Medical Marijuana

Can it help you? Should it be legal? A report from California

| March/April 1998

  • Ida Pemberton marijuana illustration courtesy of the University of Colorado Museum.
  • Ida Pemberton marijuana illustration courtesy of the University of Colorado Museum.
  • Spreading hemp on the ground in Kentucky. From Hemp (Cannabis sativa) by S. S. Boyce (New York: Orange Judd, 1900).
  • Illustration from American Medicinal Plants by Charles F. Millspaugh, M.D. (New York: Boericke & Tafel, 1887).

Since November 1996, when voters in California overwhelmingly approved Proposition 215, the Compassionate Use Act, it has been legal under state law for any “seriously ill” Californian to obtain marijuana upon the recommendation of a physician and for patients and their caregivers to cultivate it. Last summer, I traveled to Northern California, the seedbed of the medical-marijuana movement, to hear what patients, doctors, and others were saying, and learn what it might mean for the rest of us.

The Patients: A Lesser-of-Evils Pain Reliever

In California I met scores of patients who credit marijuana with dimming their pain, quelling their nausea, firing their appetites, and quelling their seizures; I also met a handful of people who believe marijuana is keeping them alive. Keith Vines is one patient who has no doubt on that score, nor does his doctor. Vines told me his story over a 16-ounce rib-eye steak at Harris’ Restaurant in Pacific Heights. I mention the detail because Vines is an AIDS patient afflicted with wasting syndrome; for someone in his situation, polishing off a big steak (along with a Caesar salad, scalloped potatoes, sugar snap peas, and a slab of pastry) counts as an accomplishment.

Not long after arriving in San Fran­cisco in 1983, Vines—a former U.S. Air Force captain and malpractice lawyer, a father, and, as a member of the Federal Narcotics Strike Force, a successful prosecutor of what had been San Francisco’s second-biggest drug case in that city’s history—was infected with HIV. By 1993, he had developed wasting syndrome, a little­-understood metabolic change that causes patients to lose rapidly not only fat but also muscle tissue. It is often a death sentence. “In a matter of months I dropped from 195 pounds to 150,” Vines said. “You wouldn’t have recognized me; it wasn’t the death camps, quite, but close.” This was hard to believe: the man before me looked as robust and thickly muscled as a football player.

Like many AIDS patients, Vines takes ten to fifteen medications a day. Many of these medicines cause debilitating nausea and suppress appetite, yet many of these drugs must be taken on a full stomach—and missing even a single dose can be disastrous. Vines was dying a slow death by emaciation when he managed to get into an experimental trial that was treating wasting syndrome with human growth hormone, a treatment approved by the U. S. Food and Drug Administration (FDA). His doctor explained that for the new drug to have any chance of working, it was essential that Vines eat three meals a day—something he found impossible to do.

Dr. Lisa Capaldini, Vines’s primary physician, suggested he try Marinol to stimulate his appetite. Marinol is a synthetic form of THC—the principal active ingredient in marijuana. It was approved by the FDA initially as an anti-emetic for chemotherapy patients and then, in 1993, as an appetite stimulant for AIDS patients. But like many people who take it, Vines found that Marinol took a long time to kick in and that, when it did, the effects were far too powerful and long-lasting. “One capsule would make me feel stoned for hours,” he said. “Sometimes I’d be too stoned to eat, or I’d just fall asleep.”

Opponents of medical marijuana often point to Marinol as a superior alternative; indeed, it appears that the government speeded the development and approval of the drug as a way to relieve the political pressure to legalize medical marijuana, which was building in the wake of the AIDS epidemic.

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