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Doctors divided on medical pot
6/31/09|The Telegraph| by Laura Griffith



EDITOR'S NOTE: This is the second in a two-part series regarding pending legislation on the legalization of medical marijuana in Illinois.

Some medical professionals are at odds as to whether medical marijuana would offer a viable treatment option for patients with extreme pain and nausea.

Others say working with the drug would be more of a moral or comfort issue.

Doctors in oncology and infectious diseases have access to a drug called Marinol, or synthetic THC, to help cancer and AIDS patients with extreme pain and symptoms consistent with "wasting syndrome."

The THC, the psychoactive ingredient in marijuana, is meant to help with pain and/or stimulate a patient's appetite and encourage weight gain. Some doctors swear by it, and others say it's not always the answer.

"This (legislation) is critically important for the simple fact that it gives options to people," said Dr. Eric Christoff, an internist and HIV specialist in the Chicago area. "The point is, people will have strikingly different reactions that are expected and not expected with certain drugs."

Christoff did not travel to Springfield in person but submitted written testimony supporting Senate Bill 1381, which is waiting to come to a vote in the Illinois House.

He said he believes his peers in Northern Illinois generally would be receptive to the legalization of marijuana for medical purposes, although not all would be comfortable personally prescribing it.

Having heard from patients who have used marijuana on their own and becoming familiar with the effects, Christoff said he wouldn't have a problem looking to medical marijuana as an option for his patients.

"I actually prescribe Marinol quite a bit in my practice. Marinol is usually used to stimulate appetite in some patients," he said. "It works in some people. For the people it doesn't work for, it causes nausea or can also make people sleepy, tired, sluggish, which can also happen with marijuana."

Dr. Mark Woodson with Hematology-Oncology Consultants in Alton and St. Louis agreed that expanded treatment options would be a plus.

"There are medications out there now to help with pain and nausea, all which have potential side effects," Woodson said. "I've used Marinol. I've seen mixed results. For select patients with careful monitoring, (medical marijuana) could be quite beneficial in my cancer patients."

In patients who marijuana helped and Marinol did not, Woodson said inhalation of the drug may have played a part in feeling the effects faster.

Should medical marijuana become legal, Woodson said while the drug would not be his first option, he would include it in a list of options given to his patients.

A lot comes down to whether a physician feels comfortable prescribing marijuana or whether a patient feels comfortable taking the drug, he said.

"A lot of elderly patients would probably be more reluctant, due to the stigma of marijuana," he said. "I think, for the most part, people are waiting to see what happens. I foresee that use in the Alton area would be very small - oncologists, infectious disease specialists."

Dr. J. William Campbell, an infectious disease specialist at St. Luke's Hospital in St. Louis who uses Marinol with HIV patients, said the issue of medical marijuana legalization raises a number of questions, including whether smoked marijuana actually is better than what's available currently or whether patients who are seeing results simply are taking more.

He expressed concerns that dosage amounts aren't as easily measured as with drugs like Marinol. A prescribed form of THC (Marinol) allows doctors to control how many milligrams a patient is ingesting, whereas patients growing their own plants would not.

Dr. John Hoelscher, a board-certified addictionologist in Alton, is opposed to legalization.

"I think it's a terrible idea," he said. "The supposed medical benefits of marijuana are mainly glaucoma treatment and nausea treatment. There are far better treatments for glaucoma and nausea than marijuana. There's no reason to have to resort to marijuana."

Hoelscher stands firm that medical marijuana is not a needed drug. He said there are stronger, well-regulated, dependable medications that can be used to treat patients instead.

He also said marijuana inhalation is "not a predictable way of getting medicine."

Hoelscher said that especially now, while marijuana is illegal, there is no way of telling how much THC is in the leaves or whether the marijuana is contaminated with other drugs.

Government regulation would decrease that chance, he said, but every plant still is different, so dosage would be difficult to tell.

"It's medically absurd to think you can have a medical prescription when you don't know what dose you're giving," he said.

As with other drugs, Hoeslcher said marijuana has its own negative side effects.

"It's not technically addictive, but certainly, there are some people that are habitual users," he said. "It has detrimental effects on their psychological function in some cases."

Jamie Clayton, an AIDS patient from Grafton, has been supporting the bill as a private citizen and as a patient who would be affected by medical marijuana legalization.

Clayton, who has participated in FDA-approved studies and appeared in a documentary on the subject entitled "Waiting to Inhale" (Waiting to Inhale - Marijuana, Medicine and the Law - A film by Jed Riffe), can see that while some patients would be willing to try the drug to get some relief, others would have a problem crossing their own moral boundaries.

"Everyone has their own opinion," he said.

Clayton stresses the importance of education on the matter and making one's own decisions, rather than persuading people to think one way or another.

In previous interviews, he has expressed the importance of giving options to patients such as himself.

"It may not be the magic bullet, (but) I would like to be able to use cannabis," he said in a previous interview. "If it's out there, and it's therapeutic, then I want to be able to include it in my therapy."

Both Clayton and state Sen. William Haine, D-Alton, the sponsor of SB 1381, are pleased with the bill's progress so far.

"Everybody's talking about it," Clayton said. "If we weren't hearing about it, I would be afraid."

"It shows that Illinois is a civilized, compassionate and mature state," Haine said.

Opponents are appalled.

"It appears that the medical marijuana bill is going to be run through the House in an unusual manner," Judy Kreamer of Educating Voices Inc. wrote in an e-mail to fellow opponents, asking them to voice their displeasure to House members.

Kreamer wrote that a vote was expected on Sunday.

Should the bill become law, Illinois would join 13 other states that have such measures in place.

With a doctor's prescription and identification card from the Illinois Department of Public Health, eligible patients would be allowed a small number of plants or two ounces of the dried drug.

"This is a popular and sensible thing to do. There's just not a lot of reason to oppose it," said advocate Bruce Mirken with the Marijuana Policy Project.

[News Admin Note: This is the second part the the two part series. The first part can be found right here. ]