Oregon resident Dave Myers brought a lot back from his stint in service in Vietnam. Myers served in the US Navy inspecting boat traffic off the Vietnamese coast and he brought back memories, good and bad, of course, and some lasting friendships, but also Hepatitis C, probably caught inspecting some dark and waterlogged junk in the South China Sea.
Now suffering from terminal liver failure due to the disease, Myers sought a transplant from Oregon Health Services University (OHSU) in Portland, one of 16 major liver transplant centers in the country. But he was rejected by program head Dr. John Ham (http://www.ohsu.edu/transplant/bios/ham.html) because he is taking Marinol, a synthetic cannabis compound and legal prescription medicine. Worse for Myers, Ham accused Myers of being a marijuana smoker, something Myers vehemently denies having done for at least 15 years, when he was first diagnosed.
The removal of Myers from the list of those awaiting liver transplants is a virtual death sentence. "With liver failure, you die -- it's as simple as that," said Dr. Jay Cavanaugh, head of the American Alliance for Medical Cannabis (http://www.letfreedomgrow.com) and himself a Hepatitis C sufferer. "And a good number die while they're waiting for the transplant," he told DRCNet.
Myers is one of about 18,000 people waiting for livers, most of them Hep C sufferers, according to the Scientific Registry of Transplant Recipients (http://www.ustransplant.org), which tracks all organ transplants in the US. According to the registry, some 5,000 liver transplants are done each year, but some 2,000 patients die while on the waiting list.
Because a large proportion of Hep C patients got the disease through intravenous drug use and because significant numbers of other liver transplant candidates developed problems due to alcohol abuse, transplant centers have developed strict protocols barring transplant eligibility for those people who continue to abuse drugs. While protocols vary from center to center, the OHSU protocol specifies "no smoking, no drinking, no illicit drugs."
Marinol, a synthetic cannabinoid, is not an illicit drug. It is a Schedule II drug available for prescription in the United States. It is commonly used to increase appetite and as an analgesic, the use for which it was prescribed to Myers by his attending physician.
OHSU deflected numerous DRCNet attempts to interview Dr. Ham or get anyone to talk about the Myers case or OHSU's liver transplant protocols, but Myers told DRCNet -- and he has the tape recording to back it up -- that Ham told him that Marinol would suppress the immune system, thus making post-transplant infections more likely.
"This has me pulling my hair out," said Cavanaugh, himself a Hepatitis C sufferer. "One thing transplant people worry about is infection," he explained. "That was the rationale used to deny Myers, that the use of cannabis would suppress the immune system and make him prone to infection, but there is no validity to that whatsoever. Cannabis is not a general immunosuppressant and those doctors must know that. And it's ludicrous anyway because once you get a transplant you get whacked with the heaviest anti-rejection drugs around, and what do they do? They suppress the immune system."
But according to Myers and the recording of his meeting with Dr. Ham, the Marinol issue was most likely a smokescreen for Dr. Ham's real concern: that Myers was smoking marijuana. "I haven't smoked marijuana for 15 years or so, and I told Dr. Ham that I would willingly submit to a polygraph and/or a lung biopsy to prove that I am not smoking marijuana," Myers told DRCNet. "He said that was unnecessary because he knew I was smoking marijuana. So now I have a doctor who is also a psychic, I guess."
If Dr. Ham's extrasensory abilities leave room for doubt, so does OHSU's position on marijuana use as a reason to keep people off the transplant waiting list. According to Transweb (http://www.transweb.org), an online resource center for transplant patients, occasional marijuana use does not automatically preclude people from obtaining liver transplants. "It depends," wrote Dr. Jeff Punch, a University of Michigan transplant surgeon in response to a query. "First it depends on the policy of the individual transplant center. Second it depends on the individual patient: what organ they need, why they need it, and other factors. For example: Most lung transplant centers will not transplant patients that smoke anything, even occasionally. Another example is patients who need a liver transplant because of alcohol abuse. In patients with a history of alcoholism, studies have shown that one marker that indicates a particular patient is more likely to return to alcoholism is continued use of any psychoactive drugs. Most transplant centers will not transplant patients with active substance abuse of any kind if the reason for the transplant relates to substance abuse."
"There is no evidence that marijuana has any negative effect on the liver," Dr. Cavanaugh said. "A 1970 study found that if you inject a mouse with a massive dose of THC, there is some liver involvement, but the human equivalent would be mainlining an ounce of cannabis. More recent studies have found that cannabinoids and other compounds in marijuana are actually hepato-protective. They reduce inflammation in the liver associated with cirrhosis. Hell, cannabis benefits the liver!" Dr. Cavanaugh said.
In Oregon, a state with an active medical marijuana program, OHSU protocols against illicit drugs don't appear to have kept up with state law. The result is that Dave Myers is not alone in being rejected. "I am aware of about a dozen other people removed from the liver transplant list at OHSU because of medical marijuana use," said D. Paul Stanford, director of the Cannabis Hemp Foundation (http://www.thc-foundation.org). "We run a medical marijuana clinic here in Oregon, and we've got some 200 patients who have Hep C," he told DRCNet. "Medical marijuana helps those patients by stimulating their appetites, and it has some antibacterial properties," he said. "Denying these people transplants because they use medicinal marijuana is a death sentence. The Hemp Cannabis Foundation is preparing a lawsuit against OHSU, including Dave Myers because the facts of his case are the strongest, but also including registered Oregon medical marijuana patients who have been bumped."
"Does the transplant team really believe I'm a non-deserving drug addict for using medical cannabis?" asked Dr. Cavanaugh. "Isn't it ironic that my Hep C doctors had no problem considering me when I was being prescribed methadone, Clonopin, Ambien, Flexaril, Neurontin, and more? Does anyone really believe I was better off and a better transplant candidate when I was whacked on all those drugs?" he asked.
"To say that someone who uses physician approved cannabis is at risk of substance abuse is just ridiculous," Cavanaugh continued. "The vast majority of patients seeking liver transplants are Hep C patients, and the majority -- but not all -- are former intravenous drug users. There is some sense to the notion that if you are continuing a self-destructive pattern of behavior, such as shooting speed or smoking crack or drinking booze, you are not a worthy candidate because you'll just ruin the new liver, but in the case of Dave Myers, he is conforming to the center's desire that he not be using drugs that could damage his liver and he is still being discriminated against because of doctors' prejudice against medical marijuana, and in this case, Marinol, a federally-approved Schedule II drug."
As for Myers, he alternates between depression and anger, he told DRCNet. "I'd like to punch Jack Ham right in the face," said Myers. "He sat right across from me, my wife, and our daughter, smirking at us. I told him I wasn't his enemy, that I was willing to work with him, but it didn't matter. My daughter was crying, and he just kept going on about no THC," Myers said.
Without a liver transplant, he will be dead within two years, he said.
"Hep C is seen as the junkies' disease," said Myers. "It has the same sort of stigma that AIDS had, but it doesn't have those celebrity spokespeople to raise awareness." Myers should know. He operates a web site for veterans with Hep C (http://www.hepvets.org) and writes on the issue for publications covering the disease. "There is a prejudice like there was in the 1960s. Then, if you had long hair and a beard you must be a pothead. Now, if you have Hep C, you must be a junkie. I've been clean and sober for 15 years," said Myers, who recently completed a stint with Promisekeepers, the conservative Christian men's fellowship.
Myers must find another transplant center that will take him, if he is to survive, he said. OHSU is the only one in the state.
Dr. Cavanaugh viewed the whole episode as outrageous. "That medical professionals would inject prejudice into a life and death decision is more than unethical. It's cruel, ignorant, and arrogant."