Leanne is awake a lot in the middle of the night. She shifts and twists. Even during the day, she cannot sit still. It does not matter what position she tries, the pain is always there. When she is able to get to sleep, she does not feel it. It is there, however, the moment she opens her eyes. It is relentless. Sometimes she cries. Sometimes she groans in disgust and tries to do something to take her mind off it. She lights a cigarette, hoping the extra dose of narcotic will dull it. That seldom works.
Every day she takes handfuls of pills that are, in combination, supposed to relieve her pain. The list reads like a pharmacy inventory: Morphine, Ultram®, Trazadone, Elavil®, Prozac®, and Tylenol® and/or Advil® for breakthrough pain. Her longtime significant other, Terry, has a similar list for his own pain. His list, too, indicates a handful of pills: Percocet®, Wellbutrin®, Valium®, Cymbalta®, Vicodin®, and, of course, Tylenol® and/or Advil® for breakthrough pain. Their doctors are at a loss for anything else to try.
Leanne is a disabled, retired licensed practical nurse who worked for the state of Pennsylvania for twenty years, resulting in her suffering from chronic neuropathic pain because of degenerative joint disease and a double knee replacement, coupled with Osteoarthritis. Terry is a disabled laborer and retired veteran with Fibromyalgia, abnormally advanced arthritis, and an inflated, bulging disk in his neck. Desperate for some alleviation, they once turned to a drug they first tried in their youth. When they owned their home, several years ago, they secretly planted and grew a pair of cannabis plants. They could dry the leaves and smoke them to get some relief from the constant pain they suffer. Since they no longer own their home, they cannot take the chance of growing it again. They also cannot get it on the market because, as Leanne put it, “You never know what you might get.” Street marijuana could be laced with all kinds of undesirable things that make smoking it unsafe. (L. McCormick, personal communication, March 11, 2010).
If they lived in California, Montana, Vermont, Rhode Island, or any other of the fourteen states who have passed laws allowing the medicinal use of marijuana, Leanne and Terry would have regular access to pain relief. Since they live in Pennsylvania, it is far too risky. Since Mr. Obama took office, the federal government has stated that they will no longer exert federal power over state laws by prosecuting medicinal cannabis users. So for Leanne and “Dad,” and thousands of people like them living in this state, Pennsylvania should join the legion of states who allow marijuana to be used for medicinal purposes.
The Food and Drug Administration (FDA) has stated “smoked marijuana has no currently accepted or proven medical use in the United States” (cited in “Medical marijuana”, 2006). It is simply not possible for that statement to be true. The cannabis plant has been used as medicine for centuries. Queen Victoria used it for menstrual cramps (Holdcroft, 2002, p. 181). A National Institute of Health research panel recently suggested that marijuana might be an effective treatment for pain (Wilsey et. al., 2008, p. 5). In Canada, the Netherlands, Switzerland, Spain, England, other Western European countries (Canada and the Netherlands lighten up, 2005, p. 136), as well as Germany and Austrailia (Medical marijuana on sale, 2003, p. A6) cannabis has been proven an effective medicine and legalized for medical purposes. Even here in the United States, marijuana was “part of the published pharmacopeia until 1942, and it was still legally available for medical use until 1970, when the Controlled Substances Act was passed” (MacDonald, 2009, p. 779). “The analgesic effect of cannabis and its main active ingredient… is now well established” (Ashton, 2008, p. 243).
Opponents to the drug complain that most of the evidence for medical marijuana is through anecdotal accounts from patients rather than a large number of scientific studies. One would think that patients would know best what does and does not work for them. In fact, “Almost all medical uses of marijuana started with successful treatments of individual cases… Proponents of case studies also mention that many medications gained widespread use based on only a few positive results, including aspirin, insulin, and penicillin” (Earleywine, 2002, p. 169).
Jessica Berg (2006) argues that the ongoing struggle for the legalization of medicinal marijuana is largely “a battle of federalism.” She believes that the argument over the medical use of cannabis is more about the “balance of power between states and the federal government” (p. C3). Politics remains a large part of whether marijuana should be legalized. Legal and political discussions often surpass medical science with regard to the use of cannabis. (MacDonald, 2009, p. 782). Drug companies usually fund controlled trials and have lobbyists who petition the FDA for new drugs. “Yet, given the limited potential for smoked marijuana to generate a profit for these [drug companies], funding [for] randomized control trials to establish its medical efficacy remains difficult” (Earleywine, 2002, p. 170).
While the FDA struggles to get a handle on prescription drug abuse, they refute marijuana as a prospective drug passed on its potential for abuse (Dresser, 2009, p. 8). They argue that marijuana is a “gateway drug” to harder, more dangerous drugs. Caroline Finucane, Editor of the International Journal of Therapy and Rehabilitation, insists, “it is unlikely that use of medicinal cannabis will lead to use of harder drugs or cognitive impairment, as people using the drug for medicinal purposes take a smaller dose, are monitored professionally, and generally only start taking it later in life” (p. 144). Francis L. Young, Administrative Law judge with the DEA, said in 1988, “Marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis, marijuana can be safely used within a supervised routine of medical care” (cited in Medical marijuana, 2006, para. 10).
Perhaps another reason the marijuana is seen as unaccepted medicine for pain in the United States and Pennsylvania in particular is, as Wayne Hall, of the Office of Public Policy and Ethics, University of Queensland, Austrailia, put it, “the analgesic effects [of marijuana] are modest compared to opiods” (Barton, 2005, p. 448). Referring to the medications listed earlier: Morphine, Ultram®, and Percocet® are opiods. A study done by University of California San Diego suggests “there is a window of modest analgesia for smoked cannabis, with lower doses decreasing pain…” (Wallace et. al., 2007, p. 785). Dale Gieringer (2002) states, “Many patients find that marijuana effectively replaces other prescription drugs and analgesics (notably opiates [also known as opiods]) which would otherwise be prescribed to treat their disease and which have worse side effects” (p. 150).
Adverse side effects would be a reasonable opposition to legalizing cannabis for medical use if they were any worse than the side effects of currently accepted medications. Smoked cannabis has fewer adverse side effects than Marinol® and Cesamet®, oral synthetic cannabis-based drugs called cannabinoids, that are already approved in pill form by the FDA. In fact, according to the National Library of Medicine’s Web site, they carry a number of common side effects with all of those powerful medications listed above and do little to combat pain. (http://www.nlm.nih.gov/medlineplus/druginformation.html). Most notable side effects of Marinol®, Cesamet®, and opiods/opiates are nausea, vomiting, drowsiness, dizziness, anxiety, loss of appetite, and dry mouth/throat. It is interesting to note that Marinol® and Cesamet® are usually prescribed to ease the nausea, vomiting, and loss of appetite associated with chemotherapy and advanced AIDS medications.
Marinol® and Cesamet® aside, there are patients who maintain that marijuana only works if it is smoked (Wingerchuk, 2004, p. 316). There are only a small number of studies available that prove or disprove the risks and benefits of smoked cannabis (Dresser, 2009, p. 8). However, doctors have used marijuana to assuage pain since the start of the first century. (Earleywine, 2002, p. 174). Certainly, it must have been smoked. In fact, “a report of the U.S. Institute of Medicine… found chronic pain to be a condition for which smoked cannabis could have unique therapeutic benefits” (Gieringer, 2002, p. 148). Clarke and Watson (2002) also contend, “higher levels of THC… are healthier for patients using smoked cannabis as they can smoke less to achieve the same dosage and effect” (p. 11). Dr. Mitch Earleywine, PhD, notes that smoking marijuana obviously helps with some patient complaints, and may be less costly than currently available treatments (p. 167). He also states that, “Smoked marijuana is cheaper, providing a clear advantage over oral THC and many other drugs” (p. 171).Smoking, though, causes apprehension over the “health-related issues that result from the delivery method” (Wallace et. al., 2007, p. 785). This apprehension is unfounded. There is no authoritative proof that smoking marijuana leads to lung problems like tobacco does (Marijuana, 2009). There are no records of marijuana users developing lung cancer from use of the drug (Earleywine, 2002, p. 181). Unlike opiods, cannabis does “not usually result in physical dependence” (Cannabis, 2010) and “cannot lead to fatal overdose, and its hazards pale in comparison to those of alcohol” (Kershaw & Cathcart, 2009, p. ST1). Everyone knows or has heard of someone who has died from adverse effects of alcohol and tobacco, both legal, over-the-counter drugs. “Science indicates that marijuana smoke is less harmful than tobacco smoke… No one has ever died from using cannabis…” (Barth, 2009, p. B5).
Perhaps the most compelling reason for adopting medicinal marijuana is to follow in the footsteps of fourteen other states in an effort to have it legalized nationally. “Bruce Mirken, director of communications for the Marijuana Policy Project, a Washington, DC, advocacy group for marijuana use [says] ‘One in four Americans now lives in a state that approves medical marijuana’” (Ananny, 2009, 163). Gerald F. Uelmen, a Santa Clara University law professor who fruitlessly defended California’s medical marijuana law to the Supreme court, stated, “The people gave us medical marijuana laws. To me that says a lot. It says… that the politicians are lagging behind the public sentiment that supported this movement” (cited in Gibeaut, 2001, p. 90). Pennsylvania joining the movement for medicinal marijuana is a necessary step toward U.S. legalization. “If enough other states enact such laws,” Gibeaut (2001) states, “then Congress eventually will feel the pressure and change the federal statue” (p. 90). Clarke and Watson (2002) add, “Cannabis smoking and cultivation for personal medical use will eventually be legalized or tolerated in may places, if not by the public openly favoring marijuana legalization, then by increasing awareness of the advantages of this potentially useful medicine” (p. 12).
Marijuana has been proven effective by a number of studies as well as patient anecdotes. The United States has kept it illegal primarily for political and power reasons. It is safer than opiods, tobacco, and alcohol: all legal drugs. It is doubtful it would front the use of harder drugs, as the U.S. government would have people believe. Pure smoked cannabis, not some synthetic derivative in a pill, is the most effective way to use the drug. Fourteen other states, and at least seven other industrialized countries, have already adopted laws allowing marijuana for medical use. Pennsylvania needs to get on board!
“If marijuana were legal here, I would not need any of these medications,” Leanne laments as she waves a hand over a leather bag filled to overflowing with prescription bottles (L. Mccormick, personal communication, March 11, 2010). The bottom line is that all of the medication Leanne and Terry take for pain, especially in combination, is toxic, potentially deadly, and does not take away all the pain. Marijuana does, and it will not kill them in the process.
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