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Russ Belville

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Oregon hospitals denying life saving organ transplants to legal medical marijuana patients

Posted: 05/14/10 04:13 AM ET

I will be covering this subject with medical experts on transplant and medical marijuana and attorneys who are pursuing remedies for medical marijuana patients who have been denied transplants on NORML's daily internet talk radio show, NORML SHOW LIVE, on Friday, May 14, 2010 at 4pm Eastern on http://live.norml.org. The episode will be repeated all evening and available for download through iTunes or other podcast feed reader..

I have been covering the cruelty of denying organ transplants to medical marijuana patients since the unfortunate story of Tim Garon.  He was a Seattle musician who was using cannabis with a doctor's recommendation legally under Washington law to cope with his severe pain and nausea.  He was given two weeks to live when he was next to receive a life-saving liver transplant.  He was then found to have THC metabolites in his urine and told he must demonstrate 60 days of clean urine tests before he'd be given the organ.  Tim Garon died days later.

(Portland Tribune) Jim Klahr needs a new liver. And he wants to take medical marijuana to help with the nausea he fights every morning as he battles hepatitis and cirrhosis. He says his body can't tolerate most drugs that physicians have prescribed for his symptoms, but pot does the trick.

Southeast Portland resident Klahr has a medical marijuana card, but he hasn't smoked since 2004, because Oregon Health & Science University, the state's only liver transplant center, won't provide organs for people with marijuana compounds in their blood, even if the patients are medical marijuana cardholders. Klahr is on the OHSU transplant waiting list.


The tragic irony is that the drugs other than cannabis that doctors would prescribe for symptoms of liver failure are often hepatoxic - harmful in long-term doses to the liver - or, as in Klahr's case, ineffective.  Cannabis is non-toxic to healthy cells and organs and has not been found to be damaging to diseased ones.  The acetaminophen we get over-the-counter in pain relievers is more damaging to the liver than cannabis.
Mike Seely, OHSU's director of transplant and procurement services, cites two reasons for the transplant policy. First, he says, federal rules trump state law. OHSU is part of a consortium with the Portland Veterans Affairs Medical Center, and federal law does not recognize medicinal marijuana. OHSU could be in danger with federal authorities if it allowed marijuana users to receive organs.

This doesn't seem to jibe with the Veteran's Administration's recent change in policy to no longer void "pain contracts" with veterans in states where they have a valid doctor's recommendation to use cannabis medicinally.  See, the VA had been forcing vets to sign contracts to receive their opioid prescription painkillers (think: oxycontin and such) that required urine screening and if they found cannabis metabolites, no pills for you!  It forced vets to give up the medical cannabis that relieved the PTSD and cut their addictive hepatoxic opioid painkiller dosages if they wanted to have any pain medication at all.

That same federal law that finds Oregon's Medical Marijuana Act to be null and void, that Seely uses to defend discrimination against cannabis patients, still applies to these veterans, yet the federal government is looking the other way now.  Is the government that allows medical marijuana-using vets to get liver-killing opioids really going to step in and force OHSU to deny that same vet a life saving liver transplant?  (Well, probably. In five years on the front lines of the drug war, nothing the government would do surprises me.  But shouldn't doctors and hospitals be fighting for the lives of patients, not cowering before the government?)

Seely says that, in addition, transplant doctors are afraid of a fungal infection occurring in patients who smoke marijuana.

This is the tired old Aspergillus argument.  This is a mold that can occur when someone cures harvested cannabis improperly.  How much of a real risk is that?  As I wrote back in March:

That deadly mold which causes 0.88255 deaths per 1 million people in the United States, with 261 deaths in 2004, is something we're supposed to fear more than "accidental suffocation and strangulation in bed" (327 deaths), "acute appendicitis" (371 deaths), and "acid reflux disease" (721 deaths) (and that's just the "A's").

Aspergillus is something the community should be aware of, just as people should know eating undercooked eggs, shellfish, and meat can lead to salmonella or e coli poisoning.  But the way we protect diners from these diseases (which, by the way, kill 5,000 a year) is with warnings about undercooked food on menus and rules for food preparation and sanitization for workers.

If we're denying livers to cannabis consumers because of the tiny risk of Aspergillus, we should be denying livers to all but vegetarians for fear of the risk of salmonella and e coli.

John Niemitz, manager of transplant services for Legacy Health System, Oregon's other transplant center, says Legacy maintains a similar policy. Niemitz cites the infection risk and adds that "there is a risk of altered consciousness," which might interfere with a patient's ability to follow a rigorous post-transplant regimen of medications and appointments.

Really, your fear is that a medical marijuana patient post-transplant is going to be too stoned to remember to take his medications or show up for the appointments that improve his chances of surviving with that new organ?  But then you're going to prescribe to him blood-pressure meds as part of that "regimen", like Clonidine and Norvasc*, that sap energy and cause depression, and painkillers in the first weeks after transplant that fog the mind.
Niemitz doesn't think Legacy's transplant policy is costing lives, as marijuana activists claim. He says that as far as he knows, every cardholder Legacy has dealt with has been willing to give up their medical marijuana as the price of getting a transplanted organ.

"People have found that pretty reasonable," Niemtiz says.


Kind of like when you hold a gun to someone's head they suddenly find your request for their wallet pretty reasonable.

Fears of rare Aspergillus and patients too medicated to take care of their new organ aside, what is the actual science on the issue of medical marijuana and organ transplants?  There's this 2009 study in the American Journal of Transplant entitled "Marijuana use in potential liver transplant candidates" that looked at almost 1,500 cannabis-using and non-cannabis-using liver transplant patients over an eight-year span and concluded "patients who did and did not use marijuana had similar survival rates."

So the only possible reason Legacy and OHSU have to deny transplants to medical marijuana patients is simply institutional bias against medical marijuana patients.  Every day Jim Klahr and others have to do without their medical marijuana is a day they've been blackmailed not to use "the safest therapeutically active substance known to man", which Oregon law says is to be "treated like other medicines".  Some won't live long enough to get their transplant, which, to be fair to Niemitz (a courtesy he won't give us) doesn't mean the no-transplant-for-medical-marijuana-patients policy cost their lives.

It just means Mike Seely and John Niemitz would rather people suffer unnecessarily than give an organ to a "pothead".


*Meds actually prescribed to my kidney-transplant-needing engineer, as well as immuno-suppressant drugs that are renatoxic (deadly to kidneys).
 

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