A maligned drug edges toward the mainstream
By the time he turned 18, Irvin Rosenfeld had long suffered from a congenital disease that caused painful, bony, and potentially cancerous growths throughout his body. Thirty to 40 had been removed in seven operations. He had to be home-schooled through high school because he couldn't even sit for more than 10 minutes, the discomfort from the pressure on the growths was so great.
Many patients search for years without finding an effective treatment for their ills, but Rosenfeld was lucky. With a thirst for independence, he decided to go to college in Miami, where he came into contact with marijuana. The first time he pulled on a joint and passed it on, Rosenfeld recalls, he didn't notice anything--until he realized he'd been sitting pain-free for half an hour, three times his normal limit. "At that point the joint was coming back to me," he recalls, "and I thought 'This is the only thing I've done differently.'"
Rosenfeld is one of a growing number of patients inhaling and hailing the benefits of medical marijuana. People with a variety of conditions--including cancer, HIV, and multiple sclerosis--have found that marijuana can reduce nausea and vomiting, quiet muscle spasms, and lower pressure inside the eye (the cause of glaucoma). The American Medical Association, the National Institutes of Health, the Institute of Medicine, and the World Health Organization have all recommended further research on marijuana's potential to treat various conditions. Former New England Journal of Medicine editor Jerome Kassirer went even further in 1997, writing: "Federal authorities should rescind their prohibition of the medical use of marijuana for seriously ill patients and allow physicians to decide which patients to treat. The government should change marijuana's status [from] Schedule I drug...[to] Schedule II drug...and regulate accordingly."
Even one of marijuana's most outspoken opponents, Columbia University psychiatry professor Herbert Kleber, concedes that, while he believes more testing is in order, marijuana is probably less addictive than some Schedule II drugs, like cocaine and morphine, that under the Controlled Substances Act of 1970 may be prescribed for certain indications. These Schedule II opiates have enjoyed a resurgence recently, due in part to research showing that their power to block pain outweighs the dangers of side effects and dependence. Yet marijuana remains classified as a Schedule I substance, with heroin and other highly addictive, dangerous, banned narcotics.
Marijuana enjoyed fairly wide medical acceptance until about 1900, and was legally available for medicinal and industrial uses until 1941, when it was removed from the United States Pharmacopoeia and National Formulary. A spurt of popularity as a recreational drug in the 1960s and '70s was countered by a backlash beginning in the Reagan years; during the Clinton administration, as many as 700,000 Americans were arrested annually on marijuana-related charges.
Even in states where legal measures protect the use of medical marijuana, patients cannot be assured of shelter. On April 18, 2000, the San Diego County Police and the U.S. Drug Enforcement Agency raided a medical-marijuana cooperative that had operated for two and a half years under a medical-marijuana statute. Five associates of the cooperative, which openly sold marijuana, could face jail terms of five years and fines starting at $10,000 each. San Diego County deputy district attorney Julie Korsmeyer says California's Proposition 215 defends only the cultivation and possession of marijuana for medical purposes, not its sale. "It never deals with how people are supposed to get the stuff," she says. David Hamlin, a spokesperson for the defendants, agrees the statute looks like fuzzy legislation, but says, "There is not a rational explanation for [the raid] in terms of basic law enforcement."
Irvin Rosenfeld has done everything possible to use marijuana legally. He sought out his local police chief to request access to confiscated marijuana to ease his symptoms. He designed a research protocol (never funded) with himself as the lab rat. He testified to a Food and Drug Administration panel that marijuana enhanced the effects of opiates he was taking for pain control. And 24 years ago, by sheer luck, he was enrolled with 12 others in a compassionate-care protocol that allowed treatment with government-grown marijuana. The program was ended by President Bush in 1992, but Rosenfeld still receives 300 cigarettes of dried cannabis plant each month for personal medicinal smoking.
"I feel very, very fortunate," says Rosenfeld, now a Florida stockbroker. "I appreciate what the government has done and hope it never stops. But I'm vocal because I want to educate people about why we should put this medicine in the hands of physicians, where it can do some good."
Medical marijuana has one very strong selling point: it may be the one appetite stimulant and antinauseant you don't eat. And a drug that doesn't enter your stomach, unlike the widely used ondansetron hydrochloride or the marijuana derivative pill Marinol, can't be vomited up. HIV patients, desperate for anything to relieve their nausea and struggles against starvation, have battled openly for its medical use. But well before that, some cancer specialists and nurses subtly steered retching, miserable patients toward the drug.
One such patient was the late son of Lester Grinspoon, M.D. '55, now associate professor of psychiatry emeritus and longtime editor of the Harvard Medical School Mental Health Letter. In 1967, 10-year-old Danny Grinspoon was diagnosed with an aggressive cancer of white blood cells. He tolerated therapy at first, but then began receiving drugs that caused uncontrollable vomiting. Grinspoon objected when his wife suggested Danny smoke marijuana to calm his stomach, but she went ahead anyway. "My surprise gave way to relief when I saw how relaxed Danny was," Grinspoon wrote later. "He did not protest when he was given the [anticancer] medicine, and we were all delighted when no nausea or vomiting later followed."
After his son's experience, Grinspoon began research that found some 30 potential medical uses for marijuana. In 1993 he and James Bakalar '64, LL.B. '67, lecturer on law in the department of psychiatry at the medical school, wrote Marihuana: The Forbidden Medicine, which contains stories of patients with chronic, painful conditions like multiple sclerosis, epilepsy, migraine, arthritis, Crohn's disease, and insomnia, all of whom have been helped by marijuana.
Despite these testimonials, "the research has not been done on marijuana," says Kleber. "The evidence for its value is primarily anecdotal. That's not enough." Important questions about dosing and possible side effects still need answers, he insists.
Is pot addictive? In a recent study from the National Institute of Drug Abuse, squirrel monkeys already hooked on cocaine displayed addictive behavior in taking delta-9 tetrahydrocannabinol (THC), the active ingredient in marijuana. A recent study from Kleber's group showed that people who smoked four joints a day for a week displayed some withdrawal symptoms after they stopped marijuana. But many drugs, licit and illicit, have much greater addictive potential than marijuana.
Opponents of legalization also charge that a smoked drug cannot be properly dosed and poses a long-term danger of cancer causation. But Grinspoon notes that new delivery devices appear able to vaporize THC without actually burning the plant. A 12-year study from Johns Hopkins also questions the long-term memory loss purportedly associated with marijuana: among 1,318 subjects under the age of 65, there were no significant differences in cognitive decline among heavy users, light users, and nonusers of cannabis.
As misconceptions about marijuana fall, it's only a matter of time until it gains legal status, Grinspoon believes. "As doctors come to see how useful cannabis is," he says, "when they see how it can stimulate appetite, reduce nausea and muscle spasms, and help with a number of conditions, there's going to be a push to make it available. I don't think it's a matter of 'if' anymore, it's a matter of 'when.'"
Grinspoon's optimism is longstanding. In 1971, two years before his son's death, he published Marihuana Reconsidered, a bestseller in which he predicted the drug would gain legal status within 10 years. So far, he's off by 200 percent. Yet Allen St. Pierre, executive director of the National Organization to Reform Marijuana Laws, notes that eight states have passed voter initiatives permitting the use of medical marijuana and several more are considering such legislation. (A Washington State voter initiative with medical marijuana provisions failed in 1997, but it would also have legalized marijuana for other uses.) Other states are relaxing their penalties for marijuana possession.
That day can't come too soon for Rosenfeld. "There are many people against us we still need to educate," he says, "and some who will be against us no matter what. People think I should be stoned out of my mind, smoking 12 joints a day for 24 years. But I have a job, I handle millions of dollars, and I can fight for my rights and try to help others. I hope our country will show its compassion for sick people."