Medical marijuana at legal, clinical crossroads
April 12, 2007
Kristen Gerencher, Dow Jones MarketWatch
Phillip Alden credits marijuana with stimulating his appetite and suppressing what he describes as debilitating foot pain that comes from an AIDS-related condition known as peripheral neuropathy.
The Redwood City, Calif., man who once relied on a cane has returned to active living, thanks to modern AIDS drugs and the pain relief he gets from pipe-smoking two or three hits of marijuana nearly every night, he said. "Today I hike, I go for walks, I Rollerblade, I work out regularly. I do everything your normal, active healthy person who doesn't have AIDS does."
"There is nothing better that works for peripheral neuropathy than medical marijuana," said Alden, 43, who was diagnosed with AIDS in 1994 and began using cannabis three years later.
Early scientific studies suggest his experience is more than psychosomatic. A study of 50 HIV patients published in the Feb. 13 edition of the journal Neurology found that patients who smoked cannabis had a 34% reduction in HIV-related intense foot pain compared with patients who smoked a placebo.
The medical and legal systems are just catching up with what some patients say is a critical last resort for pain management. Despite being at odds with federal drug policy, a growing number of states are willing to protect patients like Alden from the threat of arrest or criminal prosecution when they use marijuana for medicinal purposes.
Two weeks ago, New Mexico joined the ranks of 11 other states -- Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, Rhode Island, Vermont and Washington -- in shielding patients with a range of serious conditions who use medical marijuana with their doctors' approval. It is sometimes used to treat conditions such as AIDS, multiple sclerosis, cancer and glaucoma that cause symptoms including pain, nausea and spasms.
There's just one hitch: the federal government says its law takes precedence over state laws, and the Drug Enforcement Administration can and does seize evidence and make arrests that can lead to jail time. Unless Congress changes the law, which now classifies marijuana as a Schedule 1 drug -- meaning it's highly addictive and has no medicinal value -- the agency's marching orders are clear.
Camilla Norman Field, deputy director of the Drug Policy Alliance, an advocacy organization, said: "It's a situation where policies and science are nowhere near aligned with each other, as with most issues that have a moral edge to them."
Life in legal crosshairs
Two recent court cases illuminate the precarious position patients are in as they light up at the intersection of conflicting laws.
Last month, a federal appeals court ruled that an Oakland, Calif., woman with an inoperable brain tumor and other painful ailments who challenged U.S. law on cannabis can face federal prosecution on drug charges, overriding California's law. Still, should she be arrested, the court left open the possibility that the patient, Angel Raich, could use medical necessity as a defense, said Joe Elford, chief counsel for Americans for Safe Access, an Oakland group that advocates legalizing medical marijuana.
Another case brought by authorities against marijuana activist Ed Rosenthal led to U.S. District Judge Charles Breyer's dismissal last month of the Justice Department's additional charges of filing false tax returns and money laundering, which the judge termed "vindictive" prosecution.
In March, the judge gave prosecutors a month to determine whether to continue the case against the "Guru of Ganja," whose 2003 conviction of felony pot-growing was overturned. On Friday, prosecutors announced they will retry Rosenthal on marijuana cultivation charges but won't appeal the dismissal of money laundering and tax charges.
"These prosecutors wield an awful lot of discretion, and we would like to see them use it in a way that doesn't go after sick and dying persons," said Elford, who has represented Rosenthal in the past.
Since Rosenthal's case began five years ago, the DEA generally hasn't conducted a raid without local law enforcement's consent, he said. "There's been some measure of restraint exercised by the federal government."
Still, more than 100 California defendants are facing trial on medical-marijuana charges, Elford said. Most of them are suppliers and not patients.
The cases exemplify the mutual mistrust between proponents and opponents of medical marijuana. Critics of the medical-cannabis movement accuse advocacy groups of exploiting patients to advance an agenda of making marijuana legal for general recreational use. Proponents say the federal government and conservative groups are pushing their multibillion-dollar war on drugs into an arena that unfairly punishes desperate, vulnerable people and their caregivers.
The Partnership for a Drug-Free America didn't return repeated calls for comment.
Regulating California's businesses
"California is the only state where there's a significant above-ground business in marijuana," said Bruce Mirken, San Francisco communications director for the Marijuana Policy Project, which recently attracted former Republican U.S. Rep. Bob Barr from Georgia as a lobbyist. See full story.
With visibility comes scrutiny. DEA agents raided San Francisco's HopeNet Coop dispensary in late 2005, taking marijuana plants, finished products and $15,000 in cash, co-owner Cathy Smith said. "What they didn't take they broke," she said.
Though she lives in fear of being arrested, she said she wants to continue helping the roughly 50 patients a day who count on her service. "We don't do much differently because we feel we were doing everything right to begin with, because we're following state law," Smith said. The lounge area in the three-room apartment she rents for the business is under construction to add city-mandated ventilation ducts and she's already widened doors to comply with the Americans with Disabilities Act.
An older, wheelchair-bound HopeNet patron named Clay said he visits about three times a week from Marin County because the price and product quality are superior to other clubs. Price is a major concern, because private health insurers typically don't cover medical cannabis. And California dispensaries are expected to tax sales.
The 20 to 25 daily pills Clay takes to control AIDS symptoms make him vomit unless he smokes cannabis regularly, he said. He knows because he tried stopping the marijuana routine and the vomiting resumed, making him miserable and unable to know if his body had absorbed his many medicines.
"If I have myself to a level where I don't get queasy I've conquered it," said Clay. "That's how important cannabis medication is to me. It stops that one major problem right there, and I'm not alone."
Keeping close watch
The threat of raids by federal investigators keeps many clubs on edge. But it's not just the federal-state legal tension that drives some to close. NIMBYism also plays a role. Some neighborhoods complain that the clubs create disturbances, disrupt traffic, attract crime, expose youth to marijuana and lead to secondary street sales.
San Francisco's Board of Supervisors tightened regulation in 2005, with a deadline for meeting new standards later this year. For example, new clubs have to be at least 1,000 feet from schools and recreational centers to get a permit from the public health department. Existing clubs within that distance aren't permitted to have on-site smoking. All dispensaries must be handicapped-accessible by July 1.
San Francisco's 32 distribution centers are mostly storefront operations, though one former storefront owner, Kevin Reed, turned his outfit into a mobile delivery business this year. See video interview.
In February, after the Neurology study on peripheral neuropathy was released, the Office of National Drug Policy reiterated its stance against medical marijuana. Its "Reality Check" fact sheets warned, "The delicate immune systems of seriously ill patients may become compromised by the smoking of marijuana. Additionally, the daily use of marijuana compromises lung function and increases the risk for respiratory diseases, similar to those associated with smoking nicotine cigarettes."
Research moves forward
But scientific inquiry presses on. The study that appeared in Neurology was just one of 11 that the Center for Medicinal Cannabis Research at the University of California-San Diego, established in 2000, has completed. Two more are now under review.
The National Multiple Sclerosis Society also is sponsoring a clinical trial of medical marijuana, said Nick LaRocca, associate vice president of health-care delivery and policy research for the nonprofit advocacy and research group in New York.
"What we're trying to do is to sponsor research to find out, comparatively speaking, the extent to which marijuana is safe and effective, the same approach we'd use with any other treatment that's proposed," LaRocca said. "We're open to the concept of marijuana as a treatment, but like any treatment it really has to be demonstrated through rigorous research. Marijuana isn't the only thing that people have reported to be beneficial."
There are some prescription-drug alternatives that are made from cannabis extracts or artificial ingredients. Approved in the U.S. for nausea and vomiting for cancer chemotherapy and appetite loss in patients with HIV/AIDS, Solvay Pharmaceutical's Marinol is a synthetic version of the psychoactive chemical THC and is available in capsule form.
GW Pharmaceuticals, a U.K. company, manufactures Sativex, a cannabis-derived spray that Canada approved in 2005 for the treatment of neuropathic pain in multiple sclerosis. GW and Otsuka Pharmaceutical Co. are researching and developing Sativex in hopes of earning Food and Drug Administration approval to treat cancer pain in the U.S.
Accounting for abuse
Alden, the AIDS patient, doesn't deny that some people abuse their access to medical marijuana.
"There are people who buy marijuana and supply it to people who don't have a card," he said. "However, what's the difference between that and people who abuse the prescription drug system?"
Dispensaries offer advantages to buying from street dealers, including price and stability, Alden said. The cannabis club he's frequented for the last five years not only has a stable address and set hours, but operates carefully, requiring patrons to show valid state-issued patient ID cards and keep the activity indoors, he said.
"I would rather not have to start seeking out street dealers again," Alden said of the possibility of having his club raided or shut down. "Street dealers tend to charge a pretty exorbitant price for the medicine. I get a pretty good price from the club."