Searching for clarity on the medical marijuana debate
David Cheney was once the picture of health: a 225-pound triathlete and marathon runner who in 1990 qualified for an international swimming competition. That was also the year the UVM-trained anesthesiologist became infected with the HIV virus while treating an end-stage AIDS patient. Cheney contracted a particularly virulent strain of the virus, and it rapidly consumed him.
Cheney's wife, Mary Callahan-Cheney, watched while the extreme pain and loss of sensation in the legs and feet of this once robust man rendered him unable to walk. "He likened it to walking on broken glass," she recalls. The nearly 50 pills he took each day killed his appetite, which only exacerbated his chronic wasting syndrome -- a common symptom of AIDS.
So Callahan-Cheney treated her husband with marijuana. As a physician and athlete, Cheney worried about his lungs and wouldn't smoke the pot. So his wife sauteed it in butter, then baked it into his desserts or mixed it into his potatoes. The cannabis-laced food relieved some of Cheney's pain and boosted his appetite, which, in turn, slowed his chronic wasting. He died in August 1999, after living with the disease for nearly a decade.
Was Callahan-Cheney ever concerned about the legal ramifications of giving her husband an illegal drug the federal government insists has no medicinal value? "No," she says simply. "I had too many other things to be worried about."
Last week, Callahan-Cheney told her story to members of the House Committee on Health and Welfare, which is now considering a bill to exempt seriously ill Vermonters from arrest and prosecution for using marijuana as long as it's consumed in the privacy of their own homes. S.76, which already passed the Senate, would only apply to patients with AIDS, cancer, glaucoma, Crohn's disease or multiple sclerosis, and who suffer from severe, debilitating, and intractable symptoms: pain, nausea, severe muscle spasms, seizures or chronic wasting. Patients would be required to register with the state Health Department, and they and their doctors would be protected from prosecution under state law, which brings more than 99 percent of all marijuana charges. If the bill passes, Vermont would become the ninth state in the nation to enact a medical marijuana law.
But the debate in the Legisla-ture over "compassionate use" is being clouded by lingering skepticism about the therapeutic worth of marijuana and its association with far more dangerous Schedule I drugs like heroin and methamphetamine. Despite the government's own findings in 1999 that cannabis has clear and demonstrable medicinal applications -- by definition, a Schedule I drug has "no medically accepted use in treatment" -- the debate invariably returns to arguments about it being a "gateway drug" for teenagers.
Mark Trouville is a special agent with the New England Field Division of the U.S. Drug Enforcement Agency. In testimony last week, he condemned S.76 on grounds that it would conflict with federal laws, stymie state and federal drug-enforcement efforts, and invite additional criminal elements into the state. He claimed that Vermont would quickly be overrun by organized gangs of drug dealers like the Hells Angels who now control Quebec's lucrative marijuana trade. Trouville also predicted that many of Vermont's sick and elderly citizens would soon fall victim to rip-offs, larcenies, assaults and even homicide.
But Trouville's testimony wasn't the most alarmist of the day. Other witnesses, like Vermont's Commissioner of Public Safety, Kerry Sleeper, warned that if this bill becomes law, people like Callahan-Cheney will be tempted to become major drug dealers.
"You cannot debate this legislation without recognizing the lack of adequate controls," said Sleeper, a 27-year law-enforcement veteran. "As written, this bill will lead to more availability of marijuana on the street, more marijuana use by our youth, more youth becoming chemically dependent, [and] an increase in drug-related crime."
According to Sleeper's calculations, this bill would permit each terminally ill patient to produce two pounds, three ounces of marijuana every 90 days, with a street value of $8,750, or about $35,000 per year. "If we take a conservative figure of 1 percent of Vermont's population utilizing this legislation, or roughly 6100 people, we can determine that Vermont will be producing and/or consuming over 53,000 pounds of high-grade marijuana with a street value of $212 million," Sleeper concluded.
Putting aside the questionable assumption that 1 percent of Vermont's population suffers from AIDS, glaucoma or some equally debilitating disease -- proponents estimate that this bill would apply to fewer than 100 people -- one can only wonder how all those blind or bed-ridden patients and their caregivers will find the time and energy to cultivate thousands of pounds of "high-grade" dope. As Callahan-Cheney pointed out, "I can pretty much guarantee that if you're taking care of a terminally ill person, you have no time to get on the market and sell it."
Even a casual observer of the Legislature could spot the stark contrast between what advocates and opponents are saying about the pros and cons of pot. On one side of the room were burly state troopers and drug-enforcement agents packing 9-mm pistols, forecasting rising rates of drugged driving, heroin addiction and overdose deaths. On the other side were white-haired octogenarians armed with canes, walkers and heartfelt stories about their elderly friends who puff the occasional joint to relieve the searing pain of glaucoma or the gut-wrenching nausea of chemotherapy.
It's no surprise that medical marijuana legislation enjoys widespread popularity -- a recent Zogby poll revealed that more than 71 percent of Vermonters support the idea, as do 83 percent of Burlington voters. What's more remarkable is the stiff political resistance, despite public support that cuts across age, economic and political lines.
Hilton Wick got a warm welcome from committee members when he appeared before them last week. A former Republican state senator who ran for governor in 1984, he came to talk about his wife, Barbara, who died of breast cancer in October 2001. Wick said she smoked marijuana in the last three to four months of her life to ease her pain.
"If Barbara were here today, I'm sure she would favor the use of marijuana by terminally ill patients," Wick said, in a gravelly and shaky voice. "And I would say this: Whether you pass this bill or not, it really may make no difference . . . as those who are terminally ill will continue to use marijuana if they find a benefit from it."
But not all of them. Many ailing people pass on pot because it's against the law. Marion Gray, 87, of Mont-pelier's Older Women's League, watched a friend of hers die of cancer several years ago. "She was in terrible pain," Gray recalled. "But she refused to use it. She suffered tremendously for keeping her children from seeing her do something illegal."
Another friend, Eleanor Van Vechten, 94, suffers from glaucoma but says she won't smoke an illegal substance either, even though her doctor says it might help her condition. "I have drops. It's supposed to help, but it doesn't much," Van Vechten said. "The thing I'm more worried about is that I have so little sight left in just one eye that when that goes, I will be totally blind. And that day is coming unless it can be pushed ahead a little with this drug."
S.76 raises some sticky legal dilemmas for Vermont's medical community. Dr. James O'Brien is president of the Vermont Medical Society, which officially opposes the medicalization of marijuana until federally approved clinical studies can validate and quantify its therapeutic uses. Clinically speaking, O'Brien said, "the science and knowledge about this is very much a moving target."
O'Brien pointed out that this bill doesn't give doctors any new treatment options. Doctors wouldn't be allowed to either prescribe or dispense marijuana, nor would they be protected from federal prosecution. But O'Brien, who called S.76 both "problematic" and "irrelevant," also blurred the lines between marijuana's medical and recreational uses, suggesting that this legislation is little more than a backdoor effort to legalize marijuana for the general public.
"If it is the will of this committee or any other committee to decriminalize small amounts of marijuana in the state of Vermont, then you can do that without dragging in a medical application," O'Brien said. "But we shouldn't trump up a medical indication for the use of this agent without there being truly good reasons."
Left in the haze were members of the Health and Welfare committee, whose comments and questions often revealed an embarrassing naivete about the most commonly used illegal drug in the United States -- and, arguably, Vermont's second largest cash crop. At one point, Commis-sioner Sleeper cited recent figures showing that last year, for the first time ever, drug-overdose deaths in Vermont outpaced automobile deaths. One committee member asked him how many of those overdoses resulted from marijuana. Apparently, few members of the committee were aware that overdosing on marijuana is virtually impossible. By one estimate, a person would have to smoke 100 pounds of pot a minute for 15 minutes to overdose on it -- or be crushed by a falling bale of it.
As committee members perused some informational pamphlets with glossy photos of plump, green buds of sinsemilla and made the occasional jokes about "wacky tobaccy" and pot-laced brownies, the buzz on medical marijuana grew louder. By the end of the hearings, there was still plenty of talk about how this bill "sends the wrong message" to Vermont's youngsters. There was virtually no mention of other far more deadly "gateway" drugs like tobacco and alcohol.
Several weeks ago, former U.S. Surgeon General Dr. Joycelyn Elders wrote an op-ed piece for The Providence Journal, in which she refutes this notion that medical marijuana laws promote teen drug abuse. Elders, who has come out in support of a similar bill now before the Rhode Island General Assembly, notes that when California passed its first effective medical marijuana law in 1996, similar fears were raised, but never materialized.
"According to the official California Student Survey, teen marijuana use in California rose steadily from 1990 to 1996, but began falling immediately after the medical-marijuana law was passed," Elders writes. "Among ninth graders, marijuana use in the last six months fell by more than 40 percent from 1995-96 to 2001-02."
And while the Vermont Medical Society doesn't support medical marijuana yet, Elders notes that plenty of other medical and public-health organizations do, including the American Academy of Family Physicians, the American Nurses Association and the New England Journal of Medicine.
But if last week's hearings did as much to cloud the issue as clear the air, one witness touched on a fundamental question underlying the whole debate: Who should decide what Vermonters can or cannot put into their bodies for their physical and mental well-being? The DEA's Trouville suggests that those decisions are best left to professionals.
"Even if smoking marijuana makes people feel better, that is not enough to call it medicine, any more than one would suggest using heroin to treat sick people," Trouville says. "Medicine must be defined by scientists and physicians, not by lobbyists."
Upon hearing the DEA agent's comment, a frail, walker-assisted old woman muttered under her breath, perhaps a bit louder than she had intended, "Oh, bullshit!" The smattering of giggles in the audience suggested this may be one subject about which the people are better informed than their politicians.