Saturday, December 20, 2008

Docs for Dope

By Margo Pierce

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Marijuana is a medicine. Not many doctors are willing to make that kind of statement publicly, especially when U.S. Drug Enforcement Administration raids result in the jailing of physicians, terminally ill patients and statelicensed marijuana growers in states where the medicinal use of marijuana is permitted by law.

But Richard J. Wyderski, a physician at Miami Valley Hospital in Dayton, believes the benefits of the herbal therapy far outweigh the risks of pushing for legalization. In this case he’s publicly backing Senate Bill 343, most commonly referred to as the Ohio Medical Compassion Act sponsored by Sen. Tom Roberts (D-Dayton).

“I provided testimony to the Senate Judiciary Committee,” Wyderski says. “I talked about the historical aspects of marijuana — it was a medicine back in the 1800s and early 1900s — and the regulatory stuff that happened that led to it no longer being used medicinally even though it was on the U.S. pharmacopoeia until the early 1940s.

“Patients who have chronic, debilitating conditions do benefit and should have access to medical marijuana to be able to use it in a safe manner under medical supervision unadulterated by other substances that might be supplied if they obtain it illegally.”

SB 343 is similar to the medical marijuana legislation proposed by State Sen. Robert F. Hagan (D- Youngstown) in 2005 (see “Toking the Cure,” Issue of March 2, 2005). That law never received a hearing, but the new bill was the subject of expert testimony in November.

The bill would create a “registry identification” card for individuals who use medical marijuana for specific medical conditions. Those with a diagnosis that fits the definition of “debilitating medical condition” outlined in the legislation would be able to apply for the card and use marijuana under the supervision of a licensed medical doctor.

Those conditions include cancer, positive status for HIV, AIDS, hepatitis C, Krohn’s disease, Alzheimer’s, multiple sclerosis, spinal cord injuries and other chronic pain syndromes.

“The Institute of Medicine report reviewed all the scientific evidence of the effectiveness of marijuana used as a medication for a variety of conditions,” Wyderski says. “Muscle spastisity for multiple sclerosis is one of the most commonly used examples, but there’s evidence it works for nausea — cancer patients who have nausea with chemotherapy.”

Under SB 343, the doctor would not actually prescribe marijuana or even supply the patient with the medicine. She would be able to advise the individual of the benefits and risks, recommend dosage, monitor reactions and provide the required diagnosis for patient registry. The patient, doctor, primary caregiver and individuals who work at sites that cultivate medical marijuana would all be protected from arrest and prosecution under state law.

That’s important, Wyderski says, because it begins to differentiate between drug use and drug abuse. In his case, he received a verbal reprimand from his own hospital for treating patients who were self-medicating with marijuana.

“I was the medical director for our outpatient clinic here in Miami Valley, and we had a lot of patients who used marijuana for pain control, to alleviate anxiety symptoms and so forth, and they were seen as bad drug abusers by our nursing staff and the administration of our clinic,” he explains. “Even though I didn’t have a lot of heartburn about it, literally they would dismiss people from the clinic. I was called out because I was allowing them to use marijuana and also prescribing other medications they needed despite the fact that they were ‘drug abusers.’

“In our policy if anybody is using an ‘illicit drug,’ marijuana being one of them, we cannot prescribe another controlled substance for that same individual. So I’m practicing bad medicine because I prescribe controlled substances for people that are using illegal drugs.”

Wyderski says that mixing the use of different drugs can cause dangerous side effects. Prescribing a “controlled substance” like codeine — a powerful painkiller — to someone taking heroin would be a bad idea, which is why his clinic requires drug screening before prescriptions are written. Disregarding the relative safety of marijuana as a medicine and putting it on par with drugs like heroine or cocaine keep a legitimate drug out of reach.

“The FDA came out with a statement in 2006 that, despite the scientific evidence of its effectiveness, marijuana’s ineffective,” Wyderski says. “So I don’t have any hope that the FDA would ever approve marijuana for prescriptive use by physicians.

“There’s a lot of marijuana research that’s missing in part because it’s so hard to do research on the medical marijuana. There are very, very few comparative studies with other drugs that are available that are FDA-approved. In some cases there have been head-to-head trials where other drugs are more effective than marijuana, which is also important information to know. It’s not just that marijuana is ineffective, just that other medications sometimes are more effective.”

The U.S. Supreme Court’s refusal to hear a case let stand a lower court ruling that a doctor is allowed to discuss the benefits and risks of marijuana, so Ohio doctors are allowed to discuss this medical option. But when it comes to pain management and quality of life for terminally ill people, doctors need more freedom and protection.

Using unregulated herbal therapies as his example, Wyderski makes his case for passage of SD 343.

“We already have people using all kind of herbal therapies for all kinds of other things, and herbal therapies are not regulated by the FDA,” he says. “We have black cohosh for menopausal symptoms. People use ginco biloba thinking it might help their memory.

“(Marijuana) is a special plant because of abuse potential, and it probably should be controlled in some way. I think SB 343 reasonably puts into place those kinds of controls while at the same time allowing individuals to have access to a plant that does have medicinal value. It sets parameters where that substance use is supervised by a clinician.”

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