifically opposes smoking marijuana for medical purposes. But
spokeswoman Karen Riley said in an e-mail message that the FDA "is
willing to consider proposals by investigators to conduct clinical trials
using marijuana."
"We
do have a number of open investigational new drug applications that study
marijuana," Riley writes. "Some of these study the ability of
marijuana to treat disease or medical conditions. Some use marijuana to assess
treatments for addiction. Some could study the physiological or pathological
effects of marijuana in the body."
Problems
With Researching Pot
However,
scientists say doing research with marijuana requires the patience of Job,
largely because the federal government still classes marijuana as a Schedule I
controlled substance with no legitimate medical use. That status requires
researchers to get a license from the Drug Enforcement Administration, part of
the Justice Department. The DEA relies on the National Institute on Drug
Abuse, or NIDA, for advice on research proposals.
"I
know one research group who says it took a year to get feedback from NIDA,"
says Dr. John Halpern of Harvard Medical School and McLean Hospital.
"Then when they resubmitted their proposal, they got another set of
criticisms."
The
director of NIDA, Dr. Nora Volkow, declined to be interviewed about medical
marijuana.
Research
Has Made Headway
But
other people in the field are open-minded about the medical uses of marijuana.
Take Dr. Glen Hanson, for example. He's a former acting director of NIDA and
still advises the agency. He does drug research at the University of Utah, and
he heads the Utah Addiction Center.
Hanson
is familiar with the scientific evidence on marijuana. Running through a list
of things some people claim marijuana's good for, Hanson says there is
legitimate support for many conditions.
Pain,
for instance. "Yes, there's some significant evidence that it's useful in
some types of pain," Hanson says.
Multiple
sclerosis? "That's more controversial," he replies. "There are
clearly some individuals with multiple sclerosis who say that it helps
them."
Glaucoma:
"There is some [evidence], but again, controversial."
Seizures:
"Again, some evidence that it may be useful in dealing with some
seizures."
The
list goes on. Hanson says there's evidence for some other claims, but not for
others.
The
thing scientists are really excited about, Hanson says, is the discovery that
many organs in the human body and brain have receptors for the chemicals in
cannabis. That observation was first made in 1988, but over the past 10 years
scientists have done a lot of work to figure out how these receptors work.
"This
area has exploded," Hanson says. "If you're asking is this a system
that can be targeted for therapeutic benefit, I think everybody who knows the
scientific pieces would acknowledge that potential."
Long
Way To Go
But
much of the research is in test tubes and animals, not in real patients with
real diseases. Human marijuana research is spotty, studies are small and
short, and results are conflicting. So there's a big gap between the
testimonials — like Ellen Smith's — and the science.
Hanson
has no doubt that cannabis research will lead to important new designer drugs
for a number of maladies. But he has no idea when.
"We
don't have a timeline," he says, "Is it going to be five years, 10
years, 20 years? That doesn't satisfy and meet the needs of people who are
suffering today. So for me, I have no problem using what we've got — and
today we have marijuana."
Patient-Driven
Movement
Chopra,
Smith's physician, agrees. But he's not without misgivings.
"With
medicine, we are used to prescribing a fixed dose with a fixed time interval
so we can monitor the side effects or the efficacy of a drug," Chopra
says. "With medicinal marijuana, it's the other way around. We have no
control over the dose or how often it's taken. And so it's really up to the
patients to experiment on their own and figure out how much they need and how
often."
At
the same time, Chopra believes marijuana should be available to patients with
no other good options. It's the patients who are driving this movement, he
says.
"The
people have spoken," Chopra says. "It's basically the people who
have come up and said, 'It does help us, look at us, we're doing well.'
They're telling the establishment, 'You're wrong,' and the establishment has
listened to them."
At
least important parts of the establishment are listening. President Obama has
said his administration has no interest in prosecuting doctors and patients
who use marijuana — as long as their state allows it.
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