High Time? 

State senator Steve Cohen is pushing legislation that would legalize medical marijuana in Tennessee.

Sitting on the sofa in her Midtown apartment, Kathye Garner breaks up a small amount of marijuana and stuffs it into the bowl of a wooden pipe. She wears a brace on one arm, the result of a recently broken wrist. She holds the pipe with the exposed fingertips of her injured hand and lights it. After a couple of puffs, the already jovial Garner cracks joke after joke, throwing her head back in laughter. Her joy is infectious, and soon the others in her living room are joining in.

In 1997, Garner was diagnosed with multiple sclerosis (MS), a neurological disease with symptoms that can range from cognitive dysfunction and balance problems to depression and fatigue. Garner's biggest problem was balance. She often fell while walking or standing, which resulted in extensive bruises. Her memories of her early days with the disease are hazy (which she attributes to cognitive dysfunction), but Garner does recall waking up one day and realizing she was unable to move her left foot. She got out of bed and dragged it behind her into the next room.

Her neurologist suggested weekly injections of Avonex, a drug commonly prescribed to slow the onset of MS symptoms. Garner gave the shots a try but says the flu-like side effects weren't worth it. It wasn't until she tried smoking marijuana that she found relief.

Garner had smoked pot while growing up in Whitehaven in the 1970s but gave it up after a brief stint in rehab in 1983 for what she describes as "multiple addictions." After learning that the National Organization for the Reform of Marijuana Laws (NORML) had lots of information on medical marijuana and its effect on MS, she decided to try pot again.

Marijuana is typically used to treat the spasms and pain associated with MS, but Garner says it also provides a relaxing way to get her mind off of her symptoms. Marijuana makes laughter come easier, which she says is "one of the greatest coping mechanisms" she has.

These days, Garner likes to think of herself as cured, and she attributes it to the healing powers of marijuana. She still sees a neurologist regularly but rarely experiences MS symptoms.

But what Garner considers medicine, the federal government classifies as a Schedule I narcotic, which basically means it has no known medical value. Yet many patients and physicians believe marijuana does have therapeutic benefits. Although few formal studies have been done, patients say marijuana helps with the nausea, lack of appetite, and pain associated with chemotherapy, AIDS, and some neurological disorders. Twelve states have legalized it for medical purposes since 1996.

If state senator Steve Cohen of Memphis has his way, medical marijuana will one day be legal in Tennessee. Cohen plans to introduce legislation that will enable doctors in Tennessee to prescribe or recommend marijuana to their patients, who in turn will be allowed to cultivate a restricted number of marijuana plants for their personal use.

Medical Pot Is the New Lottery

"I've seen several friends die of cancer over the years, and many of them smoked marijuana when they were experiencing chemo or extreme loss of appetite," says Cohen. "The laws are crazy to restrict an individual from something that can make them feel better when they're dying. There are so many other legal drugs out there that are much more habit-forming, addictive, and potent."

After finally getting the Tennessee Lottery into law, Cohen says he was looking for something new he could throw into the "marketplace of ideas." He says he's been considering the medical marijuana issue for some time, especially now that he and his friends are getting older. He knows passage of medical pot legislation this year is a long shot, but he plans to run a thorough educational campaign, so that the public and his fellow senators will be more receptive when he reintroduces the bill. It's a method that worked for the lottery, though it took 17 years.

In an unscientific poll of his district, Cohen found that close to 80 percent of his constituents support the idea of legalized medical marijuana. Cohen's numbers may seem high, but when compared to polls across the country, they aren't unreasonable.

In November, an AARP survey found that 72 percent of respondents favored the use of medical marijuana when recommended by a physician. In a CNN/ Time magazine poll from October 2002, 80 percent of respondents supported allowing the use of medical marijuana.

Surprisingly, the idea isn't exactly new in Tennessee. From 1981 to 1992, state law allowed the use of medical pot. But Cohen says legal marijuana wasn't available, so the law was pointless. When the Senate voted to repeal the law in 1992, Cohen says he was the only senator who voted to keep it. But now that medical pot has been legalized in 12 states, Cohen thinks the issue will have a little more support this time around.

But there's still plenty of opposition in the Senate.

"I'm opposed to it because there's not much research to show that medical marijuana is an effective way to treat diseases and their symptoms," says Senator Diane Black (R-Gallatin). "If someone has cancer, I don't know that you really want to put more carcinogens in their bodies."

Senator Mark Norris (R-Collierville) says he'll be approaching the issue with an open mind, but he's "not inclined to be supportive" of the bill. He says he has received correspondence from some constituents asking him to seriously consider the bill. He has yet to hear from anyone who opposes the bill.

"It's been my understanding that there are other medications out there," says Norris. "Cohen's quick to point out that some people suffering from nausea and other digestive problems associated with chemo may not be able to keep oral medications down, so I'd need to know what other alternatives exist."

The Wonder Drug

The list of conditions marijuana is believed to treat runs the gamut. AIDS, cancer, Crohn's disease, multiple sclerosis, Alzheimer's, anorexia, neuropathic pain, migraines, glaucoma, arthritis, and epilepsy are just a few of the conditions listed in the November 2002 U.S. General Accounting Office's "Descriptions of Allowable Conditions under State Medical Marijuana Laws."

With 60 unique chemicals known as cannabanoids, marijuana is believed to have a significant number of therapeutic benefits. Synthetic THC -- the psychoactive component of marijuana -- is legally available in all states in an oral form called Marinol. But many advocates of medical cannabis believe other helpful chemicals that are only released in smoking marijuana make that method of treatment more effective. They also say it's harder to regulate the dosage with Marinol. With smoked marijuana, patients inhale as little or as much as they need, and its effects are almost instantaneous, providing immediate relief.

"Marinol takes a good hour or more to work, and if you're in pain or nauseated, that hour can be torture," says Bruce Mirken, director of communications for the Marijuana Policy Project, one of the leading advocacy groups for medical marijuana and for decriminalization of the drug for recreational use.

Paul Kuhn, who's involved with the advocacy group Tennessee Alliance for Medical Marijuana, became a believer in pot's medical benefits after his wife, Jeanne, used marijuana to fight off the nausea from her chemotherapy 10 years ago.

When Jeanne was diagnosed, her cancer had already spread to her liver, and treatment required high-dose chemotherapy. She talked to her oncologist about using medical marijuana to ward off the intense nausea that would result from the chemo. At the time, medical pot was still illegal in all states. The oncologist tried to convince her that legal medications could be just as effective, but she was concerned about side effects. Since Marinol is known to affect the liver and her cancer had spread there, she didn't feel comfortable taking it. She decided to use pot, and Paul Kuhn says she never experienced nausea.

"For the final round, Jeanne decided to see how well Zofran worked, which is one of the best legal medications," says Kuhn. "She went in, got a shot of Zofran, and came home. She hadn't been home long when she felt the nausea coming back, so she said, 'Give me the damn pot.' One puff and it was gone."

Medical pot is also used to help alleviate some types of pain. Victor Charlie (name changed to protect identity) of Southaven was paralyzed in his right leg 28 years ago as the result of an accident. Although he can't move his leg, he still has phantom neuropathic pain. He's been prescribed opiates such as oxycodone, hydrocodone, and methodone, but he says those medications make it hard to function.

"Marijuana's more useful because it's less debilitating, not to mention that one of the biggest problems with opiate use is constipation," says Charlie. "Cannabis works well for lower levels of pain, but sometimes there is a point where opiates or sedatives are the only way to go."

The Good, the Bad, and the Unknown

Although a number of studies have been conducted on the effectiveness of marijuana as medicine, not many are accepted by the medical community. It's also not easy for researchers to legally perform studies, since marijuana is labeled Schedule I under the Controlled Substances Act. Most of the research has been done in other countries, including Great Britain and Thailand.

However, one of the most commonly cited American studies supporting medical marijuana is the 1999 National Academy of Sciences' Institute of Medicine (IOM) report. It states: "Until a non-smoked rapid-onset cannababinoid drug delivery system becomes available, there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting."

Ironically, the study was ordered by former U.S. drug czar Barry McCaffrey, who, after California passed the first medical marijuana law in 1996, declared marijuana a "Cheech and Chong medicine," claiming that "not one shred of evidence" proved its usefulness. These days, the IOM report has become one of the most accepted studies favoring the drug's medicinal use.

Clay Jackson, a hospice physician for Methodist Healthcare, says it's not easy to conduct a blind study with smoked marijuana. The difficulty lies in creating a realistic placebo. Anyone who has smoked marijuana would probably recognize faux pot.

Jackson doesn't dispute that marijuana may have some therapeutic benefits, but he says he believes most people who turn to marijuana have been underserved or denied access to proper care for their symptoms.

In his hospice practice, he focuses on alleviating symptoms rather than finding cures. Jackson says most of his terminally ill patients seem satisfied with the care they're receiving. He rarely gets asked about medical marijuana, but he does prescribe Marinol to treat nausea and anorexia.

"You have to be realistic," says Jackson. "There's not a large number of people out there with unmet medical needs because we don't have legalized marijuana. There's a large number of people out there with unmet medical needs because we lack the will or the responsibility to make it happen."

Many people don't receive proper medical treatment because they lack health insurance. Cohen points out that medical marijuana would be an alternative for those who can't afford expensive prescription drugs. In most states where medical pot is legal, patients grow their own or buy it on the black market, which is fairly cheap in comparison.

"THC pills are terribly expensive, and it's just a great way to benefit the big drug producers," says Cohen. "Marijuana can deal with it just as well, and it's not expensive or addictive."

The most common delivery system for medical cannabis -- smoking -- is used as an argument against it. Although marijuana can be vaporized and inhaled, or eaten, the effects are more instantaneous when smoked. Critics say the benefits are not worth the harm smoking does to the lungs. Advocates say that smoking pot for a short time to alleviate chemo-induced nausea won't cause much long-term damage.

"It's also important to keep in mind that some of the patients who may be smoking marijuana might already have some advanced stage of cancer or other terminal illness, so their life expectancy may not be that long anyway," says Jackson. "Whatever the negative effects of smoking might be, it could be that those patients will never see them."

Police Matters

Howard Wooldridge, a former police officer from Michigan and a founding member of Law Enforcement Against Prohibition (LEAP), speaks with police officers around the country about medical marijuana, including some in Memphis and Nashville. He says the police's biggest concern is how to determine legal users.

"That's so simple. If I'm in a state that has a concealed weapons permit and I carry a gun in my truck, when I'm stopped by law enforcement, I have to show them a permit," says Wooldridge. "If I don't have that permit, they can arrest me. It would work the same with marijuana. The state would issue an ID card that says John Smith can legally possess [a limited amount of] marijuana."

Wooldridge says that although many police officers express enforcement concerns, most he has talked with support legalizing medical marijuana.

"Cops hear stories at family gatherings about somebody using medical marijuana," he says. "Even though the government is telling us it's not medicine, people believe their aunt or uncle who used it during chemotherapy."

Sergeant Vincent Higgins, public affairs officer for the Memphis Police Department, wouldn't say whether local police support a medical marijuana bill. He said local officers will enforce whatever the Senate decides.

Another common concern is "usage creep." Opponents say legalizing pot for some will increase usage by people attempting to self-medicate. They also argue that allowing people to cultivate plants could result in patients selling some of their crop illegally.

"If you look at the groups that are pushing this, these are the groups that have been pushing legalization of all marijuana for years," says Senator Black.

Clifton Harviel, a Memphis attorney on the NORML legal committee, disagrees.

"I don't see medical use leading to recreational use," he says. "Any substance is susceptible to abuse, but I don't think that's any reason to keep it away from our physicians. I think that's a bit of a smoke screen."

The States Versus the Feds

One big catch to states legalizing medical marijuana does exist: It remains illegal on the federal level. A person legally cultivating marijuana for medical use in California is still subject to arrest and punishment under federal law. In other words, the local cops can't bust them, but the federal Drug Enforcement Agency (DEA) can.

This catch-22 is now the subject of a Supreme Court case. In November, the court heard the arguments of Angel Raich and Diane Monson, two medical marijuana patients from California who were busted by federal agents. They had already been excused from federal prosecution by the Ninth Circuit Court of Appeals in December 2003. That court ruled that prosecuting patients who are in accordance with state medical marijuana laws is an unconstitutional exercise of Congress' Commerce Clause authority.

But the U.S. Justice Department asked the Supreme Court to overturn the Ninth Circuit Court's decision. The high court heard the arguments on November 24th and is expected to rule by this summer.

"Right now, there's almost a gentleman's agreement in the areas where they have [legalized medical marijuana]," says Harviel. "They're not doing much until they see how the Raich case comes out."

Medical marijuana is legal in California, Colorado, Alaska, Arizona, Montana, Maryland, Maine, Hawaii, Nevada, Oregon, Vermont, and Washington. In those states, a ruling in favor of Raich would mean patients would no longer face federal prosecution. An overturned decision would mean medical pot would remain legal for those states, but federal harassment could continue.

"The Supreme Court could squish [medical marijuana use] like a bug, and then there'd be no point in spending resources trying to pass something that you know is not going to meet with current law," says Harviel. "[The decision] is going to shake things up a lot, but which way it shakes them, we can't know yet."

Since his November announcement that he plans to introduce a medical marijuana bill, Cohen says he's received supportive e-mails and letters from people all over the country. Few have written him in opposition.

He says he'll hold off proposing the bill until after an educational campaign for his fellow legislators and the public. He'll probably also wait until the Supreme Court rules on the Raich case. He isn't too hopeful that the bill will pass the first time around.

"This is a year of education, and then maybe next year, we'll have a better chance," says Cohen. "Until then, I'd advise people to keep taking their Vitamin C and E and don't plan on getting sick and having marijuana around to help. It'll probably be a couple of years before they'll have any pain relief in Tennessee."

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