To give you some idea of what we have discovered and what we are looking for, we are posting several

excerpts from the revised and expanded edition of Marihuana, the Forbidden Medicine. Here are several accounts of medical marijuana use from our book, in the words of people who have experienced its value.

!" #$ H#M%TH#$!&' (F$%M )$. *$+",&%%"%,T#%!$TH$+T+, &$#M#",T$.!/ ,'")$%M# 0+&%/!$ %$ M!"+ 1)#&$#,,+2# )+,%$)#$ &,#.)%T.M%$ #$#0$+ )+!0#T+ *!,T$%&!$#,+, M!$+3.!"! !") !*+"*

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#arly in 5678, after the death of ,idney Farber, the Harvard children9s oncologist for whom the ,idney Farber ancer $esearch enter was named, my wife and + were invited to dinner at the home of a fellow Harvard Medical ,chool faculty member. He wanted me to meet #mil Frei, who had arrived from Houston to serve as )r. Farber9s successor. !t dinner, )r. Frei told me about an eighteen1year1old Houston man with leukemia who had become more and more resistant to cancer chemotherapy because he could no longer tolerate the nausea and vomiting. His doctors and his family were finding it increasingly difficult to persuade him to take the drug on which his life depended. %ne day, to )r. Frei9s surprise, the young man willingly agreed to take the drug and from then on offered no resistance to chemotherapy. He eventually revealed that he had been smoking marijuana twenty minutes before each session: it prevented all vomiting and even the slightest hint of nausea. )r. Frei asked me whether this property was mentioned in the nineteenth1century medical literature on cannabis, and

+ told him that it was. %n the way home my wife 0etsy, who had listened with great interest, suggested that we obtain some cannabis for our son )anny. )anny was first given the diagnosis of acute lymphatic leukemia in 3uly 56;7: he was ten years old. For the first few years he was good natured about his treatment at hildren9s Hospital in 0oston, and even about the occasional need for hospitali<ation. 0ut in 5675 he started taking the first of the drugs that cause severe nausea and vomiting. )anny was one of those patients in whom these reactions were uncontrollable and not sufficiently alleviated by standard antiemetics. He would start to vomit shortly after treatment and continue retching for up to eight hours. He vomited in the car as we drove home, and on arriving he had to lie in bed with his head over a bucket on the floor. ,till, + was shocked when 0etsy suggested that we find cannabis for )anny. + objected because it was against the law and because it might embarrass staff members at the hospital, who had been so remarkable in their commitment to )anny9s care. + dismissed the idea. )anny9s next treatment was two weeks later. =hen + arrived, 0etsy and )anny were already in the treatment room. + shall never forget my surprise. "ormally my wife and son were in a state of great anxiety before the treatment began, but this time they were completely relaxed, and, what is more, seemed almost to be playing a joke on me. Finally they let me in on the secret. %n the way to the clinic that morning they had stopped near =ellesley High ,chool, and 0etsy had asked one of )anny9s friends to get her some marijuana. %nce he recovered from his disbelief, the friend had run off and reappeared a few minutes later with a small amount of marijuana. 0etsy and )anny had smoked it in the parking lot of the hospital just before entering the clinic. My surprise gave way to relief as + saw how comfortable )anny was. He did not protest as he was given the medicine, and we were all delighted when no nausea or vomiting followed. %n the way home he asked his mother if he could stop for a submarine sandwich, and when he got home he began his usual activities instead of going straight to bed. =e could scarcely believe it. The next day + called )r. "orman 3affe, the physician who was in charge of )anny9s care. + explained what had happened and said that while + did not want to embarrass him or the rest of the medical staff, + could not forbid )anny to smoke marijuana before his next treatment. )r. 3affe responded by suggesting that )anny smoke marijuana in his presence in the treatment room.

)anny did that the next time. =hen he was given the chemotherapeutic agent, )r. 3affe could observe for himself that he was completely relaxed. !fterward he again asked for a submarine sandwich. From then on he used marijuana before every treatment, and we were all much more comfortable during the remaining year of his life. )octor 3affe asked me to join him in reporting our observations to )r. Frei, who was sufficiently interested to perform the first clinical experiment on the use of cannabis in cancer chemotherapy. >,allan ,#, ?inberg "#, and Frei +++ #. !ntiemetic effect of delta161tetrahydrocannabinol in patients receiving cancer chemotherapy. "ew #ng. 3. Med 86@ (567A-4 767A1767B. (T%&-

%,T#%!$TH$+T+, %steoarthritis is the most common of all joint diseases, affecting sixteen million people in the .nited ,tates alone, including two1thirds of those over sixty1five. +t usually develops slowly over many years as the layer of shock1absorbing cartilage that protects the ends of bones breaks down, exposing them and allowing them to grind together. The breakdown of cartilage probably results from poor joint alignment or an accumulation of everyday minor traumatic injuries. The main symptoms are joint stiffness, swelling, and pain, especially in the morning. !s the loss of cartilage progresses, irritating the soft tissue around the joint, pain may become constant and interfere with sleep. The disease occurs eCually in both men and women: men are affected especially in the hips and back, women in the hands, and both sexes in the knees. The following account is by Day /ee, an osteoarthritis sufferer who uses marijuana4 + am fifty1one years old. + have raised five children to productive adulthood pretty much single1handedly, and now have four happy grandchildren. + just completed my third year of study toward a 0,%& >0usiness %perationsB degree, while living alone most of the time. + rather enjoy the challenge. Three years ago + began researching the subject of marijuana as a medicine for a term paper. + chose this topic because, after nearly thirty years of recreational, creative, and therapeutic use, + now relegate most of my cannabis to the medicine cabinet 11 exactly as my grandmother did before the politicians just said Eno.E )uring my five1year bout with migraines, marijuana replaced )emerol injections many times: for &M, and cramps, it replaced Mydol and aspirin: for colds, it replaced expectorants, suppressants, decongestants, antihistamines, and analgesics. =hen + had

to pull myself out of depression after my oldest son drowned, marijuana substituted for 2alium and lithium. !nd now + use it for the chronic pain of arthritis. .ntil you or someone you love tries to deal with arthritis, you cannot understand how destructive it is to the Cuality of life. My mother died at the age of sixty1three, physically much older than her biological age. )octors couldnFt agree on whether she had !l<heimerFs or severe depression, but no one misdiagnosed her arthritis. +n the last ten years of her life her hands became crippled, deformed, and nearly useless. Hot wax gloves, ace bandages, creams, and pain medications were of no avail. Her tiny, misshapen fingers twisted and curled over each other, some facing the wrong way: her pain was constant and merciless. For the last couple of years my own hands have begun to take a central place in my life. )octors tell me an injury triggered a propensity that was already there. + have lost most of the strength in my left hand, and pain in both hands is a loud reminder to limit my movements. The ache involves the knuckles, middle joints, and wrists: cold weather or the slightest injury makes it worse. +t is getting hard to lift things and open cans. My fingers become stiff from inaction, from too much action, or from the wrong actions. My sleep is disturbed. =hen + smoke what + call Ekind medicineE, it9s never more than three or four minutes before the ache begins to fade. !lthough it is still there, it seems to have moved into the distance. The physical relief lasts hours longer than the actual high. + try to get a lot done while + am still feeling it. The ideal dose for me is a half joint every four hours. ,ince + can9t always afford to buy that much, when + have some + limit myself to a half joint twice a day 11 once in the morning to work and once at night to sleep. =hen + run out, + simply suffer until + can afford more, and then take on the unpleasant and dangerous task of trying to find cannabis of medicinal Cuality. + used to worry about people knowing + was high, but no one notices, so + have stopped worrying. My mother died in despair, robbed of this gentle medicine by politics. ,he refused to try marijuana because of the misinformation spread by the government and anti1 marijuana groups. %nce my aunt complained to my mother that her son, my cousin, had dropped out of school and was smoking pot. My mother replied, E'ou know, marijuana makes people stupid.E /ater + asked her, E)o you think +Fm stupidGE she looked at me with astonishment and said, E%f course not.E + told her + smoked marijuana. Trembling with fear, she said, E+ often thought + would try it if a doctor would make sure nothing went wrong.E 0ut no doctor would have helped her, and anyway, my father, with his snapped1shut mind, would have turned us all in. + should have educated her anyway, but + didn9t know what + know now. +Fm sorry itFs too late

for her. !s for me, + have decided to spread the word for the sake of everyone who needs this medicine or cares about someone who could benefit from it. hronic pain such as the pain of osteoarthritis is usually treated with opioid narcotics or various synthetic analgesics, but these drugs have many limitations. %pioids are addictive and tolerance develops. The most commonly used synthetic analgesics 11 aspirin, acetaminophen (Tylenol-, and non1steroidal anti1inflammatory drugs (",!+)s- like ibuprofen 11 are not addictive, but they are often insufficiently powerful. Furthermore, they have serious toxic side effects, including gastric bleeding or ulcers and, in the long run, a risk of liver or kidney disease. ,tomach bleeding and ulcers induced by aspirin and other ",!+)s are the most common serious adverse drug reactions reported in the .nited ,tates. These drugs may be responsible for as many as 7;,HHH hospitali<ations and more than 7,;HH deaths annually. Heavy drinkers (more than six ounces of alcohol a day- are especially sensitive to the gastrointestinal effects of ",!+)s. !cetaminophen (Tylenol- is increasingly prescribed instead because it largely spares the digestive tract, but it can cause liver damage or kidney failure when used regularly for long periods. Medical researchers have estimated that patients who take one to three acetaminophen tablets a day for a year or more account for about I15H percent of all cases of end1stage renal disease, a condition that is fatal without dialysis or a kidney transplant. *iven the limitations of opioids and the non1 addictive synthetic analgesics, one might have expected pain specialists to take a second look at cannabis, but the medical literature again suggests little reconsideration. (T%&-

&$#M#",T$.!/ ,'")$%M# The symptoms of premenstrual syndrome (&M,-, which occurs in the week before menstruation, include anxiety, sadness, irritability, fatigue, moodiness, difficulty in concentrating, and various physical discomforts. annabis was commonly used in the nineteenth century for the treatment of symptoms associated with the menstrual cycle. 3.$. $eynolds, Jueen 2ictoria9s physician, prescribed it to her for premenstrual symptoms and menstrual cramps. +n 5I6H he wrote in The /ancet, #ngland9s premier medical journal, that E=hen pure and administered carefully it >cannabisB is one of the most valuable medicines we possess.E !lthough there is no twentieth1century medical literature on the topic, many women with premenstrual syndrome say that they find cannabis useful. 3udy Fix is a thirty1five1year1old administrative assistant to a =all ,treet broker4

+ have used marijuana for many years to alleviate the symptoms of premenstrual syndrome 11 bloating, headaches, mood swings, and anxiety. + also use it to relieve cramping and fatigue during the menstrual cycle itself. + have tried conventional medicines such as aspirin, acetaminophen, and ibuprofen. %nly ibuprofen has any effect: it eliminates cramping, but only in a triple dose that causes increased bloating, drowsiness, and constipation. =hen + start to experience the confusion, anger, and hypersensitivity that signal the onset of a premenstrual mood swing, smoking a joint is the one remedy that works immediately to soothe my nerves. +t is as if my whole system has been slowed to put everything in order. My thought processes are less jumbled: + react less impulsively and become more rational. +f + smoke half a joint at night, + sleep better. My husband of six years has attested to these effects many times. For the last five years + have worked in a fast1paced and tense environment that reCuires me to keep a clear head and make important decisions. %n a normal day smoking pot might be detrimental to my performance, but when +9m premenstrual it becomes necessary if + am to function at my usual capacity. +9ll go outside and take a few hits off a joint, and by the time + return + feel much more in control. +9m able to organi<e my work and think each task through. + usually smoke at two1hour intervals. My employer and some of my co1workers are aware of the situation, and they support me fully, even though they do not smoke marijuana themselves. + recently gave a woman at my workplace a joint during her menstrual period, and she came in the next morning raving about how it eased her cramps and decreased her anxiety. $ecently my husband was charged with possession of marijuana. He had just bought some at a local grocery and we were stopped by undercover cops as we drove away. The police drew their guns, put us up against a wall, and threatened my husband with a beating. !fter speaking with us and seeing we were reasonable people, they told us they had to arrest him to help close down the store. =e were told that he would be held a few hours and then issued a summons, which they said would probably be thrown out of court. The whole experience made me angry. 0oth we and the officers were put in a compromising position. +f pot were legal, the police could concentrate on more serious issues. Meanwhile, + still have to worry about losing my job if the wrong person sees me smoking. + am not a menace to society but a productive person seeking relief from a very real medical problem. The benefits of marijuana greatly outweigh the risks: + have found nothing else as effective and non1irritating. + hope the medical community will grow more assertive in supporting the legali<ation of medical marijuana. ,elective serotonin reuptake inhibitors (,,$+s- such as fluoxetine (&ro<ac- have been shown to be an effective treatment for severe &M,, but they often have side effects,

including loss of sexual desire, that limit their use, and they may not work for all women with the disorder. Further clinical investigation of cannabis is warranted. (T%&-

0+&%/!$ %$ M!"+ 1)#&$#,,+2# )+,%$)#$ +n bipolar or manic1depressive disorder, the inconsolable misery of major depression alternates with mania or uncontrolled elation. +n the manic phase people with bipolar disorder are cheerful, gregarious, talkative, energetic, and hyperactive. Their spending is often extravagant and their behavior reckless. They may imagine that they have extraordinary talents and are or soon will be rich and powerful. This reckless, restless cheerfulness and expansiveness can suddenly turn into incoherent agitation, irritability, rage, paranoia, or grandiose delusions. !ntidepressants alone are not a good treatment for bipolar disorder and may even make it worse. /ithium carbonate, introduced into medicine at about the same time as tricyclics, has revolutioni<ed the treatment of bipolar disorder. +t prevents mania and to a lesser extent bipolar depression. !lthough lithium takes several weeks to start working, its success rate is about 7H percent and 8H percent of patients are completely freed of their symptoms. &atients generally reCuire long1term maintenance treatment, and because lithium can be toxic it must be used carefully. hronic use may endanger the heart, kidneys, and thyroid gland. .sually the dose is gradually increased until the drug begins to work and then periodically readjusted according to the patient9s age, medical condition, and psychiatric symptoms. The amount of lithium in the blood must be checked regularly because it is ineffective if too low and risky if too high. ,ome side effects are weight gain, hand tremors, drowsiness, and excessive thirst or urination. &atients often cannot tolerate lithium either because of the side effects or because it takes some of the joy from their lives along with the manic episodes. +t has been described as a Eloose1fitting emotional straitjacket.E %nly 8H percent of patients with bipolar disorder take lithium alone. %ther drugs used in the treatment of bipolar disorder are the anticonvulsants carbama<epine (Tegretol- and valproic acid ()epakote-, which may be used either alone or in combination with lithium. Thirty to KH percent of patients with bipolar disorder are not consistently helped by conventional treatment. For some of them cannabis may be useful in ameliorating the symptoms, reducing side effects of lithium, or both. The following accounts are by a forty1year1old software engineer and his thirty1seven1 year1old wife, who suffers from bipolar disorder. He speaks first4

My wife and + and our two boys live in Tyngsboro, Massachusetts. My wife was given a diagnosis of bipolar disorder in 56I8 and has been taking lithium since 5668. ,he also uses marijuana for her symptoms. ,he has had six psychiatrists in the past fourteen years and has been interviewed by many more. + have always told them that she uses marijuana regularly, and not one of them has told her to stop. They do not even seem to care or pay attention. + posted a Cuestion about this to the alt.support.depression.manic newsgroup on the +nternet. + asked whether doctors knew something about marijuana but could not recommend it because of its illegality. The responses were varied, but most people who were manic1depressive said marijuana helped them, and one said that some doctors considered it effective in controlling mood disorders. My wife functions much better when she uses marijuana. =hen she is hypomanic, it relaxes her, helps her sleep, and slows her speech down. =hen she is depressed and would otherwise lie in bed all day, the marijuana makes her more active. =hen she runs out of marijuana and can9t get more, she becomes more irritable and hard to live with. /ithium is also effective, but it doesn9t always keep her in control during seasonal mood changes. %ur dilemma is that our thirteen1year1old has been through the )!$# program and has learned about the evils of drugs and alcohol. He opposes all substance use, legal or illegal 111 and + want it that way. 0ut he knows that my wife uses marijuana and it EeatsE at him, although he also knows about her illness and how marijuana helps. .nderstandably, all this confuses him. + believe that marijuana could help some people if it were made available as a prescription medicine. ertainly there are other health and social issues involved, and + can9t decide what would be right for the country as a whole. !ll + know is that in this family it has relieved us all of much suffering. "ow his wife4 + am thirty1seven, and + have been using marijuana for twenty years. + was diagnosed bipolar in 56I8. + take lithium and =ellbutrin >bupropionB, although + dislike these drugs. +9ve gained about forty pounds since + started taking lithium, but otherwise there are no side effects. My thirteen1year1old son knows about my illness. He has also known about my marijuana smoking for about five years. He reali<ed what + was doing after he participated in the )!$# program in school. +t bothers me when he comes home and says they talked about drugs and he was thinking that his mother is Eone of themE. He

doesn9t want anyone to know his mother is a Edruggie,E and until now we9ve kept it as our secret. + don9t think he would tell anyone, but +9m still afraid something might get out. ,ometimes these programs use tricks to get kids to inform on their friends and relatives. They say, E+f you really care about this person, the only way you can help them is to report them.E My husband has talked to him about it. He has explained that lithium and the other medications +9m taking are drugs. He also explained that many legal drugs are far more dangerous than marijuana and that no one has ever died from using marijuana. 0ut my son insists that if it is illegal, then it is wrong. This bothers me so much that + have considered stopping. The trouble is that at times when + feel tired and run1down, just a couple puffs of marijuana bring me back to life. ,ometimes + think it brings me to a level of normalcy that everyone else achieves naturally. !t other times, when everything seems to be going like a whirlwind around me and + can9t keep track of what +9m thinking about or saying or feeling, the marijuana just seems to slow the world down a bit. =hen + have trouble sleeping, it helps <onk me out, but if + have trouble waking up it brings me to life. + don9t like being thought of as a Edrug1abusing mother,E but + actually think +9m a better mom when +9m feeling in control because of marijuana. (T%&-

&,#.)%T.M%$ #$#0$+ &seudotumor cerebri is an uncommon disorder characteri<ed by abnormally high pressure of the cerebrospinal fluid ( ,F-. #ither the fluid is being produced at an accelerated rate or its outflow is being slowed: the underlying cause is unknown. The symptoms, which may include headaches, nausea, vomiting, and visual disturbances, resemble those of a brain tumor 11 thus the name. The patient9s vision may be endangered by papilledema (swelling of the optic disk-. The disorder is three times more common in women than in men, and it may last from several months to a lifetime. "one of the available treatments is especially effective, and the high rate of spontaneous recovery makes the evaluation of treatments difficult. &atients are sometimes given corticosteroids and high doses of diuretics to reduce fluid pressure. FreCuent lumbar punctures (spinal taps- may be reCuired to drain off ,F. +n serious cases surgery is performed to insert a tube to shunt fluid from the brain into the abdominal cavity. !s a last resort, when vision is seriously threatened and other treatments have failed, a surgeon may make an incision in the sheath of the optic nerve to relieve the pressure of papilledema.

/ori Horn is a twenty1nine1year1old woman with pseudotumor cerebri who has used marijuana recreationally since the age of eighteen. Here is her story4 !bout four years ago + decided to Cuit using marijuana because bills were becoming hard to pay. !fter five months of abstinence + began to develop severe headaches and disturbances in my vision (spots before my eyes-. + went to see an optometrist, thinking + might need glasses. He sent me to a hospital ophthalmologist, who found acute pressure behind my eyes and three pinprick hemorrhages. + was rushed to an emergency room, where a neurologist said + might have a brain tumor. Fortunately, L1 rays, !T scans, blood tests, and a spinal tap all came back negative. !t that point + was given the diagnosis of pseudotumor cerebri. The doctors prescribed Motrin >ibuprofen, a non1steroidal anti1inflammatory drugB, prednisone >a powerful steroidB, and )iamox >aceta<olamide, a diureticB. The prednisone made me extremely moody: my face swelled up and + gained an enormous amount of weight. The )iamox caused muscle cramps and made my leaky bladder worse. Motrin did almost nothing for my headaches. + was told + might need surgery (which didn9t always work- to prevent blindness. + began to live in fear of losing my sight: + had nightmares and cried for hours. 0y now it had been eight months since +9d last used marijuana, so + decided to smoke a joint. +t was almost magical. For the next two weeks + had no headaches, no disturbances in vision. )octors even said my eyes looked better (the papilledema had disappeared-. =hen + told my neurologist, he didn9t seem very interested but said, E+f it works, use it.E !lthough it was against doctors9 orders, + Cuit taking all the prescribed medications and began smoking a joint once every few days instead. "ow + find that + get headaches and visual disturbances if + go more than a week without a good joint. The more potent the marijuana, the longer my eyes remain healthy. They look so good now that all talk of shunt surgery and spinal taps to relieve pressure has ended. My family has watched the miracle of my marijuana use, and they know it helps me. + thank *od it was there as an alternative to the knife and to drugs like prednisone. + only wish + had a doctor to back me up, but the hospital where + was treated offered me no support, not even written documentation of my self1medication and its miraculous effects. =hen + heard about you + decided to tell you my story. +t touches my heart to find that there really are people who care about people like me. =hat can + do, where can + goG +9ve been charged with possession once already. + pray it doesn9t happen again. (T%&-

)+!0#T+ *!,T$%&!$#,+, %ne long1term effect of diabetes, especially the kind that begins early in life (sometimes referred to as juvenile or Type + diabetes-, is damage to nerve fibers of the autonomic nervous system. This system controls, among other things, the gastrointestinal tract, and three1fourths of people with diabetes have gastrointestinal symptoms. %ne common syndrome is diabetic gastroparesis (the word means paralysis of the stomach-, a disorder in which food remains in the stomach because of a failure of peristalsis, the natural contraction and relaxation of muscles that moves it along. The resulting symptoms include bloating, belching, nausea, vomiting, a sense of fullness, and appetite loss. ,ome serious conseCuences are malnourishment and loss of control over blood sugar levels. &atients are advised to avoid foods that slow gastric emptying and given prescriptions for agents that speed it up, such as metoclopramide ($eglan- and cisapride (&ropulsid-. +n the most severe cases surgery is attempted. "one of the standard treatments works particularly well. The following account was written by a thirty1seven1year1old man who suffers from this syndrome4 +n 56;@, when + was five, + was diagnosed with diabetes mellitus after falling into a three1day coma. 0y the time + was hospitali<ed, my blood sugar was so high that all the veins in my body had collapsed. + have been dependent on insulin ever since, and it is a miracle that + am alive today to write this. My purpose is to inform other diabetics about a treatment for one particular diabetic complication. + am one of those diabetics who is regarded as EbrittleE because our blood sugar fluctuates wildly and almost uncontrollably. The resulting poor blood circulation and nerve damage (neuropathy- affect every part of the body, causing a myriad of symptoms. The one that concerns me here is the loss of function in the gut that occurs after many years of nerve and circulatory damage. The muscles of the *+ tract, especially the stomach, are unable to move food through my system. +t9s called diabetic gastroparesis. The food sits in the stomach and causes bloating, acid buildup, and nausea, which may lead to vomiting. +f this goes untreated, it can be life1 threatening. 0lood sugar Cuickly rises to dangerous levels, and the resulting dehydration almost always leads to hospitali<ation for as much as a week. This condition must be fairly common, since the pharmaceutical companies make two medications specifically designed to treat it, $eglan and &ropulsid. $eglan is effective but very sedating. + used it for eight years, and + feel almost as though + slept through those years. +t also caused me to lose eCuilibrium and contributed to a loss of sexual

functioning. &ropulsid, which + have been taking for about two years, does not have these side effects, but it doesn9t move food through my system nearly as well, even at the double dose + am taking now. !nother drawback is the cost of M5;H a month, which is a real hardship for someone living on a fixed income. + take my medication as prescribed, but in addition, when + can, + have begun to smoke a small amount of cannabis twenty minutes before each meal, usually just a couple of hits from a pipe. This outlaw drug makes the prescribed medication more effective. The bloating, the nausea, and the feeling of fullness go away, with practically no side effects. For the first time in years + can sit down to a meal and actually feel like eating (to see what + mean, try eating a full meal when you are already full from having just eaten-. The only problem + have with cannabis is that the supply is unreliable and street prices are just ridiculous. Most of the time + cannot find it or cannot afford to pay the going rate. !nd + am made to feel like a criminal for seeking an effective treatment for a potentially life1threatening condition. ,omeone who is dying from a chronic degenerative disease should not have to face incarceration because an effective medication for that disease has been made illegal by the government. + am only asking to be allowed to raise a small patch in my own yard for my own personal use. =ho is harmed by thatG Meanwhile, + hope + can help improve the Cuality of life for others suffering from gastroparesis by sharing my experience with cannabis. (T%&-

M!$+3.!"! !") !*+"* /argely by historical accident, marijuana in late twentieth1century !merica is regarded as exclusively a habit of the young. 0ut it has not been so closely associated with youth at other times and places, including the .nited ,tates in the nineteenth century, when cannabis was used mainly as a medicine. More than three decades have passed since marijuana first became popular in the .nited ,tates, and members of the generation that learned to enjoy it then are moving toward old age. Many of them will probably discover that cannabis can ease the burdens of age as well as enhance the pleasures of youth. The people who tell their stories below may be pioneers. %ne such pioneer is )el 0rebner who is 7I4 +n old age it often seems that everything is depressing. ETry not to get old,E + advise young checkout clerks while +9m fumbling old1lady1like for the grocery money. ,ometimes + think +9m not really joking. + may make an offhand remark about the funeral of the week, but that9s no joke either. !t seventy1eight you attend too many funerals. The daughter of an old friend calls and you know the instant you hear her

voice that she is going to tell you that your old friend has succumbed. %f course + am reminded that +9m going to die in a minute. !fter all, my father died at seventy1nine. + get an MI,HHH bill from my dentist. + remember when dentist bills were around M8H. My knees hurt. =hy doesn9t my son callG /ast night + trumped my partner9s ace. +9ve been playing pretty good bridge for sixty yearsN !nd + did thatG &ensionN =ho wants a pensionN +t is increasingly painful to observe political chicanery, corruption, and cynicism. ,ophie, my best friend for seventy years, calls and we sputter together about these things. =e send newspaper editorials and columns to each other. =e despair of the world. %h, and + forget names + have known forever. The names of friends, writers, actors, names + used this morning. + hate myself. My husband hates me too, + guess. + listen to him muttering baby talk to the cat, and + crawl into myself and feel sorry for the lost woman + was. +n short, sometimes old age seems to present a daunting parade of gloomy displeasures and discomforts. !nd when all these natural burdens accumulate, help is hard to get. =ell, it may be easy to get &ro<ac or lithium. Hard to get is what may be the best medicine 11 marijuana. +9m trying to exercise restraint, but this is an issue on which + am tempted to morali<e and preach. !n occasional hit on a simple little dried leaf in a pipe or rolled into what looks like about a third of a tobacco cigarette takes me on a small but restorative ego trip. + enjoy this three or four times a week, using about a tablespoonful of the weed altogether. The Cuality of the pot varies, and so do the results, but almost invariably + achieve some release from the emotional and physical burdens of a Eripe old age.E + have happy thoughts about the person whose funeral + attended recently. =hat fun we had together at the 56@6 =orld9s FairN =hat a good life she hadN !ll those adorable grandchildrenN My father died at seventy1nine, but my mother is one hundred and two years old, and anyway, if + die + won9t know it. !nd meanwhile + have this fabulous book to read, putting it aside now and then to prolong the pleasure. + dip up a handful of mixed nuts and munch contentedly, enjoying all those expensive bridges + paid for. My knees don9t hurt. They will, but right now + don9t have to go down any stairs, and anyway they9re not so bad. /ook at all the people who need knee surgery and hip replacement. !ll + have is a little discomfort. + can handle it. + call my five1hundred1month1old baby and we share a few jokes, some news. He keeps me on the phone, and we plan a weekend. He will bring some friends +

particularly enjoy. ,o what if + trumped my partner9s aceG )on9t we all do that once in a whileG +9ll do fine next time + play. That pension check is just dandy. +t9s paying for my dentist, and + don9t have to put on tight shoes with heels and go to work in the morning. 0ut boy, wasn9t + goodG !nd couldn9t + do it nowG (Thus speaks marijuana.Thank heaven + have ,ophie to sputter with about political opportunism. =e actually have a great time lashing out at our leaders. 'es, + forget names, but + almost always do well playing Famous "ames, even against much younger people. !nd between us, my husband and + can usually come up with a name we are looking for. HeyN How can he not love meG + go over and kiss him, and together we smile down on the best cat in the world as we snuggle for a while. + am basically an optimist, but + would have more persistent negative feelings about heading into my eighties and extinction if + did not have the pleasure of my marijuana1induced ego trips. !nd that9s not all. + also find it helpful for insomnia, itchy skin, boredom, loss of appetite, indigestion, and 11 name it. ,ometimes, to be sure, + recall that using the forbidden medicine is a crime, and + wonder what kind of ego trip a women9s prison would provide. (T%&-

To give you some idea of what we have discovered and what we are looking for, we are posting several excerpts from the revised and expanded edition of Marihuana, the Forbidden Medicine. Here are several accounts of medical marijuana use from our book, in the words of people who have experienced its value.

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#arly in 5678, after the death of ,idney Farber, the Harvard children9s oncologist for whom the ,idney Farber ancer $esearch enter was named, my wife and + were invited to dinner at the home of a fellow Harvard Medical ,chool faculty member. He

wanted me to meet #mil Frei, who had arrived from Houston to serve as )r. Farber9s successor. !t dinner, )r. Frei told me about an eighteen1year1old Houston man with leukemia who had become more and more resistant to cancer chemotherapy because he could no longer tolerate the nausea and vomiting. His doctors and his family were finding it increasingly difficult to persuade him to take the drug on which his life depended. %ne day, to )r. Frei9s surprise, the young man willingly agreed to take the drug and from then on offered no resistance to chemotherapy. He eventually revealed that he had been smoking marijuana twenty minutes before each session: it prevented all vomiting and even the slightest hint of nausea. )r. Frei asked me whether this property was mentioned in the nineteenth1century medical literature on cannabis, and + told him that it was. %n the way home my wife 0etsy, who had listened with great interest, suggested that we obtain some cannabis for our son )anny. )anny was first given the diagnosis of acute lymphatic leukemia in 3uly 56;7: he was ten years old. For the first few years he was good natured about his treatment at hildren9s Hospital in 0oston, and even about the occasional need for hospitali<ation. 0ut in 5675 he started taking the first of the drugs that cause severe nausea and vomiting. )anny was one of those patients in whom these reactions were uncontrollable and not sufficiently alleviated by standard antiemetics. He would start to vomit shortly after treatment and continue retching for up to eight hours. He vomited in the car as we drove home, and on arriving he had to lie in bed with his head over a bucket on the floor. ,till, + was shocked when 0etsy suggested that we find cannabis for )anny. + objected because it was against the law and because it might embarrass staff members at the hospital, who had been so remarkable in their commitment to )anny9s care. + dismissed the idea. )anny9s next treatment was two weeks later. =hen + arrived, 0etsy and )anny were already in the treatment room. + shall never forget my surprise. "ormally my wife and son were in a state of great anxiety before the treatment began, but this time they were completely relaxed, and, what is more, seemed almost to be playing a joke on me. Finally they let me in on the secret. %n the way to the clinic that morning they had stopped near =ellesley High ,chool, and 0etsy had asked one of )anny9s friends to get her some marijuana. %nce he recovered from his disbelief, the friend had run off and reappeared a few minutes later with a small amount of marijuana. 0etsy and )anny had smoked it in the parking lot of the hospital just before entering the clinic.

My surprise gave way to relief as + saw how comfortable )anny was. He did not protest as he was given the medicine, and we were all delighted when no nausea or vomiting followed. %n the way home he asked his mother if he could stop for a submarine sandwich, and when he got home he began his usual activities instead of going straight to bed. =e could scarcely believe it. The next day + called )r. "orman 3affe, the physician who was in charge of )anny9s care. + explained what had happened and said that while + did not want to embarrass him or the rest of the medical staff, + could not forbid )anny to smoke marijuana before his next treatment. )r. 3affe responded by suggesting that )anny smoke marijuana in his presence in the treatment room. )anny did that the next time. =hen he was given the chemotherapeutic agent, )r. 3affe could observe for himself that he was completely relaxed. !fterward he again asked for a submarine sandwich. From then on he used marijuana before every treatment, and we were all much more comfortable during the remaining year of his life. )octor 3affe asked me to join him in reporting our observations to )r. Frei, who was sufficiently interested to perform the first clinical experiment on the use of cannabis in cancer chemotherapy. >,allan ,#, ?inberg "#, and Frei +++ #. !ntiemetic effect of delta161tetrahydrocannabinol in patients receiving cancer chemotherapy. "ew #ng. 3. Med 86@ (567A-4 767A1767B. (T%&-

%,T#%!$TH$+T+, %steoarthritis is the most common of all joint diseases, affecting sixteen million people in the .nited ,tates alone, including two1thirds of those over sixty1five. +t usually develops slowly over many years as the layer of shock1absorbing cartilage that protects the ends of bones breaks down, exposing them and allowing them to grind together. The breakdown of cartilage probably results from poor joint alignment or an accumulation of everyday minor traumatic injuries. The main symptoms are joint stiffness, swelling, and pain, especially in the morning. !s the loss of cartilage progresses, irritating the soft tissue around the joint, pain may become constant and interfere with sleep. The disease occurs eCually in both men and women: men are affected especially in the hips and back, women in the hands, and both sexes in the knees. The following account is by Day /ee, an osteoarthritis sufferer who uses marijuana4

+ am fifty1one years old. + have raised five children to productive adulthood pretty much single1handedly, and now have four happy grandchildren. + just completed my third year of study toward a 0,%& >0usiness %perationsB degree, while living alone most of the time. + rather enjoy the challenge. Three years ago + began researching the subject of marijuana as a medicine for a term paper. + chose this topic because, after nearly thirty years of recreational, creative, and therapeutic use, + now relegate most of my cannabis to the medicine cabinet 11 exactly as my grandmother did before the politicians just said Eno.E )uring my five1year bout with migraines, marijuana replaced )emerol injections many times: for &M, and cramps, it replaced Mydol and aspirin: for colds, it replaced expectorants, suppressants, decongestants, antihistamines, and analgesics. =hen + had to pull myself out of depression after my oldest son drowned, marijuana substituted for 2alium and lithium. !nd now + use it for the chronic pain of arthritis. .ntil you or someone you love tries to deal with arthritis, you cannot understand how destructive it is to the Cuality of life. My mother died at the age of sixty1three, physically much older than her biological age. )octors couldnFt agree on whether she had !l<heimerFs or severe depression, but no one misdiagnosed her arthritis. +n the last ten years of her life her hands became crippled, deformed, and nearly useless. Hot wax gloves, ace bandages, creams, and pain medications were of no avail. Her tiny, misshapen fingers twisted and curled over each other, some facing the wrong way: her pain was constant and merciless. For the last couple of years my own hands have begun to take a central place in my life. )octors tell me an injury triggered a propensity that was already there. + have lost most of the strength in my left hand, and pain in both hands is a loud reminder to limit my movements. The ache involves the knuckles, middle joints, and wrists: cold weather or the slightest injury makes it worse. +t is getting hard to lift things and open cans. My fingers become stiff from inaction, from too much action, or from the wrong actions. My sleep is disturbed. =hen + smoke what + call Ekind medicineE, it9s never more than three or four minutes before the ache begins to fade. !lthough it is still there, it seems to have moved into the distance. The physical relief lasts hours longer than the actual high. + try to get a lot done while + am still feeling it. The ideal dose for me is a half joint every four hours. ,ince + can9t always afford to buy that much, when + have some + limit myself to a half joint twice a day 11 once in the morning to work and once at night to sleep. =hen + run out, + simply suffer until + can afford more, and then take on the unpleasant and dangerous task of trying to find

cannabis of medicinal Cuality. + used to worry about people knowing + was high, but no one notices, so + have stopped worrying. My mother died in despair, robbed of this gentle medicine by politics. ,he refused to try marijuana because of the misinformation spread by the government and anti1 marijuana groups. %nce my aunt complained to my mother that her son, my cousin, had dropped out of school and was smoking pot. My mother replied, E'ou know, marijuana makes people stupid.E /ater + asked her, E)o you think +Fm stupidGE she looked at me with astonishment and said, E%f course not.E + told her + smoked marijuana. Trembling with fear, she said, E+ often thought + would try it if a doctor would make sure nothing went wrong.E 0ut no doctor would have helped her, and anyway, my father, with his snapped1shut mind, would have turned us all in. + should have educated her anyway, but + didn9t know what + know now. +Fm sorry itFs too late for her. !s for me, + have decided to spread the word for the sake of everyone who needs this medicine or cares about someone who could benefit from it. hronic pain such as the pain of osteoarthritis is usually treated with opioid narcotics or various synthetic analgesics, but these drugs have many limitations. %pioids are addictive and tolerance develops. The most commonly used synthetic analgesics 11 aspirin, acetaminophen (Tylenol-, and non1steroidal anti1inflammatory drugs (",!+)s- like ibuprofen 11 are not addictive, but they are often insufficiently powerful. Furthermore, they have serious toxic side effects, including gastric bleeding or ulcers and, in the long run, a risk of liver or kidney disease. ,tomach bleeding and ulcers induced by aspirin and other ",!+)s are the most common serious adverse drug reactions reported in the .nited ,tates. These drugs may be responsible for as many as 7;,HHH hospitali<ations and more than 7,;HH deaths annually. Heavy drinkers (more than six ounces of alcohol a day- are especially sensitive to the gastrointestinal effects of ",!+)s. !cetaminophen (Tylenol- is increasingly prescribed instead because it largely spares the digestive tract, but it can cause liver damage or kidney failure when used regularly for long periods. Medical researchers have estimated that patients who take one to three acetaminophen tablets a day for a year or more account for about I15H percent of all cases of end1stage renal disease, a condition that is fatal without dialysis or a kidney transplant. *iven the limitations of opioids and the non1 addictive synthetic analgesics, one might have expected pain specialists to take a second look at cannabis, but the medical literature again suggests little reconsideration. (T%&-

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The symptoms of premenstrual syndrome (&M,-, which occurs in the week before menstruation, include anxiety, sadness, irritability, fatigue, moodiness, difficulty in concentrating, and various physical discomforts. annabis was commonly used in the nineteenth century for the treatment of symptoms associated with the menstrual cycle. 3.$. $eynolds, Jueen 2ictoria9s physician, prescribed it to her for premenstrual symptoms and menstrual cramps. +n 5I6H he wrote in The /ancet, #ngland9s premier medical journal, that E=hen pure and administered carefully it >cannabisB is one of the most valuable medicines we possess.E !lthough there is no twentieth1century medical literature on the topic, many women with premenstrual syndrome say that they find cannabis useful. 3udy Fix is a thirty1five1year1old administrative assistant to a =all ,treet broker4 + have used marijuana for many years to alleviate the symptoms of premenstrual syndrome 11 bloating, headaches, mood swings, and anxiety. + also use it to relieve cramping and fatigue during the menstrual cycle itself. + have tried conventional medicines such as aspirin, acetaminophen, and ibuprofen. %nly ibuprofen has any effect: it eliminates cramping, but only in a triple dose that causes increased bloating, drowsiness, and constipation. =hen + start to experience the confusion, anger, and hypersensitivity that signal the onset of a premenstrual mood swing, smoking a joint is the one remedy that works immediately to soothe my nerves. +t is as if my whole system has been slowed to put everything in order. My thought processes are less jumbled: + react less impulsively and become more rational. +f + smoke half a joint at night, + sleep better. My husband of six years has attested to these effects many times. For the last five years + have worked in a fast1paced and tense environment that reCuires me to keep a clear head and make important decisions. %n a normal day smoking pot might be detrimental to my performance, but when +9m premenstrual it becomes necessary if + am to function at my usual capacity. +9ll go outside and take a few hits off a joint, and by the time + return + feel much more in control. +9m able to organi<e my work and think each task through. + usually smoke at two1hour intervals. My employer and some of my co1workers are aware of the situation, and they support me fully, even though they do not smoke marijuana themselves. + recently gave a woman at my workplace a joint during her menstrual period, and she came in the next morning raving about how it eased her cramps and decreased her anxiety. $ecently my husband was charged with possession of marijuana. He had just bought some at a local grocery and we were stopped by undercover cops as we drove away. The police drew their guns, put us up against a wall, and threatened my husband with a beating. !fter speaking with us and seeing we were reasonable people, they told us they had to arrest him to help close down the store. =e were told that he would be

held a few hours and then issued a summons, which they said would probably be thrown out of court. The whole experience made me angry. 0oth we and the officers were put in a compromising position. +f pot were legal, the police could concentrate on more serious issues. Meanwhile, + still have to worry about losing my job if the wrong person sees me smoking. + am not a menace to society but a productive person seeking relief from a very real medical problem. The benefits of marijuana greatly outweigh the risks: + have found nothing else as effective and non1irritating. + hope the medical community will grow more assertive in supporting the legali<ation of medical marijuana. ,elective serotonin reuptake inhibitors (,,$+s- such as fluoxetine (&ro<ac- have been shown to be an effective treatment for severe &M,, but they often have side effects, including loss of sexual desire, that limit their use, and they may not work for all women with the disorder. Further clinical investigation of cannabis is warranted. (T%&-

0+&%/!$ %$ M!"+ 1)#&$#,,+2# )+,%$)#$ +n bipolar or manic1depressive disorder, the inconsolable misery of major depression alternates with mania or uncontrolled elation. +n the manic phase people with bipolar disorder are cheerful, gregarious, talkative, energetic, and hyperactive. Their spending is often extravagant and their behavior reckless. They may imagine that they have extraordinary talents and are or soon will be rich and powerful. This reckless, restless cheerfulness and expansiveness can suddenly turn into incoherent agitation, irritability, rage, paranoia, or grandiose delusions. !ntidepressants alone are not a good treatment for bipolar disorder and may even make it worse. /ithium carbonate, introduced into medicine at about the same time as tricyclics, has revolutioni<ed the treatment of bipolar disorder. +t prevents mania and to a lesser extent bipolar depression. !lthough lithium takes several weeks to start working, its success rate is about 7H percent and 8H percent of patients are completely freed of their symptoms. &atients generally reCuire long1term maintenance treatment, and because lithium can be toxic it must be used carefully. hronic use may endanger the heart, kidneys, and thyroid gland. .sually the dose is gradually increased until the drug begins to work and then periodically readjusted according to the patient9s age, medical condition, and psychiatric symptoms. The amount of lithium in the blood must be checked regularly because it is ineffective if too low and risky if too high. ,ome side effects are weight gain, hand tremors, drowsiness, and excessive thirst or

urination. &atients often cannot tolerate lithium either because of the side effects or because it takes some of the joy from their lives along with the manic episodes. +t has been described as a Eloose1fitting emotional straitjacket.E %nly 8H percent of patients with bipolar disorder take lithium alone. %ther drugs used in the treatment of bipolar disorder are the anticonvulsants carbama<epine (Tegretol- and valproic acid ()epakote-, which may be used either alone or in combination with lithium. Thirty to KH percent of patients with bipolar disorder are not consistently helped by conventional treatment. For some of them cannabis may be useful in ameliorating the symptoms, reducing side effects of lithium, or both. The following accounts are by a forty1year1old software engineer and his thirty1seven1 year1old wife, who suffers from bipolar disorder. He speaks first4 My wife and + and our two boys live in Tyngsboro, Massachusetts. My wife was given a diagnosis of bipolar disorder in 56I8 and has been taking lithium since 5668. ,he also uses marijuana for her symptoms. ,he has had six psychiatrists in the past fourteen years and has been interviewed by many more. + have always told them that she uses marijuana regularly, and not one of them has told her to stop. They do not even seem to care or pay attention. + posted a Cuestion about this to the alt.support.depression.manic newsgroup on the +nternet. + asked whether doctors knew something about marijuana but could not recommend it because of its illegality. The responses were varied, but most people who were manic1depressive said marijuana helped them, and one said that some doctors considered it effective in controlling mood disorders. My wife functions much better when she uses marijuana. =hen she is hypomanic, it relaxes her, helps her sleep, and slows her speech down. =hen she is depressed and would otherwise lie in bed all day, the marijuana makes her more active. =hen she runs out of marijuana and can9t get more, she becomes more irritable and hard to live with. /ithium is also effective, but it doesn9t always keep her in control during seasonal mood changes. %ur dilemma is that our thirteen1year1old has been through the )!$# program and has learned about the evils of drugs and alcohol. He opposes all substance use, legal or illegal 111 and + want it that way. 0ut he knows that my wife uses marijuana and it EeatsE at him, although he also knows about her illness and how marijuana helps. .nderstandably, all this confuses him. + believe that marijuana could help some people if it were made available as a prescription medicine. ertainly there are other health and social issues involved, and

+ can9t decide what would be right for the country as a whole. !ll + know is that in this family it has relieved us all of much suffering. "ow his wife4 + am thirty1seven, and + have been using marijuana for twenty years. + was diagnosed bipolar in 56I8. + take lithium and =ellbutrin >bupropionB, although + dislike these drugs. +9ve gained about forty pounds since + started taking lithium, but otherwise there are no side effects. My thirteen1year1old son knows about my illness. He has also known about my marijuana smoking for about five years. He reali<ed what + was doing after he participated in the )!$# program in school. +t bothers me when he comes home and says they talked about drugs and he was thinking that his mother is Eone of themE. He doesn9t want anyone to know his mother is a Edruggie,E and until now we9ve kept it as our secret. + don9t think he would tell anyone, but +9m still afraid something might get out. ,ometimes these programs use tricks to get kids to inform on their friends and relatives. They say, E+f you really care about this person, the only way you can help them is to report them.E My husband has talked to him about it. He has explained that lithium and the other medications +9m taking are drugs. He also explained that many legal drugs are far more dangerous than marijuana and that no one has ever died from using marijuana. 0ut my son insists that if it is illegal, then it is wrong. This bothers me so much that + have considered stopping. The trouble is that at times when + feel tired and run1down, just a couple puffs of marijuana bring me back to life. ,ometimes + think it brings me to a level of normalcy that everyone else achieves naturally. !t other times, when everything seems to be going like a whirlwind around me and + can9t keep track of what +9m thinking about or saying or feeling, the marijuana just seems to slow the world down a bit. =hen + have trouble sleeping, it helps <onk me out, but if + have trouble waking up it brings me to life. + don9t like being thought of as a Edrug1abusing mother,E but + actually think +9m a better mom when +9m feeling in control because of marijuana. (T%&-

&,#.)%T.M%$ #$#0$+ &seudotumor cerebri is an uncommon disorder characteri<ed by abnormally high pressure of the cerebrospinal fluid ( ,F-. #ither the fluid is being produced at an accelerated rate or its outflow is being slowed: the underlying cause is unknown. The symptoms, which may include headaches, nausea, vomiting, and visual disturbances, resemble those of a brain tumor 11 thus the name. The patient9s vision may be

endangered by papilledema (swelling of the optic disk-. The disorder is three times more common in women than in men, and it may last from several months to a lifetime. "one of the available treatments is especially effective, and the high rate of spontaneous recovery makes the evaluation of treatments difficult. &atients are sometimes given corticosteroids and high doses of diuretics to reduce fluid pressure. FreCuent lumbar punctures (spinal taps- may be reCuired to drain off ,F. +n serious cases surgery is performed to insert a tube to shunt fluid from the brain into the abdominal cavity. !s a last resort, when vision is seriously threatened and other treatments have failed, a surgeon may make an incision in the sheath of the optic nerve to relieve the pressure of papilledema. /ori Horn is a twenty1nine1year1old woman with pseudotumor cerebri who has used marijuana recreationally since the age of eighteen. Here is her story4 !bout four years ago + decided to Cuit using marijuana because bills were becoming hard to pay. !fter five months of abstinence + began to develop severe headaches and disturbances in my vision (spots before my eyes-. + went to see an optometrist, thinking + might need glasses. He sent me to a hospital ophthalmologist, who found acute pressure behind my eyes and three pinprick hemorrhages. + was rushed to an emergency room, where a neurologist said + might have a brain tumor. Fortunately, L1 rays, !T scans, blood tests, and a spinal tap all came back negative. !t that point + was given the diagnosis of pseudotumor cerebri. The doctors prescribed Motrin >ibuprofen, a non1steroidal anti1inflammatory drugB, prednisone >a powerful steroidB, and )iamox >aceta<olamide, a diureticB. The prednisone made me extremely moody: my face swelled up and + gained an enormous amount of weight. The )iamox caused muscle cramps and made my leaky bladder worse. Motrin did almost nothing for my headaches. + was told + might need surgery (which didn9t always work- to prevent blindness. + began to live in fear of losing my sight: + had nightmares and cried for hours. 0y now it had been eight months since +9d last used marijuana, so + decided to smoke a joint. +t was almost magical. For the next two weeks + had no headaches, no disturbances in vision. )octors even said my eyes looked better (the papilledema had disappeared-. =hen + told my neurologist, he didn9t seem very interested but said, E+f it works, use it.E !lthough it was against doctors9 orders, + Cuit taking all the prescribed medications and began smoking a joint once every few days instead. "ow + find that + get headaches and visual disturbances if + go more than a week without a good joint. The

more potent the marijuana, the longer my eyes remain healthy. They look so good now that all talk of shunt surgery and spinal taps to relieve pressure has ended. My family has watched the miracle of my marijuana use, and they know it helps me. + thank *od it was there as an alternative to the knife and to drugs like prednisone. + only wish + had a doctor to back me up, but the hospital where + was treated offered me no support, not even written documentation of my self1medication and its miraculous effects. =hen + heard about you + decided to tell you my story. +t touches my heart to find that there really are people who care about people like me. =hat can + do, where can + goG +9ve been charged with possession once already. + pray it doesn9t happen again. (T%&-

)+!0#T+ *!,T$%&!$#,+, %ne long1term effect of diabetes, especially the kind that begins early in life (sometimes referred to as juvenile or Type + diabetes-, is damage to nerve fibers of the autonomic nervous system. This system controls, among other things, the gastrointestinal tract, and three1fourths of people with diabetes have gastrointestinal symptoms. %ne common syndrome is diabetic gastroparesis (the word means paralysis of the stomach-, a disorder in which food remains in the stomach because of a failure of peristalsis, the natural contraction and relaxation of muscles that moves it along. The resulting symptoms include bloating, belching, nausea, vomiting, a sense of fullness, and appetite loss. ,ome serious conseCuences are malnourishment and loss of control over blood sugar levels. &atients are advised to avoid foods that slow gastric emptying and given prescriptions for agents that speed it up, such as metoclopramide ($eglan- and cisapride (&ropulsid-. +n the most severe cases surgery is attempted. "one of the standard treatments works particularly well. The following account was written by a thirty1seven1year1old man who suffers from this syndrome4 +n 56;@, when + was five, + was diagnosed with diabetes mellitus after falling into a three1day coma. 0y the time + was hospitali<ed, my blood sugar was so high that all the veins in my body had collapsed. + have been dependent on insulin ever since, and it is a miracle that + am alive today to write this. My purpose is to inform other diabetics about a treatment for one particular diabetic complication. + am one of those diabetics who is regarded as EbrittleE because our blood sugar fluctuates wildly and almost uncontrollably. The resulting poor blood circulation and nerve damage (neuropathy- affect every part of the body, causing a myriad of

symptoms. The one that concerns me here is the loss of function in the gut that occurs after many years of nerve and circulatory damage. The muscles of the *+ tract, especially the stomach, are unable to move food through my system. +t9s called diabetic gastroparesis. The food sits in the stomach and causes bloating, acid buildup, and nausea, which may lead to vomiting. +f this goes untreated, it can be life1 threatening. 0lood sugar Cuickly rises to dangerous levels, and the resulting dehydration almost always leads to hospitali<ation for as much as a week. This condition must be fairly common, since the pharmaceutical companies make two medications specifically designed to treat it, $eglan and &ropulsid. $eglan is effective but very sedating. + used it for eight years, and + feel almost as though + slept through those years. +t also caused me to lose eCuilibrium and contributed to a loss of sexual functioning. &ropulsid, which + have been taking for about two years, does not have these side effects, but it doesn9t move food through my system nearly as well, even at the double dose + am taking now. !nother drawback is the cost of M5;H a month, which is a real hardship for someone living on a fixed income. + take my medication as prescribed, but in addition, when + can, + have begun to smoke a small amount of cannabis twenty minutes before each meal, usually just a couple of hits from a pipe. This outlaw drug makes the prescribed medication more effective. The bloating, the nausea, and the feeling of fullness go away, with practically no side effects. For the first time in years + can sit down to a meal and actually feel like eating (to see what + mean, try eating a full meal when you are already full from having just eaten-. The only problem + have with cannabis is that the supply is unreliable and street prices are just ridiculous. Most of the time + cannot find it or cannot afford to pay the going rate. !nd + am made to feel like a criminal for seeking an effective treatment for a potentially life1threatening condition. ,omeone who is dying from a chronic degenerative disease should not have to face incarceration because an effective medication for that disease has been made illegal by the government. + am only asking to be allowed to raise a small patch in my own yard for my own personal use. =ho is harmed by thatG Meanwhile, + hope + can help improve the Cuality of life for others suffering from gastroparesis by sharing my experience with cannabis. (T%&-

M!$+3.!"! !") !*+"* /argely by historical accident, marijuana in late twentieth1century !merica is regarded as exclusively a habit of the young. 0ut it has not been so closely associated with youth at other times and places, including the .nited ,tates in the nineteenth

century, when cannabis was used mainly as a medicine. More than three decades have passed since marijuana first became popular in the .nited ,tates, and members of the generation that learned to enjoy it then are moving toward old age. Many of them will probably discover that cannabis can ease the burdens of age as well as enhance the pleasures of youth. The people who tell their stories below may be pioneers. %ne such pioneer is )el 0rebner who is 7I4 +n old age it often seems that everything is depressing. ETry not to get old,E + advise young checkout clerks while +9m fumbling old1lady1like for the grocery money. ,ometimes + think +9m not really joking. + may make an offhand remark about the funeral of the week, but that9s no joke either. !t seventy1eight you attend too many funerals. The daughter of an old friend calls and you know the instant you hear her voice that she is going to tell you that your old friend has succumbed. %f course + am reminded that +9m going to die in a minute. !fter all, my father died at seventy1nine. + get an MI,HHH bill from my dentist. + remember when dentist bills were around M8H. My knees hurt. =hy doesn9t my son callG /ast night + trumped my partner9s ace. +9ve been playing pretty good bridge for sixty yearsN !nd + did thatG &ensionN =ho wants a pensionN +t is increasingly painful to observe political chicanery, corruption, and cynicism. ,ophie, my best friend for seventy years, calls and we sputter together about these things. =e send newspaper editorials and columns to each other. =e despair of the world. %h, and + forget names + have known forever. The names of friends, writers, actors, names + used this morning. + hate myself. My husband hates me too, + guess. + listen to him muttering baby talk to the cat, and + crawl into myself and feel sorry for the lost woman + was. +n short, sometimes old age seems to present a daunting parade of gloomy displeasures and discomforts. !nd when all these natural burdens accumulate, help is hard to get. =ell, it may be easy to get &ro<ac or lithium. Hard to get is what may be the best medicine 11 marijuana. +9m trying to exercise restraint, but this is an issue on which + am tempted to morali<e and preach. !n occasional hit on a simple little dried leaf in a pipe or rolled into what looks like about a third of a tobacco cigarette takes me on a small but restorative ego trip. + enjoy this three or four times a week, using about a tablespoonful of the weed altogether. The Cuality of the pot varies, and so do the results, but almost invariably + achieve some release from the emotional and physical burdens of a Eripe old age.E

+ have happy thoughts about the person whose funeral + attended recently. =hat fun we had together at the 56@6 =orld9s FairN =hat a good life she hadN !ll those adorable grandchildrenN My father died at seventy1nine, but my mother is one hundred and two years old, and anyway, if + die + won9t know it. !nd meanwhile + have this fabulous book to read, putting it aside now and then to prolong the pleasure. + dip up a handful of mixed nuts and munch contentedly, enjoying all those expensive bridges + paid for. My knees don9t hurt. They will, but right now + don9t have to go down any stairs, and anyway they9re not so bad. /ook at all the people who need knee surgery and hip replacement. !ll + have is a little discomfort. + can handle it. + call my five1hundred1month1old baby and we share a few jokes, some news. He keeps me on the phone, and we plan a weekend. He will bring some friends + particularly enjoy. ,o what if + trumped my partner9s aceG )on9t we all do that once in a whileG +9ll do fine next time + play. That pension check is just dandy. +t9s paying for my dentist, and + don9t have to put on tight shoes with heels and go to work in the morning. 0ut boy, wasn9t + goodG !nd couldn9t + do it nowG (Thus speaks marijuana.Thank heaven + have ,ophie to sputter with about political opportunism. =e actually have a great time lashing out at our leaders. 'es, + forget names, but + almost always do well playing Famous "ames, even against much younger people. !nd between us, my husband and + can usually come up with a name we are looking for. HeyN How can he not love meG + go over and kiss him, and together we smile down on the best cat in the world as we snuggle for a while. + am basically an optimist, but + would have more persistent negative feelings about heading into my eighties and extinction if + did not have the pleasure of my marijuana1induced ego trips. !nd that9s not all. + also find it helpful for insomnia, itchy skin, boredom, loss of appetite, indigestion, and 11 name it. ,ometimes, to be sure, + recall that using the forbidden medicine is a crime, and + wonder what kind of ego trip a women9s prison would provide. (T%&-