Doc Says Pot Pill No Good -- Just Let Em Smoke It!

By Jim Totten • DAILY PRESS & ARGUS • October 5, 2008

There's a key reason why some groups want to make it legal for some seriously ill patients to smoke marijuana to ease vomiting and nausea.

Although there is a pharmaceutical version of marijuana called Marinol that comes in pill form, it doesn't work, according to Dr. Elaine Chottiner. She serves as section head of hematology and oncology at Saint Joseph Mercy Health System, which runs the Saint Joseph Mercy Woodland Center in Genoa Township.

"If Marinol worked, nobody would care about legalizing marijuana," Chottiner said.

On Nov. 4, Michigan voters will decide the fate of the medical use of marijuana ballot question. Under Proposal 1, there would be specific guidelines to using marijuana. A physician would need to approve marijuana use for a patient with a debilitating medical condition, and patients would receive an identification card. Patients would only have protected use in their home and could not smoke it in public places.

Chottiner said Marinol was approved because it was shown in clinical trials to alleviate vomiting and nausea caused by certain kinds of chemotherapy. It contains a synthetic form of THC, the major active substance in marijuana, which helps relieve nausea and vomiting from chemotherapy and stimulates appetite for AIDS patients.

However, Chottiner said few patients have found the pill to be effective and usually don't seek refills. She said absorption is probably one reason the drug doesn't work as well, since it takes longer to digest something than smoke it. Also, Marinol contains only one of marijuana's 66 compounds.

Chottiner said a few people have asked her about smoking marijuana to ease their symptoms, and a few patients have told her they're smoking marijuana to ease their nausea and vomiting. In general, Chottiner said only a very small percentage of patients have chronic nausea and vomiting from chemotherapy. She said most chemotherapy does not cause those symptoms. She also said there are excellent medications available — and that work — to prevent those symptoms.

Chottiner, who indicated she was neutral on the ballot question, said there are pros and cons with the proposal.

She said the most important issue is helping patients.

"We want to do everything we can for our patients and alleviate their suffering," she said. "If this is something that can be used for this purpose, it would be helpful to find a way to provide it."

However, Chottiner said she feels much more comfortable prescribing drugs that have gone through the U.S. Food and Drug Administration approval process. She said the FDA conducts rigorous clinical trials so doctors know what's in a drug, a proper schedule and dosage for a particular drug. She said it would be difficult to prescribe marijuana because there are no standards.

Chottiner said she doesn't prescribe herbs because "you never know what you're getting."

Contact Daily Press & Argus reporter Jim Totten at (517) 548-7088 or at jtotten@gannett.com.