June 8, 2005
Medical Experts Disagree on Marijuana Ruling
Debate hinges on whether data backs use of cannabis for pain relief
Before becoming the medical consultant to the Hospice Foundation of America, Dr. William M. Lamers worked for three decades with terminally ill cancer patients, helping to ease their pain.When asked for his opinion on Monday's 6-3 U.S. Supreme Court decision supporting a nationwide ban on medicinal marijuana, he didn't mince words.
"I think it's a tragedy that a drug that's apparently safe and is effective as an analgesic, a real pain reliever, isn't available to patients who need it," he said from his home in Malibu, Calif. "The law is totally out of touch with reality -- it's inappropriate, and the result of an uninformed bureaucracy."
Lamers stressed that he and all responsible doctors "have to respect the law. It's just too bad it turned out this way," he said.
Monday's decision in Gonzales vs. Raich means federal laws banning the use of medicinal marijuana now supersede any state legislation allowing the plant or its derivatives to be used for pain relief when recommended by a physician. Ten states had passed such legislation: Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, Vermont and Washington. Arizona also enacted similar legislation, but with no formal program to administer pot by prescription.
But supporters of medical marijuana noted the state laws remain in effect, so it's unlikely state officials would prosecute patients who use the drug. And the likelihood of federal enforcement is fairly remote. Allen Hopper, a lawyer with the Drug Law Reform Project of the American Civil Liberties Union, said the federal government handles only about 1 percent of marijuana prosecutions, the Associated Press reported.
Another expert in dealing with terminally ill patients offered up a somewhat more cautious response to the court ruling.
Dr. Perry G. Fine is vice president for medical affairs at the National Hospice & Palliative Care Organization, the nation's largest and oldest hospice organization. Referring to Monday's decision, he said, "This is just such a complicated issue; it has tremendous political overtones and public health overtones."
But Fine, who is also a professor of anesthesiology at the University of Utah's Pain Research Center in Salt Lake City, agreed with Lamers that available research seems to support marijuana's effectiveness as a pain reliever.
"From a purely medical standpoint, there seems to be ample evidence for efficacy in a variety of symptoms that plague patients or cause distress for patients with a variety of chronic, progressive illnesses," he said. "Also, there's increasing scientific evidence that leads us to understand why the active ingredients -- various cannabinoids -- do have therapeutic value."
That statement is at odds with the view of John Walters, director of National Drug Control Policy at the White House. He told the Associated Press Monday that, "to date, science and research have not determined that smoking marijuana is safe or effective."
Some of the nation's largest medical groups agree with Walters, stressing that more data is needed before cannabinoids can be approved as treatment.
In its official policy paper, the American Medical Association (AMA) calls for "further adequate and well-controlled studies of marijuana and related cannabinoids" for conditions where anecdotal evidence suggests the drug might prove useful, such as cancer patients. The AMA also urges the National Institutes of Health to fund research into "a smoke-free inhaled delivery system" for marijuana or its active ingredient, delta-9-tetrahydrocannabinol (THC).
Patients with the progressive and debilitating nerve disorder multiple sclerosis (MS) are among the most frequently cited users of medical marijuana. Television host Montel Williams has been an outspoken advocate for its use, claiming it helps ease his MS-related pain.
However, in a statement released Monday, the National Multiple Sclerosis Society agreed with the AMA that "we still do not have the necessary scientific information to determine the safety and efficacy of marijuana for medical use in MS."
It points to numerous studies where physicians were unable to find the drug effective in reducing symptoms they could measure, such as spasticity. On the other hand, data on a synthetic THC and an oral derivative of marijuana, cannabis oil, "did confirm that people using marijuana feel better in ways that cannot be measured by their physicians," such as their own perception of pain, according to a society statement.
The bottom line? "More research is needed to determine the potential role of cannabinoids in MS treatment," the society concludes.
Monday's high court decision stems from the 2001 arrest of two California residents -- Angel Raich, who suffers from brain cancer; and Diane Monson, who grew marijuana in her garden to combat chronic back pain. At the time, their use of home-grown marijuana was legal under the state's Compassionate Use Act. Both women were arrested, however, during raids conducted by officers from the U.S. Drug Enforcement Agency, sent to enforce the federal ban.
Lawyers for the two women contended that state law protected them from federal prosecution, but Monday's ruling effectively gives the thumbs-down to that argument. Writing for the majority, Justice John Paul Stevens specified that Congress could change federal law to allow medical marijuana use, should it ever choose to do so. In her dissent, Justice Sandra Day O'Connor wrote that states should be able to set their own rules on this issue.
Next week, the House of Representatives is scheduled to vote on an appropriations bill that would prohibit the Justice Department from spending money to enforce federal drug laws against patients using medical marijuana. While a similar amendment failed last year, 19 Republicans voted for it. The bill was not brought to a vote in the Senate, The New York Times reported Tuesday.
John Radulovic, a spokesman for the National Hospice and Palliative Care Organization, stressed that the vast majority of patients in serious chronic pain do have analgesic alternatives besides marijuana and its derivatives.
"I think most hospice and palliative care physicians are very experienced, so I've heard that in about 95 percent of cases professionals trained in pain management can bring pain under control with legal means," he said. He added that his organization "doesn't support illegal drug use. We do, however, recognize the right a patient has for self-determination. We certainly wouldn't deny care to a patient based on any [treatment] choice they would make."
For Lamers, the Court's decision remains disheartening. "The law must be changed," he said. "I can't support breaking the law and I can't advise others to do it. All I can say is that as a doctor who does an awful lot of work with patients in pain, marijuana is a very effective, safe and relatively inexpensive pain reliever."
For more on controlling pain, visit the American Pain Foundation.