|A Personal Report of Therapeutic
Marijuana use in Holland
by Arthur P. Leccese
My name is Arthur P. Leccese, I am 42 years old, and I have the good fortune to have moved two years ago to the Netherlands, where it is possible to obtain cheap and nearly legal marijuana. I define "medical marijuana" as pharmaceutical grade marijuana provided by pharmacists to insured patients given prescriptions by their physicians. The Dutch government has an ambivalent attitude towards such medical marijuana. There are some individuals, suffering from terminal diseases, who have for the last two years been quietly receiving medical marijuana. I suffer, not from a terminal illness, but from the painful muscle spasms and nerve irritation arising from a trauma-induced herniated lumbar disc. I have been able to obtain a prescription for medical marijuana from a physician, but have not been able to convince any Dutch pharmacist to fill this prescription.
Despite this bizarre situation, I have obtained substantial benefits from being able to discuss my marijuana use with a compassionate physician. In addition, Dutch tolerance of recreational marijuana users has made it possible for me to achieve better results with my "therapeutic marijuana" than I was able to obtain with the viciously prohibited marijuana of the Midwestern U.S. In the earlier 1980s, while I was a student, I was involved in a car accident that signaled the onset of my symptoms. Since that time, I have attempted all legal therapeutic interventions: these ranged from injection of epidural steroids, to the chronic consumption of non-steroidal anti-inflammatory drugs (NSAIDs), to the use of opioid drugs like codeine. These treatments were either unsuccessful or had so many intolerable side effects that I was forced to stop. Epidural steroids are painful, require three outpatient surgical visits, and can only be given so frequently and so many times in total. Finally, they affect mainly nerve irritation, not muscle pain or spasm. NSAIDs were totally ineffective and they induced stomach distress and socially embarrassing bouts of burping.
The opioids were, of course, incredibly effective in relieving my pain. Sadly, constipation and the mental fog of narcotic intoxication made these drugs highly unsatisfactory for chronic use. Finally, since I was self-medicating with illegally obtained marijuana, I have tried since 1986 to obtain Marinol from my regular US physicians and many specialists. They were always unwilling to prescribe it. One physician even blocked my repeated attempts to have this request and refusal noted in my medical records! Since I couldnt legally obtain THC to treat my symptoms, I broke the law daily in the United States by possessing and using illicitly obtained marijuana. My academic position led to many travels, which fortunately enabled me to come into contact with many kind and talented U.S. individuals who were able to provide semi-regular and sometimes high-quality marijuana. Despite this availability, I began to be annoyed with the sharp contrast between the way I could treat myself in the US with prescribed opiate drugs and the way I was forced to treat myself with illicit, and hence unprescribed, marijuana.
Naturally, the illegal nature of marijuana put my suppliers at great risk, and more than once my supply was interrupted by the arrest and incarceration of a provider. In contrast, I could obtain legally prescribed opioids from any U.S. pharmacy, and the availability was only restricted by the opening hours of the store. My medical marijuana also cost much more than prescribed opioids, because suppliers of medicines always pass along the economic costs of their risks to their paying customers. Since I was obtaining the marijuana from outside my usual medical circle of insurer-physician-pharmacist, I was forced to pay the extra crime tariff foisted upon marijuana growers. During my last two years in the United States, I was paying, on top of my regularly insured medical costs, an additional $500 a month in order to obtain effective and tolerable treatment for my pain by consuming illicitly obtained marijuana.
The cost was even greater because of the difficulties involved in obtaining marijuana with sufficient levels of THC and the other active ingredients. My prescribed opioids were, naturally, always clearly labeled as to purity and potency. On the other hand, those who grow marijuana in the U.S. select their plants for a variety of characteristics. Many of the choices made by marijuana growers are determined by the unique situation arising from the prohibition of the plant, rather than the need to provide a consistent high-quality medical product.
For example, plants may be favored by growers because they allow an early harvest, or because they are particularly amenable to growth outdoors. On the other hand, plants may be favored because consumers report that they enjoy the appearance, flavor or specific nature of the intoxication arising from a particular plant. That is, a plant may become popular with growers simply because of a "fad" among consumers. Regardless of the reason, it is a simple fact that one must search long and hard when one is looking in the Midwestern U.S. for an illicit grower who can consistently provide marijuana of therapeutic value. As mentioned above, even this long search may be fruitless, should the grower be arrested. In addition, should the grower live far away, one must pay extra transportation costs.
For the last two years of my time in the U.S., I was forced to take a seven-hour solo automobile ride once a month in order to gain consistently safe access to marijuana that would be of consistent therapeutic value. It was bad enough that this ride added significantly to the indirect cost of my marijuana, but the ride was physically unpleasant for someone with my back condition, and psychologically distressing for someone who constantly feared arrest. Again, a contrast with my personal experience with prescribed opioids is instructive. I could obtain my prescribed opioids from any one of a number of conveniently nearby pharmacies. These pharmacies, are of course, regulated by the government, staffed by helpful professionals, and protected by the police.
My Dutch physician became convinced of the legitimacy of my problem only after I arranged for the transfer of my extensive U.S. medical records. I was given a prescription for 50 grams per month of medical marijuana. Obtaining this prescription provided me with the first opportunity in my life to discuss, with a physician, the specifics of how to best integrate my family and personal medical history with the use of marijuana for pain relief. For example, I was able to discuss my concerns about the possible cardiopulmonary consequences of chronic marijuana smoking, given my family history of severe heart and lung disease. Whenever I had discussed this issue with U.S. physicians, I was invariably and aggressively told that the potential negative cardiopulmonary consequences of chronic marijuana smoking rendered the drug inappropriate for my use. In contrast, with my Dutch physician, I was able to discuss the advantages and disadvantages of different methods of marijuana consumption. Since I had a chronic pain condition with occasional bouts of severe pain and disability, my doctor recommended that I regularly consume low doses of medical marijuana in tea and/or edible treats. It was hoped that this would enable relatively constant and low levels of THC in my system, allowing a balance between therapeutic effect and intoxication. Any severe flare-ups that might "break through" the chronic levels of THC could be immediately eliminated by a few puffs of medical marijuana. I have employed this technique of chronic low-dose oral consumption supplemented with occasional inhalations for nearly 18 months now. I find it highly effective in dealing with most of my chronic pain.
Even though edible treats are treated as "hard drugs" here in Holland, I am able to obtain cheap and effective edible treats from a number of nearby coffee shops. These products are intended for a recreational market, and are quite inferior to the tinctures and candies that could be manufactured by pharmacists or drug companies. Nonetheless, since these are commercial products intended for repeat recreational customers, the amount of marijuana in a particular edible good obtained from a particular coffee shop is remarkably consistent.
Thus, I am able to easily titrate my intake of edible marijuana to insure maximal therapeutic effect with minimal intoxication. Of course, when I have the time, I make my own edible concoctions with very specific doses of marijuana, thus enabling an even better titration. While it would be cheaper if I could obtain medical marijuana from my pharmacist, Dutch tolerance of recreational marijuana users means that I can obtain, direct from friendly growers, cheap and effective marijuana that I can afford to use. As I live in Amsterdam, it is no problem for me, while out and about, to find a nice coffee shop (or even a quiet bench in a park) where I can smoke a marijuana cigarette without fear of harassment.
Since there is a lack of prohibition against the use of recreational marijuana in Holland, and since more and more Dutch people are becoming aware that some marijuana use is medicinal, it has even been possible for me to smoke a marijuana cigarette in situations where even the recreational smoking of tobacco would be discouraged. Indeed, a co- worker once questioned whether it was appropriate for me to smoke a joint over my lunch time, and then to return to work. This persons objections were silenced when I pointed out that I needed the marijuana as medicine for pain relief, and they agreed completely with my assertion that it was certainly better for me to work after smoking marijuana than it would be for me to work after consuming a prescription opioid pain reliever.
In conclusion, even though it is inappropriate today to refer to any country of the world as allowing medical marijuana, it is appropriate to say that the therapeutic use of marijuana is more advanced in Holland than anywhere else. That is, the toleration of recreational marijuana has made it easier for people such as myself to bring this therapeutic compound within the confines of their usual medical care, allowing total health without the physical and psychological consequences of a vicious and unscientific prohibition. This raises an interesting challenge to those in the U.S. and other countries, who hope to enhance the probability of the legalization of recreational marijuana through first promoting the myth-destroying use of medical marijuana. It may well be that this approach is incorrect, and that drug war mythology must be exploded by long-term tolerance of recreational marijuana before a conservative community of medical practitioners will accept an illicit drug as a medicinal compound.
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