Drug-war politics shouldn't prevent doctors from easing patient's suffering
by Dr. Rob Killian

October 18, 1998 - Tacoma News Tribune - leted@p.tribnet.com

As a hospice physician, I have seen marijuana work to relieve suffering. I have seen patients start eating again. I have seen them stop vomiting after chemotherapy when they used marijuana to relieve their nausea. I have sat at the bedside of sick and suffering patients long enough to learn that modern medicine often falls short in offering complete relief of suffering among our sickest patients.

Last year, after the voters defeated a much broader attempt to change all of our drug policies, I promised to bring them a narrow, more tightly written effort to decriminalize the medical use of marijuana. I am proud of the effort made this year. I learned my lesson.

Initiative 692 is not a misguided attempt to legalize drugs. It is a simple and specific attempt to protect our neighbors who are very sick. It protects physicians like me who have broken with tradition and been brave enough to use anything that might relieve a patient's suffering.

The opponents of this measure do not believe marijuana has a place in medicine. They will say anything to scare the voters. They will say there are no studies proving marijuana's efficacy.

Ten years ago the U.S. Drug Enforcement Administration, after exhaustive investigation, called for the immediate rescheduling of marijuana from schedule one to schedule two. Its report stated that "it would be unreasonable, arbitrary and capricious for the DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in this record." For political reasons the DEA administrator overruled his own agency and refused to reschedule marijuana.

Marijuana as medicine is not a new concept. Nor is its use foreign in the history of American medicine. Prior to 1937, American physicians used marijuana for its anti-nausea and anti-inflammatory effects. In 1937, the U.S. government passed the Marijuana Tax-Stamp Act and began a war of rhetoric against the drug that included a propaganda film, "Reefer Madness."

The first federal study proving marijuana had some medical benefit was published in 1967. This study was done on patients undergoing cancer chemotherapy treatment. It showed that marijuana did, indeed, have an anti-emetic effect. Since then more studies have looked at this effect as well as marijuana's effects in stimulating the appetite, lowering internal eye pressure for patients with glaucoma and easing chronic muscle pain from illnesses such as multiple sclerosis.

When the federal government failed to make marijuana safely available for use by these patients, a majority of states designed and funded studies and compassionate-use programs to make marijuana available to the most needy of their citizens. These state-sponsored programs lasted into the early 1980s, until the federal government got more aggressive and blocked access to marijuana for further research.

Politics have stood in the way of science and good medicine for too long. I am not alone in wondering about the illogic of the federal stonewall against this drug. The editor of the New England Journal of Medicine, Jerome Kassirer, M.D., stated in an editorial that "a federal policy that prohibits physicians from alleviating suffering by prescribing marijuana for seriously ill patients is misguided, heavy-handed and inhumane."

He further stated that it "was hypocritical to forbid physicians to prescribe marijuana, while permitting them to use morphine and meperidine to relieve extreme dyspnea and pain."

The American Academy of Family Physicians has a stated policy supporting "the use of marijuana under medical supervision and control for specific medical conditions." The American Public Health Association has urged Congress to make marijuana legally available for medical use.

The American Medical Association adopted a policy last year calling for the federal government to fund and support research into the many claims of marijuana's medicinal qualities.

It also stated that "the AMA believes that effective patient care requires the free and unfettered exchange of information on treatment alternatives and that discussion of these alternatives between physicians and patients should not subject either party to criminal sanctions."

Initiative 692 grew out of efforts by local physicians and community leaders to create a law to protect physicians and patients. The initiative is based on a bill introduced this year in the Legislature by Democratic state Sens. Jeanne Kohl and Pat Thibadeau, both of Seattle.

I-692, unlike last year's failed I-685, is simple and tightly written. It specifically addresses the medical use of marijuana for terminal or debilitating illnesses, which are specifically defined in the act. It protects physicians who discuss the risks and benefits of marijuana treatment with their patients. The initiative has many safeguards written to protect the public and our children. It does not in any way legalize marijuana for recreational use.

The safeguards built into this initiative are significant. It would not allow the use of marijuana by patients who do not have terminal or debilitating illnesses. It strictly prohibits the use of marijuana while driving or in the workplace. It requires parental consent for patients under 18 years of age. It does not change any of our laws that prohibit nonmedical marijuana use, nor does it apply to any other drugs.

Our neighbors who happen to find themselves ill with cancer, multiple sclerosis, glaucoma, chronic pain or AIDS already suffer enough. They are not criminals if they can find no relief with traditional medications. Their physicians are not criminals just because they are willing to discuss the risks and benefits of this drug with their patients.

It is time to create a law that protects both patients and physicians. It is a simple matter of compassion and it deserves your support on Nov. 3. Please join with me and vote yes on I-692.

Dr. Rob Killian is a family physician practicing in Seattle. He is the author and primary sponsor of Initiative 692.

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