Legal alternatives to smoking marijuana make change unnecessary
by Dr. Susan Garcia-Swain

October 18, 1998 - Tacoma News Tribune

Last November, the sponsors of the failed Initiative 685 - the measure that would have legalized marijuana and other drugs in Washington state for those suffering from "serious illnesses" - claimed voters simply "weren't educated enough about the issue." Indeed, 60 percent of Washington voters rejected the measure.

The reason I-685 was so soundly defeated wasn't because voters didn't know enough; the proponents spent hundreds of thousands of dollars promoting their cause in television ads. Rather, it was rejected because the more voters discovered about the issue, the less appealing it was.

Those same sponsors are back with yet another medical marijuana measure - Initiative 692. Unfortunately, this year's version is not much better. Even those of us who desperately want to help those suffering from the effects of serious illnesses can't overlook the multitude of problems facing this initiative. Like last year, good intentions can't hide the fact that the proposed "cure" is worse than the disease.

While the sponsors claim this year's initiative is tighter and includes provisions to minimize the opportunity for abuse, I-692 still contains many of the same problems that doomed last year's drug measure. For example, I-692:

* Will allow "patients" to possess marijuana without a prescription from a doctor.

* Does not provide specific guidelines with regard to the amount one can legally possess.

* Does not specify for which diseases one can legally possess the drug. It just says "terminally or seriously ill patients."

* Does not alter federal law; patients, doctors and all concerned will still be breaking the law.

* Does not provide for safe distribution of the drugs; patients still must buy it from people who are selling it illegally. Thus, there is no way to control potency, content or quality of the drug.

Without tight restrictions regarding the quantity one can possess, who can possess it and how one can obtain it, I-692 leaves the door wide open for abuse.

Going beyond the obvious problems in the text of the initiative, there is a larger debate over the medical effectiveness of marijuana. While the proponents cite anecdotal situations in which people felt better after smoking marijuana, the fact is that there is no single piece of evidence stating that marijuana is an effective form of medication.

This is why the Washington State Medical Association refused to endorse I-692 and will continue to do so until studies are completed regarding its effectiveness and safety as a medicine. Nationally, an American Medical Association investigation led the AMA to conclude that marijuana has little to no effectiveness in the treatment of nausea and vomiting associated with chemotherapy, AIDS wasting, multiple sclerosis, epilepsy, spasticity, pain or glaucoma - all conditions that the initiative's sponsors claim are appropriately treated with marijuana.

While there are anecdotal stories of people who have experienced relief from marijuana use, studies show that the effects are inconsistent. But those same studies consistently show that marijuana caused significant and intense adverse effects that preclude its medical use.

The proponents of I-692 attempt to show support of the medical community by citing a statement written in the New England Journal of Medicine that criticizes policies prohibiting doctors from prescribing marijuana. This was not the opinion of the journal - which has no policy regarding this matter - but the opinion of one doctor who wrote an editorial. And the statement does not apply here because doctors would still not be allowed to prescribe the drug under this initiative.

Finally, proponents fail to include the remainder of the doctor's recommendation that medical marijuana would have to be highly regulated; "to ensure its proper distribution and use, the government could declare itself the only agency sanctioned to provide the marijuana." This initiative doesn't come close to providing any regulation.

Along with the AMA and WSMA, many other medical organizations have taken stands against the use of inhaled marijuana smoke as medicine. These include, among others, the American Society of Addiction Medicine, the American Cancer Society, the National Multiple Sclerosis Association, the American Academy of Ophthalmology and the National Cancer Institute.

I-692 completely sidesteps the testing process performed by the Food and Drug Administration. This process was established to protect Americans from drugs that could be harmful or fatal to patients. While FDA safeguards aren't fail-safe, they are far superior to the alternative offered by the proponents of this initiative: none.

Doctors have a duty when they prescribe or recommend a treatment to know the what, how, when, why, where and who of those treatments. This measure provides no means for such a level of care. Section 4 of the initiative gives physicians protection for advising the medical use of marijuana - " ... where such use is within a professional standard of care ..." But there would be no standard under this initiative. Because marijuana would be unproven and unregulated, doctors would have no basis for determining potency, quality, dosage, frequency or route of administration.

If I-692 passes, there will be no controls, no regulation and no standards of any kind to protect people against dangerous doses of marijuana. There will be no tracking methods so that when drugs are released, there is a procedure for reporting the effects - good and bad. There will be no method for recalling them when they pose a danger to public safety. No protections against a chemotherapy patient dying because the batch of marijuana that was supposed to make him feel better had been contaminated.

What many find curious about this measure is that the drug Marinol - a potent form of the active cannabinoid ingredient, THC, which is found in marijuana - is currently available as a prescription. The drug takes longer to set in but has been demonstrated by the FDA to be a safe and effective alternative to marijuana. Why are the proponents of I-692 so focused on legalizing marijuana, which has been proved unsafe for medical purposes, when a legal and safe form is available?

We are not trying to be moral authoritarians. This is about public safety and ensuring protections against bad medicine. The proponents of I-692 - the same billionaires who sponsored last year's attempt to legalize marijuana here and in other states - will spend millions between now and Nov. 3 to say that marijuana needs to be legally available to the sick and dying.

They won't spend a cent telling you the devilish details about how it will happen or the potential risks marijuana poses for patients. Nor will they cite a single, scientific study concluding that marijuana is effective medicine. Nor will they tell you that this initiative is unnecessary, since a safe and FDA-tested alternative is currently available for prescription. Nor will they explain that physicians and those who transfer the drug to patients would still be committing a federal crime and can be charged, as those recently busted in California and Arizona can attest.

While the ballot box is a wonderful place to practice democracy, it can be a dangerous place to practice medicine. Medically, legally, responsibly, there is only one logical conclusion. Vote no on Initiative I-692.

Dr. Susan Garcia-Swain is an attorney and a licensed physician specializing in addictive medicine. She is a member of the Washington Society of Addictive Medicine and the Washington Bar Association. Garcia-Swain practices in Seattle and serves as co-chair of the "No on I-692" campaign's Medical Advisory Board.

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