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Doctors leery to prescribe marijuana as medication

By Sarah Spivack
Arizona Daily Wildcat
November 12, 1998
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Although Arizonans support using otherwise illegal drugs for medicinal purposes, doctors are unlikely to start prescribing marijuana, one UA physician and two Arizona legislators said.

Last week, voters rejected Proposition 300, which would have upheld the state's decision to ban physicians from prescribing drugs such as marijuana, heroin, LSD and PCP without Food and Drug Administration approval.

"The people have spoken their will," said Robert Dorr, director of the University of Arizona's pharmacy program. "I think they have over-estimated the number of doctors who will be willing to prescribe (marijuana)."

Arizona Sen. Ruth Solomon, a Democrat, pointed to a legal basis for physicians' hesitance to prescribe drugs approved by the proposition.

It is still against federal law to prescribe such drugs, and doctors could lose their licenses for doing so, Solomon said.

"The (proposition's) language is very expansive and does not deal at all with federal dispensing privileges," she said.

State Rep. Mike Gardner, a Republican, said the new law is also problematic for phar-macists wanting to provide illegal drugs.

"You might not go to state prison, but you'll go to federal prison," Gardner said.

There are also medical reasons to reject marijuana as a treatment, said Dorr, who conducted a study fifteen years ago on the medical uses of the pot derivative THC.

There are more effective medicines on the market for preventing nausea and vomiting that have fewer negative side-effects, he said.

"This isn't going to change anything in the medical community," Dorr said, adding that cancer doctors have had access to THC in pill form for more than 10 years and have rejected it. Marijuana-based medications are only useful for a small percentage of patients who cannot take more effective drugs, he said.

Marijuana smoking has been shown to be more effective than the pills in clinical trials, Dorr said. The new law will enable physicians to prescribe marijuana in plant form, but Dorr doubts any physician will promote smoking.

"Burning a plant and inhaling hot air in the upper windpipes is always dangerous," he said. "Smoking is just something we're not going to recommend."

Given the slim chance of physicians pre-scribing marijuana and some other narcotics, Solomon thinks terminally ill patients could be misled by the passage of Proposition 300.

"If someone is critically ill, now that we have this law, they will think they can get marijuana and will have false hopes," Solomon said.

Solomon, who supports continuing research on medical marijuana, thinks the referendum was poorly constructed.

"People think that they're going to be able to get marijuana for their relief from other sources (than drug dealers), and they can't," Solomon said. "Where do you get a safe product?"

Even if distribution was approved by federal law, very few patients would find marijuana to be an ideal drug.

Pot derivatives are used primarily for patients who are critically ill, said Murray DeArmond, director of campus health. The average UA patient is not going to need marijuana, and DeArmond has never heard of the UA Student Health Center receiving a request for the drug.

"We rely heavily on the Tucson community to treat students with severe health problems," he said.

Dorr said the THC pill never became popular among terminally ill patients because people over 50 react to it with "dysphoria - the opposite of a high," Dorr said.

"Because cancer is a disease of older age, (the drug) was not a commercial success," he said.

Proposition 300 follows in the wake of 1996's Proposition 200, which would have allowed physicians to prescribe drugs such as marijuana to help relieve pain in seriously or terminally ill patients.

Proposition 200 also would have sent nonviolent drug offenders to treatment and probation instead of prison.

Although voters approved the law, it was repealed soon after by state lawmakers.

"Some legislators decided they didn't like the proposition (200) because they think the public was confused about what they chose," said Greg Fahey, UA associate vice president of state relations.

Until last week, Arizona lawmakers could repeal referendum decisions approved by less than half of registered voters. Since voter turnout usually hovers around 50 percent, most decisions could easily be overturned, Fahey said.

Gardner opposed both propositions on the grounds that it is inappropriate to legalize drugs not approved by the FDA.

"I don't believe that what the Legislature did was overturn (Proposition 200) - we just wanted a higher standard of medical proof," he said. "Let's not politicize medicine."

Sam Vagenas, campaign consultant for Proposition 300, denied that Arizona is anticipating impossible federal government compliance with medicalization laws.

"We're not leaping ahead of the FDA here, " he said, adding the administration has approved a study on LSD for terminal patient care.

The Drug Enforcement Agency approved marijuana for medical use in the 1980s, but President Bush denied a change in the drug's legal status.

"The DEA described marijuana as a medicine, along with tens of millions of voters," he said.

Vagenas said it was unlikely that doctors would prescribe most "Schedule I" drugs, such as heroin and LSD.

"Effectively, I think we're talking about medical marijuana," with Proposition 300, he said.

Vagenas said backers "left the door open" to medicalize other Schedule I drugs to avoid future campaigning if studies show heroin, LSD and others are useful.

Gardner said there is "no question" that backers of Proposition 300 are aiming to legalize all drugs. He claims the laws aren't really about medicalization.

Solomon had similar concerns.

"Any time you move to legalize all Schedule I drugs - (even) for the purposes of medicine - you're making a very strong statement about legalization," she said.

Vagenas said the proposition is a result of failing drug policies.

"There's a strong argument to be made that jailing only impedes treatment," he said. "Arizona voters are smart and they think that the drug war is failing."

Sarah Spivack can be reached via e-mail at Sarah.Spivack@wildcat.arizona.edu.