Seattle -- Betty Hiatt's morning wakeup call comes with the purr and persistent kneading by the cat atop her bedspread. Under predawn gray, Hiatt blinks awake. It is 6 a.m., and Kato, an opinionated Siamese who Hiatt swears can tell time, wants to be fed.
Reaching for a cane, the frail grandmother pads with uncertain steps to the alcove kitchen in her two-room flat. Her feline alarm clock gets his grub, then Hiatt turns to her own needs.
She is, at 81, both a medical train wreck and a miracle, surviving cancer, Crohn's disease and the onset of Parkinson's. Each morning Hiatt takes more than a dozen pills. But first, she turns to a translucent orange prescription bottle stuffed with a drug not found on her pharmacist's shelf -- marijuana.
Peering through owlish glasses, Hiatt fires up a cannabis cigarette with a wood-stem match. She inhales. The little apartment -- a cozy place of knickknacks and needlepoint -- takes on the scent of a rock concert.
"It's like any other medicine for me," Hiatt says, blowing out a cumulus of unmistakable fragrance. "But I don't know that I'd be alive without it."
With the U.S. Supreme Court poised to soon rule on whether medical marijuana laws in California and nine other states are subject to federal prohibitions, elderly patients such as Hiatt are emerging as a potent force in the roiling debate over health, personal choice and states' rights.
No one knows exactly how many old folks use cannabis to address their ills, but activists and physicians say they probably number in the thousands. And unlike medical marijuana's younger and more militant true believers, the elderly are difficult for doubters to castigate as stoners.
Their pains are unassailable. Their needs for relief are real. Most never touched pot before. As parents in the counterculture 1960s, many waged a generation-gap war with children getting high on the stuff.
Now some of those same parents consider the long-demonized herb a blessing.
Patients contend that cannabis helps ease the effects of multiple sclerosis, glaucoma and rheumatoid arthritis. It can calm nausea during chemotherapy. Research has found that cannabinoids, marijuana's active components, show promise for treating symptoms of Parkinson's disease and Alzheimer's, perhaps even as anti-cancer agents.
A recent AARP poll found that 72 percent of people age 45 or older believed adults should be allowed to use cannabis with a physician's recommendation. (The poll found a similar proportion staunchly opposed to legalizing recreational pot.) Even conservative elders such as commentator William F. Buckley and former Secretary of State George Shultz have supported marijuana as medicine.
Hiatt and those like her are "more and more the face of the marijuana smoker," said Ethan Nadelmann of the Drug Policy Alliance, which advocates treating cannabis like alcohol: regulated, taxed and off-limits to teens.
"There's this sense that when you get old enough, you've earned the right to live your own life," Nadelmann said. "The mantra of the drug war has been to protect our kids. But the notion of a drug war to protect the elderly? That's ludicrous."
Stories of suffering elders are not lost on John Walters, director of the White House Office of National Drug Control Policy, President Bush's point man for the war on illegal narcotics. But as he beats the drum for psychotropic abstinence, the drug czar doesn't mince words.
"The standard of simply feeling different or feeling better" does not make pot safe and effective medicine, said Walters. People who abuse illegal drugs such as crack cocaine feel a similar burst of euphoria, he noted, "but that doesn't make crack medicine."
Congress and federal drug regulators have repeatedly rebuffed pleas to legalize medical use of cannabis, which is classified as a dangerous Schedule I drug, along with heroin and LSD. Walters argues there is no clinical proof qualifying smoked pot as medicine. Any beneficial compounds that do exist in the leafy plant, he said, should be synthesized, sent through the rigors of the regulatory process and packaged as a pharmaceutical, not smoked like black-market weed.
"This is not like growing a rosebush in your yard," Walters said. "This is a plant the products of which are used for serious and expensive abuse among illegal drugs."
Hiatt isn't seeking a recreational high at this early hour, with much of Seattle asleep.
She received a diagnosis of breast cancer in 2001. Chemotherapy left her a wreck. She threw up anti-nausea drugs, so her oncologist suggested cannabis, legal for medical purposes in the state of Washington.
"I thought he was a little off track," she recalls. "I had never done anything like that. I was very uneasy."
A few puffs of pot smoke each morning help quell the nausea caused by her prescription drugs, she said. Her appetite is restored and she never gets high.
Her two granddaughters, ages 18 and 20, display a ho-hum attitude about Granny toking up.
"It's just totally the norm," said Jessica, the elder of the two.
Hiatt's son Doug, a defense attorney, endorses his mother's use of medical pot, picking up her cannabis every few weeks from a collective.
Her other son doesn't share that unfettered faith. Dan Hiatt, an assistant district attorney in Atlanta, was shocked to learn his mother was seeking relief from a drug that has landed many a pusher behind bars, his mother recalled. (Dan Hiatt declined to be interviewed.)
But he never tried to talk her out of it, Betty Hiatt said. "I don't think he likes it, but he accepts it. He loves me. He knows I wouldn't be doing it for fun."
Hal Margolin, 73, claims the same dependency.
Pain drove the Santa Cruz man to the drug. It began a decade ago, as the cervical vertebrae at the top of Margolin's back calcified, strangling a bundle of nerves and producing a searing sensation in his extremities. His feet can feel as if scalded by boiling water.
Margolin tried to address the unrelenting agony the standard way, buying maxi-packs of Advil and Aleve. An operation made things worse. He lost the feeling in his fingers and the soles of his feet, and at times he was reduced to crawling to the bathroom. Despite a prosperous retirement, a good marriage and two happy grown children, Margolin contemplated suicide.
He tried pot at a friend's urging. A few tokes and the pain seemed to recede to the background, Margolin said. "I was no longer obsessing" about it, he said.
Finding marijuana at the start was no easy task. At times, the bald and bespectacled retiree was forced out on the streets to score his weed.
Dressed in a cardigan sweater against the coastal cool, he would amble along the ramshackle blocks adjacent to the town's beachfront Boardwalk. Mustering his courage, Margolin would approach one of the street kids he figured was dealing. Most of the time, they scoffed.
"They thought I was some kind of undercover cop," he said.
Now he gets his cannabis from a Santa Cruz dispensary serving 200 patients, many of them terminally ill. In a decade of operation, the cannabis cooperative has lost more than 150 clients to cancer, AIDS and other ills. A woman who used pot to tame the painful aftereffects of polio died last year at 93. Margolin now is among the oldest.
For him, marijuana has been "the difference between clinical depression from the pain, and carrying on with my life."
Although it was part of the U.S. pharmacopeia early in the 20th century, cannabis was outlawed during the Great Depression. In recent decades, advocates have repeatedly failed to gain federal approval for doctors to prescribe the herb.
An exhaustive 1999 study by the National Academy of Science's Institute of Medicine concluded that marijuana can help curb pain, nausea and AIDS- related weight loss. The study warned against the toxic effects of the smoke, but said cannabis could be given under close doctor supervision to patients who don't respond to other therapies.
Now several small drug companies are pressing forward with prescription forms of the drug, such as the cannabis mouth spray that G.W. Pharmaceuticals of Britain is expected to soon begin marketing in Canada.
During the buildup to prescription forms, the raw plant shouldn't be ignored, said Dr. Raphael Mechoulam, a pioneer in cannabinoid chemistry at Hebrew University of Jerusalem. If it helps the elderly fight pain until prescription drugs are available, he said, "then why not?"
Some have already found ways around lighting up.
Catherine Ballinger, 94, saw a busy retirement undercut by infirmity. A fiercely independent woman who worked for years as a technical illustrator during the heyday of Southern California's aerospace industry, Ballinger lives in pain. Her right hip and knee grind bone on bone and arthritis bedevils her. She can hardly walk. Pain forced the Torrance (Los Angeles County) woman to give up a beloved hobby, painting seascapes while perched on the Pacific bluffs.
She was never a smoker, so Ballinger's doctor recommended trying cannabis baked into brownies. Her agony shrank, Ballinger says, allowing her to sleep. Although no miracle cure, the brownies made life tolerable.
"If those guys in Washington had the pain I suffer," she said, "they wouldn't put up all these legal barriers for patients to obtain medical marijuana."
It is controversial even in states that have approved it, and medical marijuana remains illegal in most of the United States. But even outside safe havens such as California and Washington, a few marijuana patients have enjoyed a free pass.
For nearly three decades, the United States has provided cannabis grown on a University of Mississippi farm to a tiny sampling of seriously ill people in a special federal program. The effort, launched in the mid-1970s to settle a "medical necessity" lawsuit brought by glaucoma patient Robert Randall, was shut to newcomers in 1992 as a flood of AIDS patients sought entry. Over the last decade, others have sued to get in but failed. All that remain are seven survivors, many pushing their golden years.
Randall died in 2001, but Elvy Musikka of Sacramento is 65. The oldest is Corinne Millet, 73, a Nebraska grandmother suffering glaucoma. The wife of a surgeon, Millet credits the government marijuana with saving her sight.
Irvin Rosenfeld calls their little band the nation's most exclusive club aside from living ex-presidents. At 52, Rosenfeld is the youngest -- and he expects to be smoking pot as medicine for decades to come. A dozen joints a day curb riveting pain from a rare disorder that causes bony protrusions to poke like cattle prods into his muscles.
Despite his copious marijuana consumption, Rosenfeld has prospered as an investment banker in Fort Lauderdale, Fla. His longtime boss marvels at his energy. Without marijuana, Rosenfeld said, "instead of being a productive member of society, I'd be a burden."
Among medical marijuana's biggest blocs are AIDS patients, including many longtime survivors edging toward old age.
Keith Vines received his diagnosis of the disease in 1986. He nearly died in 1993, as AIDS wasting stripped him of 60 pounds. When pills didn't help, his physician recommended marijuana.
For years an assistant district attorney in San Francisco, Vines felt like a "fish out of water" skulking into a medical marijuana dispensary the first time. But pot increased his appetite. Nausea from his medications ebbed. At 55, he has smoked it for a decade, limiting use to a few times a week.
Now this law-and-order guy would love to sit down with Walters or the president, close the door and talk.
He'd tell them about losing friends and feeling despair. He would talk about retiring early from a job he loved, after AIDS compromised his short-term memory. He'd ask that they stop fighting the sick and elderly.
"Survival," Vines said, "is struggle enough."
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