The Des Moines Register
Thursday, December 5, 1996, Page 16A


Marijuana: What's the fuss?

An Iowa woman smokes it legally.
Why can't others, by prescription?

        Lost in the dust kicked up by the suddenly renewed storm over legalizing marijuana is the fact that the drug has been legal for 10 years, in pill form.  Distributors in Cedar Rapids and Omaha supply the prescription pills to Iowa, and it's on the approved list for the poor.  In fiscal `96, Iowa Medicaid paid $17,500 for the drug, trade name Marinol, at $4.63 per pill, primarily for treatment of nausea caused by cancer chemotherapy.
        In theory, the pill is the therapeutic equal of the cigarette.  The U.S. Public Health Service has found no evidence that smoking marijuana provides any greater therapeutic value than Marinol, whether used to treat glaucoma, multiple sclerosis, AIDS, or any of the other conditiom for which it's prescribed.  The National Institutes of Health agree.  Others - including an Iowan who has used both legally - disagree.
        Meanwhile, months of stormy debate in California and Arizona over legalizing marijuana for medical use came to a head last month when voters in both states said yes, by comfortable margins.  But far from putting the matter to rest, the vote has shifted the argument to the national stage.  In congressional hearings this week, the two states' actions were blasted as part of an insidious national drive to legalize drugs and push users toward harder stuff.
        With the pill form available, and two medical/scientific branches of the federal government contending that the effects of the pill and the cigarette are equivalent, why the fuss over making marijuana cigarettes available through medical channels?
        Because they're far from equal, according to an Iowa victim of multiple sclerosis.  Marijuana cigarettes work for her.  Marinol doesn't.
        Barbara Douglass of Storm Lake is one of only eight Americans provided with legal marijuana cigarettes through a U.S. Food and Drug Administration program for "compassionate" relief.  She became ill with multiple sclerosis in 1988.  She was given a prescription for Marinol, and found it far too powerful.
        "You took Marinol, and the Marinol took you," she said.  "It's too heavy, too strong."
        The pills came in a gel form whose dosage was difficult to regulate, she said.  It would "knock out everything you wanted to think, say and do."
        She continued the treatment for three months in 1991 and told her doctor it was not helping.  Then a lawsuit temporarily opened a tiny window of opportunity that allowed distribution of marijuana cigarettes to a handful of people, she among them.  The cigarettes come from North Carolina's Research Triangle.
        The advantage of smoking marijuana, she said, is that you can adjust the dosage as needed to ease your pain, simply by the number of draws on the cigarette before setting it down.  She smokes 10 per day.
        But while Marinol failed her, Douglass said, it worked for a friend.  It eased the pain and nausea caused by the chemotherapy after surgery for breast cancer.

        Some who favor legalizing marijuana cigarettes argue that Marinol contains just one of several substances in marijuana that provide pain relief.  The contradiction between that contention and the findings of the PHS and NIH may be worth further study.  But the fundamental issue of legalization remains:
        Should doctors have the prerogative to presribe dangerous and possibly addictive drugs when they think their patients need them?  And the answer is the same, whether the drug be marijuana, morphine, codeine, Demerol, or any of a bunch of others on the "controlled substance" list: Yes.  To deny doctors all the tools that should be available to them is to let those who misuse drugs dictate medical policy.
        Far from weakening either our laws or our resolve in the war on drugs, recognizing the value of some misused drugs helps to dispel the notion that our policy is grounded in hysteria.