James is a thirty-five year old male veteran, disabled since 1986 and home-bound for the last few years. His current medical problems prevent him from working, and he is forced to spend most of his time resting or recuperating from the minimal exertions his disabilities will allow. Buying groceries, washing a glass, getting into bed or even simply bathing are agonies he endures on an everyday basis. 

While in the service, he was trained as an electronics technician and a nuclear reactor operator. He was medically discharged from the Navy in 1987. He later enrolled into the local university, but was forced to withdraw in late 1994 as his health rapidly declined due to  excessive weight loss. He had started out at 200 pounds in August of 1993; yet, by the time he withdrew in September and despite the efforts of his physicians, his weight plummeted to a mere 146 pounds.  During this period, James had been recieving his care at the VA Hospital. In August of 1993, the Gastroenterology Department began to treat him for severe diarrhea. A short time later, other symptoms arose which included anorexia, nausea and unbearable stomach pains from merely a sip of water. Some of the pain was alleviated when the doctors discovered and got rid of a series of infections (e. coli, hafnia alvei, and a yeast infection). Yet James still had no appetite, and the severe nausea and diarrhea continued. After losing more than fifty pounds, one of his doctors informed him that they had exhausted their options in drugs that might help with his medical condition. 

At that time, the doctor confided in James and mentioned marijuana as an avenue for a cure. After discussing a little about the effects of marijuana, the doctor suggested that James go to the medical library in the hospital and look it up for himself. James did just that, and discovered an amazing amount of information about this stereotypically "bad" drug. In fact, it was the only thing listed in the Merck Manual (at that time) for weight gain. Two months later, James had lost 20 extra pounds and was faced with a difficult decision: whether to try the only medication that might help, or rely on the failing treatments the doctors were providing. After much prayer and thought, James procured some of the herb and smoked it. A rather strange interaction between the medicine doctors had prescribed (Mono-Amine Oxidase Inhibitors) for his fibrositis and marijuana caused James to have "heightened experiences" for nearly four months, which disappeared after he discontinued the use of the medication. After the first several times he tried it, James noticed his pain and nausea disappear, and developed a classic case of the "munchies"--a truly unusual experience for someone who typically has no appetite at all. 

A few weeks later, both 26 pounds heavier and healthier, James informed his doctors of his use of marijuana. The doctors, amazed at James' recovery, replied he should continue his new method of medication. Within two years, James was 194 pounds healthier, thanks to the miraculous properties of the marijuana. He was able to exercise and eat healthy at last. However, in 1997, James' home was searched by the police. The authorities questioned him, and he explained the medicinal help the drug provided. He was put under voluntary arrest two weeks later, and James was forced to bondout. Due to James' use of medical marijuana, a court cased ensued. In response to these legal problems that have arisen, his primary care provider at the VA hospital had his need for marijuana reviewed. The combined Gastroenterology Departments at the VA Medical Center and a local University Medical Center jointly evaluated his case. They informed him that they initially wanted to put him in the hospital for two months at a time. They wished to try potential drugs without the beneficial effects of the marijuana. However, the doctors feared that if he began to lose weight again, they might not be able to stop it this time. Subsequently, the doctors told him they would not let him try any other drugs or treatment, and that marijuana was his only option. James inquired about Marinol®, but was told that was not an option, either. 

Because of two lung infections and subsequent allergies, James has had to experiment with a variety of ingestion methods besides smoking the typical joint. He has tried brownies and muffins, but was forced to smoke some marijuana to keep the food down. Even though the relief of pain, nausea, and diarrhea brought on by eating the brownies and muffins lasted far longer than when James just smoked it, he did not enjoy the prolonged feelings of disorientation and muddled thinking. Also, although the ingestion of the marijuana did help with the nausea and diarrhea, it did little to help with the anorexia he suffers from. Unfortunately, James can no longer afford  the luxury of experimentation. He smokes from a pipe, a small concession in his allergic reactions to cigarette paper. 

James' legal costs are a year of probation, six months suspended
driver's license and a $475.00 fine. He admits his total costs for
marijuana are far more expensive than the VA medications (which cost nothing), but at least the marijuana works. One-fifth of James' income is spent on purchasing his medicine. Currently, James is petitioning the VA to provide him with both medical marijuana and a vaporizer as a medical device. He summarizes his current legal problem between his doctors and the State of Arkansas this way: "The doctors say 'Use it' and the State says 'Don't you dare!'"
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August 3, 1998
Letter from Stephen R. Moore, LMSW, BCD, Clinical Socia  Worker McClelland VAMC

"Mr. James John Markes is a patient in our primary care clinic. He is also followed in our speciality clinic for his stomach and back. Mr. Markes was referred to DDN (stomach clinic) due to weight loss a couple of years ago. Mr. Markes had lost about 70 pounds at time of referral. The doctors in DDN tried several medications to help with his weight loss and did not find any. Dr. Ringo [sic, correct spelling is Ringold], a resident MD, recommended marijuana as a [sic] option. Mr. Markes took marijuana and started gaining weight. Dr. Ringo is no longer practicing in this VAMC. Mr. Markes stated he was going to contact Dr. Ringo to get a statement concerning the marijuana use since there is not note in the chart." 

Signed by: /es/Stephen R. Moore
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November 19, 1998 

Letter from Dr. Lester Grinspoon: 

"To whom it may concern: 

"I have been studying marijuana as a medicine since the early 1970s and have published a book, "Marijuana, The Forbidden Medicine," (revised and expanded edition, published by Yale University Press, 1997) on the subject. In the course of a great deal of experience with patients who use cannabis, there is no doubt that it is quite useful to people who suffer from various kinds of disturbances of the gastrointestinal system, particularly Crohn's disease, irritable bowel syndrome, colitis, and diabetic gastroparesis. Having read the case history of Mr. Markes, I am quite certain that cannabis is, as he reports, quite useful to him in the symptomatic relief of his colitis. Many patient suffering from colitis report both its usefulness and its lack of serious side effects. I do hope that you will find this information of use.  

Sincerely yours, Lester Grinspoon, MD 

Harvard Medical School

A copy of this letter was sent to McClelland VAMS and included in Mr. Markes' medical records. 
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October 1999 -- A letter from Mr. Markes to the Director, McClelland Veterans Administration hospital, Little Rock  

"... Dr. Hassan told me, as representative of the gastroenterology department of both the McClelland VA hospital and UAMS hospital, that they would not let me try any other medications for my otherwise lethal digestive disorder, reputedly a form of collagenous colitis. I did not ask for marijuana as a medicine -- I asked for an alternative. He said there were no alternatives and if I wished to continue living, I must continue to use medical marijuana.

"I formally and officially request that the VA hospital either provide me with an alternative or provide me with authorization to use or the actual substance of medical quality marijuana. I do not wish to die or be forced to continue getting it on the black market. If the doctors are going to insist I use only marijuana, then it is the hopsital's responsibility to provide this life sustaining medicine. 

"The FDA declared marijuana to be an orphan drug for AIDS wasting syndrome earlier this year. The hospital can apply for access to medical marijuana for a life threatening condition -- where all other medicines have been exhausted -- thru the humanitarian IND [innovative new drug] program. It is plainly described in VA regulations. The hospital has this responsibility, not I. The FDA's website has health information and contact information to assist those applying. I encouraged them to do so. I also request authorization to use a marijuana vaporizer so I do not have to smoke the marijuana any more. I am trying to preserve my health and life." 
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THE VA RESPONSE:

December 1999

"I sincerely regret the difficulties you have experienced in obtaining treatment for your disability. Your opinion of our facility and the service provided by our employees is very important to us.  "Dr. Vivek Raj, our staff physician in gastroenterology, reviewed your medical records. He has advised me that our gastroenterology (GI) staff initially evaluated you in October 1993 for complaints of diarrhea. You returned for several appointments and diagnostic tests the following year. You returned to our GI clinic on Dec 8, 1997, with complaints of chronic low back pain, weight loss, chronic nausea, vomiting, and diarrhea. Biopsies showed mild, nonspecific inflammation with no evidence of chronic inflammatory bowel disease or collagenous colitis. Dr. Hassan noticed that your symptoms were well controlled at that time [Editor's note: this control was an acknowledged use of marijuana] and your care was referred back to your primary care physician. There is no mention in Dr. Hassan's notes that he ever recommended the use of marijuana. 

Your request for marijuana for your medical disability cannot be approved. There is inadequate medical data to support the use of marijuana for treatment of irritable bowel disease. If you have further questions, you may contact Dr. Raj ---.

"Thank you for bringing this matter to our attention. Issues such as this offer us an opportunity to view the service we provide from a veteran's perspective. It is our continued goal to provide the best possible care to the veterans we serve. 

Sincerely,
George H. Gray, Jr., MD
Medical Center Director

REFERENCES

Information extracted from VA medical records:
 

I have the following medical conditions:

1.digestive disorder (collagenous colitis?)
  -My digestive system does not tolerate the introduction and passage
   of most food and drink.
  -anorexia
  -nausea
  -diarrhea
  -weight loss

2.Sacralization of left transverse process of L-5, formerly fused,
  broken in Navy. Bone on bone, very painful

3.Damaged nerves in left foot, groin

4.Torn muscles in left side neck

5.Fibrositis/fibromyalgia

6.hypoglycemia

7.allergic rhinitis (severe drainage fills lungs)
  -multi-odor allergies
  -multi-food allergies

8.damaged knees (dislocate when feet rotated out)

9.damaged shoulders (extreme laxity)

10.multi-drug allergies and intolerances.
  -aspirin, tylenol, ibuprofen (can't use anything related to these
   three, allergic to ASA, liver enzyme problems with the others)
  -erythromycin/quebron combo (separate is fine)
  -valium
  -MAO inhibitors (react strongly and interestingly to marijuana)
  -low tolerance for amytriptiline, trazedone (used for fibrositis)
  -can't tolerate anti-histamines and decongestants. Even had bad
   reaction to benadryl. Can tolerate guafenesin.
  -narcotics (have memory problems when used, refuse to take addictivedrugs, use biofeedback for most pain control)

11.degenerating disk(L-4 - L-5), with herniation on left side.

Marijuana affects these conditions in this way:

   1.  (Covered in letter)

   2.  When I use the marijuana, it not only gives me an appetite, but
       also helps   with the pain of my back.

   3.  No noticeable effect from smoking.

   4.  Relaxes muscles in the neck and alleviates some of the pain.

   5.  Alleviates much of the pain and temperature intolerance in the
       fibrositis.

   6.  If I don't eat soon after smoking marijuana, the effects are
       more noticeable.

   7.  When I smoke the marijuana, I have a slight reaction with the
       allergic  rhinitis  which is far less than the food and odor
       allergies.  If I am having a food or odor allergy, I cannot use
       the marijuana until I clear my lungs.

  8.& 9.  Doesn't significantly help.

 10.  (Covered in the above.)

 11.  I don't know how to separate the pain from the broken back and the degenerating disk, but the marijuana helps with all of the    back pain.

NOTE:   I use the marijuana prior to eating. I should be eating about 6 small meals a day, but cannot afford the medicine in order to eat that well.  Since some of the effects last longer than others, I utilize that and optimize usefulness of marijuana for my other conditions as well.

At right: The work of activist James John Markes made print in the Arkansas Democrat-Gazette during last year's petition drive to get Med-MJ on the ballot. To read the full story, click here.  

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