Medical Marijuana? Don't Do It, D.C. By Barry R. McCaffrey

Director of the White House Office of National Drug Control Policy.

As the recipient of Harvard University's Zinberg Award this past spring, I reviewed what the late Dr. Norman Zinberg, a pioneer in drug-related research, had to say about illegal drugs some three decades ago. Zinberg argued that "set and setting" -- which is to say "text and context" -- are pretty much the whole show. To assess the cultural meaning of alcohol or tobacco, for example, you have to consider how it is used by whom. Wine, for instance, is different when framed by a religious ritual in church than when drunk in the street by a "wino" holding a bottle in a bag.

What has changed in drug use over the past 30 years is both set and setting -- a younger set has adopted the habit, and children are using a wide range of drugs in settings where they spend most of their time: schools, playgrounds and cars. The new survey conducted by the National Center on Addiction and Substance Abuse (CASA) indicates that a half-million eighth-graders say they began using marijuana in the sixth and seventh grades. If we picture the 22-year-old co-ed of the 1960s smoking pot at a rock concert, her counterpart in the '90s is 12 years old and stoned during third-period English.

The joke has been told: "If you remember the '60s, you probably weren't there." Today's teens are missing their education or the turn on Highway 95, not a political rally or jam session. The stakes have changed along with the drugs. With marijuana being the second leading cause of car crashes among young people (after alcohol) and with a hundred thousand teenagers moving on to heroin, life itself is at risk for American kids.

The context for today's drug abuse is homelessness and hopelessness. With broken families becoming the rule rather than the exception, and with communities racked by violent crime, too many youngsters no longer have the proverbial kitchen table where parents can tell them not to use drugs. Teen pregnancy, venereal disease, delinquency, domestic abuse and rising school dropout rates are other features of the setting in which illicit drugs are located. Many proponents of legalizing drugs fail to notice the new terrain where poly-drug use is likely to include crack cocaine, dangerous hallucinogens, so-called "designer" drugs, and potent chemicals with purity levels that promote addiction. The short-lived flower children have been replaced by gangs with guns. What may have begun with pleasure-seeking ends up with pain-control.

Signatures are now being gathered in the District of Columbia for 1997 Initiative 57, the legalization of "medical marijuana." If approximately 17,000 names can be collected (a figure determined by a percentage of each ward) and submitted to the D.C. Board of Elections, the petition will be put on the ballot, possibly this November. Were this measure approved by a majority of voters, Washingtonians would be able to grow, use, and distribute marijuana with a physician's recommendation. (No written prescription is required.)

The loosely structured initiative, which allows up to four "friends" to grow or otherwise provide marijuana for any "patient," would permit residents of D.C. to organize and operate marijuana corporations -- ostensibly for the sick. In Arizona, a similar marijuana ballot was passed -- it also legalized LSD for medical purposes despite the absence of any proven medical benefit -- only to be repealed by the state legislature after careful consideration.

If pot is such a wonderful medicine, why haven't more doctors prescribed Marinol, the real "medical marijuana"? The active ingredient in the cannabis leaf, THC, is synthesized in measured dosages as Marinol, a prescription drug that has been available for 15 years. The argument that this chemical needs to be smoked, exposing patients to carcinogenic agents that damage the lungs, doesn't make sense. No one argues that in place of penicillin capsules, people should revert to moldy bread.

Crude marijuana, unlike Marinol, would evade the testing process of the Federal Drug Administration that has made American medicine among the safest in the world. The current scientific process for approving medications, which entails peer review by researchers and physicians, should not be supplanted by a nonmedical, political process. Advocates of drug legalization admit that they have couched the question in medical terms to camouflage the issue.

The latest research suggests that marijuana relies upon the same mechanism of chemical reinforcement in the dopamine pathways that is utilized by addictive drugs such as heroin and cocaine. By hijacking the body's pleasure system, drugs produce counterfeit highs that substitute for life's genuine rewards.

In the Netherlands, where marijuana technically has been legalized for personal use, "medical marijuana" was prohibited by the Dutch minister of health. Holland has no reason to distort the scientific process in order to represent therapeutic applications for pot. In the United States, a medical blanket has been thrown over marijuana, obscuring debate. We should not accept a substance with minimal medical efficacy and maximal psychotropic effects.

Marijuana For Medicine, Not Abuse

By Wayne Turner and Steve Michael

Letter to the editor published Wednesday, November 5, 1997, in The Washington Post .

In the pages of The Washington Post, drug czar Gen. Barry McCaffrey [op-ed, Sept. 9] and former HEW secretary Joseph Califano [op-ed,Sept. 30] have grossly mischaracterized the District's medical marijuana ballot measure as part of a sinister conspiracy to legalize narcotics for recreational use. Far from it, Initiative 57, proposed by the local AIDS advocacy group ACT UP Washington, simply provides a legal defense, in limited circumstances, to seriously ill and dying patients who use small amounts of marijuana to ease their suffering.

For those of us fighting for years on the front lines of the AIDS epidemic, where the devastating impact of addiction and substance abuse is a daily reality, nothing less than a tightly crafted initiative, permitting strictly medical use, could be introduced for the approval of D.C. voters.

The sick beds of AIDS patients, cancer sufferers and others with serious and terminal illnesses are caught in the middle of a confrontation between the pro-drug legalization lobby and prosecutors who jail patients to look tough on drugs. Initiative 57 gives the voters of the District the opportunity to reject both extremes.

AIDS activists designed Initiative 57 to protect the very ill, not the partygoer. The proposed D.C. medical marijuana ballot initiative is too restrictive for the big-money pro-legalization lobby. Initiative 57 won't turn every corner Starbucks coffeehouse into an Amsterdam-style hashish bar. Instead, Initiative 57 closes loopholes and tightens vague language incorporated into medical marijuana measures sponsored elsewhere.

The legislative text of Initiative 57, ignored by McCaffrey and Califano, specifically addresses many of the objections raised by those alarmed by the prospect of legalization. Under the District's Initiative 57:

Non-medical use is explicitly prohibited. Seriously ill patients must be under the supervision and care of a licensed physician.

Patients are limited to small amounts of marijuana in order to be protected from criminal prosecution.

Medical use is no excuse for criminals and "shall not be a defense to any crime of violence, the crime of operating a motor vehicle while impaired or intoxicated, or a crime involving danger to another person or to the public" or any other crime.

The doctor-patient relationship is protected by preventing prosecutors from targeting physicians who recommend marijuana to their patients.

No more than four caregivers may be designated, defined as a person "who is feeding, nursing, bathing, or otherwise caring for a medical patient while the medical patient is in a weakened condition."

Buyers' clubs must be registered and licensed through the same D.C. government agency that oversees the medical profession and the hospital industry. Initiative 57 protects the community from drug dealers by requiring those who distribute marijuana to medical patients to register and be subjected to the same regulations as other not-for-profit corporations. They also are restricted "exclusively for the medical use of medical patients who are authorized by this act to obtain marijuana for medical purposes."

Initiative 57 doesn't replace science. It simply keeps seriously ill patients out of jail, pending the ultimate approval of medicinal marijuana by the U.S. Food and Drug Administration. In an action welcomed by activists, a panel at the National Institutes of Health recommended the resumption of full-scale research into medical marijuana at the federal level. Initiative 57 is a stopgap measure, providing a legal defense in limited circumstances for those patients who turn to marijuana when conventional therapies fail.

McCaffrey argues that the medical-use defense provided under Initiative 57 will somehow promote recreational drug use. The world of chemotherapy, vomiting and AIDS wasting syndrome is not glamorous. For AIDS patients throwing up their food and pills, for cancer patients undergoing the severe side effects of chemotherapy, there is a clear distinction between medical use and substance abuse.

We urge the voters of the District to look beyond the misinformation propagated by the likes of McCaffrey and to protect medical patients and their providers from criminal prosecution by signing, supporting and ultimately voting for the "Legalization of Marijuana for Medical Treatment Initiative of 1997."

The writers are founders of ACT UP, the AIDS Coalition to Unleash Power, in Washington. Steve Michael is the sponsor of Initiative 57.

Marijuana's Medicinal Miracles

Monday, November 17, 1997; Page A22
The Washington Post

Strange as it may seem, here is one right-wing Republican who agrees with Wayne Turner and Steve Michael in their column about marijuana ["Marijuana for Medicine, Not Abuse," op-ed, Nov. 5].

When our grown daughter was undergoing chemotherapy for lymph cancer, she was sick and vomiting constantly as a result of her treatments. No legal drugs, including Marinol, helped her.

We finally turned to marijuana. With it, she kept her food down, was comfortable and even gained weight.

Those who say Marinol and other drugs are satisfactory substitutes for marijuana may be right in some cases but certainly not in all cases.

If doctors can prescribe morphine and other addictive medicines, it makes no sense to deny marijuana to sick and dying patients when it can be provided on a carefully controlled, prescription basis.

LYN NOFZIGER