MAR 1998


Therapists Talk 
Shrink Rap 


    Michael E. Holtby, LCSW, BCD


First published in Resolute!, March, 1998

To be reprints only with the author's permission.

I am not in favor of legalizing another addictive drug. From personal and clinical experience I know the damage of a psychological addiction to pot. I know how it can exacerbate a depression, lower one's energy level and immune system. I know how one's life can get organized around getting high, and damage one's relationships, motivation, and judgement. For PLWA's on Crixivan marijuana competes for the same liver enzymes to metabolize.

I am also against the legalization of over-the-counter use of Valium, Xanax and other drugs in the class my polysubstance abuser clients call "benzos". And yet, the benzodiazepines also have their place: alleviating anxiety and insomnia. I am also against the general use of dilaudid, percodan, and morphine. However, all these drugs are very useful for medical purposes, and I certainly don't want to limit our ability to combat pain. In a similar way I believe marijuana plays an equally useful role in the alleviation of seizures, persistent muscle spasms, chronic pain, nausea, and diarrhea. As the accompanying account by Lee Cantwell convincingly describes, marijuana probably saved his life. For the person living with AIDS marijuana is particularly helpful countering wasting syndrome. For those having to undergo chemotherapy, marijuana is probably the drug of choice for nausea. There is also evidence that marijuana can be helpful for spinal cord injuries, neuropathic pain, multiple sclerosis, glaucoma, and epilepsy. We have historically drawn a distinction between the recreation usage of drugs, and their use as medicinal prescriptions. We must do the same with cannabis.

Opponents will say that there are already effective treatments for all these conditions. In particular they will point to Marinol, which is a pill form of the active ingredient in marijuana, THC. However, in comparing the two marijuana has three distinct advantages: (1) it hits the system quicker by smoking it, whereas Marinol's absorption is variable and less predictable; (2) it is easier to regulate the dosage, and (3) it doesn't last uncomfortably long like the pills do.


Why have we had such a hard time accepting medical usage of marijuana? It appears the answer lies with the difficulty the federal government has had separating prescription use for medical purposes from the total decriminalization of pot. The White House says, "It would send the wrong message to kids." And Barry McCaffrey, the Director of the Office of National Drug Control Policy argues against the medical use of marijuana by talking about how eighth graders have tripled their marijuana use over the past five years. How ludicrous that would sound if we were debating the use of xanax or dilaudid!

Mr. McCaffrey goes on to quote the National Institutes of Health's conclusion, "There is no scientifically sound evidence that smoked marijuana is medically superior to currently available therapies." Yet they have also blocked all attempts to conduct responsible research. A 1982 report by the Institute of Medicine of the National Academy of Sciences was buried when it recognized the therapeutic effect of cannabis and recommended further research. The government only printed 300 copies of the study -- not even enough for each member of Congress.

Another federal study conducted by the National Toxicology Program was left on a back shelf for 2 years until the newsletter, AIDS Treatment News brought it to light. The study was ignored despite its $2 million price tag, and a panel of expert reviewers' finding that the study's conclusions and methodology were sound. The study found the main active ingredient in marijuana failed to cause cancer in lab rats, and actually may have protected them against other malignancies.

A leading AIDS clinician and researcher, Dr. Donald Abrams of the University of California, S.F. just got a research grant approved but only after a protracted battle with NIH which began in 1992. The U.S. government previously would not allow him to obtain a legal supply of marijuana, and the DEA wouldn't let him import it from the Netherlands.

Canadians have experienced similar roadblocks. Dr. Don Kilby has applied to Health Canada to allow Jean Charles Pariseau, a 30-year-old PLWA the use of marijuana. Dr. Kilby said, "I've made (applications for other non-approved drugs) before, and in typical cases, the medicines can be approved within two or three days." After the failure of a number of nausea-fighters and appetite stimulants, Pariseau tried marijuana. His weight shot up pounds, and Dr. Kilby changed his prognosis from three months to three years to live. Unfortunately, the Canadian government turned down his request because Dr. Kilby's application did not include a licensed "manufacturer". Mr. Pariseau was also arrested for the possession of marijuana.

Meanwhile, the American Medical Association has just proposed that doctors be allowed to discuss with their patients the potential medicinal benefit of marijuana without fear of criminal prosecution, or threats by Attorney General Janet Reno to take away their prescribing privileges. The resolution stated: "the AMA believes that effective patient care requires the free and unfettered exchange of information on treatment alternatives and that discussion of these alternatives between physicians and patients should not subject either party to criminal sanctions."

The New England Journal of Medicine also recently called on the government to reclassify marijuana so it can be prescribed by doctors for medical purposes. The Journal's editor-in-chief, Dr. Jerome Kassirer writes, "I believe that a federal policy that prohibits physicians from alleviating suffering by prescribing marijuana for seriously ill patients is misguided, heavy-handed and inhumane."

What gets lost is the distinction between the War on Drugs and medicinal efficacy. The Virginia Nurses Association's position paper on pot states, "Rationally considered, cannabis is far less toxic and far safer than many routinely prescribed and over-the-counter medicines currently used today."

Thirty-six states have passed some form of legislation recognizing the medical value of marijuana. In November, 1996 the voters in both Arizona and California approved the possession and cultivation of marijuana with a doctor's recommendation. However, a state appeals court ruled in December, 1997 to reinstate the injunction that originally shut down the San Francisco Cannabis Buyer's Club in an August, 1996 raid. The Club sells medicinal marijuana to nearly eight thousand clients. Again, the concern is whether it is just a front for more widespread recreational usage.


It is very likely that a medical marijuana initiative will be on the ballot this coming November in Colorado. A group called Coloradans for Medical Rights has proposed a law which would issue identification cards through the health department to qualifying patients and "primary caregivers" which will prevent their being arrested for possession. Each patient is limited to two ounces of marijuana or six plants under cultivation with no more than three which are mature and producing. The law also provides for doctors to be explicitly protected for advising the use of cannabis. In an effort to insure the initiative passes it falls short of what patients really need: it does not actually supply marijuana. There will be no buyer's clubs as in California. Patients, who don't grow their own pot, must expose themselves to illegal sources. Of course, our local governments could provide it from drug raids rather than burning, or otherwise destroying it. Nothing like this has been proposed in the current initiative, but one California county's police department is doing just that.

If you would like to help the cause in Colorado, contact Marty Chilcutt, the campaign's spokesperson at (303) 864-4224.


For more information visit the following web sites:

Patients Out of Time -- Cannabis as Medicine

The Scientist, November 1995.

    Peter Gwynne, "Trials of Marijuana's Medical Potential Languish As Government Just Says No."

HIV In Site

    Includes extensive research and Literature Review on "Safety, Efficacy and Effects of Smoked Marijuana on People with HIV with Mild to Moderate Weight Loss," by Donald Abrams, M.D. and others.

Be sure and read the accompanying article by Lee Cantwell,

 "Confessions of a Pot Smoker"



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.