AMA Scientific Affairs Council Recommends Pro-Medical Marijuana Platform, Organization Declines for Now, Takes Smaller Steps Instead 6/22/01

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Meeting this week in Chicago, the nation's largest physicians' organization, the American Medical Association (AMA), debated but failed to pass a resolution shifting the AMA's policy on medical marijuana in a slightly more progressive direction. Under AMA policy in place since 1997, the doctors' organization opposes the use of medical marijuana and rejects its reclassification as a Schedule II drug, but calls for more research on the issue. (An earlier 1995 policy still in place reaffirms the AMA's opposition to the legalization of marijuana, but calls for a reduction in penalties.)

But as the ferment surrounding medical marijuana heightened in the late 1990s, the AMA decided to take another look. The AMA's Council on Scientific Affairs reviewed the rapidly changing social and legal context of medical marijuana use, noting its approval by voter initiatives in eight states and by the Hawaii legislature, cited continuing controversies over marijuana's abuse potential, and perused the literature on medical marijuana in the last few year. The council reported on marijuana's efficacy in treating:

  • HIV Wasting Syndrome: "THC is only moderately effective in the treatment of HIV-wasting, and its long duration of action and intensity of side effects preclude routine use in some patients."
  • Nausea from cancer treatments: "Oral THC and smoked marijuana retain antiemetic efficacy but are clearly less effective than current standard therapies."
  • Muscle spasticity related to Multiple Sclerosis: "Spasticity. Anecdotal, survey, and clinical trial data support the view that smoked marijuana and oral THC provide subjective relief of spasticity, pain and tremor in some patients with multiple sclerosis (MS) or trauma."
  • Pain relief: "Case reports suggest that smoked marijuana may benefit selected patients suffering from headache, menstrual cramps, or abdominal pain related to tubal ligation, and may decrease opioid requirements. Controlled evidence does not support the view that THC or smoked marijuana offers clinically effective analgesia without causing significant adverse events when used alone. There is a small margin between clinical benefit and unacceptable adverse events. However, smoked marijuana may benefit individual patients suffering from intermittent or chronic pain."
In its recommendation to the AMA delegates in Chicago, the council called for further studies of marijuana's efficacy, urged the National Institutes of Health (NIH) to facilitate and not impede such research, called for marijuana delivery systems that do not involve smoke, and urged the AMA to support "compassionate use" of medical marijuana for the sick and dying:

"Until such time as rapid-onset cannabinoid formulations are clinically available, our AMA affirms the appropriateness of compassionate use of marijuana and related cannabinoids in carefully controlled programs designed to provide symptomatic relief of nausea, vomiting, cachexia, anorexia, spasticity, acute or chronic pain, or other palliative effects. Such compassionate use is appropriate when other approved medications provide inadequate relief or are not tolerated, and the protocols provide for physician oversight and a mechanism to assess treatment effectiveness."

That formulation was more than the delegates could handle. Even though, as council member Dr. Melvin Sterling of Orange, California, told the conference, "This report is about suffering; it's not about getting high," other delegates reiterated concerns about the drug's misuse potential and that endorsing medical marijuana could lead to further non-medical use. Some voiced fears that the AMA could be viewed as a "pro-legalization" organization if it endorsed "compassionate use."

According to the Marijuana Policy Project's Chuck Thomas, who attended the sessions, only a few delegates spoke against the "compassionate use" provision, most notably Dr. Michael Miller from Wisconsin. Thomas reports that Miller convinced his state delegation to oppose the provision, telling them it would hurt his ability to testify against medical marijuana bills at home.

Thomas wrote that Miller is an active member of the American Society of Addiction Medicine (ASAM), as is Dr. Stuart Gitlow -- ASAM's delegate to the AMA -- who served on the seven-member reference committee studying the council's recommendations. ASAM, which has been criticized by drug treatment reform activists for providing a home to advocates of abusive treatment modalities on the Straight/Synanon model. (See articles at http://fornits.com/anonanon/ and http://thestraights.com and http://www.peele.net -- which mention ASAM members Richard Schwartz, Robert Dupont and Doug Talbott.) ASAM (http://www.asam.org) has as one of its public policy objectives to be "widely recognized in the media and the public as a leading advocate and authority on the prevention, treatment, and scientific basis of addiction."

In voting not to support "compassionate use" of medical marijuana, the AMA turned a cold shoulder to patients such as Michael Krawitz of Roanoke, Virginia, who traveled to Chicago to tell the AMA how medical marijuana relieved his pain. Krawitz, has an artificial hip and has had part of his stomach and intestines surgically removed, he told the conference. He told the assembled physicians he gets relief from marijuana, but not from marinol.

On a positive note, the AMA did strike its opposition to the Single User Investigational New Drug program, pioneered by Robert Randall in 1978, which allows a handful of persons to obtain the drug from the federal government. The AMA also let stand its 1997 policy endorsing "the free and unfettered exchange on information on treatment alternatives," a clear shot over the bow to then drug czar Gen. Barry McCaffrey and his efforts to intimidate California physicians from recommending medical marijuana to patients in the wake of 1996's Prop. 215.

MPP's Thomas managed to find a silver lining. "The support for compassionate access to medical marijuana is overwhelming," said Thomas in a press release on the vote. "While the AMA delegates rejected the compassionate access recommendation of their own Council on Scientific Affairs, at least they rescinded their former position, which explicitly opposed compassionate access. Now the AMA is neutral on the issue."

Thomas was also able to prod an AMA spokesman to go on the record stating that patients should not be jailed for taking their doctors' advice to use medical marijuana. "Our plea again is that no criminal sanctions (be applied to marijuana use), and to encourage our patients to discuss this freely with their doctors," said Dr. Herman Abromowitz, an AMA trustee, Reuters reported.

Visit http://www.ama-assn.org/ama/upload/mm/hod_d6_doc.doc to view the AMA Council on Scientific Affairs recommendations online.

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