Floridians will decide Nov. 4 whether to add medical marijuana to the state Constitution, testing if a cultural change fostered in the liberal West and Northeast can penetrate the South.
Hundreds of small studies have shown that pot holds potential for lessening pain, stimulating appetite, fighting nausea, alleviating movement disorders and slowing the spread of some types of cancer.
But that science is not a slam dunk argument for passing Florida's proposed Amendment 2.
Those studies are not on a par with the large clinical trials that are the gold standard for modern medical practice to measure benefits and side effects. Clinical trials calibrate doses to find the sweet spot for helping people while inflicting the least harm. The FDA promotes safe production. Doctors prescribe specific doses.
A few prescription medicines synthesized or derived from marijuana have already navigated this process and are on the market. Others may follow.
You don't cultivate poppies and smoke opium to fight pain, opponents say. You don't chew willow bark, even though aspirin originated there. And you need not smoke pot.
On the other side of the debate are people who view marijuana as no more dangerous to society than alcohol, or less so. They say doctors and patients should determine treatments without fear of arrest.
Thorough, long-term research might shed more light on marijuana's promise and peril. But the federal government classifies pot as a dangerous substance with no redeeming medical value. Researchers struggle to find funding for large-scale studies. Universities and drug companies shy away from testing an illegal drug.
What remains — particularly for Amendment 2's proponents — are the experiences of patients. Dozens have contacted the Tampa Bay Times wanting to tell their stories anonymously. Some didn't want friends, employers or family to know of their pot use. Many feared legal repercussions.
A few, however, were willing to go public. Here are their stories.
Not waiting to die
ST. PETERSBURG — Artist Jim Buresch's pot use stretches back more than two decades, to San Francisco and the depths of the AIDS crisis. Drug cocktails to fight HIV disease made him vomit and eliminated any interest in eating, he says. Friends all around him were dying.
Pot minimized nausea and restored appetite, he says, and "I wasn't as depressed. I wasn't as traumatized. I wasn't just sitting around waiting to die.'' Now 45 and living in St. Petersburg, Buresch takes modern HIV medication that keeps the virus at bay. He still uses pot whenever he can afford it. "I'm actually very robust,'' Buresch says. "Most people do not know I have HIV.''
Buresch prefers hydroponic marijuana, a pricey product often harvested from local grow houses. It is usually very high in THC, the ingredient that combats nausea. Because of its potency, Buresch doesn't have to smoke much to calm his stomach.
On one vacation trip to France, Buresch could not take pot on the plane, so he got a prescription for Marinol, a synthetic copy of THC that the FDA has approved for treatment of nausea. It didn't work, Buresch says. "I couldn't eat. I was constantly nauseous. It was really a bad experience.''
One danger from pot is mold and foreign substances that can contaminate even fancy product sold in state-regulated dispensaries, Buresch says, and "people like me with suppressed immune systems really want to avoid mold in our lungs.'' Cheap Mexican imports carry the highest risk, he says. Local hydroponic product is a little safer, and even a state regulated dispensary will occasionally serve up contaminated marijuana, Buresch says.
The difference is what happens next.
When he lived in Seattle for five years, Buresch says, he twice bought pot he thought contained mold from an unofficial, unlicensed dispensary. He inhaled one drag, detected that moldy taste and put it down. The store promptly gave a refund.
Buresch doubts a Pinellas street dealer would extend the same courtesy.
He couldn't swallow
WESLEY CHAPEL — Before his tonsil cancer showed up last year, Glen Baker, 44, might smoke pot to relax with friends after work.
"I wouldn't get high,'' he says. "It was just like drinking a beer.''
So Baker knew how marijuana might help when 35 radiation and four chemotherapy treatments nauseated him, burned his throat and tongue, eliminated his taste buds and destroyed his salivary glands.
"The pain was excruciating. I couldn't swallow,'' Baker said.
In seven weeks he dropped from 225 pounds to 175.
Opiate painkillers could deaden the pain, Baker says, but they made him more nauseated and groggy than the chemo treatments did.
And it was crucial that he get nutrition into his body.
Protein drinks tasted horrible, he says. Broth, mashed potatoes, scrambled eggs, anything soft would do, but they hurt terribly going down. He got queasy just looking at them — unless he had help.
Before dinner, he would smoke pot. The effect took hold within seconds, he says.
"You feel a wave or warmth go over you,'' Baker says. "It can literally make the nausea go away instantly. You take a hit and it does not make the total pain go away, but it is a lot less. It wasn't like I was going to go to a buffet or anything, but it was a chance to get something in. Without it I would have had zero appetite.''
Pain diminished gradually after his treatments ended. Doctors gave him two weeks to wean off the opiates. Because they made him nauseated, Baker quit cold turkey and paid the price.
"That stuff is the devil,'' Baker says. "I was on the floor in a fetal position, you ache so much.''
Despite that withdrawal experience, Baker says he is grateful for the painkillers. "I'm not sure I could have survived without them.''
But people in need should also have pot as an option, he says.
Chronic pain dwarfs all other diagnoses for getting a medical marijuana card. This worries some people because pain can be easily faked. In California — which does not register medical marijuana patients — people walk into unregulated dispensaries, see a doctor for a few minutes and walk out with pot on the spot.
But people genuinely suffering from chronic pain face tough decisions about treatment.
Narcotic painkillers were originally designed for acute, short-term pain — say a broken arm. Long-term use leads to tolerance and sometimes results in higher doses and addiction.
Oral remedies — whether prescription opiates or pot — can take a half hour to work their way through the digestive system and into the brain. Smoked pot goes directly into the blood stream and arrives in seconds. Users can calibrate how much they need on the fly and adjust the strength rapidly if the pain persists.
"It's really not fair that we have demonized (pot) so much,'' Baker says. "That you should lose your house and livelihood over a a plant? It's absolutely ridiculous.''
He feels good
LECANTO — Pot-smoking cancer patients often say they break the law because of pain, nausea and lack of appetite.
For Haydon Fouke, it is more fundamental: "It just makes me feel good.''
Fouke, a 75-year-old retiree, has lived for 15 years with multiple myeloma, a serious blood cancer.
Marijuana has had specific uses related to his disease. It helped him eat during a stem cell transplant that ruined his taste buds, he says. It eased pain during a clinical trial in which an experimental drug made his chest feel "like a boa constrictor was squeezing it.''
But mainly, he just likes pot.
Every night before dinner, he nibbles one quarter of a brownie infused with a potent strain.
"I'm not a religious person, but I am very reverent,'' Fouke says. "And, oh my God, that euphoria thing overwhelms me. That sense of well being is a wonderful side effect of marijuana.''
The marijuana can cause temporary hallucinations, which Fouke calls a gift. "It's almost an out-of-body experience,'' he says. "I can almost fly across mountains and oceans and deserts. You can get back into some of your dreams.''
Along with regular exercise and good diet, Fouke says, marijuana helps him stay positive. "I have a very high quality of life,'' he says. "I don't get depressed,'' like some cancer patients. (
Fouke does worry about arrest and prosecution. Even if violators escape jail time, they may lose their driver's license and be subject to drug tests during probation.
Fouke, who smoked his first joint at age 32, acknowledges that marijuana may carry danger for some people. A recent study by Northwestern University, MIT and Harvard, for example, showed structural changes in the brains of college students who smoked regularly.
"I don't think people should use it before about 24, if their IQ is still developing,'' says Fouke.
But he sees validation for his approach when he goes to a cancer treatment center and sees patients who use cocktails of opiate pain killers, antidepressants and other prescription drugs.
"They walk around like zombies,'' Fouke says. "I went to a support group and they were all negative. Three people talked and they all cried.''
She stays on track
HOLIDAY — Jennifer Perez, 36 and mother of three, suffers from bipolar disorder and social anxiety.
For years, doctors prescribed mood stabilizers, antidepressants, antipsychotics and antianxiety drugs. Her mania and anger continued to wreak havoc, she says, and she suspects the drugs' side effects sometimes made things worse.
She attempted suicide three times. She took to bed for two months and gained 70 pounds.
Two years ago, she replaced all but one of her prescription drugs with two joints or so a day of $120-an-ounce Mexican street pot.
"It stabilizes me,'' Perez says. "It's much better than the cocktail of drugs that doctors wanted me to take. It slows everything down just enough that I am really only thinking about one thing instead of 10. I actually stay on track.''
Perez says her personal physician surprised her by recommending that she continue the marijuana regimen as long as it seems to work.
It's by no means a miracle drug. Several studies have indicated that marijuana can aggravate bipolar symptoms in some people. Perez agrees that it sometimes intensifies feelings of paranoia and can cloud her short-term memory. If she over imbibes, she can get depressed for a day. If she smokes too close to bedtime, she may be up at midnight mopping the floors.
"But it is the only drug I have tried that does not make me want to kill myself, does not alter my personality and helps me eat,'' Perez says. "I need a mood stabilizer that won't make me too high, so I can function and be productive as a wife and mother.''
Her social anxiety was so strong, Perez says, that she couldn't take a walk for fear someone might say hello. She stopped going to the grocery store — too many people, too close. She still treats anxiety with a low dose of Paxil, but adding in the pot helped her relax and she is back shopping for the family's groceries.
Pre-pot days were scary, she says. She was buffeted by rage and once sat in the car punching the windshield, "so I wouldn't hit my mom or husband.'' She took the anti-anxiety medication Xanax at the time, and learned that it sometimes boosts hostility and thoughts of suicide.
She also took Prozac, an antidepressant that can cause suicidal thoughts. Driving home one day in the midst of a manic cycle, a strange thought crept into her head.
" 'I would kill myself today,' " she recalls telling herself. "I didn't think I felt bad, or sad, it was just like thinking, 'I'll cut the grass today.' "
She made a list for her family of things that needed doing, closed the garage door and turned on the car. Her husband came home before she died.
Perez says she warns her teenaged boys about using pot, while explaining to them why she smokes it. Pot is illegal and sometimes "makes me feel like a bad mom,'' she says. "But I told them it either this or I am going to get very angry and something bad is going to happen.''
Contact Stephen Nohlgren at firstname.lastname@example.org