By Deborah J. Saunders
Rocky Mountain News - Sunday, November 17, 2002
If the federal government was right in saying medical marijuana has no medicinal value, why have so many doctors risked their practices by recommending its use for patients with cancer or AIDS? Marcus Conant, the doctor who identified the first cases of Kaposi's sarcoma among San Francisco AIDS patients, can answer that.
Imagine you're the doctor for a 40-year-old lady with breast cancer. They put her on chemotherapy, and every time she takes her therapy, she throws up. She can't sleep; she's up sick all night. She has trouble caring for her children.
Medical marijuana can alleviate her nausea and give her an appetite.
Conant wouldn't write her a prescription for medical marijuana. He can't. But he would write a note for her file recommending marijuana.
Since his patients have access to their files, they can present a copy of said note to a marijuana club authorized by California's Proposition 215. If they use the note, well, that's their business.
Conant sued the federal government to prevent federal law enforcement from investigating or punishing doctors who exercise their First Amendment right to recommend medical marijuana. Last month, a Ninth Circuit Court of Appeals panel ruled in his favor.
The Feds had argued that recommending marijuana was analogous to prescribing it, but the court agreed that this advice entailed "dispensing of information." That distinction goes to the heart of the matter…. the ability of doctors to give their best advice to people who desperately need it.
Why not prescribe marinol, the legal pill form of marijuana? Conant said that some patients don't respond well to it, and that it takes 45 minutes to work. If they take too little, it doesn't work at all. If they take too much, they fall asleep and don't eat.
My friend Julia, who is battling cancer, occasionally has used marijuana to help her sleep, but not too often. Too much pot makes her think about dying. Still, Julia knows other cancer patients for whom cannabis is "the only thing that stands between them and a complete inability to get down food." Cancer patients may take as many as 12 medications a day. They juggle which pills they can take with or without food, and with or without other drugs. There's something to be said, Julia added, for a drug that you can smoke at any time.
It's not clear whether federal drug czar John P. Walters will appeal the decision.
My advice: Don't.
Walters also should reconsider his opposition to medical marijuana. Walters complains that advocates use sick people's pain as a platform to legalize pot for everyone. Legalize medical, though, and you take away that high ground.
It won't happen, said Daniel Abrahamson of the Drug Policy Alliance, because, "The drug czar's office can't abide the thought of losing any ground or having any legitimacy given to the issue of medical marijuana." Walters' spokesman, Tom Riley, resents "this caricature; it's very frustrating. 'Oh' they're drug warriors. They don't care that people are suffering and in pain.'"
Riley doesn't deny that marijuana can make patients feel better. A cigarette, he said, can make an emphysema patient feel great. His bottom line: The federal government doesn't make medical policy based on anecdotes.
But when the anecdotes are so plentiful, there's something missing in the research. Then nurses wear Prop 215 pins; they surely know something that the Feds don't.
Conant, 66, has no use for a system that won't let him alleviate misery. He closes his eyes, leans back in his chair and mutters, "To deny sick people relief because of abuses is not humane."
Debra Saunders is a columnist with the San Francisco Chronicle