Spring 1994 Vol. 04, No. 4 Laying the Groundwork
I am a Medical Marijuana Patient who for 19 years has grown marijuana in my vegetable and herb garden to treat my epilepsy. After entanglement with law enforcement I have come to realize that while patients may be protected by a specific defense of necessity, there is little that will ensure against reprisal by authorities.
I began experimentation with marijuana following an auto accident in 1973. I suffered a closed head trauma that left me shaken by up to five grand mal seizures per day. I became addicted to pharmaceutical medication that did not relieve the seizures that plagued my life. About 25% of epileptics do not respond to medicines. I am one of many who do not. While the prescription drugs left me debilitated, I discovered that with marijuana I could completely control the onset of a seizure. For me this knowledge was freedom. By using it I am able to abandon pharmaceutical medication and its side effects.
Arrest and acquittal
In August of 1992 my husband, Mike and I were arrested for felony cultivation of five marijuana plants that I grow openly in our front yard. This crime is punishable by three years in state prison. After our arrest we realized the importance of challenging the existing laws governing the medical use of marijuana. We hoped that in presenting a necessity defense we might clarify the medicinal use of marijuana, freeing myself from further prosecution and establishing a precedent for patients relief. After 7 1/2 months the district attorney of Santa Cruz County, California dropped charges against me for marijuana cultivation. He stated, "No reasonable jury would find her guilty."
Having won what I thought to be the right to use the only medicine that controls my seizure activity, I again planted five marijuana plants in my front garden. In September of 1993 CAMP agents arrived at our home and after a three hour search they confiscated my medicine and arrested us.
Under ordinary circumstances the dismissal would seemingly have set a precedent for patients who satisfy the six points of necessity for cultivation. And indeed it does. But are we protected by the law? Or are we shuffled between departments? The fact is, even though there is no alternative that will provide relief for my condition, and despite my having adequately established necessity through the judiciary system, it is still illegal to use or cultivate marijuana.
California State Senator Henry Mello has presented a non-binding resolution, SJR 8 in a bipartisan effort to allow the use of marijuana medicinally. There is at present no provision by the federal government to meet the needs of patients, only the remnants of the antiquated Compassionate IND (Investigational New Drug) serving nine government-approved patients exists to this day. This defunct program supplied patients with government marijuana, but the project was axed by the Bush administration in March of 1992.
There exist three phases of study that are necessary in ascertaining the acceptability of a new drug for medical use in treatment. The FDA requires: Phase I; safety, Phase II; pilot studies on efficacy, and Phase III; controlled studies on efficacy and safety. According to Judge Francis L. Young, presiding Administrative Law Judge to the United States Department of Justice in the DEA hearings on the Marijuana Rescheduling Petition in 1988, it has been established that marijuana satisfies both Phase I, II and Phase III studies on safety and efficacy.
Having demonstrated sufficient evidence to substantiate these findings it then seems redundant to continue further studies on the safety or efficacy of marijuana. By succumbing to the FDAs present acceptance of only Phase II; safety studies, we surrender ground already gained. In fact, as patients’ needs are ever growing it is essential to focus on the third phase, i.e., controlled trials, if any aspect of further research could be considered necessary. To regress only into pilot research clearly abandons nearly 20 years of legal battles. Delay only serves to create further suffering on the part of patients. It is urgent to create a solution to this problem by meeting the needs of those who are suffering and dying immediately.
Helping cancer patients
In 1978, someone I loved became ill with a prognosis of terminal cancer in the advanced stages of leukemia. I thought that marijuana might help and I encouraged her, hoping that it would curb her severe reaction to chemotherapy. We found that a tea solution from marijuana reduced her nausea and helped her to sleep. As she put it, "It’s the best sleep I can remember having in years". She found that her last months of life were improved by using marijuana. In fifteen years over 20 of our friends and family members have died. Most of them have used marijuana at some time during their dying process.
Since our initial arrest I have been inundated with calls from patients seeking protection, information and help. I have begun working closely with terminal patients who use marijuana. From them I have been able to collect information to begin an anecdotal efficacy study in the form of a visual analog.
While this type of study could conceivably track the results of marijuana use for any number of different ailments, I had restricted my study to that of terminal patients. However, as an overwhelming interest grows I have offered the daily visual analog for use to certain other patients. I hope to collect a broad data base to substantiate the effectiveness of marijuana on many ailments. Any patient who meets the six points of medical necessity would be a likely candidate for such a study. I have encountered no objection to the use of marijuana by the medical profession in cases of AIDS, cancer, glaucoma and my own case of epilepsy.
I was contacted by HA, a terminal patient who has pancreatic and liver cancer. We discussed how we might develop a simple record of marijuana use in order to register its effects on his dying process. Together we were able to expand a daily visual analog to collect data from patients who use marijuana. It features a graph on which a patient can record responses both before and after marijuana use under different categories.
In a recent conversation with HA we talked extensively about his illness. He has lived for a remarkable three years with his diagnosis. I asked him to tell me what marijuana did for him and why he thinks he had defied the odds of a 6 month prognosis. He mentioned the usual stuff; adding energy, his increased appetite, relieving pain, and so on. Then he said a most remarkable thing! He told me that marijuana changed his perception.
Reduced pain and distress
What we have found is that while it is apparent that marijuana can be used to help ailing patients with sleep and to "get the munchies" it has a deep reaching affect on pain and aids some patients to achieve an altered awareness level.
How can this altered state be of importance in the treatment of terminally ill patients? HA says that while he feels marijuana has prolonged his life because he enjoys a ravenous appetite, there exists another factor. He states that marijuana alters the way he perceives his inevitable death. HA insists that his marijuana use has helped him to accept his illness and its eventual outcome. His wife says that he has regained his sense of humor. Not many of us can smile in the face of such a reality.
Working with HA has opened my mind to the great hidden issue that lies circumspect to this plant medicine. Why shouldnt we alter our consciousness? Of the many terminal patients with whom I have had the opportunity to be of some small assistance, I have seen time and again that although there often is little we can do to alter a situation, we can change our view of it. Marijuana can do this for some people.
One of the major causes of failure in any treatment for pain is the failure to differentiate pain from suffering. If a patient thinks that s/he feels better when using marijuana, then what is the difference between that idea and actually feeling better?
In the first four months that I worked with HA he cut his use of 1000 Dilaudid per month and did not renew his prescription for a period of four months, relying solely on marijuana. Recently he ran out of marijuana and was subsequently admitted to the hospital for pain control at a cost of $8,000. Such an example of the prohibitive cost of medical care is a substantial reason to allow patients to meet their own needs by growing marijuana for personal use. A few weeks later HA ran out again. His doctor advised another hospital stay to control pain. HA suggested an attempt at procuring more marijuana. He received his medicine and he stayed out of the hospital. His doctor was enthusiastic at the results.Another terminal patient with bone cancer began using marijuana baked in cake and brownies at the onset of his 2 week prognosis. This was nearly six weeks ago. Shortly after he began ingesting marijuana he started a rigorous chemotherapy treatment of Cisplatin in conjunction with other pharmaceutical drugs. He managed the first part of the week-long treatment with only one bout of nausea and he gained six pounds. His doctor and hospice nurse applauded his marijuana use.
In our last visit he told me that there is no doubt in his mind that marijuana is behind his success. He did suggest, however, that a few chocolate chips in the brownies would create a near perfect medicine!
Helping spasticity patients
I asked a 32 year old spinal cord injury victim what kind of alternatives were available in lieu of using marijuana for spasticity. He said that he had been offered the alternatives of drugs, i.e., muscle relaxants, opiates and antidepressants, or a procedure where preliminary therapeutic techniques include surgical interruption of muscle tissue to relieve spasticity. Neither of these seem any more reasonable than simply smoking or ingesting marijuana.
A 100% disabled veteran has abandoned the use of pharmaceutical drugs, including Ativan and varying pain medication that he has relied on for over 20 years by replacing them with marijuana brownies. It is an inexpensive alternative that keeps him from depression, anxiety and mood swings. Marijuana affords him the opportunity to be a productive member of society and a more conscientious father. Prior to his marijuana use he states that under the influence of the pharmaceuticals that he would often lay about the house for days at a time. He claims that replacing drugs with marijuana has improved his attitude. He states that he is finding a way out of the depression that Ativan causes, while the pain of arthritis from a war wound has diminished and is easier for him to accept.
Reduced medical costs
As a Schedule I drug, marijuana is considered dangerous and of no medicinal value. It is difficult to understand the DEAs position on this issue when the FDA provides a marijuana derivative called Marinol to some patients. It is curious that the FDA and pharmaceutical companies pursue the development of synthetic marijuana if indeed it has no medicinal use. Should the FDA and the DEA succeed, patients may be further forced to forfeit their ability to use this plant medicine in its natural form.
The life of a patient is restricted by the limits of illness. Being able to have a hands-on approach to relieve their suffering by growing their own medicine can be an extremely valuable and empowering experience. For many this is a simple action they can take for themselves to provide free health care and vitally important quality control. Purity of medicine is imperative in order to prevent further health problems such as those associated with molds, toxins or chemical impurities; i.e. aspergillosis, caused by mold, presents an acute pneumonia which occurs in immunosuppressed patients. Quality, high potency marijuana and the availability of different varieties can have far reaching affects on varied symptoms of illness.
For the many patients whose prognosis include cancer, AIDS, epilepsy, birth defects, glaucoma, and spasticity marijuana provides a variety of answers. In cases where there exists no alternative upon which a patient can rely for relief it is likely that s/he would meet the six points of necessity. Protection lies in establishing credible testimony to meet the six points. Substantial evidence to support such a defense must be presented. It is extremely important for a patient to notify a physician of her/his marijuana use. One must examine the six elements that constitute a necessity defense and discuss alternative medicine with ones physician. Be certain that such information is entered in to medical records. Documentation is everything.
Not everyone is protected by this procedure. While any ailment is worthy of relief not every patient will prove all six points. There is a question as to the existence of an ‘adequate alternative’ to an approved FDA drug. Should an adequate alternative exist then what kind of side effects does it offer? Does it provide the desired relief? A patient can certainly be instrumental in determining the answers to these queries.
There are thousands who experience the fear of prosecution and the pain that must be endured without the availability of this herbal remedy. Patients and caregivers take the risk, because there is no choice.
The gap widens as we consider the many illnesses for which marijuana can be of aid. In cases such as PMS, migraine headaches, depression or any number of other debilitating maladies that may not be considered life threatening, there seems to be a great deal of resistance to the acceptance of marijuana as treatment.
The six points of medical necessity refer to a situation where there is no other means of action to prevent the disorder. A court might hinder a defense of medical necessity were the accused not suffering from a seriously debilitating disease.
Among the patients I have worked with one recurring testimony is the financial burden that illness brings. Even when an insurance company pays up to 80% of medical costs, the balance can shatter fragile finances. I have spoken with families who have lost much of their life savings, or sold their cars and heirlooms in order to pay the remainder of their hospital bills. Often this is the case.
Free medical care can be augmented by providing for oneself. Marijuana is a plant that can be grown for free in a garden, a closet or on a patio. Provisions for those who do not garden could be remedied through government or private concerns. Some patients or caregivers might choose to grow this herbal medicine and could do so with a doctors prescription and a permit. A doctor could surely determine how to prescribe it just as s/he does with other medicines.
One needn’t possess psychic abilities to know that an underground exists to offer supplies of marijuana. The "war on drugs" has skyrocketed to include grandmothers with cancer and their backyard gardens, caregivers growing a few plants for loved ones and friends hitting the streets searching out this proven remedy. These alternatives are both risky and expensive. The price of illness is costly in America.
We are patients challenged by the drawbacks of our disease. The concern of patients who use marijuana is not how it hinders us, but how it makes us well. Compared to the pharmacopoeia of synthetic alternatives that many of us have been offered, this natural medicine provides a means to function in our daily lives, and for some of us it furnishes a view that reaches far beyond our limitations. Understanding pain and touching the dying clearly demonstrate this altered perspective.
As patients, we grope through the darkness of our illness without knowing from where relief will come. We hope that there will be an answer to our suffering. When we find one there is little that could deter us from its use or convince us of its evil.
The Six Points Of Necessity are:
- the act charged as a crime must have been done to prevent a significant evil
- the harm caused by the act must not be disproportionate to the harm avoided
- the accused must entertain a good faith belief that the act was necessary to prevent greater harm
- the belief must be objectively reasonable under all of the circumstances
- there is no adequate alternative to the commission of the act
- the accused must not have contributed to the creation of the emergency