Rx: Cannabis

Having addressed alcohol yesterday, I might as well put down $5 on a Daily Double ticket and move on to marijuana today. I’m not ready to join NORML or leap into Woody Harrelson’s arms and embrace the legalization of marijuana, but I’m beginning to wonder if that leap is as ill-advised as common wisdom declares it to be. Frankly, I’ve yet to come up with a real crackerjack response to the question of why we allow the almost unrestrained consumption of alcohol and yet forbid any use of marijuana. Both can be abused; both can create a form of dependence; both are less than kind to brain cells; both can affect the appetite; both produce an altered sense of reality or euphoria. I also have to admit that I can’t recall ever hearing about marijuana being a factor in sexual abuse, domestic abuse, road rage or other forms of violence. Weed users have been known to attack a t-bone steak or a plate of pasta, but everything else is fairly safe around them. Like I said – I’m beginning to wonder.

However, when it comes to the use of medical marijuana, I made the legalization leap as soon as I heard it is effective in alleviating pain, nausea and glaucoma and in stimulating appetite for patients whose medical treatment has killed their desire to eat. I’ve yet to hear a persuasive argument in opposition to allowing medical marijuana to be prescribed for regulated use under the care of a doctor. After all, doctors prescribe just about every other controlled substance known to mankind, most of which can be and are used and abused by every manner of patient. I’ve heard arguments such as:

· We can’t trust doctors to prescribe marijuana in a responsible manner. We trust them with everything else they prescribe; what’s different here?

· Marijuana isn’t effective. How many other drugs are the subjects of studies that question their effectiveness; how many others that are supposedly effective don’t actually work for certain patients or ailments? Besides, this argument taken to its logical extension would not allow the use of placebos, which are harmless by definition.

· Patients who feel that they’re helped by marijuana are kidding themselves; it’s a placebo effect. Okay, so what? If a placebo is effective in relieving pain or nausea for a patient, for whatever reason, how does that make it less valuable than another substance that relieves pain or nausea for another patient?

· The patient could give their prescribed marijuana to others. Perhaps; but, again, that risk is no greater than a patient sharing other pain meds with someone else.

Cannabis has been used for medicinal purposes for over 4,800 years. It was used throughout the world in the 1800s until the development of aspirin made it less popular. When its commercial use was effectively prohibited in the U.S. in 1937 the only opponent to the initial legislation was, interestingly, the American Medical Association. It remained in the U.S. Pharmacopeia until 1942.

The only reason I can see for this anachronism is that we made a moral judgment about marijuana in the 1930s and then in a storm of religious and political fervor we expanded that judgment to near hysteria, as captured so well in the bizarre 1936 movie, Reefer Madness. Perhaps the nadir on this subject was reached in 1996 when Newt Gingrich proposed H.R. 4170 which mandated the death penalty for a second offense of smuggling more than 50 grams of pot into the U.S. While that special piece of conservative madness was rejected, we can’t back down from our 70-year old position because that involves admitting a national error, which is not an American strong suit.

Here’s the fun fact of the day: cannabis is mentioned in the Hebrew Bible in Exodus 30:23 where God commands Moses to make a holy oil that includes cannabis and to use it to anoint the Ark of the Covenant and the Tabernacle. Needless to say, the ancient Hebrew God was a bit touchy about what was allowed to touch the Ark or the Tabernacle, so this command from On High is about as far from Reefer / Gingrich Madness as one can get. By the way, the Hebrew words for cannabis mean “reed of balm”. “Balm” is a great word for this discussion, because that’s what patients who need it are seeking. Of course, what do those old Hebrew people know?

The U.S. Supreme Court has unanimously ruled that there are no permitted exceptions to the marijuana prohibitions imposed by federal law, thus effectively gutting any state laws that take a contrary position. Therefore, it will take a revision of federal law or a new approach to the Supreme Court to get the status quo changed.

A new case is headed to the Supreme Court involving a woman who argues a “right-to-life theory”, asserting that marijuana use should be allowed if it’s the only viable option to keep a patient alive, by stimulating appetitive, or free from excruciating pain. This woman suffers from a brain tumor and scoliosis. The government is opposing this argument on the same basis as prior arguments – there’s no medical value to the drug and no exception allowed under federal law. I suspect the government will win.

This debate will be settled only when a critical mass of public opinion forms around the issue of relieving pain and nausea for seriously ill patients. Some patient will galvanize this issue for the public and the large numbers who have supported various state efforts to legalize medical marijuana will finally be heard in Washington, DC. Washington has been unable to hear the cries for help from people who are suffering, but they are always able to hear the demand for change from people who go into voting booths.

Power to the people.