MPP's Follow-Up Report on the Institute of Medicine's Medicinal Marijuana Hearing in New Orleans : January 1998

The Institute of Medicine (IOM) held its second of three medicinal marijuana hearings on January 22-23, 1998, in New Orleans. The topic was "Acute and Chronic Effects of Marijuana," which focused mainly on the potential health risks of marijuana use. The public testimony portion was held on Thursday, January 22, and the scientific sessions were held on Friday.

In December 1998, the IOM will release a report detailing its findings and making recommendations for future research. This report will be limited to scientific and clinical issues; it will not address policy and legal issues. The Marijuana Policy Project's (MPP's) goal is to make the study investigators aware that thousands of marijuana-using patients are living in fear of arrest and prison, so that the recommendations in the report accurately reflect this emergency.

*Public Testimony*

The MPP arranged for seven speakers to testify on Thursday:

• David Edwards, M.D., a retired pathologist, explained that marijuana does not cause fatalities, contrasted marijuana's toxicity with that of prescription drugs and various legal herbal medicines, and discussed the many harmful effects of prison.
• Leo Hollister, M.D., who has been studying marijuana's effects for more than three decades, provided scientific evidence that marijuana is a relatively safe substance.
• Greg Scott, an illegal user of medicinal marijuana, explained how it helped treat his AIDS conditions and contrasted the effects of marijuana with the debilitating effects of the many prescription drugs he has taken, including morphine. Scott said, "Every day, I risk arrest, property forfeiture, fines and imprisonment."
• Jim Montgomery, who was arrested and imprisoned for using medicinal marijuana, tearfully explained how the horrendous health conditions in prison caused him to have his leg amputated -- which is unquestionably more damaging than his medical use of marijuana.
• Barbara Douglass, one of the eight legal marijuana-using patients, testified that her long-term use of medicinal marijuana has not caused any health problems.
• Irvin Rosenfeld, another legal patient (and successful stockbroker), testified that 12 joints per day for 25 years have not caused any health problems -- but that mistreatment by the police during a marijuana arrest in 1983 (after he was already legally approved by the federal government) caused his ankle to hemorrhage.
• MPP Director of Communications Chuck Thomas suggested that the IOM report recognize that the laws are more dangerous than the medicinal use of marijuana. Therefore, the IOM should recommend that the top research priority should be to expedite the approval of smokable marijuana as a legal medicine. [testimony and suggested recommendations at here

In addition to the MPP's entourage, only three people testified

• Local criminal defense attorney Gary Wainwright described the legal ordeal his client, Greta Dubowick, had to endure because of her medicinal marijuana use;
• Louisiana State University Professor Richard Scribner, M.D., M.P.H., explained that marijuana is not a major cause of crime, especially compared to alcohol;
• and Kenison Roy, M.D., a local representative of the American Society of Addiction Medicine, claimed that marijuana is dangerous and addictive -- but still supported research and the eventual medical availability of the plant if it is approved by the FDA and tightly controlled.

  In sum, it was a 9-1 near-shut out. A clear and compelling case was made that marijuana should be legally available as a medicine, and the IOM study investigators, Stanley Watson, M.D., and John Benson, M.D., listened attentively and compassionately.

  *Scientific Sessions* On Friday, prominent experts selected by the IOM presented testimony:

  • Stephen Sidney, M.D. (Kaiser Permanente) -- Presented epidemiological evidence that marijuana does not cause an increase in early fatalities.
  • Thomas Klein, M.D. (University of South Florida) -- Argued that marijuana and/or THC may diminish the immune system's ability to fight off certain infections.
  • Donald Tashkin, M.D. (University of California at Los Angeles) -- Presented evidence that marijuana may cause pulmonary damage -- but acknowledged that epidemiological evidence is lacking and that marijuana does not seem to be more dangerous than tobacco.
  • John Morgan, M.D. (City University of New York Medical School) -- Decisively dispelled the myths that marijuana is highly addictive or causes amotivational syndrome.
  • Dr. Richard Foltin and Dr. Margaret Haney (Columbia University)-- Offered experimental and anecdotal evidence that marijuana may diminish productivity and cause withdrawal symptoms. Chuck Thomas and Dr. Morgan challenged their interpretations, revealing that (1) productivity is dependent on the necessity and desirability of the reward, making it likely that marijuana-using patients who need to work for a living will not experience decreased productivity, and (2) the withdrawal symptoms are clinically insignificant.
  • Robert Pandina, M.D. (Rutgers University) -- Decisively dispelled the "gateway&quo; myth.

  Most of the myths of marijuana's extreme dangers were dispelled. The few claims of harm that emerged -- such as possible immune system and pulmonary damage -- were essentially insignificant when compared to the side effects of countless legally available medicines. In sum, a compelling case that marijuana is too dangerous to be used as a medicine was *not* made.

  *News Coverage*

  Extremely favorable articles, focusing primarily on the patients, were written by the _New Orleans Times-Picayune_ and the Associated Press (AP). The AP article featured a photo of medicinal marijuana user Barbara Douglass.

  The local ABC and CBS affiliates also provided good coverage. News stations across the nation also ran local stories giving their perspectives on the hearing, e.g., the CBS affiliate in Tampa and the NBC affiliate in Chicago.

  *Background and Conclusion*

  On January 3, 1997, Drug Czar Barry McCaffrey announced that the White House Office of National Drug Control Policy would pay theInstitute of Medicine $1 million to conduct an 18-month "comprehensive review" of "the health effects and potential medical use of marijuana."

  The Marijuana Policy Project immediately began working to influence IOM to make the report as favorable as possible. IOM is not a government agency, and it has a reputation for being quite objective, regardless of the source of funding. Indeed, in the past IOM has issued reasonable reports regarding drugs.

  The MPP has been in contact with the IOM study directors for this project from the start, has sent them useful information, has recommended doctors and patients as expert witnesses, and has helped ensure that the study's "principle investigators"quot; are unbiased. But the most important endeavor is to make sure that each hearing -- open to public testimony -- is filled with supportive doctors and patients.

  The patients' testimony served to (1) remind IOM that the issue is patients, not cannabinoids, and (2) help attract favorable media coverage. The New Orleans hearing, as well as last month's hearing in Irvine, California, accurately conveyed that medicinal marijuana is effective and safe enough to be used as a medicine.

  Most importantly, the public testimony at the New Orleans hearing focused on the fact that patients can be arrested and imprisoned for using their medicine. The MPP is hopeful that the IOM will recognize this emergency and follow the MPP's suggestions for the final report.

  *MPP's Suggestions for the IOM's Medicinal Marijuana Report*

  The MPP urges the Institute of Medicine to state the following:

  1. Smokable marijuana works as a medicine for some people.
  2. Thousands of patients are already using medicinal marijuana, despite its illegality.
  3. Marijuana is one of the safest therapeutically active substances known. The most significant health risk associated with the medicinal use of marijuana is a prison sentence.
  4. The IOM has found no scientific evidence indicating that prison is better for patients than marijuana.
  5. Because the present laws are so dangerous to patients, the number one research priority should be to conduct the simplest, least expensive studies required to get smokable marijuana approved by the FDA as a legal medicine as quickly as possible. While research into the value of isolated, synthesized cannabinoids would be beneficial to patients in the long run, such research should not distract from the number one goal of getting smokable marijuana approved as a legal medicine. Research should be funded, and a sufficient quantity of marijuana should be provided, if the research is designed to determine if smokable marijuana meets the minimum standards of safety and efficacy.

  END

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