To date, nine states have legalized medical use of the substance.
By Tanya Albert, AMNews staff.

Medical societies in three states are fighting to see November ballot initiatives dealing with marijuana go down in flames. The groups argue that the measures are bad for public health.

Voters in Alaska, which legalized medical marijuana in 1998, will decide whether to decriminalize marijuana altogether for adults. In Oregon, voters face a question of whether to expand existing medical marijuana laws. And Montana voters will decide whether to legalize medical marijuana, which would make the state the 10th to do so.

AMA policy calls for "further adequate and well-controlled studies" of medical use of marijuana and other related cannabinoids in patients with serious conditions for which preclinical, anecdotal or controlled evidence suggests that the drug might help. The Association opposes legalization of the substance for nonmedical use.

Last month, the Alaska State Medical Assn. joined with Gov. Frank Murkowski and state and local police to oppose the measure in Alaska.

"The medical society doesn't want public health problems, and this would create public health problems," said ASMA President Paul Worrell, MD. "It is not going to make the community a better place to live."

The ballot initiative would do away with civil and criminal penalties for those 21 and older who "grow, use, sell or give away marijuana or other hemp products."

Research has found that smoking 3 marijuana joints is as bad for your lungs as 20 tobacco cigarettes.

The "Yes On 2" group that has formed to support the initiative said that its passage would protect Alaskans' right to privacy and protect patients with cancer, glaucoma, HIV/AIDS and other conditions who use the substance as a way to manage their diseases.

"Marijuana prohibition doesn't work," the group said in a statement. "Measure 2 would reduce teen access to marijuana by taking it off the streets and regulating it."

The ASMA's Dr. Worrell, who treated drug abuse patients regularly in the late 1970s and 1980s, disagrees. He said his experience is that marijuana is a gateway drug to other illegal substances, such as cocaine. "I have seen it firsthand," he said.

Oregon looks to expand

Oregon is among the nine states that allow patients to use medical marijuana. The law requires patients to get a note from their doctors that they can bring to the state to receive a license. Patients or their caregivers are then allowed to grow the marijuana.

The ballot proposal would permit creation of licensed, nonprofit dispensaries that the Oregon Dept. of Human Services would regulate. The dispensaries would be allowed to grow and sell marijuana to registered patients and their caregivers.

But a caregiver could serve up to 10 patients without a medical marijuana dispensary license. He or she could grow up to 10 plants and possess one pound of usable marijuana at any time. Or, if the caregiver proves production of only one crop annually, he or she could possess up to six pounds per patient immediately after that one harvest.

In addition, the proposal would include naturopaths and nurse practitioners in the definition of "attending physician" -- the person who writes the note necessary for a patient to obtain a medical marijuana license. It also would expand "debilitating medical condition" to include any medical condition for which an attending physician determines that marijuana would benefit the patient.

The Oregon Medical Assn. took no position when voters were asked to pass the first medical marijuana initiative in the 1990s, but the association opposes the new measure.

It believes the ballot proposal is simply a way to try to legalize marijuana. "If people want to have a legislative debate to legalize marijuana, that's fine," said Robert Dannenhoffer, MD, OMA's president-elect. "But don't do it under the guise of medical marijuana."

The group also is urging voters to say no because the measure would be bad public health policy. In a letter included in a state-provided voter guide, OMA President John C. Moorhead, MD, points to a British Lung Foundation report that shows that smoking three marijuana joints is as bad for your lungs as 20 tobacco cigarettes and a study that shows a link between marijuana smoking and depression and other illnesses.

"Ballot Measure 33 is a thinly disguised attempt to legalize marijuana, because FDA-approved medication with the very same substance [THC] that is in marijuana already is available to patients," Dr. Moorhead wrote.

But the measure's proponents, including some physicians, disagree. Six doctors sent a letter included in the official Oregon voter information that supports the ballot initiative.

"Measure 33 is not legalization, because a health care provider must qualify the patient," wrote Richard Bayer, MD, the letter's lead author. "Primarily, Measure 33 establishes dispensaries so patients can get immediate access to medicine -- just like a pharmacy."

He points to a 1999 Institute of Medicine report to support his argument.

The IOM concluded that marijuana's active components are potentially effective in treating pain, nausea, the anorexia of AIDS wasting and other symptoms, and should be tested in clinical trials. New delivery mechanisms for the drug that are safe, fast-acting and reliable but that do not involve inhaling harmful smoke should be developed, the institute stated.

"For centuries patients used marijuana (cannabis) as medicine, achieving favorable results to treat a variety of conditions," Dr. Bayer wrote. "Many dying and suffering patients are afflicted with conditions for which the responsible use of marijuana as medicine helps."

Montana's first look

A ballot measure in Montana would legalize medical marijuana for the first time there.

The initiative would allow patients with debilitating conditions who are under medical supervision to produce, possess and use marijuana to alleviate symptoms of illnesses such as cancer, glaucoma and HIV/AIDS.

In a situation similar to that in other states, a patient or a patient's caregiver would register with the state to grow and possess limited amounts of marijuana. The patient would have to submit a written certification from a physician that the patient has a debilitating medical condition and would benefit from using the substance.

A minority of physicians in the state support the initiative. The Montana Medical Assn. opposes it.

"The MMA felt there would be a substantial risk of abuse if the measure to legalize medical marijuana were to succeed," said Kurt Kubicka, MD, MMA's immediate past president and current chair of the legislative committee.

"There is an alternate, FDA-approved form of THC available," he said.


Going to the voters

Residents in three states will vote on ballot questions that propose various marijuana laws.

Should marijuana be legalized for those older than 21?

Should patients with debilitating medical conditions be allowed to grow and use marijuana if they submit to the state written certification from a physician that the patient would benefit from using marijuana?

Should the state create licensed, nonprofit dispensaries that would grow and sell marijuana to registered patients and caregivers?

Should naturopaths and nurse practitioners be included in the definition of "attending physician?"

Should the definition of "debilitating medical condition" be expanded to include any other medical condition that an attending physician determines would be helped by marijuana?