US: Web: Study: Smoking Marijuana Does Not Cause Lung Cancer
by Fred Gardner, (02 Jul 2005) CounterPunch United States

Marijuana smoking -"even heavy longterm use"- does not cause cancer of the lung, upper airwaves, or esophagus, Donald Tashkin reported at this year's meeting of the International Cannabinoid Research Society. Coming from Tashkin, this conclusion had extra significance for the assembled drug-company and university-based scientists ( most of whom get funding from the U.S. National Institute on Drug Abuse ). Over the years, Tashkin's lab at UCLA has produced irrefutable evidence of the damage that marijuana smoke wreaks on bronchial tissue. With NIDA's support, Tashkin and colleagues have identified the potent carcinogens in marijuana smoke, biopsied and made photomicrographs of pre-malignant cells, and studied the molecular changes occurring within them. It is Tashkin's research that the Drug Czar's office cites in ads linking marijuana to lung cancer. Tashkin himself has long believed in a causal relationship, despite a study in which Stephen Sidney examined the files of 64,000 Kaiser patients and found that marijuana users didn't develop lung cancer at a higher rate or die earlier than non-users. Of five smaller studies on the question, only two -involving a total of about 300 patients- concluded that marijuana smoking causes lung cancer. Tashkin decided to settle the question by conducting a large, prospectively designed, population-based, case-controlled study. "Our major hypothesis," he told the ICRS, "was that heavy, longterm use of marijuana will increase the risk of lung and upper-airwaves cancers."

The Los Angeles County Cancer Surveillance program provided Tashkin's team with the names of 1,209 L.A. residents aged 59 or younger with cancer ( 611 lung, 403 oral/pharyngeal, 90 laryngeal, 108 esophageal ). Interviewers collected extensive lifetime histories of marijuana, tobacco, alcohol and other drug use, and data on diet, occupational exposures, family history of cancer, and various "socio-demographic factors." Exposure to marijuana was measured in joint years ( joints per day x 365 ). Controls were found based on age, gender and neighborhood. Among them, 46% had never used marijuana, 31% had used less than one joint year, 12% had used 10-30 j-yrs, 2% had used 30-60 j-yrs, and 3% had used for more than 60 j-yrs. Tashkin controlled for tobacco use and calculated the relative risk of marijuana use resulting in lung and upper airwaves cancers. All the odds ratios turned out to be less than one ( one being equal to the control group's chances )! Compared with subjects who had used less than one joint year, the estimated odds ratios for lung cancer were .78; for 1-10 j-yrs, .74; for 10-30 j-yrs, .85 for 30-60 j-yrs; and 0.81 for more than 60 j-yrs. The estimated odds ratios for oral/pharyngeal cancers were 0.92 for 1-10 j-yrs; 0.89 for 10-30 j-yrs; 0.81 for 30-60 j-yrs; and 1.0 for more than 60 j-yrs. "Similar, though less precise results were obtained for the other cancer sites," Tashkin reported. "We found absolutely no suggestion of a dose response." The data on tobacco use, as expected, revealed "a very potent effect and a clear dose-response relationship -a 21-fold greater risk of developing lung cancer if you smoke more than two packs a day." Similarly high odds obtained for oral/pharyngeal cancer, laryngeal cancer and esophageal cancer. "So, in summary" Tashkin concluded, "we failed to observe a positive association of marijuana use and other potential confounders."

There was time for only one question, said the moderator, and San Francisco oncologist Donald Abrams, M.D., was already at the microphone: "You don't see any positive correlation, but in at least one category [marijuana-only smokers and lung cancer], it almost looked like there was a negative correlation, i.e., a protective effect. Could you comment on that?"

"Yes," said Tashkin. "The odds ratios are less than one almost consistently, and in one category that relationship was significant, but I think that it would be difficult to extract from these data the conclusion that marijuana is protective against lung cancer. But that is not an unreasonable hypothesis."

Abrams had results of his own to report at the ICRS meeting. He and his colleagues at San Francisco General Hospital had conducted a randomized, placebo-controlled study involving 50 patients with HIV-related peripheral neuropathy. Over the course of five days, patients recorded their pain levels in a diary after smoking either NIDA-supplied marijuana cigarettes or cigarettes from which the THC had been extracted. About 25% didn't know or guessed wrong as to whether they were smoking the placebos, which suggests that the blinding worked. Abrams requested that his results not be described in detail prior to publication in a peer-reviewed medical journal, but we can generalize: they exceeded expectations, and show marijuana providing pain relief comparable to Gabapentin, the most widely used treatment for a condition that afflicts some 30% of patients with HIV.

To a questioner who bemoaned the difficulty of "separating the high from the clinical benefits," Abrams replied: "I'm an oncologist as well as an AIDS doctor and I don't think that a drug that creates euphoria in patients with terminal diseases is having an adverse effect." His study was funded by the University of California's Center for Medicinal Cannabis Research.

* * *

The 15th annual meeting of the ICRS was held at the Clearwater, Florida, Hilton, June 24-27. Almost 300 scientists attended. R. Stephen Ellis, MD, of San Francisco, was the sole clinician from California. Los Angeles Farmacy operator Mike Ommaha and therapist/cultivator Pat Humphrey showed up to audit the proceedings... Some of the younger European scientists expressed consternation over the recent U.S. Supreme Court ruling and the vote in Congress re-enforcing the cannabis prohibition. "How can they dispute that it has medical effect?" an investigator working in Germany asked us earnestly. She had come to give a talk on "the role of different neuronal populations in the pharmacological actions of delta-9 THC." For most ICRS members, the holy grail is a legal synthetic drug that exerts the medicinal effects of the prohibited herb. To this end they study the mechanism of action by which the body's own cannabinoids are assembled, function, and get broken down. A drug that encourages production or delays dissolution, they figure, might achieve the desired effect without being subject to "abuse..." News on the scientific front included the likely identification of a third cannabinoid receptor expressed in tissues of the lung, brain, kidney, spleen and smaller branches of the mesenteric artery. Investigators from GlaxoSmithKline and AstraZeneca both reported finding the new receptor but had different versions of its pharmacology. It may have a role in regulating blood pressure.

Several talks and posters described the safety and efficacy of Sativex, G.W. Pharmaceuticals' whole-plant extract containing high levels of THC and CBD ( cannabidiol ) formulated to spray in the mouth. G.W. director Geoffrey Guy seemed upbeat, despite the drubbing his company's stock took this spring when UK regulators withheld permission to market Sativex pending another clinical trial. Canada recently granted approval for doctors to prescribe Sativex, and five sales reps from Bayer ( to whom G.W. sold the Canadian marketing rights ) are promoting it to neurologists. Sativex was approved for the treatment of neuropathic pain in multiple sclerosis, but can be prescribed for other purposes as doctors see fit.

A more detailed report on the ICRS meeting will appear in the upcoming issue of O'Shaughnessy's, a journal put out by California's small but growing group of pro-cannabis doctors. To get on the mailing list, send a contribution of any amount to the CCRMG ( California Cannabis Research Medical Group ) at p.o. box 9143, Berkeley, CA 94709. It's a 501c3 non-profit and your correspondent's main source of income.

Meanwhile, Back in San Francisco...

The California contingent was en route to the ICRS meeting when Marian Fry, M.D. and her husband, attorney Dale Schafer, were arrested on federal charges of conspiring to provide marijuana to a patient. On the same day, three San Francisco cannabis clubs were raided by the DEA and 19 people -all Asians and a few Latinos- charged with conspiracy to cultivate and distribute marijuana. Affidavits allege that they grew cannabis in rented houses in S.F., the East Bay and the Peninsula for sale to dispensaries and on the black market. Three men were charged with intent to sell ecstasy. ( An undercover agent allegedly had purchased 1,000 tabs from a man named Enrique Chan. During the raids on 26 locations, a total of 50 tabs were found on one individual. ) The two alleged ringleaders, Richard Wang and Vincent Wan, were charged with money laundering. Defense lawyers say the alleged money laundering consisted of using dispensary proceeds to underwrite the grow ops. At a July 1 detention hearing, bail for Wang was set at $2 million. Wan has not yet been apprehended or turned himself in.

Former district attorney Terence Hallinan is representing Sergio Alvarez, who hired him several months ago after police raided a house in the Sunset district where Alvarez was allegedly cultivating marijuana. "I didn't know at the time that that would become part of a conspiracy case," Hallinan said after the detention hearing. Alvarez's bail was set at $500,000; his working-class parents are putting up their modest Sunnyvale home as surety. Hallinan says that every cannabis dispensary has links to a network of growers, and that the decision to take down these three was an attempt to exploit anti-Asian sentiment. "They asked themselves, 'Who will we start with now that we've been given permission [by the U.S. Supreme Court's ruling in the Raich case]? Let's go after the Chinese!' San Francisco has more than a hundred-year history of anti-Chinese attitudes and policies." Contemporary resentments towards Asians in San Francisco center around their apparent economic successes. It's an impossibly expensive housing market, and one occasionally hears non-Asians say, with mixed admiration and envy, things like: "How can they arrive from Hong Kong in 1995 and buy a house in the Sunset in 1996?" The answer is: by pooling resources ( conspiring ) with friends and family to make the down payment.

[shopvac]

good report fred, keep the good info comin

[wikidcalibudgrl]

Very good info,,,i agree,, an after receiving a "Form" letter back from Wally Hergar in regards to the letter i sent asking him to support the Raich case,, I feel i should copy this story and send it to him. Because in his return "form letter" it states "For one,,," (which Really irked me) that the pharmacies already had a THC related product called Marinol on the market ( which i have heard from a friends dying ( now deceased ) father that it was not as effective as vapnig MMJ.) The form letter went on to say smoking of MMJ causes cancer and the MMJ has over 400 of the same bad chemicals in it that tabbaco has in it ( YEAH F'N RIGHT!!) and so on, and so on,,, basically saying (to me, IMHO) that he wants the major drug companies to have the right to make synthetic versions of this naturaly occuring medicine so that they can make billions of More dollars off the sick and dying ppl of the world insted of just letting those ppl alone to grow and vap their own home grown medicine... Can we say HYOPCRITE!!! Only in it for the special intrest parties and their big $$ ,,,, Fuckers

Unpublished Federal Study Found THC-Treated Rats
Lived Longer, Had Less Cancer ('AIDS Treatment News' Obtains 126-Page
Study, 'NTP Technical Report On The Toxicology And Carcinogenesis Studies
Of 1-Trans-Delta-9-Tetrahydrocannabinol, CAS No. 1972-08-3, In F344/N Rats
And B6C3F(1) Mice, Gavage Studies')


AIDS TREATMENT NEWS has obtained a 126-page draft report of a
major toxicology study of THC, the main psychoactive ingredient of
marijuana. The study was completed over two and a half years ago, and
passed peer review for publication, but has been kept quiet until this
month, when someone leaked copies of the draft report. As far as we
know, the public has never been told about this research -- for example,
the drug- reform movement seems not to have known about its existence.
This work may have been hushed because its findings are not what the
drug-war industry would want.

The study gave huge doses of THC to rats and mice by stomach tube,
and looked for cancers and other evidence of toxicity. First there were
small toxicity studies, which used enough THC to kill some of the
animals; later, two-year studies were run in both rats and mice, using
doses which were still much higher than those of marijuana smokers. The
two-year studies tested THC in several hundred rats and several hundred
mice.

In rats, those given THC had a clear survival advantage over the untreated
controls; this effect was statistically significant in all dose groups, and in
both males and females. In mice (which were given much larger doses
than the rats relative to body weight) there was no survival difference
among the groups -- except that those given the highest dose (which was
close to the lethal dose for mice) had worse survival.

In both mice and rats, in both males and females, "the incidence of benign
and malignant neoplasms ... were decreased in a dose-dependent manner"
-- meaning that the more THC the animals were given, the fewer tumors
they developed.

The treated animals weighed less than the controls (even though both ate
about the same amount of food); the researchers speculated that the lower
body weight may have partly accounted for the increased survival and
reduced tumors in the THC-treated animals.

The doses were large enough to cause seizures and convulsions in many
of the animals, especially when they were dosed or handled. These did
not start immediately, but after many weeks, depending on the dose. The
researchers looked for brain lesions in animals which had seizures, but
found none.

No evidence of carcinogenic activity in the rats, but there was "equivocal
evidence" of one kind of thyroid tumor in the mice -- with no evidence of
a dose-dependent response. Other tumors were less common in the
treated animals than in the controls -- except in one case, which the
toxicologists believed was due to the fact that the treated animals lived
longer, and therefore had more opportunity to develop tumors.

The report includes a professionally objective review of the biological
effects, possible toxicities, and possible medical uses of THC and
marijuana.

The title of the report is "NTP Technical Report on the Toxicology and
Carcinogenesis Studies of 1-Trans-Delta(9)- Tetrahydrocannabinol (CAS
No. 1972-08-3) in F344/N Rats and B6C3F(1) Mice (Gavage Studies)."
Over 35 researchers contributed to this study, and 12 others reviewed
their work; several institutions, including the National Toxicology Program
and SRI International, were involved. The document we received is report
NTP TR 446, NIH Publication No. 94-3362, of the U.S. Department of
Health and Human Services. ("NTP" stands for National Toxicology
Program, which is made up of four Federal agencies within Health and
Human Services.) Each page of the draft is stamped "not for distribution
or attribution." In addition to the 126-page document we have reviewed
here, there are 11 appendices, which we have not seen.

According to the draft, the report will be available from NTP Central Data
Management, 919/541-1371. AIDS TREATMENT NEWS requested a
copy of the final report when it is ready, and also requested a copy of the
draft. Now that the existence of the report has become publicly known,
we have heard that draft copies are being sent if requested -- despite the
notice on each page not to distribute them.

Comment

It would be wrong to interpret this study as showing a beneficial or
protective effect of marijuana. The animals were given very large doses,
resulting in substantially lower body weight, which may itself have caused
much of the survival and tumor improvements. Also, this study used
THC, not marijuana smoke -- which like any smoke contains many
chemicals, some of which are likely to be harmful.

But the study does provide strong evidence that there is no significant
cancer risk (if any at all) from the main psychoactive ingredient of
marijuana; any such risk would be from incidental substances in the
smoke. And if there is such a risk, the modern high-potency marijuana
would likely reduce it, by reducing the amount of smoke required to
obtain the desired effect.

Also, there is no known case of any human death from overdose of
marijuana or THC, or from any other acute toxicity of these substances --
a remarkable safety record, compared with alcohol, aspirin, or many other
common drugs. (The toxicology report does not say there have been no
deaths, but the authors listed none, after doing an exhaustive survey of the
literature.)

The literature review on the effects of THC and marijuana shows how
medical research has been politically skewed (although the paper itself
does not state this point). There are almost no studies of possible medical
uses of marijuana, but many studies looking for possible harm. Any
positive findings, therefore, can be used to support the drug war -- while
negative findings (those which fail to show any effect) are usually ignored.
Although many doctors and patients have reported important medical
benefits, scientific studies of medicinal use have seldom been allowed to
happen, since positive findings could challenge the official public- relations
tactic of demonization. The drug war itself has controlled the medical
research agenda, since it controls legal access to marijuana. Like most
permanent wars, it strives for self preservation.

The newly available Federal toxicology study provides the best evidence
yet that the risks of THC are small. What other drug would increase life
expectancy of rats when given in huge overdoses daily for two years? The
recent Federal attacks on medical marijuana -- against doctors and
desperately ill patients -- are needlessly cruel, and bizarrely inappropriate
to scientific and medical understanding.

[Gamma Goblin]

Interesting reports Fredster. Thank you for sharing those with us.

Yeep , whole lotta info , thanx!

Mom starts chemo today and I am hoping this article will help convince her that it is OK to take cannabis while under going this....

Fred, do you have any articles that specificly deal with chemo and cannabis?


Thanks,
ms.G

[cannakid]

this takes the taco my frends, this proves that merijuana is safer than tobacco, alchihol, and nearly every other substance in wich man has found use of. this is the science that will prove with out a doubt the truth of cannabis and the lies that its prohabition has thrived on. if only our legislators will see theas truthes to be self evident and decriminalize marijuana. its our fuiture we just dont see it yet.

Originally Posted by Ms.Grat3ful

Mom starts chemo today and I am hoping this article will help convince her that it is OK to take cannabis while under going this....
Fred, do you have any articles that specificly deal with chemo and cannabis?
Thanks,
ms.G

The use of inhalation marijuana as an antiemetic for cancer chemotherapy


New York State Journal of Medicine, October 1988, pp. 525-527

By Vincent Vinciguerra, MD; Terry Moore, MSW; Eileen Brennan, RN
From the Don Monti Division of Oncology, Department of Medicine, North Shore University Hospital, Manhasset, NY, and the Department of Medicine, Cornell University Medical College, New York, NY. Address correspondence to Dr. Vinciguerra, Chief, Division of Oncology/Hematology, North Shore University Hospital, 300 Community Dr, Manhasset, NY 11030.

Abstract: A prospective pilot study of the use of inhalation marijuana as an antiemetic for cancer chemotherapy was conducted. Fifty-six patients who had no improvement with standart antiemetic agents were treated and 78% demonstrated a positive response to marijuana. Younger age and prior marijuana exposure were factors that predicted response to treatment. Toxicity was mild and consisted primarily of sedation and xerostomia. This preliminary trial suggests the usefulness of inhalation marijuana as an antiemetic agent. Because of the lack of a randomized placebo control group, the precise role of this agent is unclear. Further studies should include derivatives of this substance in combination with standard effective drugs to control chemotherapy-induced nausea and vomiting.

A great deal of clinical information has recently been generated concerning
the efficacy of various antiemetic agents for patients treated with cancer
chemotherapy. (1-3). Without effective control of nausea and vomiting,
patient compliance with potentially curative chemotherapy programs
diminishes, compromising not only quality but quantity of life. Effective
new chemotherapeutic agents could never be successfully tested in clinical
trials if they possessed potent emetic side-effects.
Although a number of agents have recently been found to be active,
including metoclopramide, (4,5) haloperidol, (6) dexamethasone, (7) and
lorazepam, (8) the need to introduce newer agensts and combination
antiemetic therapy may be necessary for continued control of symptoms.
Also, complete control of nausea and vomiting during anticancer treatment
must take into account not only the physical effects but also the
psychological ones. Control of anxiety through behavior modification and
relaxation is an effective antiemetic treatment of anticipatory nausea and
vomiting. (9)

Natural and synthetic cannabinoids are known to be effective
antiemetic agents. (10-12) Delta-9-tetrahydrocannabinol (THC) has been
found to be superior to prochlorperazine. (13) Also, patients who are
refractory to standart antiemetic agents have significant reduction in
nausea and vomiting with oral THC. (14) There is little information on
the efficacy of inhalation marijuana aside from anecdotal reports from
patients who obtained the drug privately.
As a part of a New York State Department of Health program, North
Shore University Hospital conducted a preliminary study of the use of
inhalation marijuana as an antiemetic agent for cancer chemotherapy. The
purpose of this study was to evaluate the efficacy of inhalation marijuana
for patients refractory to standard agents, to identify patient
characteristics to predict response, and to evaluate toxicity and patient
acceptance of this form of treatment.

METHODS

Patients with histologically confirmed malignancies who were actively
receiving chemotherapy were entered into the protocol. Eligibility
criteria included: 18 years of age or older, refractoriness to
conventional antiemetic agents, and absence of severe cardiac or
psychiatric disease. Patients had to agree not to drive or operate heavy
machinery or a motor vehicle for at least 12 hours after the last dose of
marijuana. Central nervous system depressants including alcohol were
prohibited during the administration of marijuana.
Marijuana cigarettes were supplied by the National Institute on Drug
Abuse (NIDA) to the New York State Department of Health. All patients
were instructed on standard smoking procedures. The patient inhales
deeply, holds the inhalation for ten seconds, and then exhales. After
waiting 10 to 15 seconds, the cycle is repeated. The total dose is
completed within five minutes. A flame-proof holder was available to
permit delivery of nearly all of the cigarette appropriate to the patient's
dosage. The dose schedule, which was calculated to the nearest one-fourth
cigarette; was 5 mg THC/m2, starting 6-8 hours prior to chemotherapy and
every 4-6 hours thereafter, for a total dose of four doses per day on each
day of chemotherapy (one cigarette= 10.8 mg THC). In order to prevent
cigarettes from drying out and causing harsh smoke, patients were
instructed to keep the cigarettes in the refrigerator or humidified.
This was a nonrandomized study where patients served as their own
controls. Patients were asked to self-rate their status by completing a
patient evaluation form after each therapeutic episode. Nausea was graded
on a scale from 1 (none) to 4 (severe), vomiting was graded from 1 (none)
to 5 (10+ times), appetite was graded from 1(none) to 5 (above normal),
and physical state was graded from 1 (very weak) to 4 (above normal), and
mood was graded from 1 (very depressed to 5 (very happy). Based on the
degree of nausea, vomiting, food intake, physical state, and over-all mood,
patients rated the overall effectiveness of marijuana as none, moderately
effective, and very effective.
Physician investigators were approved by the Hospital's Patient
Qualification Review Board. Physicians utilized the official New York
State triplicate prescription form as their research order for medication.
Informed consent was obtained from all patients and the procedures followed
were approved by an institutional research committee.

RESULTS

Seventy-four patients entered the study and 56 were evaluable. Eighteen
patients who had initially agreed to be treated with marijuana later
decided not to participate. Eighteen patients rated the marijuana very
effective (34%) and 26 patients rated it moderately effective (44%) for
an overall response rate of 78% (44/56). Twelve patients (22%) noted no
benefit.


TABLE I. Patient Characteristics (Percent)


Responders Nonresponders P
Value
(N=44) (N=12)


Female 64 75
NS*
Mean age (yr) 41 51
(median) (40) (54)
Breast cancer 36 33
NS
Lymphoma 34 25
NS
Prior radiation therapy 30 8
NS
Prior THC 29 20
NS
Prior Marijuana 52 17
0.06
Euphoria 60 36
NS
(high)
Smoker 53 38
NS


*NS= not significant
Standard deviation= 11.9
Standard deviation= 15.6

Characteristics of responding and nonresponding patients are listed in
Table I. While no statistically significant differences were noted between
responders and nonresponders with regard to sex, type of diagnosis, prior
radiation therapy, prior oral THC treatment, incidence of euphoria, or
smoking history, it is important to remember that the sample sizes were
small, making interpretation of differences difficult. Patients who
responded to marijuana cigarettes were more likely to be younger, median
age 40 vs 54 for nonresponders, and had prior marijuana exposure, 52% vs
17% (p= 0.06).
The most common diagnoses for this group of patients were breast
cancer, lymphoma, lung cancer, colon cancer, ovarian cancer, testicular
cancer, sarcoma, acute leukemia, and myeloma. The most common emetic
chemotherapeutic agents were cyclophosphamide, doxorubicin, cis-platinum,
procarbazine, methotrexate, dacartazine, and streptozocin, given either
singly or in combination. Four of seven patients treated with cis-platinum
responded favorably to marijuana cigarettes.
Toxic side effects included sedation in 88%, dry mouth in 77%,
dizziness in 39%, and confusion in 13%. Anxiety, headache, and fantasizing
were also seen but were less common. There was no toxicity in 13% of
patients (Table II).


TABLE II. Percent Toxicity


Sedation 88
Dry Mouth 77
Dizziness 39
Confusion 13
Anxiety 11
Headache 11
Fantasizing 11
None 13


DISCUSSION

The results of this prospective study suggest that inhalation
marijuana is active in controlling nausea and vomiting resulting from
chemotherapy. Marijuana benefited patients who were treated with a wide
range of chemotherapeutic agents including drugs which have considerable
emetogenic potential. A prior report by Chang et al (15) documented
effectiveness of oral THC and inhaled marijuana against high-dose
methotrexate, which normally has mild gastrointestinal toxicity. While
most experience indicates that THC is generally ineffective against
cis-platinum-induced emesis, benefit was seen in a small number of patients
treated in our program with this agent.
Since this was a single arm, nonrandomized, outpatient program, this
study lacks a controlled placebo group. Nevertheless, the patients acted
as their own controls, having previously failed standard antinausea
medications. They evaluated marijuana based on their subjective rating of
the severity of nausea, vomiting, appetite and food intake, mood, and
physical state after chemotherapy treatment. A placebo-controlled,
randomized inpatient study which quantitates all emetic episodes would
obviously provide objective and precise information. (16)
Failure to respond to oral THC does not preclude benefit from inhaled
marijuana. Twenty-nine percent of patients who failed oral THC responded
to the cigarette form. This is not unexpected, since only 5-10% of orally
administered THC is absorbed, whereas inhaled marijuana has a five-to
tenfold greater bioavailability. (17) Clearly, oral THC is an effective
treatment for chemotherapy-induced emesis. Most studies have demonstrated
THC to be better than placebo and comparable to prochlorperazine. (18)
The major obstacle related to the oral and inhaled cannabinoids is the
route of administration. Patients with anticipatory vomiting do not retain
the oral THC. Because of its poor water solubility, parenteral
adminstration of cannabinoids has been difficult. The only cannabinoid
available for parenteral use, levonantradol, is currently being
investigated and has documented activity comparable to THC. (19) Perhaps
intranasal or transdermal forms of THC will be developed and found to be
clinically useful.
Patient characteristcs were evaluated to identify factors which would
predict response to marijuana. There were no significant differences
between responders and nonresponders with regard to sex, diagnosis, prior
radiation therapy, prior THC ingestion, induced euphoria, and history of
cigarette smoking. The only factors that approached significance were
young age and prior marijuana intake. Unlike the experience with oral THC,
experiencing a euphoric high was not a prerequisite to obtaining the
antiemetic effect with marijuana. (20)
The mechanism of the antiemetic action of cannabinoids is unknown.
Inhibition of prostaglandin and cyclic adenosine monophosphate has been
suggested. Its major action is more likely related to its effect on the
brain, as marijuana causes central nervous system depression and impairment
of brain function. At the cellular level, cannabinoids interfere with the
synthesis of nucleic acids and chromosome proteins. (21)
Some of the problems encountered in this study which could influence
interpretation of the results were the low patient accrual and the fact
that nearly 25% of patients who initially consented refused to receive
treatment. Reasons for patients' refusal to participate included physician
and patient bias against smoking, harshness of smoke from the cigarettes,
and preference for oral THC capsules. The major objection was related to
the social stigma attached to the use of marijuana. Many patients rejected
the idea of "smoking pot" at home and exposing their children to the
implications of this type of medication. Should this therapy become
available in a different vehicle of administration, patient acceptance
would significantly improve.
Our results demonstrate that inhalation marijuana is an effective
therapy for the treatment of nausea and vomiting due to cancer
chemotherapy. A randomized, controlled trial would, however, be necessary
to accurately define the exact role of this drug. Toxic effects are well
tolerated and the availability of a parenteral form would improve patient
utilization of this agent. Future antiemetic protocols should include the
active ingredient of marijuana in combination with current effective
agents.

Acknowledgments. The authors thank Rosemarie Galderisi and Annie
Middleton for their assistance.


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as an ant;iemetic in cancer patients receiving high-dose methotrexate. Ann
Intern med 1979; 91: 819-824.
16. Carey MP, Burish TG, Brenner DE: Delta-9-tetrahydrocannabinol in
cancer chemotherapy: Research problems and issues. Ann Intern Med 1983;
99: 106-114
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18. Poster DS, Penta JS, Bruno S, et al: Delta-9-tetrahydrocannabinol in
clinical oncology. JAMA 1981; 245: 2047-2051.
19. Citron ML, Herman TS, Vreeland F, et al: Antiemetic efficacy of
levonantradol compared to delta-9-tetrahydrocannabinol for
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109-112.
20. Ungerleider JT, Andrysiak T, Fairbanks L, et al: Cannabis and cancer
chemotherapy. Cancer 1982; 50: 636-645.
21. Council on Scientific Affairs: Marijuana. Its health hazards and
therapeutic potentials. JAMA 1981; 246: 1823-1827.

============================== ==============
CHEMOTHERAPY

With respect to whether or not marijuana has a "currently accepted
medical use in treatment in the United States" for chemotherapy patients,
the record shows the following facts to be uncontroverted.

Findings Of Fact

1. One of the most serious problems experienced by cancer
patients undergoing chemotherapy for their cancer is severe nausea and
vomiting caused by their reaction to the toxic (poisonous) chemicals
administered to them in the course of this treatment. This nausea and
vomiting at times becomes life threatening. The therapy itself creates a
tremendous strain on the body. Some patients cannot tolerate the severe
nausea and vomiting and discontinue treatment. Beginning in the 1970's
there was considerable doctor-to-doctor communication in the United
States concerning patients known by their doctors to be surreptitiously
using marijuana with notable success to overcome or lessen their nausea
and vomiting.

2. Young patients generally achieve better control over nausea
and vomiting from smoking marijuana than do older patients, particularly
when the older patient has not been provided with detailed information on
how to smoke marijuana.

3. Marijuana cigarettes in many cases are superior to
synthetic THC capsules in reducing chemotherapy-induced nausea and
vomiting. Marijuana cigarettes have an important, clear advantage over synthetic THC capsules in that the natural marijuana is inhaled and generally takes effect more quickly than the synthetic capsule which is ingested and must be processed through the digestive system before it takes effect.

4. Attempting to orally administer the synthetic THC capsule
to a vomiting patient presents obvious problems - it is vomited right
back up before it can have any effect.

5. Many physicians, some engaged in medical practice and some
teaching in medical schools, have accepted smoking marijuana as effective
in controlling or reducing the severe nausea and vomiting (emesis)
experienced by some cancer patients undergoing chemotherapy for cancer.

6. Such physicians include board-certified internists,
oncologists and psychiatrists. (Oncology is the treatment of cancer
through the use of highly toxic chemicals, or chemotherapy.)

7. Doctors who have come to accept the usefulness of marijuana
in controlling or reducing emesis resulting from chemotherapy have dose
so as the result of reading reports of studies and anecdotal reports in
their professional literature, and as the result of observing patients
and listening to reports directly from patients.

8. Some cancer patients who have acknowledged to doctors that
they smoke marijuana for emesis control have indicated in their discussions that, although they may have first smoked marijuana recreationally, they accidentally found that doing so helped reduce the emesis resulting from their chemotherapy. They consistently indicated that they felt better and got symptomatic relief from the intense nausea and vomiting caused by the chemotherapy. These patients were no longer simply getting high, but were engaged in medically treating their illness, albeit with an illegal substance. Other chemotherapy patients began smoking marijuana to control their emesis only after hearing reports that the practice had proven helpful to others. Such patients had not smoked marijuana recreationally.

9. This successful use of marijuana has given many cancer
chemotherapy patients a much more positive outlook on their overall
treatment, once they were relieved of the debilitating, exhausting and
extremely unpleasant nausea and vomiting previously resulting from their
chemotherapy treatment.

10. In about December 1977 the previously underground patient
practice of using marijuana to control emesis burst into the public media
in New Mexico when a young cancer patient, Lynn Pearson, began publicly
to discuss his use of marijuana. Mr. Pearson besought the New Mexico
legislature to pass legislation making marijuana available legally to
seriously ill patients whom it might help. As a result, professionals in
the public health sector in New Mexico more closely examined how marijuana might be made legally available to assist in meeting what now openly appeared to be a widely recognized patient need.

11. In many cases doctors have found that, in addition to
suppressing nausea and vomiting, smoking marijuana is a highly successful
appetite stimulant. The importance of appetite stimulation in cancer
therapy cannot be overstated. Patients receiving chemotherapy often lose
tremendous amounts of weight. They endanger their lives because they
lose interest in food and in eating. The resulting sharp reduction in
weight may well affect their prognosis. Marijuana smoking induces some
patients to eat. The benefits are obvious, doctors have found. There is
no significant loss of weight. Some patients will gain weight.

This allows them to retain strength and makes them better able to fight
the cancer. Psychologically, patients who can continue to eat even while
receiving chemotherapy maintain a balanced outlook and are better able to
cope with their disease and its treatment, doctors have found.

12. Synthetic anti-emetic agents have been in existence and
utilized for a number of years. Since about 1980 some new synthetic
agents have been developed which appear to be more effective in
controlling and reducing chemotherapy-induced nausea and vomiting than
were some of those available in the 1970's. But marijuana still is found
more effective for this purpose in some people than any of the synthetic
agents, even the newer ones.

13. By the late 1970's in the Washington, D.C. area there was a
growing recognition among health care professionals and the public that
marijuana had therapeutic value in reducing the adverse effects of some
chemotherapy treatments. With this increasing public awareness came
increasing pressure from patients on doctors for information about
marijuana and its therapeutic uses. Many patients moved into forms of
unsupervised self-treatment. While such self-treatment often proved very
effective, it has certain hazards, ranging from arrest for purchase or
use of an illegal drug to possibly serious medical complications from
contaminated sources or adulterated materials. Yet, some patients are
willing to run these risks to obtain relief from the debilitating nausea
and vomiting caused by their chemotherapy treatments.

14. Every oncologist known to one Washington, D.C. practicing
internist and board-certified oncologist has had patients who used
marijuana with great success to prevent or diminish chemotherapy-induced
nausea and vomiting. Chemotherapy patients reporting directly to that
Washington doctor that they have smoked marijuana medicinally vomit less and eat better than patients who do not smoke it. By gaining control over their severe nausea and vomiting these patients undergo a change of mood and have a better mental outlook than patients who, using the standard anti-emetic drugs, are unable to gain such control.

15. The vomiting induced by chemotherapeutic drugs may last up
to four days following the chemotherapy treatment. The vomiting can be
intense, protracted and, in some instances, is unendurable. The nausea
which follows such vomiting is also deep and prolonged. Nausea may
prevent a patient from taking regular food or even much water for periods
of weeks at a time.

16. Nausea and vomiting of this severity degrades the quality
of life for these patients, weakening them physically, and destroying the
will to fight the cancer. A desire to end the chemotherapy treatment in
order to escape the emesis can supersede the will to live. Thus the
emesis, itself, can truly be considered a life-threatening consequence of
many cancer treatments. Doctors have known such cases to occur. Doctors
have known other cases where marijuana smoking has enabled the patient to
endure, and thus continue, chemotherapy treatments with the result that
the cancer has gone into remission and the patient has returned to a
full, active satisfying life.

17. In San Francisco chemotherapy patients were surreptitiously
using marijuana to control emesis by the early 1970's. By 1976 virtually
every young cancer patient receiving chemotherapy at the University of
California in San Francisco was using marijuana to control emesis with
great success. The use of marijuana for this purpose had become
generally accepted by the patients and increasingly by their physicians
as a valid and effective form of treatment. This was particularly true
for younger cancer patients, somewhat less common for


older ones. By 1979 about 25% to 30% of the patients seen by one San
Francisco oncologist were using marijuana to control emesis, about 45 to
50 patients per year. Such percentages and numbers vary from city to
city. A doctor in Kansas City who sees about 150 to 200 new cancer
patients per year found that over the 15 years 1972 to 1987 about 5% of
the patients he saw, or a total of about 75, used marijuana medicinally.

18. By 1987 marijuana no longer generated the intense interest
in the world of oncology that it had previously, but it remains a viable
tool, commonly employed, in the medical treatment of chemotherapy
patients. There has evolved an unwritten but accepted standard of
treatment within the community of oncologists in the San Francisco,
California area which readily accepts the use of marijuana.

19. As of the Spring of 1987 in the San Francisco area,
patients receiving chemotherapy commonly smoked marijuana in hospitals
during their treatments. This in-hospital use, which takes place in
rooms behind closed doors, does not bother staff, is expected by
physicians and welcomed by nurses who, instead of having to run back and
forth with containers of vomit, can treat patients whose emesis is better
controlled than it would be without marijuana. Medical institutions in
the Bay area where use of marijuana obtained on the streets is quite
common, although discrete, include the University of California at San
Francisco Hospital, the Mount Zion Hospital and the Franklin Hospital.
In effect, marijuana is readily accepted throughout the oncologic
community in the bay area for its benefits in connection with
chemotherapy. The same situation exists in other large metropolitan
areas of the United States.

20. About 50% of the patients seen by one San Francisco
oncologist during the year l987 were smoking marijuana medicinally. This is about 90 to 95 individuals. This number is higher than during the previous
ten years due to the nature of this physician's practice which includes
patients from the "tenderloin" area of San Francisco, many of whom are
suffering from AIDS-related lymphosarcoma. These patients smoke marijuana
to control their nausea and vomiting, not to "get high." They self-
titrate, i.e., smoke the marijuana only as long as needed to overcome
the nausea, to prevent vomiting.

21. The State of New Mexico set up a program in 1978 to make
marijuana available to cancer patients pursuant to an act of the State
legislature. The legislature had accepted marijuana as having medical
use in treatment. It overwhelmingly passed this legislation so as to
make marijuana available for use in therapy, not just for research.
Marijuana and synthetic THC were given to patients, administered under
medical supervision, to control or reduce emesis. The marijuana was in
the form of cigarettes obtained from the Federal government. The program
operated from 1979 until 1986, when funding for it was terminated by the
State. During those seven years about 250 cancer patients in New Mexico
received either marijuana cigarettes or THC. Twenty or 25 physicians in
New Mexico sought and obtained marijuana cigarettes or THC for their
cancer patients during that period. All of the oncologists in New Mexico
accepted marijuana as effective for some of their patients. At least ten
hospitals involved in this program in New Mexico, in which cancer
patients smoked their marijuana cigarettes. The hospitals accepted this
medicinal marijuana smoking by patients. Voluminous reports filed by the
participating physicians make it clear that marijuana is a highly
effective anti-emetic substance. It was found in the New Mexico program
to be far superior to the best available conventional anti-emetic drug, compazine, and clearly superior to synthetic THC pills. More than 90% of the patients who received marijuana within the New Mexico program reported significant or total relief from nausea and vomiting. Before the program began cancer patients were surreptitiously smoking marijuana in New Mexico to lessen or control their emesis resulting from chemotherapy treatments. They reported to physicians that it was successful for this purpose. Physicians were aware that this was going on.

22. In 1978 the Louisiana legislature became one of the first-
State legislatures in the nation to recognize the efficacy of marijuana
in controlling emesis by enacting legislation intended to make marijuana
available by prescription for therapeutic use by chemotherapy patients.
This enactment shows that there was widespread acceptance in Louisiana
of the therapeutic value of marijuana. After a State Marijuana
Prescription Review Board was established, pursuant to that legislation,
it became apparent that, because of Federal restrictions, marijuana could
be obtained legally only for use in cumbersome, formal research programs.
Eventually a research program was entered into by the State, utilizing
synthetic THC, but without much enthusiasm, since most professionals who
had wanted to use marijuana clinically, to treat patients, had neither
the time, resources nor inclination to get involved in this limited,
formal study. The original purpose of the Louisiana legislation was
frustrated by the Federal authorities. Some patients, who had hoped to
obtain marijuana for medical use legally after enactment of the State
legislation, went outside the law and obtained it illicitly. Some
physicians in Louisiana accept marijuana as having a distinct medical
value in the treatment of the nausea and vomiting associated with certain
types of chemotherapy treatments.

23. In 1980 the State of Georgia enacted legislation
authorizing a therapeutic research program for the evaluation of
marijuana as a medically recognized therapeutic substance. Its enactment
was supported by letters from a number of Georgia oncologist and other
Georgia physician, including the Chief of oncology at Grady Hospital and
staff oncologist at Emory University Medical Clinic. Sponsors of the
legislation originally intended the enactment of a law making marijuana
available for clinical, therapeutic use by patients. The bill was
referred to as the "Marijuana-as-Medicine" bill. The final legislation
was crafted, however, of necessity, merely to set up a research program
in order to obtain marijuana from the one legitimate source available -
the Federal Government, which would not make the substance available for
any other purpose other than conducting a research program. The act was
passed by an overwhelming majority in the lower house of the legislature
and unanimously in the Senate. In January 1983 an evaluation of the
program, which by then had 44 evaluable marijuana smoking patient-
participants, accepted marijuana smoking as being an effective anti-
emetic agent.

24. In Boston, Massachusetts in 1977 a nurse in a hospital
suggested to a chemotherapy patient, suffering greatly from the therapy
and at the point of refusing further treatment, that smoking marijuana
might help relieve his nausea and vomiting. The patient's doctor, when
asked about it later, stated that many of his younger patients were
smoking marijuana. Those who did so seemed to have less trouble with
nausea and vomiting. The patient in question obtained some marijuana and
smoked it, in the hospital, immediately before his next chemotherapy
treatment. Doctors, nurses, and orderlies coming into the room as he
finished smoking realized what the patient had been doing. None of them
made any comment. The marijuana was completely successful with this
patient, who accepted it as effective in controlling his nausea and
vomiting. Instead of being sick for weeks following chemotherapy, and
having trouble going to work, as had been the case, the patient was ready
to return to work 48 hours after that chemotherapy treatment. The
patient thereafter always smoked marijuana, in the hospital, before
chemotherapy. The doctors were aware of it, openly approved of it and
encouraged him to continue. The patient resumed eating regular meals and
regained lost eight, his mood improved markedly, he became more active
and outgoing and began doing things together with his wife that he had
not done since beginning chemotherapy.

25. During the remaining two years of this patient's life,
before his cancer ended it, he came to know other cancer patients who
were smoking marijuana to relieve the adverse effects of their
chemotherapy. Most of these patients had learned about using marijuana
medically from their doctors who, having accepted its effectiveness,
subtly encouraged them to use it.

26. A Boston psychiatrist and professor, who travels about the
country, has found a minor conspiracy to break the law among oncologists
and nurses in every oncology center he has visited to let patients smoke
marijuana before and during cancer chemotherapy. He has talked with
dozens of these health care oncologists who encourage their patients to
do this and who regard this as an accepted medical usage of marijuana.
He has known nurses who have obtained marijuana for patients unable to
obtain it for themselves.

27. A cancer patient residing in Beaverton, Michigan smoked
marijuana medicinally in the nearby hospital where he was undergoing
chemotherapy from early 1979 until he died of his cancer in October of
that year. He smoked it in his hospital room after his parents made arrangements with the hospital for him to do so. Smoking marijuana controlled his post-chemotherapy nausea and vomiting, enabled him to eat regular-meals again with his family, and he became outgoing and talkative. His parents accepted his marijuana smoking as effective and helpful. Two clergymen, among others, brought marijuana to this patient's home. Many people at the hospital supported the patient's marijuana therapy, none doubted its helpfulness or discouraged it. This patient was asked for help by other patients. He taught some who lived nearby how to form the marijuana cigarettes and properly inhale the smoke to obtain relief from nausea and vomiting. When an article about this patient's smoking marijuana appeared in a local newspaper, he and his family heard from many other cancer patients
who were doing the same. Most of them made an effort to inform their
doctors. Most Physicians who knew their patients smoked marijuana
medicinally approved, accepting marijuana's therapeutic helpfulness in
reducing nausea and vomiting.

28. In October 1979 the Michigan legislature enacted
legislation whose underlying purpose was to make marijuana available
therapeutically for cancer patients and others. The State Senate passed
the bill 29-5, the House of Representatives 100-0. In March 1982 the
Michigan legislature passed a resolution asking the Federal Congress to
try to alter Federal policies which prevent physicians from prescribing
marijuana for legitimate medical applications and prohibit its use in
medical treatments.

29. In Denver, Colorado a teenage cancer patient has been
smoking marijuana to control nausea and vomiting since 1986. He has done
this in his hospital room both before and after chemotherapy. His doctor
and hospital staff know he does this. The doctor has stated that he would prescribe marijuana for this patient if it were legal to do so. Other patients in the Denver area smoke marijuana for the same purpose. This patient's doctor, and nurses with whom he comes in contact, understand that cancer patients smoke marijuana to reduce or control emesis. They accept it.

30. In late 1980 a three year old boy was brought by his parents to a hospital in Spokane, Washington. The child was diagnosed as having cancer. Surgery was performed. Chemotherapy was begun. The child became extremely nauseated and vomited for days after each chemotherapy treatment. He could not eat regularly. He lost strength. He lost weight. His body's ability to ward off common infections, other life-threatening infections, significantly decreased. Chemotherapy's after-effects caused the child great suffering. They caused his watching parents great suffering. Several standard, available anti-emetic agents were tried by the child's doctors. None of them succeeded in controlling his nausea or vomiting. Learning of the existence of research studies with THC or marijuana the parents asked the child's doctor to arrange for their son to be the subject of such a study so that he might have access to marijuana. The doctor refused, citing the volume of paperwork and record-keeping detail required in such programs and his lack of
administrative personnel to handle it.

31. The child's mother read an article about marijuana smoking
helping chemotherapy patients. She obtained some marijuana from friends.
She baked cookies for her child with marijuana in them. She made tea for
him with marijuana in it. When the child ate these cookies or drank this
tea in connection with his chemotherapy, he did not vomit. His strength
returned. He regained lost weight. His spirits revived. The parents
told the doctors and nurses at the hospital of their giving marijuana to
their child. None objected.

They all accepted smoking marijuana as effective in controlling
chemotherapy induced nausea and vomiting. They were interested to see
the results of the cookies.

32. Soon this child was riding a tricycle in the hallways of
the Spokane hospital shortly after his chemotherapy treatments while
other children there were still vomiting into pans, tied to intravenous
bottles in an attempt to re-hydrate them, to replace the liquids they
were vomiting up. Parents of some of the other patients asked the
parents of this "lively" child how he seemed to tolerate his chemotherapy
so well. They told of the marijuana use. Of those parents who began
giving marijuana to their children, none ever reported back encountering
any adverse side effects. In the vast majority of these cases, the other
parents reported significant reduction in their children's vomiting and
appetite stimulation as the result of marijuana. The staff, doctors and
nurses at the hospital knew of this passing on of information about
marijuana to other parents. They approved. They never told the first
parents to hide their son's medicinal use of marijuana. They accepted
the effectiveness of the cookies and the tea containing marijuana.

33. The first child's cancer went into remission. Then it
returned and spread. Emotionally drained, the parents moved the family
back to San Diego, California to be near their own parents. Their son
was admitted to a hospital in San Diego. The parents informed the
doctors, nurses and social workers there of their son's therapeutic use
of marijuana. No one objected. The child's doctor in San Diego strongly
supported the parent's giving marijuana to him. Here in California, as
in Spokane, other parents noticed the striking difference between their
children after chemotherapy and the first child.

Other parents asked the parents of the first child about it, were told of
the use of marijuana, tried it with their children, and saw dramatic
improvement. They accepted its effectiveness. In the words of the
mother of the first child: ". . . When your kid is riding a tricycle
while his other hospital buddies are hooked up to IV needles, their heads
hung over vomiting buckets, you don't need a federal agency to tell you
marijuana is effective. The evidence is in front of you, so stark it
cannot be ignored." [footnote 6]

34. There is at least one hospital in Tucson, Arizona where
medicinal use of marijuana by chemotherapy patients is encouraged by the
nursing staff and some physicians.

35. In addition to the physicians mentioned in the Findings
above, mostly oncologists and other practitioners, the following doctors
and health care professionals, representing several different areas of
expertise, accept marijuana as medically useful in controlling or
reducing emesis and testified to that effect in these proceedings:

a. George Goldstein, Ph.D., psychologist, Secretary of
Health for the State of New Mexico from 1978 to 1983 and chief
administrator in the implementation of the New Mexico program utilizing
marijuana;

b. Dr. Daniel Danzak, psychiatrist and former head of the
New Mexico program utilizing marijuana;

c. Dr. Tod Mikuriya, psychiatrist and editor of
Marijuana: Medical Papers, a book presenting an historical perspective of
marijuana's medical use;

d. Dr. Norman Zinberg, general psychiatrist and Professor
of Psychiatry at Harvard Medical School since 1951;

6 Affidavit of Janet Andrews, ACT rebuttal witness, par. 98.

e. Dr. John Morgan, psychopharmacologist, Board-certified
in Internal Medicine, full Professor and Director of Pharmacology at the
City University of New York;

f. Dr. Phillip Jobe, neuropsychopharmacologist with a
practice in Illinois and former Professor of Pharmacology and Psychiatry
at the Louisiana State University School of Medicine in Shreveport,
Louisiana, from 1974 to 1984;

g. Dr. Arthur Kaufman, formerly a general practitioner in
Maryland, currently Vice-President of a private medical consulting group
involved in the evaluation of the quality of care of all the U.S.
military hospitals throughout the world, who has had extensive experience
in drug abuse treatment and rehabilitation programs;

h. Dr. J. Thomas Ungerleider, a full Professor of
Psychiatry at the University of California in Los Angeles with extensive
experience in research on the medical use of drugs;

i. Dr. Andrew Weil, ethnopharmacologist, Associate
Director of Social Perspectives in Medicine at the College of Medicine at
the University of Arizona, with extensive research on medicinal plants;
and

j. Dr. Lester Grinspoon, a practicing psychiatrist and
Associate Professor at Harvard Medical School.

36. Certain law enforcement authorities have been outspoken in
their acceptance of marijuana as an antiemetic agent. Robert T. Stephan,
Attorney General of the State of Kansas, and himself a former cancer
patient, said of chemotherapy in his affidavit in this record: "The
treatment becomes a terror." His cancer is now in remission. He came to
know a number of health care professionals whose medical judgment he
respected. They had accepted marijuana

as having medical use in treatment. He was elected Vice President of the
National Association of Attorneys General (NAAG) in 1983. He was
instrumental in the adoption by that body in June 1983 of a resolution
acknowledging the efficacy of marijuana for cancer and glaucoma patients.
The resolution expressed the support of NAAG for legislation then pending
in the Congress to make marijuana available on prescription to cancer and
glaucoma patients. The resolution was adopted by an overwhelming margin.
NAAG's President, the Attorney General of Montana, issued a statement
that marijuana does have accepted medical uses and is improperly
classified at present. The Chairman of NAAG's Criminal Law and Law
Enforcement Committee, the Attorney General of Pennsylvania, issued a
statement emphasizing that the proposed rescheduling of marijuana would
in no way affect or impede existing efforts by law enforcement
authorities to crack down on illegal drug trafficking.

37. At least one court has accepted marijuana as having medical
use in treatment for chemotherapy patients. On January 23, 1978 the
Superior Court of Imperial County, California issued orders authorizing a
cancer patient to possess and use marijuana for therapeutic purposes under the direction of a physician. Another order authorized and directed the Sheriff of the county to release marijuana from supplies on hand and deliver it to that patient in such form as to be usable in the form of cigarettes.

38. During the period 1978-1980 polls were taken to ascertain
the degree of public acceptance of marijuana as effective in treating
cancer and glaucoma patients. A poll in Nebraska brought slightly over
1,000 responses - 83% favored making marijuana available by prescription,
12% were opposed, 5% were undecided. A poll in Pennsylvania elicited
1,008 responses - 83.1% favored availability by prescription, 12.2% were
opposed, 4.7% were undecided. These two surveys were conducted by professional polling companies. The Detroit Free Press conducted a telephone poll in which 85.4% of those responding favored access to marijuana by prescription. In the State of Washington the State Medical Association conducted a poll in which 80% of the doctors belonging to the Association favored controlled availability of marijuana for medical purposes.

Discussion

From the foregoing uncontroverted facts it is clear beyond any question that many people find marijuana to have, in the words of the Act, an "accepted medical use in treatment in the United States" in effecting relief for cancer patients. Oncologists, physicians treating cancer patients, accept this. Other medical practitioners and researchers accept this. Medical faculty professors accept it. Nurses performing hands-on patient care accept it.

Patients accept it. As counsel for CCA perceptively pointed out at
oral argument, acceptance by the patient is of vital importance. Doctors
accept a therapeutic agent or process only if it "works" for the patient.
If the patient does not accept, the doctor cannot administer the treatment. The patient's informed consent is vital. The doctor ascertains the patient's acceptance by observing and listening to the patient. Acceptance by the doctor depends on what he sees in the patient and hears from the patient. Unquestionably, patients in large numbers have accepted marijuana as useful in treating their emesis. They have found that it "works". Doctors, evaluating their patients, can have no basis more sound than that for their own acceptance.

Of relevance, also, is the acceptance of marijuana by state
attorneys- general, officials whose primary concern is law enforcement. A large number of them have no fear that placing marijuana in Schedule II, thus
making it available for legitimate therapy, will in any way impede
existing efforts of law enforcement authorities to crack down on illegal
drug trafficking.

The Act does not specify by whom a drug or substance must be "accepted [for] medical use in treatment" in order to meet the Act's "accepted" requirement for placement in Schedule II. Department of Justice witnesses told the Congress during hearings in 1970 preceding passage of the Act that "the medical Profession" would make this determination, that the matter would be "determined by the medical community." The Deputy Chief Counsel of BNDD, whose office had written the bill with this language in it, told the House subcommittee that "this basic determination . . . is not made by any part of the federal government. It is made by the medical community as to whether or not the drug has medical use or doesn't". [footnote 7]

No one would seriously contend that these Justice Department witnesses meant that the entire medical community would have to be in agreement on the usefulness of a drug or substance. Seldom, if ever, do all lawyers agree on a point of law. Seldom, if ever, do all doctors agree on a medical question. How many are required here? A majority of 51%? It would be unrealistic to attempt a plebiscite of all doctors in the country on such a question every time it arises, to obtain a majority vote.

In determining whether a medical procedure utilized by a doctor is
actionable as malpractice the courts have adopted the rule what it is acceptable for a doctor to employ a method of treatment supported by a respectable minority of physicians.

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Thank You Fredster.... I am very grateful.... :smile: