Dr. Denney in Arkansas
Philip Denney, MD, seemed to be winning some hearts and minds as he testified before a committee of the Arkansas legislature Nov. 17 in support of "An Act to Permit the Medical Use of Marijuana." The bill had been introduced by Rep. Lindsley Smith and co-sponsored by Sen. Sue Madison, both Democrats from Fayetteville, a relatively liberal university town. It would establish a state-run identification card program and permit physician-approved patients to possess four ounces. Growers could have three flowering and 10 immature plants, and could possess up to one pound "in conjunction with a harvest."
Denney had been invited to Little Rock by Denele Campbell, director of the Drug Policy Education Group, who drafted the bill (using Oregon’s medical marijuana law as a starting point). Campbell, 55, is a piano tuner by trade and a longtime environmental activist who began focusing on medical marijuana six years ago. She and her allies tried in 1999 and 2002 to change the law by popular initiative but failed to qualify for the ballot. "The problem wasn’t getting people to sign but getting enough people to collect signatures," said Campbell, who testified ahead of Denney.
Campbell’s assertion that almost two-thirds of Arkansans support medical marijuana was challenged by Republican Rep. Johnny Key of Mountain Home: "It would seem to me that if you have 63% of the voters, you wouldn’t have too much trouble gaining those signatures. It kind of makes me wonder about that survey, considering that you haven’t been able to secure enough signatures two times in a row… " Campbell cited several polls substantiating her claim and Keys countered, "But at this point we don’t know how the questions were asked." She said she would send him the polls.
Denney changed the tone of the session immediately by changing the terminology. "I’m a physician who has 30 years of experience in family practice and emergency medicine," he began. "I’ve had a longstanding interest in the science of cannabis as medicine. Let me stop right there to say I prefer the term ‘cannabis’ to ‘marijuana.’ ‘ Marijuana’is a slang term that comes from the Mexican song La Cucaracha, which I’m sure you’ve all heard." There was a murmur of acknowledgment. In the ensuing discussion the legislators (all except Key) would use the Latin term and sound respectful rather than contemptuous.
Denney said he had seen about 12,000 California patients, ranging in age from seven to 93, who used cannabis to treat a wide variety of chronic conditions. "I have found in my study of these patients that cannabis is really a safe, effective and non-toxic alternative to many standard medications. There is no such thing as an overdose. We have seen very minimal problems with abuse or dependence, which at worst are equivalent to dependence on caffeine. While a substance may have some potential for misuse, in my opinion, that’s a poor excuse to deny its use and benefit to everyone else.
"The primary use in my practice is to treat chronic pain… Frankly, we have very poor treatment for chronic pain. The opiates, which are derived from the opium poppy, are good medicines for acute pain -pain that lasts six or eight weeks after you break your leg or have your appendix out. But the opiates are very problematic in treating chronic pain.
"Patients tell me that cannabis makes their pain more tolerable and therefore improves their quality of life. They also tell me that if they have access to good quality cannabis they don’t need to use as much of the opiates. It’s very striking. Virtually all of my patients who use cannabis in lieu of narcotics report at least a 50% reduction in narcotic use, and some are able to eliminate them completely.
"Cannabis is particularly effective in treating the nausea associated with gastrointestinal illness and chemotherapy. My patients tell me uniformly that cannabis is the best medicine available for this problem."
The first question came from a former police officer who had lost a friend to cancer. His friend had been prescribed some kind of legal synthetic medicine. Why was anything else needed? Denney identified the drug as Marinol and explained that many patients can’t tolerate or afford it. Marinol can cost $1,400/month. "The plant material contains 66 cannabinoids, Marinol contains only one. At least one of the other cannabinoids is needed for the full effect…" The former cop added that he and others in law enforcement had been "very grateful that our friend had something available to him." He seemed receptive to something else becoming available, and thanked Denney "for traveling all this way to talk to us."
Whereas earlier agenda items had been discussed to the accompaniment of lobbyists chatting as they came and went, Denney’s Introduction to Cannabis Therapeutics held everyone’s attention. He explained G.W. Pharmaceuticals’ approach, noting that their whole plant extract was now legally available in Canada. He was asked, "Doctor, regarding this cannabis, can you tell me what percent of your patients smoke the cannabis as opposed to these other forms of ingestion?" Denney replied, "There is a new technology called vaporization where you just heat the cannabis to the boiling point of THC, which is lower than the ignition point of cellulose, therefore all that comes off is the vapor, there is no smoke. This is a very effective method…"
The first item on the agenda had concerned the legislators’ effort to curb cigarette smoking by Arkansans. Denney pointed out that "a person addicted to nicotine who smokes a pack a day smokes approximately four-and-a-half ounces per week, whereas the average cannabis user in our practice uses a quarter of an ounce per week… There’s some fascinating evidence coming out to indicate that the active ingredients in cannabis actually protect the respiratory system rather than put it at risk. Cannabis is an effective bronchodilator, for example, which is very intriguing."
The finding that cannabis-only smokers are not at increased risk for lung cancer is reported in the Autumn issue of O’Shaughnessy’s, which I had brought to distribute to the legislators and reporters covering the hearing. But Campbell asked me not to, fearing that pictures of the herb in proximity to an ad for Dr. Denney’s practice might undermine his credibility. "This is the Bible Belt," she reiterated. (Indeed, the legislature’s website lists each member’s "Church Affiliation.")
"How do patients obtain the cannabis?," Denney was asked. He listed three options available in California: "The black market," which he advises patients to avoid. "So-called clubs and dispensaries, which are quasi-legal… About 160 are now in operation. They provide patients with access to high quality medicine but the prices are not very reasonable." And "Patients growing their own -which is the option I recommend, if at all possible. They get high quality medicine at a very reasonable price, and it puts them in charge of at least part of their own medical care, which for many patients in these situations is really quite empowering."
Denney was asked how many states have adopted medical marijuana laws (13) and about cannabis growing wild ("ditchweed -not very good medicine") and about the impact of the recent Supreme Court ruling. Denney said the DEA had made an effort to reassure Californians that individual patients would not be targeted.
He described the registration system in California and his misgivings about it: "The state has refused to protect individual patient information from the feds… There’s an issue of fairness: no one is required to carry an i.d. card for and other drugs… And patients worry that they might be singled out for harassment by law enforcement at the local and county level.
Rep. Gregg Reep (Dem., Warren) expressed his interest in a deep drawl: "Obviously, there’s people that’s opposed to this. I’ve sat here and listened, and you make a lot of sense. What is the primary opposition that you find that people have to allowing this to be used, and what is your response to that opposition?"
Denney responded, "I think the primary opposition comes from bias -the bias that this is a fraud and a hoax, just an excuse for people to use drugs. This has been the position of the federal government for a long time, and has been ingrained in law enforcement. You can go right now to the website of the California Narcotics Officers Association and read that there is absolutely no medical use for cannabis whatsoever. They continue to claim that this is a major drug of abuse and a major problem. They continue to claim that this is a gateway to drugs of abuse, which was clearly disproven in a report by the Institute of Medicine." The real gateway drugs, Denney opined, are cigarettes and alcohol.
"My cynicism," he added, "tells me that there is a lot of money in the war on drugs. In California this money comes from the federal government, it comes through the state Department of Justice and is distributed to each county by a formula. You get points for every arrest you make, you get points for every conviction you get, and what’s most disturbing, you get points for how long the sentences are. These points are put together to determine how much each county gets of this substantial money. In my county, El Dorado County, in the last year that I have records for, 2001, it approached a million dollars. It’s spent for all the fancy stuff -night-vision goggles, camouflaged uniforms and helicopter time and vehicles with tinted windows. In addition, it pays for much of their ovetime."
Rep. Johnny Key then shared a truly radical insight: "I see a difference between marijuana and the opiate drugs in that no one is coming to us asking for legalization of opium poppies, nobody’s asking for legalization of coca leaves. Why is it just marijuana? I sat here 18 months ago when we had this bill or one similar to it before us and this is the only one that keeps coming up. So, from your medical knowledge and training and experience, why is it just marijuana that we keep talking about?"
Denney, who is white-haired and courtly, resisted the temptation to respond, "Why, indeed?" He said, "This really is a political question and not a medical question. The federal government has flatly refused to even consider allowing cannabis to be used medically. I could write a prescription for you today to go to the drugstore and obtain cocaine. I could also write a prescription for morphine, or amphetamine. So, part of the problem is that the full benefits of cannabis are not available in any other way. Cannabis is so widely used and so many people have experience with it directly -that must also play a role."
Rep. Reep noted the difference between cannabis and "a substance that has been processed and purified under FDA guidelines." Denney, as quick as he is diplomatic, said, "I think you’re right: the FDA does have an obligation to make sure that the medicines we take are safe and effective. And I would welcome the FDA getting involved in this. I really think the answer is to have this substance available at the pharmacy on prescription, just like all the other medications that we use. If we could just get past some of the political opposition to allow physicians to be in charge… And many patients would prefer filling a prescription to get cannabis that they had some idea was grown safely and without pesticides."
"So wouldn’t it be simpler to work for a solution on the federal level?," Reep asked. Denney expressed "mixed feelings about that." He recalled learning in college "that we are a republic made up of states that retain all the powers that they don’t assign to the feds. Individual states can and should make health policy. Californians have decided what they want to do about cannabis, and I think Arkansans should, too." Reep said, "I think there’s some areas we could find agreement on." Which summed up the sense of the meeting.
Denney was followed by a lawyer, Cathi Compton, who told of a case in which an elderly, indigent couple in Calhoun County had been arrested for growing a few marijuana plants in their backyard. Their grown daughter was suffering from stomach cancer; they were using it to make a tea for her. They worked out a plea bargain limiting their punishment to probation. The judge refused to approve the deal, saying "There’s too much dope here." The old folks began to weep. "Then the prosecuting attorney made the most eloquent and moving speech I’ve ever heard in all my years in the practice of law," said Compton, "explaining to the court the reason we’d come up with this agreement. The court accepted the plea agreement after all and the elderly couple went on their way, after an enormous amount of stress and strain, and they then had to make a ridiculous trip once a month to the probation officer, ’cause they really had no criminal intent… On a more personal level, I buried my daddy this summer from cancer. If I could have given him marijuana in any form or fashion to relieve the anxiety that he felt as he began not being able to breathe, I’d have given it to him. I would have faced jail time, penitentiary time, but I would have done it. And I submit that most of you would do the same thing."
The case for continued prohibition was made by a small, soft-spoken man named John Thomas, director of the Arkansas Physicians Resource Council (an administrator, not a doctor), who combined a humble manner with a vicious rap. "There’s been a lot of stories about people who have benefited, and I don’t deny any of those stories," he said sweetly, "but I would like to add that the National Institute of Health (sic) has done an exhaustive study on the use of medical marijuana and they have determined that it is not a safe or more effective treatment than Marinol… The American Medical Association, the American Cancer Society, the National MS society, the American Glaucoma Society have not accepted smoking marijuana for medical use… I find that it’s ironic that we spent at least an hour talking about how we’re trying to stop smoking in the state and now we’re talking about prescribing -at least sometimes this would be smoked. So you can’t really safeguard this. I think Representative Key made a very good point that yes, physicians do write some very strong prescriptions, and that smoking marijuana might be considered much more mild than what we prescribe, but we are not telling people to go their homes and grow opium -however you make opium- we’re not asking them to do it at home, we’re controlling that process."
The last speaker was a 43 year old CPA named Debbie Carter who had undergone surgery for brain cancer but was not fully cured. She said she had finished a year of chemotherapy in March. She went down to 95 pounds. Cannabis restored her appetite and enabled her to reduce her dependence on antidepressants, seizure medications, and other drugs. "Brain cancer," she said matter-of-factly, "is very hard to deal with. On chemo you just get so sick, you sometimes can’t even hold down your anti-nausea medicine. And that’s when I would smoke marijuana and I would finally come to a little rest, you know, and be able to take my other medicine. You don’t want to eat at all. But the marijuana would make me a little hungry, and I would eat a little bit…"
Denele Campbell said afterwards, "The legislators who were present and asking most of the questions were some of our strongest opponents. I believe they were favorably influenced by the testimony. I think perhaps for the first time they have some things to think about that won’t be easily dismissed from their minds. The challenge has been — and remains — to take the discussion beyond their prejudices, and I think we were successful in that regard.
"Term limits is a big problem here. About the time legislators have heard enough about the issue and learned enough about the overall legislative process to decide they might support such a controversial reform, they are out of office. We will be mailing educational materials to each legislator and candidate during 2006. Whoever is elected or re-elected in November 2006 will have heard about our issue from those mailings. We hope to have a few co-sponsors on a bill introduced in January ’07, and that we can at least get that bill out of committee.
"Those who were at the hearing or any prior hearing, have learned important things they didn’t know about marijuana. And they won’t forget, whether they are re-elected, or simply return to their communities. Their legislative experience will always put them in a leadership role in their communities, and what they know will serve them for the rest of their lives. In this regard, we are educating the state’s grassroots leadership through our hearings –at the least.
"Not only did Dr. Denney answer their questions quite well, he put an ethical, caring face on the ‘California’ mythology that permeates the mid-south Bible belt."