Carol Rosenfield hurts. Pain and fatigue smother her, arriving without warning. Sometimes, the 58-year-old West Hollywood woman says, symptoms of her multiple sclerosis strike so hard she feels as if she's melting, "like the Wicked Witch of the West."
What she wants -- what she says she needs -- is Dr. Geoffrey Guy's medicine.
On the far side of the Atlantic, Guy and his fledgling British pharmaceutical company are poised to release a prescription drug packed with equal parts potential and controversy. Contained in a tiny spray bottle, the drug developed by GW Pharmaceuticals is named Sativex. Most know it by its street name: marijuana.
Even in advance of its expected approval in Britain, the medication is roiling anew the long and bitter standoff over medical marijuana in America, a conflict that has knotted California since 1996, when voters approved cannabis as medicine.
Despite the U.S. government's long resistance to marijuana for the ill, the Bush administration is privately voicing a cautious interest in Guy's medication. Apart from the drug's potential benefits to patients, some administration officials see it as a step toward ending the emotionally charged duel between the nine states that have legalized medical cannabis and the federal government, which stands by its unbending ban on marijuana for any use.
Instead of hitting the street-corner drug dealer, medical marijuana patients could get a doctor's prescription filled at the neighborhood pharmacy. The sick who stick with smoked cannabis would risk seeing sympathy ebb, sparking a new wave of raids on the dozens of cannabis dispensaries that have survived to serve California patients.
Though such potential pitfalls aren't lost on pot activists, some see a different future. By vaulting a long-demonized substance from the fringe to the pharmacy, they contend, prescription elixirs such as Sativex could help reshape public opinion about a drug maligned by federal officials as Cheech and Chong medicine.
Rosenfield doesn't plan to stand on the sidelines and wait. She doubts the U.S. Food and Drug Administration and federal Drug Enforcement Administration will give Sativex a green light any time soon. If it gets into British pharmacies and receives good reviews, Rosenfield vows, she will find a way to obtain the marijuana extract, crossing the Atlantic herself if necessary.
"Oh my god, yes," said Rosenfield, who uses marijuana to control her symptoms but would trade it for a prescription drug that works better. "If this Sativex is released in England, I will find a way to get it."
Sativex, which is sprayed in the mouth and absorbed by the mucus membrane, has undergone extensive clinical trials and is expected to be marketed in the United Kingdom, initially for treatment of multiple sclerosis and certain types of chronic pain.
Guy, a stout and energetic man who wears owlish glasses and professes to have never smoked marijuana despite his company's singular focus on the plant, believes further research might eventually prove cannabis-based medicines effective against many other illnesses, from cancer pain and rheumatoid arthritis to migraine headaches and Parkinson's disease.
"We haven't suffered any of the scoffing about the medical possibilities of cannabis as you have in the U.S.," Guy said. "The U.S. psyche has a great deal of difficulty getting past the notion of this as a demon drug."
GW Pharmaceuticals has generated skepticism in some quarters of the British press, with one broadsheet suggesting that Sativex rests on a flimsy premise advanced by Guy, the company's cheerleader in chief. But for most of last year GW's stock rocketed, particularly after the feisty start-up signed an agreement with Bayer, the pharmaceutical giant, to market the drug in Britain and Canada.
The company's creation was something of a happy accident for Guy.
In 1997, government officials were aghast at heavily publicized arrests of MS patients who had been medicating themselves with marijuana. British officials made it clear that they had no intention of legalizing smoked cannabis as medicine. But through side channels, they collaborated with Guy to launch research toward a prescription drug.
"We insisted they develop a proper medicine," said Alan Macfarlane, the British Home Office's chief drug branch inspector. "It had to be textured like a medicine, look like a medicine, behave like a medicine and be delivered like a medicine."
Guy, 49, set out on a bit of historical sleuthing to see how cannabis was used during the late 1800s, its heyday in the British pharmacopeia. (Queen Victoria is said to have used cannabis to ease menstrual pain.) The pharmaceutical firm focused on MS and neuropathic pain, the most common uses of medical cannabis in Britain today.