This Is Smart Medicine

ANYONE WHO HAS EVER smoked marijuana will tell you he gets hungry afterward. That kind of anecdotal evidence led doctors and patients to experiment with marijuana as a treatment for extreme nausea, or wasting syndrome. I have seen hundreds of AIDS and cancer patients who are los- ing weight derive almost im- mediate relief from smoking marijuana, even after other weight-gain treatments--such as hormone treatments or feeding tubes--have failed. But it's not just individuals who have recognized the medicinal benefits of marijuana. No less an authority than the FDA has approved the use of Marinol, a drug that contains the active ingredient in marijuana.

The problem with Marinol is that it doesn't always work as well as smoking marijuana. Either you take too little, or 45 minutes later you fall asleep. Even though insurance will pay for Marinol--which costs about $200 a month--some patients spend their own money, and risk breaking the law, for the more effective marijuana. That's fairly good evidence that smoking the drug is superior to taking it orally. How would we keep patients from giving their prescribed marijuana to friends? The same way we keep people from abusing other prescription drugs: by making patients understand the dangers of giving medication to other people. A physician who prescribes marijuana without the proper diagnoses should be held up to peer review and punished. There are drugs available at the local pharmacy--Valium, Xanax, Percodan--that are far more mood-altering than marijuana. They aren't widely abused. It's not important that a few zealots advocate the wholesale legalization of marijuana. The federal government can't craft policy based on what a few irrational people say. This is a democracy, and what the people of California voted for was to make marijuana available for medical use for seriously ill people.

For skeptics, a study devised at San Francisco General Hospital would test the benefits of smoking marijuana once and for all. It, too, was endorsed by the FDA--but the federal government won't provide the marijuana for the study. Washington recently offered to fund a $1 million review of literature on medical marijuana, but it refuses to allow a clinical trial, which is what's really needed.

When citizens even speak up in favor of legalizing marijuana for medicinal use, as happened this fall in California and Arizona, the government tries to stop them. Gen. Barry McCaffrey and the Justice Department have threatened to revoke the prescription-drug licenses of doctors who prescribe marijuana. This is a truly dangerous step. The government has no place in the examination room. Our society has long felt that certain relationships require privileged communication, such as those between a priest and a parishioner or a lawyer and a client. If a patient wants to discuss marijuana, I don't want to have the responsibility of reporting him, and I have to feel comfortable that the patient will not report me. This is a First Amendment issue of freedom of speech between doctor and patient.

Perhaps the most persuasive argument for medicinal marijuana I've encountered came two years ago, when the California Assembly was debating a medical-marijuana bill. One GOP assemblyman said he had had a great deal of trouble with the issue. But when a relative was dying a few years before, the family had used marijuana to help her nausea. That story helped the bill pass. Wouldn't it be awful if people changed their minds only after someone close to them had died?