Supporters of Marijuana Bill Concede Problems

Supporters of Marijuana Bill Concede Problems
Posted by CN Staff on January 03, 2006 at 22:54:04 PT
By Felice J. Freyer, Journal Medical Writer
Source: Providence Journal
Providence, R.I. -- The medical marijuana law that passed yesterday allows doctors to recommend that patients obtain from illegal sources a drug of unknown potency and unknown purity. This is not how doctors normally prescribe treatment.But if the longstanding support of the Rhode Island Medical Society is any indication, many are willing to go this route -- because of the potential benefits to patients who can't get relief from pain, nausea, muscle spasms and other problems.
Even supporters of the concept, however, admit that it's "weird."Under the new law, a doctor, a nurse practitioner or anyone else permitted to write prescriptions can sign a statement attesting that "the potential benefits of the medical use of marijuana would likely outweigh the health risks" for a patient with a "debilitating medical condition."With this certification, the patient can apply for a card from the Health Department that prohibits prosecution by state authorities for growing or possessing marijuana. (Under a U.S. Supreme Court decision earlier this year, however, the federal government can prosecute.)The law doesn't say where the marijuana will come from, but it's understood that patients or their caregivers will get it illegally from drug dealers, or grow it from seeds obtained illegally."It's a weird concept, isn't it?" said Dr. Margaret A. Sun, president of the Rhode Island Academy of Family Physicians, who testified in favor of the law before the General Assembly. "I'll give them a letter that it's OK for them to use medically, and then they're going to some alleyway and buy it on the street."Before the law is put to use, the Health Department must write regulations. Sun hopes the regulations will provide some safeguards. Sun also is concerned about not knowing the strength or purity of the marijuana that patients may obtain. But she calls the law "a step in the right direction" for those who don't have an alternative.Dr. Robert S. Crausman, chief administrative officer of the state Board of Medical Licensure and Discipline, disagrees. "It raises a world of issues for us," he said. "Our statute says it's unprofessional conduct to violate federal law. To create another law that allows doctors to violate federal law . . . puts our board in a very awkward circumstance."What other medications do doctors prescribe in this fashion?" said Crausman, who practices medicine part-time, specializing in lung diseases.If a patient of his requested a medical certification to obtain marijuana, Crausman says he would probably decline because he wouldn't know where they were getting the marijuana plants. "I don't tell my patients on digoxin to take foxglove tea. . . . Aspirin comes from bark. When was the last time you took bark for a headache?"In a 1999 review of medical marijuana, the Institute of Medicine of the National Academy of Sciences concluded that the active ingredients in marijuana had "potential therapeutic value" for pain relief, control of nausea and vomiting, and appetite stimulation. But it called smoking marijuana a crude way to deliver the medication, and one that also delivers harmful substances. Other than the hazards of smoking, the institute concluded, the side effects of marijuana are no worse than those of other medicines.The new Rhode Island law allows marijuana use for cancer, glaucoma, HIV infection, AIDS, hepatitis C, or any condition causing wasting, chronic pain, severe nausea, seizures or muscle spasms.Crausman acknowledged that marijuana contains "wonderful active ingredients," but he wishes they were available through pharmacies in a purified, regulated form. Meanwhile, he said, effective drugs are available for every condition and symptom that marijuana is said to treat -- including a pill containing the chief active ingredient in the plant.But that pill often doesn't work because the drug isn't well-absorbed through the stomach. And many doctors and patients say that the existing medications don't work for everyone.Sun, the family physician, said that her sister, who suffers from multiple sclerosis, smokes marijuana to relieve the muscle rigidity that sometimes makes her fall. "She'll take a puff or two of pot, wait 15 minutes, and get her muscles able to move more easily," Sun said."She's on a lot of medications, including muscle relaxers," Sun said. "They're very sedating. They work well, and eventually you become tolerant so you don't fall asleep. Then they don't work as well. . . . She finds that this is something that works well, works quickly and doesn't sedate her."Among the patients in her East Providence practice, Sun said she doesn't have anyone she believes would benefit from smoking marijuana. "I'm sure there'll be people asking me for it," she added with a laugh. But doctors already face drug-seeking patients who want prescriptions for legal narcotics, she said.Dr. Thomas A. Bledsoe, an internist who is interim director of Brown Medical School's Center for Biomedical Ethics, called the new law "an unsatisfactory solution." But he said he might make use of it for certain patients, after explaining the risks and unknowns. "Patients who are competent have decision-making capacity," Bledsoe said. "I see my job as giving them advice and giving them information."In terminal cancer patients, Bledsoe said, "The symptoms that [marijuana] can help with can be very nasty, very interfering with normal life. We're talking about the rest of their life, and it's short. Quality of life is very important."Diane Lipscombe, a professor of neuroscience at Brown Medical School who studies the biology behind chronic pain, said that the classic drugs for pain relief simply don't work for millions of people.Marijuana contains substances called cannabinoids that are also produced naturally in the body, just as the body produces natural opiates, she explained. The two substances work together in the brain to numb pain. Cannabinoids may enhance the effect of opiates, and they are of particular interest because they also affect peripheral nerves, not just the brain, she said."There are millions of people who have no effective treatment for pain," said Lipscombe. "All I can say is, anything that can help people who are in constant pain is a good thing."Note: The law doesn't say where the marijuana will come from, but it's understood that it will be obtained illegally from drug dealers, or grown from seeds obtained illegally.Complete Title: Supporters of Medical Marijuana Bill Concede ProblemsSource: Providence Journal, The (RI)Author: Felice J. Freyer, Journal Medical WriterPublished: Wednesday, January 4, 2006Copyright: 2006 The Providence Journal CompanyContact: letters projo.comWebsite: Articles & Web Site:Marijuana Policy Project Override Veto, Then Begin New Session Override Turns Marijuana Bill Into Law Legislators Override Carcieri’s Marijuana Veto
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Comment #10 posted by FoM on January 07, 2006 at 21:58:37 PT
M. Charles Bakst: How Will Assembly Shake Out?
Sunday, January 8, 2006For once, legislators listened to real people with real problems and sided with them.Override of Governor Carcieri's veto of a bill to allow medical use of marijuana was a dramatic, if substantially symbolic, step.It happened last week as lawmakers gathered for the start of the 2006 General Assembly, and I wondered what it signaled for the year. How willing will the Democratic-dominated Assembly be to face tough issues? How intelligent will it be in recognizing that some ideas are dumb? Will legislators respond to the needs of society or retreat back into insularity and back-biting?On Tuesday, just before the '06 session formally began, the House followed the Senate's action of months before and paid attention to Rhode Islanders in pain. In urging his colleagues to override Carcieri's medical marijuana veto, Rep. Tom Slater, the bill's House sponsor, portrayed the legislation as a way for Rhode Island to join 10 other states and extend mercy and relief to victims of cancer, AIDS and other diseases whose suffering could be alleviated."Everybody in here knows some person who has been afflicted by one of these," Slater declared, calling upon lawmakers to think of victims of ovarian cancer, lung cancer, pancreatic cancer, breast cancer, and other horrors. And I was stunned to see how quickly -- indeed, instantaneously -- I could think of people I knew who died from them.The new law, whose Senate sponsor was Sen. Rhoda Perry, protects from arrests under state law patients who get statements from their doctors and ID cards from the Health Department. Of course, federal anti-drug laws still apply and the measure does not spell out a legal way to obtain the marijuana.Still, advocates and supporters are confident the measure itself can help ease the minds of sufferers and that marijuana can be of real benefit.Polly Reynolds, a former Channel 10 news producer who has multiple sclerosis and who pleaded for such a bill in a Providence Journal essay last year, was at the State House on Tuesday. She told me that marijuana helps her get through a day. "If I don't do it, I'm really apt to fall into very deep depression and into frustration and crawl back under the covers."I asked her why she came. Reynolds, 53, said, "Especially now that I can't do anthing, I feel like so sort of bereft of my old life. This was something I could do."She brought her 15-year-old daughter, Amy Connell, with her to show her how the democratic process works.I met Rhonda O'Donnell, 43, a registered nurse who also has MS and who lobbied for the bill. She said she had not treated her condition with marijuana but says she will try doing so now. I wondered what she thought when Republican Carcieri vetoed the measure. "I thought he had no compassion for sick and disabled people," she said.I played a tape of the quote for Jeff Neal, the governor's press secretary. He informed Carcieri of it and reported back that the governor had lost an aunt and a close friend to MS and that Carcieri's sister has MS. "He is sympathetic and compassionate toward individuals who are suffering from conditions like MS," Neal said, but added, "Reasonable people can disagree on the appropriateness of medical marijuana as a treatment option."Carcieri believes the new law will encourage criminal activity and is so broadly written that nearly any Rhode Islander could qualify for it.It is, certainly, an odd situation. I asked Democratic Lt. Gov. Charles Fogarty, a supporter of the bill, where someone looking forward to relief could obtain the marijuana. He replied, "I can do a lot of things as lieutenant governor but I do not have the ability to procure marijuana."Similarly, Rep. Steve Costantino, another prominent backer, acknowledged that the situation is "a little up in the air." He added, "The issue isn't so much where they get it." He said the issue is if people have a disease that can be helped by marijuana, the legislation can afford some protection.It may be that the best thing to come out of this law -- an experiment that will expire on June 30, 2007, unless the Assembly renews it -- is that it may help generate a national debate on the issue.I'm all in favor of debating anything that people in agony believe will ease their agony.As Fogarty told me, "I don't want to be the one to say, 'No, you can't have that, you have to suffer."'Non related portion of article removed.Copyright: 2006, Published by The Providence Journal Co.
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Comment #9 posted by FoM on January 04, 2006 at 21:13:10 PT
Editorial: R.I.'s Marijuana Law
Thursday, January 5, 2006Providence, R.I. -- A more humane society would not turn its back on suffering -- and, in some cases, terminally ill -- people who find that marijuana eases their agony. So it is good news, on balance, that the Rhode Island Assembly overturned Governor Carcieri's veto of a medical-marijuana bill, to become the 11th state to allow such use. That should give welcome comfort to some Rhode Islanders suffering from, for instance, the rigors of chemotherapy.But the law has big problems.For one thing, the U.S. Supreme Court ruled 6 to 3 last year, in a case involving medical marijuana, that federal drug law supersedes state law.The Ocean State bill would let patients, with the recommendation of a doctor or care-giver, possess up to 12 plants, or 2.5 ounces, of marijuana without being subject to local or state prosection. But the Feds could still prosecute.That may have little effect, since most drug enforcement is on the local level, and federal agents tend to focus on dealers. But somebody transporting marijuana to a patient -- or, especially, to large numbers of patients -- could well be prosecuted criminally by the Feds. Some doctors and caregivers may be very hesitant to recommend marijuana for fear of being involved in a crime.That raises another big issue: Where would patients get marijuana? There are no legal sources, and no standards for dosage or quality of marijuana, unlike prescription drugs. Users, then, would presumably have to deal with neighborhood criminals to get their marijuana or seeds -- by definition, increasing crime -- and they could not be sure that very harmful or toxic elements were not mixed in. And would a lot of people start growing their own?It thus made good sense for the legislation to include a sunset provision; it will expire on July 1, 2007, unless lawmakers vote to keep it going. During the interim, the effect of the program -- on law and order, as well as patients -- will be studied.That said, there are very sick people who would gladly accept the risks of using marijuana, and they should have that freedom.Perhaps the best effect of the new Rhode Island law would be to encourage a further national discussion of medical marijuana. At some point, the Supreme Court might have to revisit the matter. Society should help sick people obtain safe and effective relief from their misery. If marijuana aids the sick, it should be available to them.Copyright: 2006 The Providence Journal Company
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Comment #8 posted by whig on January 04, 2006 at 20:48:11 PT
Benjamin Rush
Not sure we want to rely upon him as our hero. was an advocate of forced psychiatric treatment. According to historian of psychiatry Thomas Szasz, [1] one of Rush's favorite methods of treatment was to tie a patient to a board and spin it at a rapid speed until all the blood went to the head. He placed his own son in one of his hospitals for 27 years, until he died. Rush also believed that being black was a hereditary illness.
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Comment #7 posted by FoM on January 04, 2006 at 09:50:23 PT
Do you know the person who called in today? He made good points and even used the word Cannabis.
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Comment #6 posted by dongenero on January 04, 2006 at 08:57:00 PT
Benjamin Rush quote
That's a great quote Sam.You rarely see Dr. Benjamin Rush's comment about medical freedom but it certainly is apropos.The vision and insight of the founding fathers always astounds me.
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Comment #5 posted by Sam Adams on January 04, 2006 at 06:46:59 PT
Whoops, guess no one listened to this guy....he saw Big Pharm coming 200 years off....“Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of men and deny equal privileges to others: The Constitution of this Republic should make a special privilege for medical freedom as well as religious freedom.” Dr. Benjamin Rush, signer of the Declaration of Independence
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Comment #4 posted by Sam Adams on January 04, 2006 at 06:45:50 PT
What's up with the headlining? Looks like they opted for the worst possible headline. Why didn't they talk to any actual patients, who I'm sure are all thrilled and dancing in the streets, not creeping off to some "alley" to see a "drug dealer".Actually, this article, driven most by comments from medical "professionals", provided a frightening view into American medicine. Egotistical, narrow-minded doctors rule your life if you're chronically ill. Most laugh derisively at herbal medicine, and prefer to given toxic pills instead. When was the last time I drank foxglove tea? Well, I don't like taking medicine in tea, but I did drink about 5 different herbal tinctures about 5 minutes ago! You know what, I educated my self on using them, and learned to choose which ones and how much to take. Shocking!In our system, the patient is considered a mindless knave, incapable of taking care of themselves. It's disgusting to me. This is the way the government wants people to be in all areas of their life - blindly accepting whatever dictum comes down from above, usually from an arrogant male authority figure or, worse yet, "expert".Now all the experts are complaining because everyone is too fat and health problems are multiplying. I say, isn't that what they wanted? Fat and stupid, not thinking for themselves, that's exactly what we're conditioned to do. They've broken down people over generations to abandon their basic self-awareness and mental self-determination skills.The truth is that vaporized cannabis or tincture should be a PRIMARY medicine for many, many different medical problems, as it was 100 years ago. I'm thankful that enough people still have a shred of compassion left to see through all medical Orwellian BS in America today. These legislators deserved to sleep well tonight, they done good!
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Comment #3 posted by siege on January 04, 2006 at 06:25:38 PT
Way is it law makers are not intelligence enough to put in the medical marijuana laws, that people can BUY SEEDS LEGALLY. 
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Comment #2 posted by OverwhelmSam on January 04, 2006 at 04:58:12 PT
All Of These "Problems" ...
...would go away if the US Congress would get off of it's butt and regulate Cannabis for medical use. It's too bad all of those drug free workplace laws will have to be repealed.
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Comment #1 posted by observer on January 03, 2006 at 23:45:54 PT
What other medications?
Prohibitionist Doc: "What other medications do doctors prescribe in this fashion?" said Crausman, who practices medicine part-timeLet's flip that right around.For which other medicines does the good doctor recommend jailing patients? (patients with debilitating medical conditions for which the medical use of the substance would likely outweigh the health risks, according to a doctor)This law is simply providing a little limited relief from the arrests and jailing that people with debilitating medical conditions get now, if they use cannabis for relief, and are caught. Jail... that's the issue. Hold prohibitionists' feet to the fire, and don't let the 700,000 annual arrests for cannabis go down the Orwellian memory hole. 
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