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New law for an old drug

Medical marijuana issues rise as communities grapple with state law

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“Last dance with Mary Jane, one more time to kill the pain,” Tom Petty sings in his hit song “Mary Jane’s Last Dance.” The song was released in 1993, just three years before California would legalize marijuana for medicinal purposes and 11 years prior to its legalization in Montana. 

One can assume that Petty was not referring to some pretty girlfriend named Mary Jane in the song, nor was he referencing an actual physical pain that he was feeling. No, rest assured, Mr. Tom Petty and his Heartbreakers were singing about self-medicating their emotional turmoil with marijuana.

Intentional or not, the lyrics are indicative of a wave that would start to sweep the nation a few years later. Thirteen states followed California’s lead and legalized marijuana for medicinal purposes, attempting to ease the physical pain of patients suffering diseases ranging from glaucoma to epilepsy.

On Nov. 2, 2004, 62 percent of Montana voters approved Initiative 148, the Medical Marijuana Act, which allows patients with a “debilitating medical condition” access to marijuana and also allows caregivers to “undertake the responsibility for managing the well-being of a person with respect to the medical use of marijuana.”

In short, the state of Montana legalized the production, sale and distribution of marijuana for medicinal purposes.

This article is the first in a series that provides an overview of where medical marijuana use stands and how many questions remain about its use, sale and distribution. These articles will explore the effects medical marijuana is having in the community, as well as ask some of the questions that remain unanswered.


Mary Jane — the drug

Anyway you smoke it, eat it, or drink it, marijuana — medical or otherwise — is a drug. It’s a drug that when absorbed into the blood stream, travels throughout the body, including the brain and produces an intoxication that can last hours. In small doses, marijuana produces a feeling of bliss and well-being, while in higher doses it can cause delusions and paranoia. 

The active ingredient in marijuana is delta-9-tetrahydrocannabinol or what is commonly referred to as THC. THC attaches to cannabinoid receptors on the nerve cells in the brain. These receptors are abundant in the parts of the brain that control pleasure, judgment, learning, memory, and those that regulate movement and coordination.

Oddly enough, there has not been much published research in medical journals dealing with the positive, medicinal effects of the drug. Most of the research points directly to the negative effects marijuana has on the body — lower testosterone levels in men, which decreases libido and leads to impotence and gynecomastia, the development of abnormally large mammary glands in males resulting in breast enlargement. Some research even suggests marijuana use leads to a rise in levels of testosterone in women. 

According to Up to Date, a medical reference for clinical physicians, marijuana smoke contains three times the amount of tar found in tobacco and 50 percent more carcinogens. These studies link marijuana use to cancer, specifically lung cancer and bladder cancer.

The same site reported findings that substantiated long-held theories linking lethargy to habitual marijuana use. One study found that individuals who smoked cannabis a minimum of 5,000 times were less likely to graduate college and more likely to earn less than $30,000 per year. 

The lone positive benefit was seen in patients who were suffering from glaucoma. These studies showed that marijuana reduced intraocular pressure in glaucoma patients.  

But overall the studies have been few and far between, which leaves medical providers searching for more information. Many medical organizations in the United States have called for the federal government to decriminalize marijuana. 

According to MD Consult, a medical online journal, the American Medical Association recommended that the federal government review its current standing on marijuana in order to promote more research. 

“When it comes down to it, there is no scientific research to back (medical marijuana) up,” Lake County Health Officer John Williams said. “Medical marijuana is relatively understudied and not scientifically based.”


Marijuana the medicine?

Regardless of what the limited research shows, medical marijuana in Montana is here, and after five years of cautiously testing the waters, Montanan citizens are approaching their local law officials and city council members with questions about zoning, sale and methods of obtaining a medical marijuana card. 

The law states that physicians can recommend marijuana — not prescribe — for patients who have chronic or debilitating diseases or medical conditions including wasting syndrome, severe or chronic pain, severe nausea, seizures and muscle spasms. 

Williams has had several patients approach him requesting documentation to approve them for a medical marijuana card. The list of symptoms includes maladies as vague as back pain or a loss of appetite. But with the lack of scientific research, Williams doesn’t feel comfortable recommending medical marijuana to his patients. 

One medical colleague of Williams agrees that the evidence doesn’t support the use of marijuana medically. But when his patients approached him, requesting written certification for medical marijuana, he consented. The doctor, who asked not to be named in the article, insists that he is complying with the law. 

Although he said he “would rather not have to deal with it,” the medical professional provides his patients with the documentation necessary to obtain their medical marijuana cards.

“A lot of these people — it makes them happier people,” he said.

The doctor reported when he recommended medical marijuana to these patients he saw a “marked decrease in pain medications.” 

He also stated that it decreases the burden on his office.

Ironically enough, there is a pill that is derived from THC called Dronabinol. Dronabinol, often referred to by its brand name, Marinol, is a drug used primarily to treat chemotherapy-related nausea and vomiting and AIDS-related anorexia — some of the same symptoms that medical marijuana treats.

But according to Williams, patients seeking their medical marijuana cards are not interested in the pill. 

“People don’t come in asking about the pill,” Williams said. “They come in for the medical marijuana card.”

“People just want to smoke pot. That’s what it is,” he added.

Williams believes that state laws have put medical professionals in a difficult position. 

"Primum non nocere," translated from Latin, states "first, do no harm." It serves physicians as the first rule of medicine and is a fundamental principle when practicing medicine. 

So should doctors recommend a drug that has had limited scientific research documenting its effectiveness and run the risk of prosecution from the federal government?

Many doctors don’t want to take the chance. 

“If you want to make it legal, make it legal,” Williams said. “Don’t make the medical community decide.”


History of marijuana

According to an article in Time magazine published in October, marijuana used for medicinal purposes is not a recent development by any means. The earliest record of the use of medical marijuana dates back to 2737 B.C. The Chinese emperor Shen Neng prescribed marijuana for the treatment of ailments such as gout, rheumatism, malaria and poor memory. Marijuana spread from China to the Middle East, India and East Africa, where ancient doctors prescribed the drug for a wide array of ailments such as childbirth and earache. The article goes on to mention that certain Hindu sects in India used marijuana for “religious purposes and stress relief.”

Its entrance into the United States in the late 18th century was no cause for alarm. Doctors actually prescribed hemp seeds and roots for treatment of inflamed skin, incontinence and sexually transmitted diseases. 

The attitude of marijuana in the United States shifted significantly with the onset of morphine addiction. According to the article, 2 to 5 percent of America’s population was addicted to the drug, which was a secret ingredient in popular medicines such as “Dr. Fenner’s Golden Relief.”

In an effort to counteract the wave of morphine addictions, the federal government introduced the Pure Food and Drug Act, which made way for the Food and Drug Administration in 1906. The FDA controlled opium and morphine, placing distribution under control of the doctor. 

After 23 states outlawed marijuana in the 1930s, the federal government introduced the Marihuana Tax Act, which forbade the use of marijuana for non-medicinal purposes. 

But marijuana remained relatively untouched by the federal government until the 1950s, when Congress passed the Boggs Act and the Narcotics Control Act, which ensured jail time for drug offenders, including marijuana users and distributors.

The Controlled Substances Act of 1970 included marijuana in the same classification as LSD and heroin, and the Reagan administration of the 1980s imposed stricter penalties for drug offenders.

Although marijuana hasn’t reignited the revolution it enjoyed in the 1960s, there is a definite trend toward acceptance of marijuana as an intoxicating substance akin to alcohol and legalization of marijuana, specifically for medicinal purposes. 


Medical marijuana state laws

California was ahead of the game when it legalized medical marijuana in 1996. And in November, California voters will return to the polls with the hot pot issue again — only this time, Californians will decide whether or not to legalize marijuana for recreational use.

The proposal, called the Regulate, Control and Tax Cannabis Act would allow adults over the age of 21 to possess 1 ounce of marijuana and allow individuals to cultivate 25 square feet of marijuana plants in their gardens. 

Critics of the proposal say that it will encourage drug use in minors and open the doors for an onslaught of harder drugs and drug tourism. 

But proponents of the plan compare the history of marijuana use to the history of prohibition, when the federal government forbade the production, sale and consumption of alcoholic beverages. Prohibition was implemented by the federal government in 1920 but was repealed in 1933. 

Supporters also argue that the tax on marijuana may help reduce California’s startling $20 billion deficit. 

Regardless of what the Golden State is up to, most of the union opposes the production, sale and use of medical marijuana. And the 13 other states that allow the use of medical marijuana are still struggling with where medical marijuana belongs in society.

Communities such as Ronan and Polson have set up moratoriums, keeping medical marijuana providers and users away from schools and churches, while most doctors in Lake County seem hesitant to recommend the drug for any medical use before more scientific data is available. 

To the relief of patients who are using medical marijuana and those that are registered caregivers, the federal government issued a “hands off” policy regarding medical marijuana in the 14 states where it is legal. 

In the memorandum, released in October of 2009, the Department of Justice told federal prosecutors that prosecution of patients using medical marijuana for medical purposes was not an effective use of federal resources.

Despite the apparent leniency of the medical marijuana policy, the federal government still prohibits the use, sale, distribution and growth of marijuana. Like heroin or cocaine, the federal government classifies marijuana a Schedule I drug, meaning it is not legitimate for medical use and is highly addictive.

As for now, communities in Montana will continue to address the issue of medical marijuana as it becomes more and more prevalent among people suffering from pain and debilitating diseases.

Though the question remains "Will it kill the pain?" local governments are trying to wade through the legal ramifications of medical marijuana, the subject of the next article in this series.

(Editor's note — This article is part of a series that provides an overview of where medical marijuana use stands and how many questions remain about its use, sale and distribution, particularly within Lake County and the Flathead Indian Reservation. These articles will explore the effects medical marijuana is having in the community, as well as ask some of the questions that remain unanswered.)

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