[Congressional Record Volume 143, Number 16 (Monday, February 10, 1997)]
[Extensions of Remarks]
[Pages E194-E195]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  NEW ENGLAND JOURNAL OF MEDICINE SUPPORTS MEDICINAL USE OF MARIJUANA

                                 ______
                                 

                           HON. BARNEY FRANK

                            of massachusetts

                    in the house of representatives

                       Monday, February 10, 1997

  Mr. FRANK of Massachusetts. Mr. Speaker, when I came to Congress in 
the early 1980's, our late colleague Stewart McKinney of Connecticut 
was the sponsor of a bill to allow doctors to prescribe marijuana for 
medical purposes when they found this to be in the interest of their 
patients. When Mr. McKinney tragically died in 1987, depriving this 
Congress of one of its most valuable Members, the bill lapsed. A few 
years ago, at the urging of some people interested in this subject, I 
reintroduced the bill, essentially the legislation which Mr. McKinney 
had initiated. While no action was taken on that bill in the previous 
Congress, and while some of the prior cosponsors had in the interim 
changed their mind on the bill--for example, Mr. Gingrich of Georgia--I 
will be reintroducing the bill this year. In the interim, voters in the 
States of Arizona and California have given their endorsement by solid 
majorities to this principle. I hope we will in this Congress seriously 
debate this issue. I have been disappointed by the failure of the 
Clinton administration to be more forthcoming, but I have been 
encouraged by the increasing interest in debating this subject 
seriously among many members in the medical profession.
  Recently, one of the leading outlets for informed opinion about 
medicine, the New England Journal of Medicine, carried an editorial by 
Dr. Jerome P. Kassirer, editor of the Journal, on this subject. His 
title--Federal Foolishness and Marijuana--accurately sums up his point 
of view.
  Dr. Kassirer says in this editorial that he believes ``that a federal 
policy that prohibits physicians from alleviating suffering by 
prescribing marijuana for seriously ill patients is misguided, heavy 
handed and inhumane.'' I should note that it is now in direct conflict 
with the wishes of the people of Arizona and California as expressed in 
referenda. Indeed, I await the support for my bill that I assume will 
be forthcoming from my conservative colleagues who are great supporters 
of States rights, and who in particular believe that when the public 
has expressed its view in referenda, Federal officials should 
acknowledge the validity of that point of view.
  Mr. Speaker, in the hope that we may again be able to change your 
mind so that you go back to your position of the 1980's in support of 
this proposition, and in the interest of furthering debate on this 
matter, I ask that the thoughtful editorial by Dr. Kassirer be printed 
here.

        [From the New England Journal of Medicine Jan. 30, 1997]

                   Federal Foolishness and Marijuana

                     (By Jerome P. Kassirer, M.D.)

       The advanced stages of many illnesses and their treatments 
     are often accompanied by intractable nausea, vomiting, or 
     pain. Thousands of patients with cancer, AIDS, and other 
     diseases report they have obtained striking relief from these 
     devastating symptoms by smoking marijuana. (1) The 
     alleviation of distress can be striking that some patients 
     and their families have been willing to risk a jail term to 
     obtain or grow the marijuana.
       Despite the desperation of these patients, within weeks 
     after voters in Arizona and California approved propositions 
     allowing physicians in their states to prescribe marijuana 
     for medical indications, federal officials, including the 
     President, the secretary of Health and Human Services, and 
     the attorney general sprang into action. At a news 
     conference, Secretary Donna E. Shalala gave an organ recital 
     of the parts of the body that she asserted could be harmed by 
     marijuana and warned of the evils of its spreading use. 
     Attorney General Janet Reno announced that physicians in any 
     state who prescribed the drug could lose the privilege of 
     writing prescriptions, be excluded from Medicare and Medicaid 
     reimbursement, and even be prosecuted for a federal crime. 
     General Barry R. McCaffrey, director of the Office of 
     National Drug Control Policy, reiterated his agency's 
     position that marijuana is a dangerous drug and implied that 
     voters in Arizona and California had been duped into voting 
     for these propositions. He indicated that it is always 
     possible to study the effects of any drug, including 
     marijuana, but that the use of marijuana by seriously ill 
     patients would require, at the least, scientifically valid 
     research.
       I believe that a federal policy that prohibits physicians 
     from alleviating suffering by prescribing marijuana for 
     seriously ill patients is misguided, heavy-handed, and 
     inhumane. Marijuana may have long-term adverse effects and 
     its use may presage serious addictions, but neither long-term 
     side effects nor addiction is a relevant issue in such 
     patients. It is also hypocritical to forbid physicians to 
     prescribe marijuana while permitting them to use morphine and 
     meperidine to relieve extreme dyspnea and pain. With both 
     these drugs the difference between the dose that relieves 
     symptoms and the dose that hastens death is very narrow; by 
     contrast, there is no risk of death from smoking marijuana. 
     To demand evidence of therapeutic efficacy is equally 
     hypocritical. The noxious sensations that patients experience 
     are extremely difficult to quantity in controlled 
     experiments. What really counts for a therapy with this kind 
     of safety margin is whether a seriously ill patient feels 
     relief as a result of the intervention, not whether a 
     controlled trail ``proves'' its efficacy.
       Paradoxically, dronabinol, a drug that contains one of the 
     active ingredients in marijuana (tetra-hydrocannabinol), has 
     been available by prescription for more than a decade. But it 
     is difficult to titrate the therapeutic dose of this drug, 
     and it is not widely prescribed. By contrast, smoking 
     marijuana produces a rapid increase in the blood level of the 
     active ingredients and is thus more likely to be therapeutic. 
     Needless to say, new drugs such as those that inhibit the 
     nausea associated with chemotherapy may well be more 
     beneficial than smoking marijuana, but their comparative 
     efficacy has never been studied.
       Whatever their reasons, federal officials are out of step 
     with the public. Dozens of states have passed laws that ease 
     restrictions on the prescribing of marijuana by physicians, 
     and polls consistently show that the public favors the use of 
     marijuana for such purposes. [1] Federal authorities should 
     rescind their prohibition of the medicinal use of marijuana 
     for seriously ill patients and allow physicians to decide 
     which patients to treat. The government should change 
     marijuana's status from that of a Schedule 1 drug (considered 
     to be potentially addictive and with no current medical use) 
     to that of a Schedule 2 drug (potentially addictive but with 
     some accepted medical use) and regulate it accordingly. To 
     ensure its proper distribution and use, the government could 
     declare itself the only agency sanctioned to provide the 
     marijuana. I believe that such a change in policy would have 
     no adverse effects. The argument that it would be a signal to 
     the young that ``marijuana is OK'' is, I believe, specious.
       This proposal is not new. In 1986, after years of legal 
     wrangling, the Drug Enforcement Administration (DEA) held 
     extensive hearings on the transfer of marijuana to Schedule 
     2. In 1988, the DEA's own administrative-law judge concluded, 
     ``It would be unreasonable, arbitrary, and capricious for DEA 
     to continue to stand between those sufferers and the benefits 
     of this substance in light of the evidence in this 
     record.''[1] Nonetheless, the DEA overruled the judge's order

[[Page E195]]

     to transfer marijuana to Schedule 2, and in 1992 it issued a 
     final rejection of all requests for reclassification.[2]
       Some physicians will have the courage to challenge the 
     continued proscription of marijuana for the sick. Eventually, 
     their actions will force the courts to adjudicate between the 
     rights of those at death's door and the absolute power of 
     bureaucrats whose decisions are based more on reflexive 
     ideology and political correctness than on compassion.


                               References

       1. Young FL. Opinion and recommended ruling, marijuana 
     rescheduling petition. Department of Justice, Drug 
     Enforcement Administration, Docket 86-22. Washington, D.C.: 
     Drug Enforcement Administration, September 6, 1988.
       2. Department of Justice, Drug Enforcement Administration, 
     Marijuana scheduling petition: denial of petition: remand. 
     (Docket No. 86-22.) Fed Regist 1992;5759:10489-508.
       Copyright 1997, Massachusetts Medical Society.

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