Ganja in Jamaica

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When Barbara Douglass of Lakeside, Iowa, came to the University of Iowa last April, she spent much of her time in a hotel room smoking marijuana. She wasn't in town to have a good time, however; marijuana is Douglass' medicine, and she was in Iowa City to speak at "Medical Marijuana: Science-Based Clinical Applications," one of the first national scientific conferences about medical uses of marijuana.

Douglass, who has multiple sclerosis, was joined at the UI conference by George McMahon, a Livermore, Iowa, resident who smokes marijuana for nail-patella syndrome, a genetic disorder involving skeletal deformities, joint problems, kidney problems, and sometimes glaucoma. Two of the eight legal users of marijuana in the United States, they were at the conference to give firsthand accounts of their experiences.

They belong to the federal research study known as the Compassionate Investigational New Drug program, which closed in 1992 after admitting 14 people around the country. Six of the patients have since died. Douglass and McMahon receive their marijuana free from the government and both smoke about ten marijuana cigarettes a day to ease the pain from their diseases.

Douglass, McMahon, and the other six patients are at the center of a national debate about whether or not marijuana should be used medically and whether or not it should be legalized, period. Advocates for its medical use note that marijuana has been shown to ease nausea and increase the appetite of cancer patients undergoing chemotherapy, and they say its effects—mood enhancement, anxiety reduction, and mild sedation—can be beneficial for patients suffering pain and anxiety associated with their illnesses.

Opponents, on the other hand, claim that marijuana has negative physiological effects, including lung cancer, cardiovascular problems, and infertility. They also fear that marijuana is a "gateway" drug that will lead to the use of more harmful drugs like heroin and cocaine, that allowing marijuana to be used as a medicinal drug will send a message to young people that marijuana use is safe, and that approving marijuana for medical use will open the doors to widespread legalization.

In recent years, the debate has grown more heated as several states have passed voter initiatives to allow the medical use of marijuana. Hawaii was the first state to pass such legislation in 2000. Even in states allowing the medical use of marijuana, however, it is still illegal for a doctor to prescribe marijuana or for a patient to use it. Regardless of state law, the federal government considers marijuana a prohibited drug.

Medical History
The idea of using marijuana medicinally is not new. Cannabis, the plant marijuana comes from, was a staple crop of ancient China and was used not only for food, fiber, oil, and paper, but to treat more than 100 ailments, including leprosy, diarrhea, infections, and loss of appetite.
In the United States, cannabis was valued as medicine during the 19th century, and during the early part of the 20th century, marijuana was prescribed as a sedative and an analgesic, to improve appetite and digestion, and for other disorders. As synthetic drugs replaced it in the 1930s, medical use of cannabis began to decline but recreational use increased.
By 1931, 29 states had outlawed marijuana, and the 1937 Marijuana Tax Act made it expensive and inconvenient to obtain. In 1942, marijuana was removed from the U.S. Pharmacopoeia because it was believed to be harmful and addictive, causing psychoses, mental deterioration, and violent behavior.
A sharp increase in recreational marijuana use in the 1960s led to the Controlled Substances Act, established in 1970. It divided drugs into five schedules and placed marijuana in Schedule I, the category for drugs considered unsafe, having a high potential for abuse, and having no accepted medical use.

Marijuana's status today as a Schedule I substance means it is available for research only after special application to federal agencies. The legal status of the drug, and public perception of it as harmful, has hindered research efforts, says Dr. Melanie Dreher, dean of the UI College of Nursing.

"There are clinical observations that show marijuana increases the appetite, and it has been shown to be quite effective to reduce wasting in AIDS patients," Dreher says. "Exploration of marijuana should be supported. Instead, it becomes increasingly difficult. The stigma attached to marijuana compromises the interest in research on this multi-dimensional and fascinating substance."

For over 30 years, Dreher has investigated marijuana use in Jamaica, a country that has a long tradition of using marijuana medically. There, Dreher says, marijuana is smoked, made into a tonic with white rum, or brewed in a tea, and it is used to treat a number of ailments, including teething and colic in babies, asthma, fevers, and nausea in pregnant women. It is also given to children to encourage a good appetite and help them do well in school.

Dreher feels more research on marijuana is warranted, and she hopes to continue her own research by exploring the use of marijuana as an aid in rehabilitation from cocaine use.

"I think it will require a cultural change of attitude to get more research done on this subject," Dreher says. "It's going to require at least temporarily setting aside culturally generated feelings about this subject so we can look at it in a more scientific way."

That was the impetus for the University of Iowa conference, held April 6-8. Dreher came up with the idea, approached the UI College of Medicine, which co-sponsored the event, and then called upon Patients Out of Time, a nonprofit organization working to legalize medical marijuana use, to organize it. The conference featured speakers and panels presenting information on clinical and basic science research on marijuana, the history of its medical use, and case presentations of patients legally receiving marijuana. About 250 people attended the conference, which was simultaneously telecast to six other institutions around the nation. Toll-free phone numbers allowed individuals at the various sites to call in with questions and comments.

"Iowa did a great job," says Al Byrne, co-founder of Patients Out of Time. "We took information that is reinforced in every respect, with bona fide scientists and peer-reviewed material. That it was at the University of Iowa gave the conference national standing. The University of Iowa was not seen as a fringe institution, but as a major university that was willing to have a legitimate, open discussion."

Bruce Upchurch, drug policy coordinator for the State of Iowa and director of the Governor's Office of Drug Control Policy, says he isn't convinced that the UI conference offered such a discussion, although he did not attend.

"I'm not sure I would classify what happened there as a scientific conference," he says. "I think a lot of the people there already had their minds made up and had an agenda in mind. A lot of people who want to do good and relieve pain and suffering get caught up in this. There should be continued research on this subject, but unfortunately, some people would like to shortcut this research. Instead of relying on science to see if there are beneficial uses for some of the chemicals in marijuana, they are trying to get the use of marijuana in general legalized."

Researchers at the UI have been looking at marijuana in different ways for several years. On the whole, however, there is not much scientific work being done in this area. "There are about 30 people in the world who study this," says Byrne. "Twenty-eight of them were at the UI conference."

Research has led to the development of at least one drug that attempts to harness the benefits of marijuana while avoiding the harmful side effects that come from smoking it. Upchurch supports efforts to identify beneficial components of marijuana and to find safer methods of delivery, but he feels more testing is necessary before marijuana can be considered medicine.

"We don't smoke our medicine in this country," he says. "If research develops a delivery system that's safe and can isolate the chemicals that are beneficial, if it's tested and approved, then yes, it should be available. But there are substances out there now, other than marijuana, that can be used to relieve pain and suffering."

Patients like Douglass and McMahon, however, aren't able or willing to use approved drugs they feel are ineffective or to wait for a legal, socially acceptable form of marijuana. For them, the debate comes down to one thing: if marijuana helps patients with debilitating diseases, it should be available to them.

"When I started smoking marijuana, I was in a hospital bed and wasn't supposed to live long enough to make it home," recalls McMahon. "I hadn't eaten in 20 days. I did not expect to get better. Now I'm walking, sleeping, riding my bike.... The difference to me is from dead to alive."

When Douglass began smoking marijuana, she also found dramatic relief from the muscle spasms and pain, sight problems, and weight loss brought on by multiple sclerosis. "I wanted anything that would help," she says.

Douglass picks up her prescription—300 marijuana cigarettes—each month when she visits her doctor, who monitors her condition and reports to the study leaders. She says she can tell when she needs to smoke by how her body becomes tense. She likes managing her own medicine and taking the amount she feels is right for her. She doesn't agree with those who feel that smoked marijuana is too harmful to be used therapeutically.

"The side effect of my marijuana is that I can sleep, and I don't know any person with multiple sclerosis who would argue with that," she says. Douglass feels marijuana should not be legalized for recreational use, but should be administered like any other prescription drug.

McMahon, on the other hand, feels marijuana should be legalized across the board for individuals to use as they see fit.

"Some people will abuse it, but I think the real danger of marijuana is that people who are caught with it are sent to prison, and prison ruins lives," he says. "I think it should be legal. I want to be able to go to any doctor and talk about it freely. It's good medicine."

Susan L. Green is an associate editor at the UI Office of Health Sciences and a freelance writer in Iowa City.



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