back to the Black Table

"I was told by every oncologist, every nutritionist, 'you do anything you have to do to get through this period.' When you watch somebody in tears, not able to move, they can't even talk, to find some sort of peace, you think, 'Thank God, whatever this is, let them do it.'"

This statement comes from Sara, my friend of 12 years, who recently beat lung cancer. Sara sounds logical, but any treatment? Most of us would break the law, even jeopardize our house to help a dear friend, our brother, or our mother with a desperate illness like cancer


or AIDS. As a citizen though, this could corrupt your community. Which side to choose? Following the June 6th Supreme Court ruling in Gonzales v. Raich, you face this question. The Raich case, involving medical marijuana, laid the groundwork for a new chapter in the ongoing balancing act between personal freedom and public safety.

Congress passed the Controlled Substances Act (CSA) in 1970, which made marijuana illegal in all


50 states. In November 1996, the California legislature passed Proposition 215 "to ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes…" Californians passed the law feeling that limited home use of marijuana by seriously ill people would be too small for the long arm of the federal law.

The Feds disagreed. By April 1997, the Drug Enforcement Agency (DEA) raided the Flower Therapy medical marijuana buyers club in San Francisco and seized their crops . In the following years, the DEA raided many clubs and individuals, while state law enforcement protested. Meanwhile, 9 other states passed laws similar to California's, which legalized marijuana for medical purposes.

The Raich case emerged from these raids. Angel McClary Raich's clothing billows over her gaunt, flaccid frame. Her face is sunken, almost hanging from her skull. Angel's wasted state results from a litany of symptoms including an inoperable brain tumor, a uterine fibroid tumor, headaches, seizures and nausea. After over 34 conventional medications caused violent vomiting, hot flashes, shakes, itching, and sweats, Angel found relief in marijuana. She smokes every two waking hours, consuming around two and half ounces per week under the supervision of Frank Lucido, a doctor with 25 years of experience.

Angel Raich sued the Feds to stop the raids, fearing a barrier to her medicine. She argued that her behavior was too trivial for federal control, and in any event, legal under state law. She lost in district court, but the 9th Circuit Court of Appeals agreed with Raich, finding "nothing contrary to the public interest in allowing individuals to seek relief from a statute that is likely unconstitutional as applied to them." So then-attorney general John Ashcroft appealed to the U.S. Supreme Court, never lacking any humor, on 4/20/04.

A Cure As Bad As the Sickness.

"A day after [chemo], the sickness started. It's more than nausea; it's physical pain in your stomach. It's literally like knives in your stomach for days afterward. You can't walk upright; I was crawling place to place, passing out where ever I crawled, and waking up hours later wondering why I started in this direction." Everyone knows about losing your hair from chemotherapy, but Sara is describing probably the most serious side effect.

Chemotherapy involves injecting your body with toxins such as Carboplatin, Cisplatin, Docetaxel, Paclitaxel or Carbotaxol for 8 hours, twice per month, for 4 months. These toxins kill cancer cells, but the amounts remaining in the bloodstream invoke a toxic response, causing vomiting. "You're throwing up and you have nothing to throw up. You can't get any food down. Everything was in the freezer or fridge. It had to be cold because if it wasn't cold you could smell it," Sara said.

Nausea can result in serious metabolic derangements, nutritional depletion and anorexia. "At one point I had lost too much [weight] and they told me that if I didn't eat, they were going to stop my treatment, wait, and then start all 8 cycles all over again," she said. Doctors use several medications for nausea; Sara took three. One medication available is a pill called Marinol, a synthetic version of THC, the active chemical in marijuana. But researchers have found this pill is less effective than smoked marijuana, which hits the bloodstream faster through the lungs.

Another side effect of chemotherapy is extreme pain such as paresthesias, where the skin feels numb or burned for no apparent reason, or hyporeflexia, a condition characterized by diminished or weakened reflexes. "A day or so after chemo, I got out of bed [and] as soon as my foot hit the ground, pain shot all the way through me, I felt like I was 85," Sara recalled. For the pain, doctors prescribe Oxycodone, Vicodin, methadone, levorphanol or other opiates. These drugs often cause hallucinations, nightmares, nausea, mental clouding and constipation. They can be overdosed fairly easily, causing death. Often they create an addiction, a la Rush Limbaugh.

"We get it all the time." says John who works at a San Diego clinic specializing in cannabis therapy and declined to give his last name. "I spoke with somebody today. People say, 'I take Oxycodone, I take Oxycontin, I take all kinds of pills. I have an addiction and I want to get off 'em.'" In July 2004, the National Institute on Drug Abuse published findings that marijuana compounds relieved pain. Since marijuana is, at worst, only mildly addictive, it offers an alternative to opiate medications.

Prolonged isolation during recuperation, the ailment's chronic pain or worse, facing death, causes serious emotional upheaval. "The mental toll it took… I think all of the medication made the mental state worse. The morphine made you even more paranoid. A lot of the stuff they put you on makes you even more paranoid. Then it becomes a cycle, because they put you on anti-anxiety drugs to level you out -- Paxil, Xanax, and all this other stuff," said Sara.

Why Weed Works.

THC receptors reside in brain areas that influence pleasure, memory, concentration, sensory and time perception, and coordinated movement. Patients are finding that marijuana's mood-altering effects aid emotional pain, too. Dr. Tod Mikuriya, a California physician specializing in cannabis therapy, authored a paper on the mental therapeutic effects of marijuana: "While most would characterize and categorize cannabis' therapeutic actions as sedative, anxiolytic, and analgesic; the power of the drug to alleviate depression is, perhaps, as an important psychotherapeutic property. Confronted by mental disorders that have diverse causes and ways of expression, depression and anxiety vary significantly in severity, expression, and manifestation. For some, cannabis is a lifeline to sanity and functionality."

John says marijuana's mental does more than improve a patients' mood. "With marijuana the patients have a new social avenue. In other words, they have more support from other medical marijuana patients. I think, by nature, the intake of marijuana has a social connotation to it, which could be negative in a political arena or a positive, I don't know. I truly view it as an extremely positive experience.

"For example, what would it be like if I had cancer? I watched my mother go through this. You get rushed off to the hospital and it becomes a very bitter and very negative experience for everybody, especially the patient. Your whole family is there, everybody's depressed, and no one knows what's going on. Marijuana comes after that stage. You've gone through the trauma and you've come to grips with your life, your ailments and how much time you have left. It then becomes an issue of, 'Who do we talk to? Who do we relate to?' I can think of a few times where it happened before my eyes and it really blew me away. I've watched a patient come in and actually meet other patients in the lobby with similar conditions. I've seen them sitting there for hours just talking. It's fascinating -- these people have something in common, they have something to grab onto. It opens a whole new world to patients. It's kind of a support group."

But patients need more than drugs for the side effects, they must directly address the ailment. Nearly a year after her treatment began Sara still took antibiotics. "It's so expensive, even with the health insurance that I have, everything was covered, but I guarantee you that I was spending $200 [a month] on medication just from co-pays." Sara said. At this point marijuana, which addresses many of the symptoms, becomes attractive. "It was so expensive that even the co-pays were $50 to $60. A bag of weed was like 50 bucks and would last you three weeks. It didn't make sense."

John sees this at his clinic. "For a lot of patients it's a cost factor, especially if you're terminally ill, on Medi-Cal or social disability. These people are really hurting for money. When you can't count on your insurance company, you have just been unemployed, or you don't have a job that offers insurance, you're basically screwed. You couldn't see a doctor if you wanted to. So they have a choice between traditional medicines or cannabis, a lot are choosing cannabis."

Well-respected institutions have found the benefits of medical marijuana compelling enough to support. The Lymphoma Foundation of America and the HIV Medicine Association of the Infectious Diseases Society of America supported Raich in her case with a amici curiae or "friend of the court" brief: "For certain persons the medical use of marijuana can literally mean the difference between life and death. At a minimum, marijuana provides some seriously ill patients the gift of relative health and the ability to function as productive members of society."

"That's what somebody has to do in the government." John said. "They gotta say, Listen to the patients. They're not lying to you; they're being honest with you."

Where We're At Right Now, Bud.

Although raiding seriously ill persons' homes for their medicine seems almost as bad as setting fire to the elderly, this is, after all, the federal government we are talking about. The federal government almost always has defensible reasons for their actions. Partially legalizing marijuana threatens public safety. Radicals aside, when an argument gets down to the nuts and bolts, we make value decisions. We weigh the private freedom against the public safety. That's where the government is coming from.

On the surface level, the DEA fears losing control over marijuana trafficking. Unscrupulous growers' or patients' crops could find their way to recreational users. Law enforcement would be hard pressed to distinguish medical marijuana from recreational marijuana. Although contrary evidence exists -- over the last three years, California marijuana arrests per capita have increased, while marijuana use has remained fairly flat -- law enforcement is clearly concerned. Most states where medical marijuana is legal have initiated patient registration or ID card programs to regulate use.

Do not judge the federal government on the line at the post office. Despite what you might believe, the government cares about our well being. Marijuana's negative effects possibly offset apparent medicinal benefits. The National Institute on Drug Abuse reports that marijuana's short-term effects include memory and learning problems; distorted perception; problem solving difficulty; and coordination loss. One study found that the resulting increased heart rate quadruples heart attack risk in the first hour after smoking. Lab tests have linked long-term use with addiction; animals chronically exposed to marijuana showed stress responses and dopamine fluctuation when weaned off the drug. Like cigarettes, smoking marijuana promotes lung cancer because it creates irritants and carcinogens. Depression, anxiety, and personality disturbances have been associated with marijuana use. A study of municipal workers found that marijuana users turned slacker by leaving work without permission, daydreaming, spending work time on personal matters and shirking tasks. Furthermore, drugs fit for medicine undergo a stringent evaluation by the FDA; smoked marijuana, as an herb, is very difficult to standardize.

On June 6th, in a 6-3 ruling, the Supreme Court agreed with the Feds -- medical marijuana remains illegal in the U.S. under federal law. From a practical standpoint, it seems little has changed. Despite the ruling, medical marijuana remains legal in California and the 9 other states. Daniel Piar, a Constitutional, Civil and Criminal Law professor at the John Marshall Law School, said, "California remains free to legalize marijuana however it wants, but the Court's ruling means that the federal government nonetheless has the power to prosecute people federally for the use of the drug. This creates a situation where an activity can be legal under state law but illegal under federal law."

"We plan to continue taking care of patients that benefit from the use of cannabis." John said. "Nothing officially changed, the state still supports medical marijuana and the Feds still don't." Piar added, "State police normally do not enforce federal law, and there are Supreme Court cases that say that they cannot be forced to do so because of federalism. Since this activity remains legal under California law, the state police will not be out enforcing the CSA. This means that enforcement of the CSA in this case will be up to the Feds. Depending on how strictly they want to enforce the law, many users could indeed fly under the radar."

"The thing most at jeopardy is the dispensaries and big growers." John said. "The patients will suffer the most. Imagine thousands of patients now forced to buy in the streets. Nothing against the local pot dealer, but dispensaries seem to be a safe, accommodating, affordable and necessary thing in California society."

The court's decision did not kill the issue; it merely brought it around an idyllic bend. Piar says the Supreme Court will likely not hear this issue again anytime soon. From here, legalizing medical marijuana must come from changes to the Controlled Substances Act. "Any changes to the CSA will have to come from Congress." Piar said. "In order to legalize medical marijuana, Congress would have to either repeal or amend the relevant part of the CSA to permit it."

The Supreme Court invited such the action at the close of the majority opinion: "As the Solicitor General confirmed during oral argument, the [CSA] authorizes procedures for the reclassification of Schedule I drugs. But perhaps even more important than these legal avenues is the democratic process, in which the voices of voters allied with these respondents may one day be heard in the halls of Congress."

With the issue now in the hands of our representatives, the argument rests firmly on all Americans' shoulders. Is deciding your own treatment hubris and decadence? Is it equally vain for interlopers to dictate an individual's treatment? It's a rising tide of trouble for sure. Don't dig it up, don't divert it. Let it swamp the country in discourse, because that's how you do it right.


Isaac Kay is an Atlanta-based writer and speaker. He is pursuing a master's degree in finance at Georgia State University and enjoys firearms and banking.