For Dutch in Pain, Drugstores Offer Pot by Prescription

By Keith B. Richburg
Washington Post Foreign Service
Wednesday, February 11, 2004; Page A22

GRONINGEN, Netherlands -- With a lever controlled by his left arm -- the only part of his body he can still move -- Peter Boonman maneuvers his motorized wheelchair across the floor of his spacious apartment to a table where he keeps a vaporizing pipe and small plastic pharmaceutical containers of pungent marijuana.

He packs the pipe with a small amount of the grass, steams it with a heat lamp and captures the highly concentrated THC vapor in a large plastic bag. He takes a hit from a short plastic tube attached to the bag and covers the top of the tube to keep the precious vapors from escaping. Then he settles back in his wheelchair and waits for the high to kick in.

Getting high makes Boonman's life bearable these days. Since his multiple sclerosis was diagnosed at the end of the 1980s, his robust body has slowly deteriorated. At 52 years old, he is almost entirely paralyzed and is confined to his wheelchair or bed.

"The MS makes me tired," he said. "The marijuana gives me strength and energy."

Boonman smokes about three grams of marijuana each day. When he runs low, he picks up the phone and calls a pharmacy here in Groningen, a city in the northern Netherlands. A pharmacist delivers the pot in small plastic jars -- usually 20 bottles, enough to last him a month. Eighty percent of the cost is covered by national health insurance.

Last March, the Netherlands passed a law allowing doctors to prescribe marijuana to patients suffering from a variety of ailments, including multiple sclerosis, AIDS and cancer. The Dutch government then contracted with two growers to produce the medicinal marijuana under strict guidelines to ensure quality and cleanliness. By September, the world's first large-scale government-contracted supplies of pot reached pharmacy shelves.

The Netherlands has long practiced what it considers a pragmatic approach to drugs, and distinguishes between hard drugs, such as heroin and cocaine, and so-called soft drugs, such as marijuana and hashish. The policy decriminalizes possession of soft drugs for personal use and allows them to be sold in designated "coffee shops."

The drug policy follows the Dutch approach in other social areas. Prostitution is legal and open, and prostitutes pay taxes; euthanasia and physician-assisted suicide are legal medical practices; and gay men and lesbians have the right to marry, exactly the same as heterosexual couples.

The Netherlands has gone even further and now treats marijuana like any other prescription drug. It is available at pharmacies in two potencies, and some patients prescribed pot can have a portion of it covered by their health insurance, like other medications.

Canada became the first country, in 2001, to legalize marijuana for medical use. But the Canadian law did not provide a way for people who wanted marijuana to get it. Legalization advocates say the Dutch system, making marijuana available in pharmacies, is more practical.

Paul van Hoorn, 71, and his wife, Jo, 70, are among the 20,000 Dutch patients who use marijuana for medical reasons. They began in 2001, she for chronic rheumatism, he for glaucoma.

In their small Rotterdam home filled with tiny figurines and dollhouses, they smoke marijuana each night at 8:30. Paul van Hoorn said he had bad skin rashes that cleared up when he began smoking marijuana. He said he reads the Bible after smoking, and he said that after he began using marijuana, he could read the fine print in the Scriptures more clearly.

Jo van Hoorn said she tried various medicines, including morphine, but nothing stopped the aching in her legs. Then she tried marijuana. "The first time I used marijuana, the cramps went away in five minutes," she said. "In five minutes, all the pain was gone. If someone had told me that, I wouldn't have believed it."

"There are a lot of times when we start laughing and giggling," she added. "I always take the first hit, and then I start to laugh." She said the laughing attacks are a side effect. "But," she noted, "a good one."

Another side effect, she said, is the cravings to eat, an urge widely known in the cannabis culture as the munchies. Having the urge to eat, Paul van Hoorn said, "is good for people with cancer, because when they have treatment, they sometimes get really thin."

The van Hoorns have become septuagenarian pot celebrities, attending marijuana fairs to sample the goods and helping to judge pot-grower competitions.

Paul van Hoorn picks his pot from a stash of several different varieties and keeps his samples in plastic baggies. "We've tried so many -- over a hundred types," he said. "It's hard to say which ones I like best." One favorite is the Dutch-grown marijuana called "Haze," he said, and another is "Northern Light." He also keeps a small amount of hashish on hand. "Sometimes, we put a little hash on top to make it stronger," he said.

For late starters like the van Hoorns, Dutch doctors recommend that they not smoke marijuana in the traditional way -- rolling it into a cigarette, or joint, or smoking it through a water pipe. Instead, doctors suggest that patients make marijuana tea or use the vaporizing method.

Evert Sholten, 48, a longtime marijuana user, several years ago designed a vaporizer using an old heating gun, when he wanted to give up smoking tobacco but to keep smoking pot. He now makes vaporizers of various sizes, including one that can run on a car cigarette lighter, for patients who need a hit of pot to get themselves to the hospital, he said. His vaporizers were on display at a recent cannabis festival in the central Dutch city of Utrecht, although many of the curious customers passing by his kiosk were pleasure smokers, not medical patients.

Sholten gives away his machines to many patients, and he is convinced of marijuana's medicinal use, particularly for people with pain. "I see the patients -- it's good for the patients," he said.

The medicinal marijuana law was generally welcomed, and passed without much public opposition or debate. But the law is being criticized by some -- for not going far enough. One well-known marijuana user, Ger de Zwaan, 51, chairman of the Patients for Medical Marijuana Foundation, based in Rotterdam, said the Dutch law is flawed because government controls keep the price of pot at pharmacies much higher than it is at coffee shops, and patients don't have access to the vast varieties available.

"The price is too high, and they don't let us, the patients, decide about the quality," de Zwaan said.

While medical marijuana use is widely accepted, it still carries a stigma among some Dutch, particularly away from the biggest cities, Amsterdam and Rotterdam.

Here in Groningen, Peter Boonman said his family has ostracized him since he became an outspoken proponent of medical marijuana in the local media.

"I have parents just across the road, and I haven't spoken to them in years," he said, pointing across his balcony to the highway outside. "If they see me, they just pass me."

"It's because of the marijuana," he said. "But it's normal. It's just medicine."