Marihuana: The Forbidden Medicine

History of Cannabis

When Congress debated marijuana legislation, the AMA opposed it, and was told to “get out of the way of the Federal Government”. That’s been pretty much the history of marijuana legislation and regulation ever since. Need it to maintain your sight? Go blind. Need it to stay alive? Then die. Get out of the way of the federal government.

Botannically classifed as a member of the family Cannabaceae and the genus Cannabis. “Most botanists agree that there are three species: Cannabis sativa, the most widespread of the three, is tall, gangly, and loosely branched, growing as high as twenty feet; Cannabis indica is shorter, about three or four feet in height, pyramidal in shape and densely branched; Cannabis ruderalis is about two feet high with few or no branches.”

The seeds are “strictly speaking” akenes: small, hard fruits. The oil was once used for lighting and soap, and is now sometimes used for varnish, linoleum, and artists’ paints.

P. 2

Bhang is made from the dried and crushed leaves, seeds, and stems. Ganja is made from the flowering tops of the female plants, and is two or three times as strong as bhang. Charas is the pure resin, also known as hashish. “The marihuana used in the United States is equivalent to bhang or, increasingly in recent years, to ganja.”

Marihuana contains more than 460 known compounds, “of which more than 60 have the 21-carbon structure typical of cannabinoids.” D9-THC is the only one that is both highly psychoactive and present in large amounts (usually 1-5% by weight).

Some synthetic congeners (chemical relatives) of THC are synhexyl, nabilone, and levonatradol.

The nerve receptors in the brain that are stimulated by THC are “found mainly in the cerebral cortex, which governs higher thinking, and in the hippocampus, which is a locus of memory.”

P. 3

“It was certainly cultivated in China by 4000 B.C. and in Turkestan by 3000 B.C.”

p. 4

Its heyday was 1840 to 1900, when more than one hundred papers were published in the Western literature recommending it. The first Western physician to look at it as a medicine was W. B. O’Shaugnessey, at the Medical College of Calcutta. “In a report published in 1839, he wrote that he had found tincture of hemp (a solution of cannabis in alcohol, taken orally) to be an effective analgesic. He was also impressed with its muscle relaxant properties and called it “an anticonvulsive remedy of the greatest value.””

The biggest uses were for migraines and stimulating appetite.

P. 6

Dr. J. B. Mattison wrote a report on his uses of marijuana, and concluded:

Dr. Suckling wrote me: “The young men rarely prescribe it.” To them I specially commend it. With a wish for speedy effect, it is so easy to use that modern mischief maker, hypodermic morphia, that they [young physicians] are prone to forget remote results of incautious opiate giving. Would that the wisdom which has come to their professional fathers through, it may be, a hapless experience might serve them to steer clear of narcotic shoals on which many a patient has gone awreck. Indian hemp is not here lauded as a specific. It will, at times, fail. So do other drugs. But the many cases in which it acts well entitle it to a large and lasting confidence.

J. B. Mattison, “Cannabis indica as an Anodyne and Hypnotic,” St. Louis Medical Surgical Journal 61 (1891): 266.

Cannabis as medicine was already in decline (as noted above) by 1890. “The potency of cannabis preparations was too variable, and individual responses to orally ingested cannabis seemed erratic and unpredictable.” Also, hemp products are insoluble in water, and so not easily injected. Opiates were easier to use for that.

“Toward the end of the nineteenth century, the development of such synthetic drugs as aspirin, chloral hydrate, and barbiturates, which are chemically more stable than Cannabis indica and therefore more reliable, hastened the decline of cannabis as a medicine. But the new drugs had striking disadvantages. Five hundred to a thousand people die from aspirin-induced bleeding each year in the United States, and barbiturates are, of course, far more dangerous yet. One might have expected physicians looking for better analgesics and hypnotics to have turned to cannabinoid substances, especially after 1940, when it became possible to study congeners (chemical relatives) of THC that might have more stable and specific effects.”

“But the Marihuana Tax Act of 1937 undermined any such experimentation.”

More from W.C. Woodward, physician-lawyer, in congress:

The newspapers have called attention to it so prominently that there must be grounds for their statements. It has surprised me, however, that the facts on which these statements have been based have not been brought before this committee by competent primary evidence. We are referred to newspaper publications concerning the prevalence of marihuana addiction. We are told that the use of marihuana causes crime.”

“Representative John Dingell’s questions are typical:”

Mr. Dingell: We know that it is a habit that is spreading, particularly among youngsters. We learn that from the pages of the newspapers. You say that Michigan has a law regulating it. We have a State Law, but we do not seem to be able to get anywhere with it, because, as I have said, the habit is growing. The number of victims is increasing each year.

Dr. Woodward: There is no evidence of that.

Mr. Dingell: I have not been impressed by your testimony here as reflecting the sentiment of the high-class members of the medical profession in my State. I am confident that the medical profession in the State of Michigan, and in Wayne County particularly, or in my district, will subscribe wholeheartedly to any law that will suppress this thing, despite the fact that there is a $1 tax imposed.

Dr. Woodward: If there was any law that would absolutely suppress the thing, perhaps that is true, but when the law simply contains provisions that impose a useless expense, and does not accomplish the result—

Mr. Dingell (interposing): That is simply your personal opinion. That is kindred to the opinion you entertained with reference to the Harrison Narcotics Act.

Dr. Woodward: If we had been asked to cooperate in drafting it—

Mr. Dingell (interposing): You are not cooperating in drafting this at all.

Dr. Woodward: As a matter of fact, it does not serve to suppress the use of opium and cocaine.

Mr. Dingell: The medical profession should be doing its utmost to aid in the suppression of this curse that is eating the very vitals of the Nation.

Dr. Woodward: They are.

Mr. Dingell: Are you not simply piqued because you were not consulted in the drafting of the bill?

“Woodward was finally cut off with the admonition: “You are not cooperative in this. If you want to advise us on legislation you ought to come here with some constructive proposals rather than criticisms, rather than trying to throw obstacles in the way of something that the Federal Government is trying to do.”

P. 13

In 1972, NORML petitioned the Bureau of Narcotics and Dangerous Drugs (formerly the FBN) to transfer marihuana to Schedule II so that it could be legally prescribed by physicians. Other parties to later join include the Drug Policy Foundation and the Physicians Association for AIDS Care. In the hearings before the BNDD, Lester Grinspoon waited to testify on the medical uses of cannabis, and “witnessed the effort to place pentazocine (Talwin), a synthetic opioid analgesic made by Winthrop Pharmaceuticals, on the schedule of dangerous drugs. The testimony indicated several hundred cases of addiction, a number of deaths from overdose, and considerable evidence of abuse. Six lawyers from the drug company, briefcases in hand, came forward to prevent the classification of pentazocine or at least to ensure that it was placed in one of the less restrictive schedules. They succeeded in part; it became a Schedule IV drug. In the testimony on cannabis, the next drug to be considered, there was no evidence of overdose deaths or addiction—simply many witnesses, both patients and physicians, who testified to its medical utility. The government refused to transfer it to Schedule II.”

The BNDD failed to call for the public hearings that were required by law, before rejecting the NORML petition. “The reason it gave was that reclassification would violate U.S. treaty obligations under the United Nations Single Convention on Narcotic Substances. NORML responded in January 1974 by filing a suit against the BNDD. The U.S. Second Circuit Court of Appeals reversed the bureau’s dismissal of the petition, remanding the case for reconsideration and criticizing both the bureau and the Department of Justice.

In September 1975, the Drug Enforcement Administration (DEA), successor to the BNDD, acknowledged that treaty obligations did not prevent the rescheduling of marihuana but contined to refuse public hearings. NORML again filed suit. In October 1980, after much further legal maneuvering, the Court of Appeals remanded the NORML petition to the DEA for reconsideration for the third time. The government reclassified synthetic THC as a Schedule II drug in 1985 but kept marihuana itself—and THC derived from marihuana—in Schedule I. Finally, in May 1986, the DEA administrator announced the public hearings ordered by the court seven years earlier.

‘Those hearings began in the summer of 1986 and lasted two years. The parties who sought rescheduling were NORML…; the Alliance for Cannabis Therapeutics…; the Cannabis Corporation of America, a pharmaceutical firm established with the intention of extracting natural cannabinoids for therapeutic use when cannabis is placed in Schedule II; and the Ethiopian Zion Coptic Church, which considers marihuana a sacred plant essential to its religious rituals. These groups were opposed by the DEA, the International Chiefs of Police, and the National Federation of Parents for Drug-Free Youth…

‘The lengthy hearings involved many witnesses, including both patients and doctors, and thousands of pages of documentation…. Administrative law judge Francis J. Young reviewed the evidence and rendered his decision on September 6, 1988. Young said that approval by a “significant minority” of physicians was enough to meet the standard of “currently accepted medical use in treatment in the United States” established by the Controlled Substances Act for a Schedule II drug. He added that “marijuana, in its natural form, is one of the safest therapeutically active substances known to man…. One must reasonably conclude that there is accepted safety for use of marijuana under medical supervision. To conclude otherwise, on the record, would be unreasonable, arbitrary, and capricious.” Young went on to recommend “that the Administrator [of the DEA] conclude that the marijuana plant considered as a whole has a currently accepted medical use in treatment in the United States, that there is no lack of accepted safety for use of it under medical supervision and that it may lawfully be transferred from Schedule I to Schedule II.””

The DEA refused to reschedule. Part of their reasoning was a list of criterion, one of which was “recognition and use by a substantial segment of medical practitioners in the United States.” In March 1991, the plaintiffs appealed again, and in April the District of Columbia Court of Appeals unanimously ordered the DEA to reexamine its standards, saying “We are hard pressed to understand how one could show that any Schedule I drug was in general use or generally available.” The DEA issued a final rejection of all pleas for reclassification in March 1992.

P. 17

State governments have been responding to pressure by patients and physicians. In 1978, New Mexico was the first to enact a law designed to make marihuana available for medical use. 33 states followed in the seventies and early eighties. Massachussetts was the 35th, in 1992.

Such laws were difficult to implement, however. Because it is not recognized by the law as medicine, it could only be used for research. And “Many states gave up as soon as the officials in charge of the programs confronted the regulatory nightmare of the relevant federal laws.” However, between 1978 and 1984, 17 states received permission to establish programs for using marihauan to treat glaucoma and the nausea induced by chemotherapy.

Even this was problematical. Lousiana received permission, but only for synthetic THC. Marijuana itself was not made legally available. “Patients felt compelled to use illicit cannabis, and a least one was arrested.”

Only ten states managed to establish programs in which cannabis was used as a medicine. New Mexico was the first, and the most successful, due “largely because of the efforts of a young cancer patient, Lynn Pierson.” Friction developed between the FDA and the people in charge of the New Mexico program. “The FDA demanded studies with placebos (inactive substances) as controls; the physicians in the New Mexico program wanted to provide sick patients with care. The FDA wanted to proceed slowly; the attitudes of the physicians reflected the urgency of their patients’ needs.” A compromise involved patients being assigned at random to either marijuana cigarettes or synthetic THC capsules. “But prolonged delays suggested to the New Mexico officials that the FDA was not dealing in good faith, and tensions began to grow. At one point state officials even considered using confiscated marihuana, and the Chief of the State Highway Patrol was asked whether it could be supplied.”

In August 1978, Lynn Pierson died of cancer, without ever having received legal marijuana. “Now the FDA approved the New Mexico IND (Investigational New Drug), only to rescind the approval a few weeks later, after the public furor surrounding Pierson’s death had died down.” The New Mexico officials considered calling a public press conference to condemn federal officials for “unethical and immoral behavior.” In November 1978, the program was approved, supplies of marijuana were promised within a month, and actually delivered two months later.

From 1978 to 1986 about 250 cancer patients in NM received either marihuana or THC after conventional medicines failed to control their nausea and vomiting. Both marijuana and THC were effective, but marijuana was superior. More than 90% reported significant or total relief from nausea and vomiting.

P. 20

The successful programs elsewhere resembled New Mexico’s. “It was understood that “research” was merely a disguise; the aim was to relieve suffering.”

Around this time, “growing demand forced the FDA to institute an Individual Treatment IND… for the use of individual physicians whose patients needed marihuana.” Also known as a Compassionate Use IND or Compassionate IND. The physician needed approval from both the FDA and the DEA, and then order the marihuana from the NIDA, who grew cannabis on a farm at the University of Mississippi., the only legal hemp farm. It was rolled into cigarettes in North Carolina, and were supposed to have 2% THC. The cigarettes had to be shipped to a pharmacy, which had to comply with strict DEA regulations for security.

In 1976 Robert Randall became the first patient to receive a Compassionate IND for marijuana. Over 13 years, a dozen more were awarded. In 1989, the FDA was deluged with applications from AIDS patients. “In early June 1991, Deputy National Drug Control Policy Director Herbert D. Kleber assured a national television audience that anyone with a legitimate medical need for marihuana would be able to get a Compassionate IND. But a few weeks later, on June 21, James O. Mason, chief of the Public Health Service, announced that the program would be suspended because it undercut the administration’s opposition to the use of illegal drugs.”

It was kept “under review” for nine months, and discontinued in March 1992. 28 patients whose applications had been approved were cancelled. The twelve who were already receiving it would continue to receive it.

Cannabis as a Medicine

Amazingly, as early as 1972 doctors were for all practical purposes prescribing marijuana to cancer patients as a matter of course; or, they left it to nurses to do so. By that same year, glaucoma patients had realized it helped them, too.

The most common effect of chemotherapy drugs are “profound nausea and vomiting. Retching (dry heaves) may last for hours or even days after each treatment, followed by days and even weeks of nausea. Patients may break bones or rupture the esophagus while vomiting. The sense of a loss of control can be emotionally devastating. Furthermore, many patients eat almost nothing because they cannot stand the sight or smell of food. As they lose weight and strength, they find it more and more difficult to sustain the will to live.”

Some patients stop, “knowing it means certain death” because the side effects seem worse than the cancer itself.

P. 26

In one of the state research programs, 78% of the patients who got no relief from standard anti-emetics became symptom-free when they smoked marihuana. [V. Vinciguerra, T. Moore, and E. Brennan, “Inhalation Marijuana as an Anti-emetic for Cancer Chemotherapy,”New York State Journal of Medicine 88 (October 1988): 525-527]

p. 30-31

A woman whose son had cancer:

We made certain that all of his doctors and nurses were aware of the situation; none objected and some clearly approved. We even arranged for him to smoke marihuana in his hospital room. In effect, reasonable people caring for Keith decided that the law did not match the reality of his needs. ‘We learned that many cancer patients were smoking marihuana and most told their doctors, who approved but were not willing to say in public what they told their patients in their offices.

P. 28

Dr. Grinspoon’s own son had cancer in 1972. At first, he objected to him using marihuana, but his wife went ahead and got their son some anyway.

My surprise gave way to relief as I saw how comfortable Danny was. He did not protest as he was given the medicine, and we were all delighted when no nausea or vomiting followed. On the way home he asked his mother if he could stop for a submarine sandwich, and when he got home he began his usual activities instead of going straight to bed. We could scarcely believe it. ‘The next day I called Dr. Norman Jaffe, the physician who was in charge of Danny’s care. I explained what had happened and said that while I did not want to embarrass him or the rest of the medical staff, I could not forbid Danny to smoke marihuana before his next treatment. Dr. Jaffe responded by suggesting that Danny smoke marihuana in his presence in the treatment room.

P. 32

There is even a sort of “underground mail system” for cancer patients who want marijuana. The parents of Keith, above, became involved in Michigan’s proposed legislation to legalize marijuana for cancer patients and glaucoma sufferers. They had originally decided to use marijuana after reading a newspaper article about a cancer patient who had received marijuana from an anonymous benefactor, who left it in a brown paper bag at the patient’s door.

One day shortly after the hearings we found a small brown bag of marihuana in our mailbox. There was no note, no identification, just an ounce of marihuana. I remembered the newspaper story I had laughed at, the one in which marihuana appeared on someone’s doorstep. Soon we received more marihuana in the mail. The donors usually remained anonymous, but not always. An Episcopal priest, for example, brought marihuana to our house and said he thought we would know who might benefit from it. As news spread through the grapevine, we heard from some similar folks. One day we received a call from a woman who had attended elementary school with Arnold, my husband. She invited us to her home and offered us a cigar box filled with marihuana. She explained that her husband, recently deceased, had smoked it to help control terminal cancer pain. She had no use for it now but did not want to throw it away.

P. 33

Harris Taft had a ten year battle with cancer starting in 1969. Mona Taft, his wife, described the start of his marihuana use:

One day in 1977, when we arrived at the treatment room where Harris was to receive the injection, he bolted and ran down the corridor. I found him a bit later, wandering the halls. He told me he couldn’t take any more chemotherapy. He was at wit’s end, exhausted by the disease, terrified by the effects of the drugs that were supposed to prolong his life. I have never before or since seen a man so genuinely and deeply frightened. Harris had come to fear the treatments more than the cancer and, he admitted, more than death itself. He told me he would choose dying over further chemotherapy. One of the nurse practicioners overheard us and interrupted; she said she understood our problem and suggested that Harris smoke marihuana to relieve the nausea and vomiting. We were startled. Although Harris had occasionally smoked marihuana socially, he couldn’t believe it would help. We asked Harris’s doctor about marihuana, and he said that he couldn’t encourage us to do anything illegal, but many of his younger patients were smoking marihuana and it seemed to reduce their trouble with nausea and vomiting. The message was pretty clear: Try marihuana and see if it helps….

When Harris went for his next chemotherapy session, he was so frightened he forgot to bring his marihuana; I had to take it to him after he called from his hospital room. Doctors, nurses, and orderlies must have seen him smoking it, but no one said anything…. this time there was no vomiting; he slept like a baby. It was his first full night of restful sleep in nearly seven years of anticancer treatments. The next morning he actually ate breakfast, a real breakthrough. No vomiting. No nausea. And he actually wanted to eat! I cannot describe how relieved and excited we were. Why hadn’t someone told us sooner? Why had my husband gone through all those years of needless suffering?

…. It was clear that his doctors knew what he was doing and approved; they couldn’t help noticing the sudden improvement in his condition.

It is impossible for me to adequately describe what a profound difference marihuana made….

During this period (1977-1979) Harris and I learned that many other cancer patients were smoking marihuana for the same purpose. Most of them had learned about it from their doctors, who could only offer hints and suggestions and rarely discussed the subject openly and thoroughly….

p. 36-38

Stephen Jay Gould, Alexander Professor of Geology at Harvard University, used marijuana after all the standard antiemetics failed.

The rest of the story is short and sweet. Marihuana worked like a charm. I disliked the “side effect” of mental blurring (the “main effect” for recreational users), but the sheer bliss of not experiencing nausea—and then not having to fear it for all the days intervening between treatments—was the greatest boost I received in all my year of treatment, and surely had a most important effect upon my eventual cure. It is beyond my comprehension—and I fancy I am able to comprehend a lot, including much nonsense—that any humane person would withhold such a beneficial substance from people in such great need simply because others use it for different purposes.

P. 38

Oncologists have been permitted to use synthetic THC orally in capsule form (Marinol), since 1985. However, smoking seems preferable, medically, to oral use. A National Cancer Institute study (Alfred Chang, 1979) found that smoked THC was absorbed more reliably.

P. 39

“In the spring of 1990 two investigators randomly selected more than two thousand members of the American Society of Clinical Oncology (one-third of the membership) and mailed them an anonymous questionnaire to learn their views on the use of cannabis in cancer chemotherapy. Almost half of the recipients responded. Although the investigators acknowledge that the group was self-selected and that there might be a response bias, their results provide a rough estimate of the views of specialists on the use of Marinol and smoked marihuana.

‘… Forty-four percent had recommended the illegal use of marihuana to at least one patient, and half would prescribe it to some patients if it were legal. On average, they considered smoked marihuana more effective than oral synthetic THC and roughly as safe.” [Journal of Clinical Oncology 9 (1991): 1275-1280, R. Doblin and M.A.R. Kleiman, “Marihuana as Anti-emetic Medicine: A Survey of Oncologists’ Attitudes and Experiences”]

p. 42-52

Marijuana reduces intraocular pressure. This discovery occured accidentally, when UCLA did some experiments for the LA police to determine if, as the police believed, marijuana use dilated the eyes. (Thus allowing ‘dilated eyes’ as probably cause for arrest.) It turns out the opposite: very slightly constricted. Glaucoma is the result of “an imbalance of pressure within the eye.” Robert Randall had reached that stage where “standard drugs are no longer effective, and blindness is iminent. “If nothing further had been done, he would have gone blind.”

I smoked my first marihuana cigarette the day Richard Nixon was elected President. Jerry Ford was President when I smoked my first legal “research” joint. Jimmy Carter was elected days before I walked out of a Washington, D.C., hospital carrying the nation’s first modern prescription for medical marihuana. I legally toked through the Reagan years, unscathed by the mindless War on Drugs. George Bush is President now. I still legally smoke medicinal marihuana and, as a result, still enjoy my sight.

…

…when I smoked marihuana I saw more clearly. I’m not talking enlightenment. I’m talking sight. Seeing. Since my mid-teens my evenings had been haunted by minor visual problems—transient tricolored halos. On some evenings I would go white-blind, my vision snared in an impenetrable swirl of absolute illumination—the white void.

I knew these problems were minor because when I noted them to my physicians they told me if I was older it might be serious. But, since I was too young for it to be serious, it must be “eye strain.” All that diligent study.

If they weren’t worried, why should I be? Particularly since marihuana relaxed my “eye strain.” Nothing special in that. Marihuana relaxes nearly everything: mind, body, soul. That chronic kink in the neck. So why not eye strain? Without marihuana to ease my “eye strain” I probably could not have completed my master’s.

Following graduation in 1971, I moved to Washington to write stirring speeches for powerful people and ended up driving a cab. I loved driving a cab. Most instructive. No boss. You set your own hours. I’d also stopped smoking marihuana. Being in a new city, surrounded by new people, I had few friends and no access—no dealer.

One evening in the summer of 1972, I closed my left eye and discovered I could not read with my right eye. Instead of clearly formed letters I saw a jumble of black ink splashed on a white page. No matter how close I drew the text, it remained indecipherable, incoherent, alien. Someone gave me the name of a good ophthalmologist. I saw him the following afternoon. I was twenty-four.

…

Said Dr. [Benjamin] Fine, “Son, you have a very serious condition called glaucoma. You have already suffered a lot of visual damage and …” “How long?”

Thrown by my directness, he responded in kind: “At best you’ve got three, maybe five years of remaining sight. You’ve lost most of the vision in both eyes. Your right eye has no central vision—no reading vision—none. In your left eye you only have a small island of healthy tissue. That’s why you can read. Your pressure in both eyes is over forty. It should be under twenty. You are in very, very serious trouble. You are going to go blind.”

Surgery was risky, especially in someone with my advanced level of damage. There was a good chance surgery would annihilate the small fragments of healthy optic tissue which remained.

“I’m sorry, son. We’ll do the best we can, but there’s not a lot we can do. You are going to go blind.” He looked worn out. Doctor Fine put pilocarpine in my eyes, gripped me by the shoulders, asked if I was all right, gave me a pat on the back, and sent me out the door with those most fateful words: “Just live life like you always have…” Patients know the end to this dreaded sentence, “because you won’t have it for long.”

…I wandered downstairs, got in my cab, and realized I could not see beyond the dashboard. Pilocarpine, a miotic, induces intense nearsightedness. I drove through D.C. rush-hour traffic guided by memory and the glare of sunlight off the cars in front of me.

I ignored this gaping invitation to debilitating depression. I could still see, still read, still softly fondle all nature’s hues and tones. Until, of course, I put in my newly prescribed Pilo [pilocarpine], which quickly reduced my sight to remnants of ill-defined shape. My introduction to the wonderfully twisted world of glaucoma pharmacology.

…

Glaucoma and its therapies introduced me to much larger, more disruptive realities. Pilo and driving don’t mix. Within a week of diagnosis, I was out of my cab and out of work. Deemed “disabled,” I landed on welfare, an unexpected ward of the state. This really was getting serious.

Within weeks of diagnosis, my prescription for Pilo doubled, redoubled, tripled, quadrupled. Within months, epinephrine was added. … Then came Diamox [a carbonic anhydrase inhibitor], a pill, a diuretic. Crushing fatigue. The taste of everything changed. Finally, in desperation, phospholine iodide, an eyedrop developed from a World War II nerve gas, was added to the mix. This battering pharmaceutical assault left me blurry-eyed, dysfunctionally myopic, photophobic, extremely tired, with a chronic backache—calcification of my kidneys. Objective medical control over elevated intraocular pressures (IOP), however, remained elusive. My rapidly escalating intake of toxic prescriptions was outraced by the dynamic character of my glaucoma. Each visual field shrank.

…my evenings were routinely visited by tricolored halos… On some nights the halos were muted. On other evenings they appread as hard crystal rings emanating from every source of light. And then there were nights, not so rare, of white-blindness—the world rendered invisible by its brilliance….

Then someone gave me a couple of joints. Sweet weed! That night I made and ate dinner, watched television. My tricolored halos arrived, which made watching TV less interesting. So I put on some good music, dimmed offending lights, and got into some serious toking. I happened to look out my window at a distant street lamp and noticed what was not there. No halos. That’s when I had the full blown, omni-dimensional technicolor cartoon light-bulb experience. In a transcendant instant the spheres spoke! So simple. Old messages—new context.

You smoke pot, your eye strain goes away. Ganja is good for you.

Sure was fun, but in the medicated haze of the next miotic morning I chided my raging rapture and began a baseline reality check. My well-educated, acutely dispassionate intellect was not kind. “Let us,” my left sphere said, “be analytical.”… This poor, super-stressed soul, unwilling to accept the cumulative horror of what has become “real life,” gets his hands on some really good pot…. In dispair and desperation, he imagines marihuana is going to “save his sight.”

Are we crazy? The answer is obvious, right? Given these facts, who would not want to believe something mystical, magical, mysterious, and forbidden is going to rescue them from the pit of eternal darkness? The idea that a legally prohibited, medically unavailable weed—a plant smoked for sheer delight, for fun—is going to “save your sight” is madcap and reckless; as farfetched, improbable, and pathetic a notion as someone insane could imagine.

So began six months of cynical observation. Six months of simple trial and error. At the end, the conclusion was unavoidable. Without marihuana there were halos and white-blind nights. When I smoked marihuana there were no halos….

If I watched very closely I could actually observe the halos depart. The cumulative evidence of a reproducible benefit was inescapable.

… What now? Do I rush to introduce nice, middle-aged, middle-of-the-road, prestigious ocular pathologist and genuinely swell fellow, Dr. Ben Fine, to my pot-driven revelation, which is, of course, of potential benefit to millions of similarly afflicted humans? Yeah, right! No way! He’s a good doctor. I like him. He’s honest. But he would not appreciate my news. There are medical questions. And, of course, legal concerns. Like malpractice, or worse.

If Dr. Fine knows but does not tell the police, does he become my criminal accomplice? A co-conspirator? “Pot Doc arrested!” His career in ruins.

If not my trusted doctor, then whom? I could tell the drug bureaucrats? Sure! “Marihuana Can Be Good For You!” This is just the sort of good news rabid antidrug zealots are longing to hear. In this very unsubtle way, fear—prohibition-induced fear—pervades any dialogue on marihuana’s medical use, separating patients from physicians, from other patients, from government. You are isolated. In the best of times, under the best of circumstances, this is not something to be wished for. When you are young and going blind, the inability to share such vital information with the physician treating you or with others who might be helped becomes downright scary. It became a time of simple goals. Keep smoking, keep your mouth shut, and stay sighted. Seeing is real. Everything else is politics.

Doctor Fine, though mystified by the sudden change in my condition, was greatly pleased by the results. My ever-eroding visual fields stabilized. My slide into darkness slowed, then halted. As my glaucoma came under medical management, other aspects of life began to right themselves. I escaped welfare and took a part-time job at a local college.

… To cope with the uncertainty of adequate supply I did what many patients still do. I grew some pot.

…By midsummer we were blessed by beautiful six-foot pot plants. Things were going swell. My vision was stable. I was employed. I’d rediscovered loose change. Alice had come to live with me. Swell. These were the last quiet days of my life.

While we were vacationing in Indiana, the local vice cops raided my house and seized my six-foot marihuana plants. I returned to find a warrant on the kitchen table with a note scribbled on the back requesting that I surreender myself for arrest. I could not know at the time, but being arrested was about the best thing that could have happened to me. Being arrested “saved my sight.”

When I told my attorneys I was smoking marihuana to treat my glaucoma, they thought it was hysterical. When they realized I was not joking, they stopped laughing only long enough to tell me to prove it. I spoke with Keith Stroup, head of the National Organization for the Reform of Marihuana Laws. Keith didn’t laugh. Instead, he carefully explained that I didn’t have a prayer. But he gave me a few phone numbers and suggested I phone around. So I phoned around the federal bureaucracy. Needless to say, I was startled when at least three bureaucrats point-blank told me, “Oh, we know marihuana helps glaucoma. We have lots of data which shows…” They knew! They knew and hadn’t bothered to tell me. They knew, but did not want anyone else to know. Remember, this is 1975, not yesterday.

…

Eventually I underwent two highly controlled medical experiments. The first, conducted at the Jules Stein Eye Institute, UCLA, required my incarceration in a mental ward for thirteen days of round-the-clock observation. I arrived in the middle of an ongoing research project involving six “routine” research subjects who were being tested on pure synthetic THC—a man-made copy of marihuana’s most mind-altering chemical. The UCLA researchers did more than simply confirm that marihuana lowered my ocular tension. They discovered that my disease could not be controlled using conventional glaucoma medicines. Left on these drugs I would go blind, just as Dr. Fine predicted. I was also tested on synthetic THC [Marinol]. What a lousy, marginal drug! The ‘high” is anxiety-provoking. The therapeutic effects, if any, are minimal, transiet, unpredictable. But THC comes in a pill. The bureaucrats, the research scientists and doctors can relate to pills. Besides, we all know you shouldn’t smoke. In the end, UCLA determined marihuana was not merely beneficial; it was critical to the medical maintenance of my vision.

OK. It’s proved. Let’s go to court. I was ready, but my anxious attorneys conspired with an even more anxiety-ridden Dr. Fine to compel me into a second, confirmatory evaluation. On the Ides of March, 1976, a second, much less fun experiment was undertaken at the Wilmer Eye Institute, Johns Hopkins University, where I was institutionalized for six of the most miserable days of my existence. The Wilmer physicians were under strict instructions from Dr. Fine to find a conventional solution. He didn’t want to testify in court.

So they threw every glaucoma drug in the book at my condition…. I got to know my roomie, a fifty-three-year-old West Virginia factory worker named Vince. We had just met, barely exchanged hellos, when Vince asked, “You tried any good marihuana?” Blown away?! You bet. Seems ole Vince had taken a break with a couple of his night shift buddies and smoked weed for the first time in his life. Bingo! Vince noticed his halos went away. “If I could get my hands on enough marihuana, I sure as hell wouldn’t be in here,” Vince convincingly said. Two days later I watched the guys in white wheel Vince into cryosurgery, a ghastly, painful procedure which freezes, kills, a part of the eye in an effort to reduce ocular pressure. That night Vince groaned in agony; his toes curled in torment. After leaving Wilmer I followed Vince’s progress for quite some time. The mutilating surgery had not helped him.

Eventually, unable to “get enough marihuana,” Vince went blind.

I had been in glaucoma therapy for nearly four years, and Vince was the first glaucoma patient I’d ever met. And Vince knew! How many others knew? At the conclusion of their pharmaceutical torment, the Wilmer doctors grudgingly conceded failure. UCLA’s evaluation was correct: in the absence of marihuana my ocular tension was beyond medical control. Ignoring the UCLA data on marihuana, the Wilmer surgeons recommended immediate surgical intervention.

What a surprise! Without marihuana I would go blind. Everyone agreed on that. The Wilmer physicians, in their zeal to evade this fact, had recommended surgical procedures Dr. Fine knew would result in blindness. He finally agreed to testify in my defense. He took the very highest ground; given the facts, it would be medically unethical to withhold marihuana. The rest, as they say, is history.

Briefly summarized:

• In May 1976, I petitioned federal drug agencies for immediate access to government supplies of marihuana.
• In July, at my trial, we raised the untried legal defense of “medical necessity.” Essentially, a simple argument that any sane soul who is going blind would break the law to save his sight.
• In November 1976, the bureaucrats cracked. They delivered a tin of three hundred pre-rolled marihuana cigarettes to my new doctor, John Merritt at Howard University. In this way I became the first American to gain legal, medically supervised access to marihuana.
• In the same month, the D.C. Superior Court ruled my use of marihuana was not criminal, but an act of “medical necessity.” It was the first successful articulation of the “medical necessity” defense in the history of English Common Law.

Elvy Musikka, a woman in her mid-forties, was first started on pilocarpine.

A new doctor suggested I consider marihuana because it was likely that otherwise I would go blind. He told me this as a friend, not a doctor; it was then that I began to realize that sometimes doctors have to choose between Hippocratic oaths and hypocritical laws. I was most fortunate this man had a heart.

…

I didn’t know where to go for marihuana and didn’t always have access to it. Once my pressures were so high my doctor obtained some for me. It was handled through his secretary. Oh, that poor woman! How she shook! Her hands were ice cold when she handed me the bag. I thanked God for these compassionate people. I knew the street value was thirty to forty dollars an ounce but she only took fifteen dollars. That couldn’t continue, of course, and I sought go obtain marihuana legally.

…

I called my hometown newspaper and told a reporter about my use of marihuana in a p interview. I spoke without giving my name or picture, because I feared losing my job and custody of my children. But a lot of people recognized the story as mine and came forward, confessing that they were regular marihuana smokers and would help me get marihuana when possible. You can imagine my shock! Some of these people were co-workers, others respected members of the community. None of them—not a one—was a bum as I had been led to think of every marihuana smoker.

In January of 1977 my doctor sent me to a research center at the University of Miami. He thought they might help me obtain marihuana legally. But the very dedicated scientists at the center didn’t want to hear the “m” word. Instead, I spent one of the most grueling days of my life. When I arrived my pressures were in the high 50s in the right eye and high 40s in the left.

They gave me everything they could think of. Drops didn’t help much, nor did using a little pump to flush the eye. I also had to drink a big glass of a sickeningly sweet liquid, which didn’t help either. At the day’s end my pressures had barely lowered to the 40s, so I was scheduled for emergency surgery.

At home that night I used a remaning bit of marihuana to bake some brownies, and ate two every twelver hours. The doctors were shocked when they checked my pressures as I arrived for surgery the next Monday morning—perfectly normal at 14 and 16! Regardless, they readied me for surgery, even though it had at best a 30 percent chance of helping me! The following morning they performed an operation on my tear ducts which turned out to be of no value. Because of it I now have to wear the big magnifying glasses that I had managed to avoid since childhood. After this procedure I had less sight, more scar tissue, and higher pressures, and I was unable to return to work.

…

By 1980 I had little money and marihuana had gone up in price, so I started growing my own plants…. My pressures became so close to normal that my doctors decided a corneal transplant was safe. It worked! I never have had such beautiful eyesight—it was so wonderful! I was so happy, until neighbors jumped the fence around my yard and stole my marihuana plants.

My pressures went sky high, and I escaped into alcohol quite a bit of the time. When I started having slight blackouts I realized alcohol was not the answer.

So reluctantly and fearfully I went through surgery again. This time I hemorrhaged and before I knew it, my right eye was blind. Since I had only 20/400 vision in my left eye, you could have lit up my bedroom with bright lights as I slept and I wouldn’t have awakened.

I was arrested on the night of March 4, 1988, and it changed my life forever. I notified the media, and this time my hometown paper photographed me and wrote a full follow-up story. I was contacted by people who had obtained marihuana legally, and my doctor and his secretary spent at least fifty hours on paperwork to be submitted to the DEA, FDA, and NIDA in an effort to secure legal marihuana. I did a lot of radio shows, and it was always heartbreaking because almost always, there was someone who had lost their sight unnecessarily…. It was amazing; many were glaucoma patients who had maintained their sight for twenty and twenty-five years with marihuana and are still illegally maintaining it today. I envied them for standing up for their health, for knowing what they were doing and taking care of themselves.

…

My trial began and ended August 15, 1988…. The judge listened carefully and decided that for me not to have tried to preserve whatever sight I had left would have been total insanity. He said that I had no intent of criminal activity, and I was acquitted. I had applied for a Compassionate IND in March 1988 and was granted legal use of marihuana provided by the government beginning October 21, 1988.

The sight in my right eye is coming back. I now have perceptions of light, colors, and shapes. In my left eye, which used to be 20/400 but is now 20/100, the optic nerve is very healthy and I have lost no peripheral vision. As a matter of fact it has improved. Miraculous—that’s cannabis.

Weighing the Risks

It is difficult to measure the toxicity of marijuana in humans, because no human has ever died from its use. Data from other animals indicates that it would take tens of thousands of doses at once to result in a “marijuana overdose”.

p. 137

“The benefits of any medicine must be weighed against the risks. Fortunately, there is unusually good evidence on the potential health hazards of marihuana—far better than the evidence on most prescription drugs. Not only has cannabis been used for thousands of years by many millions of people, but there is much recent research inspired by the federal government’s interest in discovering toxic effects to justify its policy of prohibition.”

Toxic effects are acute (resulting from a single dose) or chronic (resulting from long-term use).

Acute effects:

Most common acute physical effect: a slight conjunctival hyperemia (reddening of the eyes) and a slightly increased heart rate. “Neither of these is uncomfortable or dangerous. After five thousand years of cannabis use by hundreds of millions of people throughout the world, there is no credible evidence that this drug has ever caused a single death.”

The toxicity of THC, as measured from mice (because there are no deaths for humans, there is no data to use), is that there is a safety factor of 40,000: 40,000 doses need to be used for 50% of the subjects to die.

The lethal dose (again, from mice) is 2,160,000 mcg/kg, or 2.16 g/kg. An 80 kg person would need to take 160 grams; for highly potent marijuana that is, say, 20% THC, this would mean 800 grams, or .8 kg, or .8*2.2, or 1.7 pounds. (Note: calculations done by me right now, on the fly.)

Behavioral and psychological effects: attention, short-term memory, tracking, and coordination “can be impaired under its influence. There is uncertainty about whether these effects persist for some time after the feeling of intoxication has passed.

The “high” lasts for two to four hours when smoked, and five to twelve hours when taken by mouth. “Its most common form is a calm, mildly euphoric state in which time slows and sensitivity to sights, sounds, and touch is enhanced. The smoker may feel exhilarated or hilarious. Thoughts flow rapidly and short-term memory is reduced. Body image and visual perception undergo subtle changes. Often it is as though the cannabis-intoxicated adult perceives the world with some of the wonder and curiosity of a child; details ordinarily overlooked capture the attention, colors seem brighter and richer, and new values may appear in works of art that previously seemed to have little or no meaning. Sometimes drowsiness or sleep ensues after an hour or two.”

Much less common “is a state of anxiety, sometimes accompanied by paranoid thoughts and occasionally mounting to a temporarily incapacitating panic. The condition is self-limiting, and simple reassurance is the best treatment. Perhaps the main danger to the user is being diagnosed as psychotic. There are no hallucinations, and the capacity to test the reality of thoughts and perceptions—the sine qua non of sanity—remains intact.” (Note that marinol is disliked because it causes anxiety more often than a high, according to the previous users.)

p. 142

“Cannabis is also sometimes said to cause an acute psychosis, described as a prolonged reaction with symptoms that include delusions, hallucinations, inappropriate emotions, and disordered thinking. The reaction is rarely reported in the United States, and tgiven the many millions of marhuana smokers in this country, the evidence for it would be less equivocal if it occurred with any regularity. Most reports of cannabis psychosis come from India and North Africa. An authority often cited is A. Benabud of Morocco, but his description of the symptoms is far from clear; they seem to resemble other acute toxic states, including, especially in Morocco, those associated with malnutrition and endemic infections. Benabud estimates the number of kif (marihuana) smokers in Morocco suffering from psychosis as not more than five in a thousand. But this is lower than the rate of all psychoses in the populations of other countries. If Benabud’s estimate is correct, we would have to conclude that, if anything, marihuana protects smokers against psychosis.”

P. 144

“Our own clinical experience and that of others suggests that cannabis may exacerbate psychotic tendencies in some schizophrenic patients when the illness is otherwise reasonably well controlled with antipsychotic drugs. Even in these patients, it is often difficult to tell whether the use of cannabis is precipitating the psychosis or merely an attempt at self-treatment for the early symptoms.”

P. 145

“One rather rare reaction to cannabis is the flashback, or spontaneous recurrence of drug symptoms while not intoxicated. Although several reports suggest that flashbacks may occur in marihuana users even without prior use of any other drug, in general they seem to occur only in those who have previously used psychedelic drugs. There are also some people who have flashback experiences of psychedelic drug trips while smoking marihuana; this is sometimes regarded as an extreme version of a more general heightening of the marihuana high that occurs after the use of hallucinogens. Many people find flashbacks enjoyable, but to others they are distressing. They usually fade with the passage of time.

The Once and Future Medicine

Study after study shows marijuana as safe; survey after survey shows that some patients improve after using it and that doctors will recommend it. But even in 1993 we were willing to pay billions of dollars a year to keep prohibition going.

p. 156

“More is known about the adverse effects and therapeutic uses of marihuana than about most prescription drugs. Cannabis has been tested by millions of users for thousands of years and studied in hundreds of experiments sponsored by our own government over the past thirty years.”

P. 158

“The cost of producing cannabis is about a dollar an ounce, and medical distribution would add at most a few dollars more. There are about sixty marihuana cigarettes in an ounce, and the average dose is one cigarette or less. Since the government could not tax a drug used for medical purposes, medical marihuana would cost only a few cents a day. But marihuana on the street is worth its weight in gold—about two hundred to six hundred dollars an ounce. The gap would create a powerful incentive for diversion.”

P. 166

More than 300,000 people a year arrested on marihuana charges. Federal, state, and local governments spend nearly ten billion dollars a year on enforcement, and hundreds of millions more to house and feed drug dealers and users in local, state, and federal prisons. A third of federal prisoners are there for drug charges, “many” for marihuana.

P. 167

“It is increasingly clear that our society cannot be both drug-free and free.”

P. 175

“Opponents of medical marihuana sometimes say that its advocates are insincere and are only using medicine as a wedge to open the way for recreational use. Anyone who has studied the history of desperate efforts to obtain legal marihuana for suffering people knows that this is false. The attitude falsely ascribed to advocates of medical marihuana is actually a mirror image of the government’s attitude. The government is unwilling to admit that marihuana can be a safe and effective medicine because of a stubborn commitment to wild exaggeration of its dangers when used for other purposes.”