Monday, April 27, 2009

Hold that joint

Today’s paper had an article about some poor fellow here in California who was going to jail for running a medical marijuana clinic. He was indicted and tried before the federal government decided to forget about these offenders. I wish people like him had been around when I began practice. At that time, marijuana was the best medicine we had for preventing nausea.

In the late 1970s, the drug cis-platinum was introduced. It is a great drug for testicular cancer, probably the major curative drug although other drugs are also given along with it. Unfortunately, it causes major league nausea and vomiting. The first patient I gave cis-platinum to was a young man with widespread testicular cancer. Once we had established the diagnosis, I admitted him into the hospital for his 5-day course of treatment.

But what to do about the vomiting? The usual drugs we had in those days would be useless. Because this was a young man, I suspected he had access to marijuana, which was, according to urban legends, a good nausea preventive. And it was. Every morning the man received his cis-platinum and then closed the door and began to smoke his joints. We never asked where he got them.

You might say that it was the best of both worlds, no nausea and a high. But it wasn’t. By the end of the 5 days the nausea was not being helped as much, and he was sick of being high. Still, smoking joints was better than the alternative and he continued puffing away throughout his 3 courses of treatment. We just had to make sure the door to his hospital room was closed so the smell wouldn’t escape into the corridor.

After that, I would often recommend marijuana for nausea. Young people had no problem getting the stuff and did well on it. The older ones had to rely on their teen-age children or friends or hang around the local high school. But the older patients weren’t very keen on the stuff. They would try it, but the side effects such as being high and having strange visions and hallucinations really bothered them and they usually gave it up.

Later on, the pharmaceutical industry came out with pills containing the “active ingredient” in marijuana, but they didn’t seem to be as effective as the real stuff. Finally, new drugs were developed that were very effective in preventing nausea, more effective than marijuana. And so a chapter of oncology practice drew to a close. But not completely.

It turns out that the newer anti-nausea drug only work for a day or so. After that, nausea and vomiting will return in patients who have had a stiff dose of cis-platinum or similarly nauseating drugs. Giving more of the anti-nausea drugs doesn’t seem to work. There is a “day after drug” available but still, there is a role for marijuana – and given the experience of today’s cancer patients, having grown up in the marijuana era, they should have little hesitation in going for it. And now, at least in California and a few other states, it is legal to sell it as long as the Feds don’t come after you.

Maybe the judge will let our man off since the U.S. Government is OK with marijuana these days. There are a lot of people selling the stuff “legally” so all patients needs is a recommendation from their doctor and some hard cash (the price has gone up a lot from when my patients were buying it and I doubt that insurance will cover it). Perhaps more cancer patients can avoid nausea.

They just need to be cool with the purple cows and pink elephants.

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