Medical marijuana debate has multiple dimensions: medical, political, personal

By Derek Spellman

dspellman@joplinglobe.com

Linda Yelvington rattles off her list of ailments: Severe scoliosis. A prosthetic hip. Cervical degenerative disc disease. DeQuerin’s syndrome in both wrists. Arthritis. Breathing problems from diminished lung capacity because of scoliosis.

The 54-year-old woman then rattles off a list of painkillers she has taken for her health problems.

“None of them are working right,” Yelvington said of the legal drugs, listing some of their side effects.

It has been several months since she has taken her preferred painkiller — marijuana — because it’s not legal in Missouri.

She contends it works just as well, if not better, with fewer side effects. Yelvington, who started taking marijuana years ago, is well-versed in studies about marijuana’s medicinal use.

Asked if the issue of legalizing marijuana for medical use is personal or political for her, she replied, “I think it’s a compassion issue.”

Activists, meanwhile, are gathering support for a statewide initiative that would ask Missouri voters to approve medical marijuana.

The forthcoming debate will likely have two dimensions — one medical and political. Both will be personal.

‘Not harmless’

On the medical debate, both sides cite research and a roster of supporters to back their claims.

A local physician said a lot depends on whether the discussion is about someone who is terminally ill and in agony or whether it is about someone who will have to deal with the long-term effects of using the drug.

“Marijuana is not harmless,” added Matthew Miller, a medical oncologist from Freeman Health System.

The medical debate is also attended by a political debate about whether the marijuana issue is an act of compassion for the dying, or a Trojan horse for outright legalization of recreational use of the drug.

Yelvington, a member of the Joplin chapter of the National Organization to Reform Marijuana Laws (NORML), acknowledged that she would likely advocate for the outright legalization of marijuana even if she didn’t have medical problems. She also acknowledged that the debates over medical marijuana and outright legalization overlap.

Still, she and a number of activists said they believe the two issues can be separated to an extent. They also reject claims that one automatically leads to the other.

But there are skeptics.

Notoriety

The Joplin area gained a measure of notoriety in recent years for marijuana activism. Joplin has been host to the Cannabis Revival and already seen one push to put a question to voters about lessening penalties for possession of the drug. That petition did not get the required number of signatures for the ballot.

Missouri Southern State University recently ranked No. 20 on High Times magazine’s list of the top 20 colleges for marijuana activism. And earlier this year, the then-mayor of Cliff Village, south of Joplin, claimed that his board of trustees had passed a “symbolic” ordinance that would have legalized the drug inside the village for medical use, although a number of residents later disputed whether that ordinance was ever actually passed.

Yelvington, who moved to Goodman from Kentucky in March, said she first experimented with marijuana decades ago, as many others did.

“I didn’t equate it with pain relief at the time,” she said, although in later years she said she discovered it worked better for her as an antiphlegmatic and for curbing depression and muscle spasms.

But now that she is lives in Southwest Missouri, she turns to legal painkillers.

“I have to, because I can’t have medical marijuana in Joplin,” she said.

Yelvington said she has family in Missouri and she would like to stay, but she has not ruled out moving to California, Colorado or New Mexico, which have medical marijuana laws in place. Ten other states also allow some form of medical marijuana, according to NORML.

But even in states that have legalized medical marijuana, it is still technically illegal for doctors to prescribe their patients marijuana under federal law, according to Keith Stroup, the legal counsel and founder of NORML. Instead, in those states, patients must have proof that doctors “recommend” marijuana for their patients.

But the patient is still “left to your own imagination” in how they go about obtaining the marijuana, Stroup said.

A few states allow the operation of not-for-profit “dispensaries” that act as cooperatives to supply patients, but otherwise a patient either must grow the plant themselves, have a designated caregiver cultivate the plant or obtain it on the black market, Stroup said.

Even patients in those 13 states who use medical marijuana are still violating federal law, Stroup said. The practical effect, though, is one of sparing the patients from penalties under local and state laws, which spares them from federal investigation. More than 99 percent of marijuana cases are handled on the state and local level, he said.

“They never go after individual patients,” Stroup said of federal authorities.

Meanwhile, activists in Missouri are eyeing 2012 as the time for a statewide ballot issue about medical marijuana, said Kelly Maddy, president of the Joplin NORML chapter.

“We are still in the planning stages for that.”

‘Red herring’

Newton County Sheriff Ken Copeland said he will follow the laws, but he does harbor reservations about legalization of marijuana for medical reasons.

Copeland has said that in his 30 years of experience in law enforcement he had “never seen a positive side of marijuana,” and that the substance usually acts as a gateway drug that leads people to experiment with other drugs.

Copeland also voiced fears that legalizing marijuana, even for medical purposes, would increase the overall availability of the drug.

“We see prescription medication abused now,” Copeland said.

Even if medical patients grow their own crop, he said, it would be accessible to children or to thieves who would try to steal it.

The U.S. Drug Enforcement Administration has gone so far as to label the movement to legalize marijuana for medical use a “red herring” and a “tactical maneuver in an overall strategy to completely legalize all drugs,” according to the agency’s Web site.

A DEA spokeswoman declined to comment on the matter, saying it was a “policy” question that needed to be directed to the Department of Justice. A Justice Department spokeswoman also declined comment.

Maddy rejected characterizations of medical marijuana as a “sneaky step towards complete legalization.”

When marijuana is authorized for medical use, those regulations often have strict guidelines and safeguards.

“When that happens I usually ask them (skeptics), ‘Exactly how does allowing seriously ill patients to use marijuana lead to the end of the prohibition of marijuana for recreational use?’” Maddy said.

Stroup, of the national NORML organization, said his group opposes people pretending to be sick so they can obtain marijuana.

Yet activists also acknowledged that a look at how marijuana affects medical patients could lead to “attitudinal changes” about the drug as a whole, Stroup said.

Medical

Whether marijuana is benign is another debate.

Advocates like Maddy cite support from organizations such as the American College of Physicians, American Public Health Association, American Nurses Association, American Academy of HIV Medicine, and the state medical societies of New York, California and Rhode Island.

They point to research suggesting marijuana has a number of clinical applications, including relief of pain, nausea, spasticity, glaucoma and movement disorders. They also say it can also be a powerful appetite stimulant, particularly for patients suffering from HIV or cancer.

Opponents noted that those conditions can be treated by other medicines that are already available and tested. They also cite studies showing marijuana as the cause of health problems including cancer, respiratory problems, a weakened immune system, loss of motor skills and an increased heart rate.

The Office of National Drug Control Policy cites an April 2006 advisory from the Food and Drug Administration that concluded: “No sound scientific studies have supported medical use of smoked marijuana for treatment in the United States, and no animal or human data support the safety or efficacy of smoked marijuana for general medical use.”

The office cites research from the Institute of Medicine and the lack of support for medical marijuana by the American Medical Association, the National Cancer Institute, the American Cancer Society and the National Multiple Sclerosis Society. They also note concerns that any temporary positive effects would be outstripped by long-term deleterious ones.

Miller, the Freeman oncologist, said he has had a few patients who have told him they used marijuana, although it is difficult to gauge its effectiveness because patients are unlikely to be forthcoming about the extent of using an illicit drug, he added. For some patients, for example, it might have helped with curbing nausea, although Miller said there also are legal drugs on the market to treat that.

Miller also noted concerns about the purity of smoked marijuana. Unlike a pill, where the ingredients and the exact amount of those ingredients are known beforehand, the same cannot be said for a marijuana cigarette.

“My concern would be the marijuana is potentially impure,” Miller said.

His personal opinion, he said, is that if the drug were legal and used to palliate a patient who is “obviously, actively dying” and in great pain, he would have no problem with that.

But that scenario is a far cry from someone who is going to live and will have to contend with the adverse effects of the drug, he said. Marijuana can inflict great harm, he said.

Yelvington, for her part, still swears by marijuana.

In the meantime, she wears a marijuana leaf pin as something of a conversation starter. She believes the public will embrace medical marijuana once people are aware of the science behind it.

“Hopefully, people will ask me about it,” she said of the pin.

‘Simply put’

“Simply put, the smoked form of marijuana is not considered modern medicine.”

— Statement from the Office of National Drug Control Policy

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