Platform

Proposition 215, which legalizes marijuana for medical use, was approved overwhelmingly by California voters this week. It faces a raft of court actions, but doctors who treat diseases for which marijuana is believed to alleviate symptoms have been thinking hard about how they’ll respond. JIM BLAIR talked with oncologists, AIDS specialists and ophthalmologists about if and how they might recommend marijuana, smoked or in some other form, to their patients. Some were far more enthusiastic about the prospect than others, but all expressed a desire for more research and a better way to deliver marijuana’s benefits than by smoking.

One addicition specialist was flat-out horrified and raised the specter of people calling a 900 number to get a medical authorization to use marijuana.

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DOUGLAS BLAYNEY

Oncologist, San Gabriel Valley

I hope that the passage of 215 will allow patients to be more open with their physicians about drugs that they take for relief of cancer-related or AIDS-related symptoms. Patients taking things they don’t tell their doctors about is very common. I think it’s both the fault of the patient who may be a little ashamed or a little nervous or uncomfortable talking to their physician about these things and also physicians who have come across as judgmental.

There are very good medicines to increase appetite and enhance control of nausea. I have prescribed Marinol, the active extract of marijuana, for my cancer patients for probably six or eight years now. In this state it takes a triplicate prescription--meaning that it’s a scheduled drug, much like Demerol and morphine.

New medicines are coming on the market all the time. Marijuana has variable potencies and variable impurities. I don’t think it’s the best solution for most people, but I’m willing to talk to patients about smoked marijuana as one of the options.

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DREW PINSKY

Addiction medicine specialist, Pasadena

I am totally aghast at the ignorance that swirls around this drug and people’s unwillingness to talk about it in rational terms. I’m also against a sham and this proposition is a complete sham. When I describe to people what it included, they can’t believe that that’s actually what it says--that people only need a verbal OK from a health practitioner to grow marijuana. It is anathema to what they thought the purpose of this was--to help sick people--which was how [supporters] sold it. But it’s a sham. It was not to help sick people--it’s to make this drug closer to being legal.

But if it’s going to be legal, let’s make it legal. Let’s not foist a sham on the public.

I think the proposition sends a terrible message to young people, which is where my greatest concern lies. This a potentially neurotoxic drug which is on the increase at alarming rates among adolescents and particularly at the neurobiological formative years before the age of 15 [when] the impact can be quite substantial. It is potentially harmful for some people and that’s just simply the fact.

Proposition 215 is ambivalent as to whether or not it has to be a physician [who prescribes marijuana]--at least as I read it. I envision the day when there could be 900 numbers that people call for approval of their marijuana use. That was my greatest fear.

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CHARLES ARONBERG

Ophthalmologist, Beverly Hills; vice chief of ophthalmology, Cedars-Sinai Medical Center

Marijuana has been found to be useful in treatment of glaucoma. Although there are many other forms of treatment--drops, pills, laser surgery, incisional surgery--it’s always good to have the maximum number of options. Marijuana has been reported to be useful in some cases where other types of treatment were not sufficient.

Some patients comment that they’ve found that marijuana works better for them than any other medicine and also may have fewer side effects.

I’m very concerned that health care professionals other than medical doctors might be permitted to prescribe marijuana and its derivates under this proposition. The potential for abuse might be even greater.

I don’t think [passage of Proposition 215] will have an immediate large impact, however, because doctors and patients have heard the negative comments and realize that any type of treatment has some downsides, disadvantages and side effects. Most doctors and patients will want the legal status clarified.

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ALEXANDRA LEVINE

Professor of medicine, chief of hematology and oncology, USC School of Medicine; director, Center for Human Retrovirology, USC

For years I have been faced with the situation of individuals with cancer or with HIV and AIDS who have significant nausea and vomiting and are not helped by the standard medications. Even though the active ingredient in marijuana, THC, is available by prescription in the form of a drug called Marinol, very often the Marinol does not work while actual marijuana does. I don’t understand why that’s true; but the fact is that I have [had] many patients over the years get no relief for the nausea of chemotherapy or their underlying disease other than from marijuana.

These people are very diverse. Some are elderly. Others are young people. What they have in common is that the usual medications have not helped, whereas one or two puffs of marijuana seem to take away the entire nausea and vomiting, allowing them to eat normally and regain weight.

I do not believe that this is an excuse for the general legalization of marijuana. There have been many bills over the years that have gone to the voters related to the general licensure of marijuana, not as a drug but as a recreational compound. All of those have failed. This particular bill did not fail and I think it was seen for what it was meant to be--a legalization of the medicinal use of a substance that has been shown to be of significant medical benefit.

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MAXINE LIGGINS

Infectious disease specialist. AIDS Health Care Foundation, Los Angeles

I was relieved that it passed because I felt that very often I was being put in the middle of something. A lot of my patients wanted marijuana and would ask me for a permission slip to become a member of the Cannabis] Buyers Club [which has conveniently, though illegally, provided marijuana for medical uses to many people.]

On the one hand I felt that if they were having relief of symptoms that they should do that, but on the other hand, possession of marijuana was illegal in California no matter what the patient’s condition. If the patients got caught even though they had a letter from me stating they had HIV and AIDS and could possibly benefit from it, that wouldn’t do them any good. I felt it would cause me to be on the wrong side of the law.

Only about one-third to one-fourth of my patients admit to smoking marijuana and of those, most say that they do it because they have alleviation of symptoms.

One of the things I’m concerned about is that smoking isn’t good for you, whether it’s cigarettes, marijuana or anything else. I would be interested in studies showing what dose of marijuana is most appropriate, whether marijuana is inactivated by heat if it is cooked in food, how much of it is actually absorbed and what dosage causes people to gain weight, just so that I have some more information to give patients about their use of it.

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SAMUEL SOLISH

Ophthalmologist and glaucoma specialist, Los Angeles

Glaucoma is more common in older people. It was first discovered in 1971 that marijuana lowers intraocular pressure, but not without the euphoric side effects that made it a recreational drug. That causes a problem for many older people. We have lots of good treatments for glaucoma that don’t involve the use of marijuana. We have many medications that have low potential for systemic side effects.

One of the synthetic marijuana analogs called Marinol has been used and it’s not very effective in lowering pressure. Marinol has few of the euphoric effects so it’s been very difficult for researchers to separate the mind-altering effects from the beneficial medical effects of marijuana.

I don’t think that smoking marijuana is good for getting a proper dose of the medication so it would have to be given in an alternate form. Medications based on cannabinoids would have to be developed.

I don’t have any plans to place any of my patients on marijuana until some of the legal and scientific issues are worked out. Universal Press Syndicate, ) 1996 G. B. Trudeau. Reprinted with permission. Caption: Cartoonist Garry Trudeau’s pointedly partisan cartoons helped make Proposition 215 a national issue.

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Doonesbury

Cartoonist Garry Trudeau’s pointedly partisan cartoons helped make Proposition 215 a national issue.