Tom Faltynowicz, a 43-year-old gay rancher in Meade County, South Dakota, was diagnosed with Aquired Immune Deficiency Syndrome (AIDS) in 1990, and is currently facing criminal charges for possessing and growing marijuana for medicinal usage.For those of you unaware of the specifics of that disease, a patient infected with the Human Immunodeficiency Virus (HIV) may or may not develop AIDS. Once infected with HIV, the disease damages the CD4 cells (T-Cells), and in fact uses those cells to replicate within the body; CD4 cells can be replaced through normal process in the early stages of the disease, but eventually the counts start to fall as the cells are overcome by the virus. A CD4 count between 700 and 1000 is considered normal in a non-HIV infected person; while a CD4 count of about 500 is considered normal when the virus is present. A CD4 count below 200 is indicative of AIDS, since it is at that point that the body loses its ability to fight off opportunistic infection.
Opportunistic infection is any infection which, under normal circumstances, the body could easily fight off. However, due to the lack of CD4 immune cells, AIDS patients are at very high risk of contracting diseases which they would never contract were it not for the virus destroying their immune system. Some diseases are so common in AIDS patients, and so uncommon in non-AIDS patients, that they are considered to be AIDS-defining diseases. Examples of AIDS-defining diseases include Pneumocystis Pneumonia (a fungal infection of the lungs) and Kaposi’s Sarcoma (once believed to be a rare form of cancer, now believed to be caused by Herpes Virus HHV8); these diseases are normally not seen in patients with a normal immune system. While there is viable treatment for many opportunistic diseases, they must be treated swiftly in an AIDS patient due to the patient’s body being unable to fight infection on its own.
Another important way of measuring HIV is by measuring the viral load. The viral load is the amount of HIV in the body. So while a CD4 count measures the amount of damage HIV has done, a viral load count will measure how much of the virus is actually in the body. In this way, doctors are able to measure whether drugs are working to halt the spread of the virus.
AIDS is a pandemic first identified in 1981 by the Centers for Disease Control (CDC), due to Pneumocystis Pneumonia being identified in five homosexual men in Los Angeles. The disease did not take over worldwide as quickly as it is generally believed, though. AIDS has been identified in tissue samples of patients who died of unknown causes as early as 1959; one postmortem case identified the virus in a tissue sample from a 15-year-old boy who died in St. Louis, Missouri, in 1969, though it is still unknown how the boy may have contracted the virus. Some scientists suggest the virus could have first infected humans sometime during the end of the 19th Century, while other scientists suggest it first infected humans during the early 20th century, between 1915 and 1930. Regardless of whether it started during the late 19th Century or early 20th Century, it took many decades for it to even become prevalent enough to be noticed. Since the virus is slow to overtake its host, the window for inadvertent infection of others is years, rather than days or weeks as with most viruses.
It is unclear exactly how the virus started, but it seems clear that it crossed species from primates (which can carry a disease known as the Simian Immunodeficiency Virus) into humans, likely when humans came into contact with the bodily fluids of monkeys, possibly during consumption, hunting or butchering the animals (monkey meat is a delicacy in some areas of the world, and is regularly eaten in some areas of Africa). The virus spread due to a number of factors, including vaccines given with unclean needles in developing countries. While AIDS is now generally viewed as a disease of gay men and intravenous drug users, the truth is far more chilling, since the virus is not contained only within a particular population. Many women and children are infected with the virus, and in some areas of the world, particularly Africa where infected patients do not have access to proper health care, the number of deaths has become catastrophic.
At this time, there is no cure for HIV, or for AIDS, nor is there a vaccine to prevent transmission. However, scientists have designed a number of drugs inhibit the virus’s replication. To understand how these drugs work, a short primer on the virus is necessary.
HIV takes over CD4 cells, changing their molecular structure by inserting its own ribonucleic acid (RNA). The virus itself, which is too small to be seen except with an electron microscope, consists of an outer envelope containing the virus and the proteins and enzymes necessary for replication; the envelope has about 72 spikes on its surface. When the virus bumps into a cell coated by the CD4 protein, the spikes stick into the cell and fuse, at which time the inner contents of the HIV envelope is released into the CD4 cell.
Once inside the cell, the HIV enzyme called reverse transciptase converts the viral RNA into DNA, which is compatible with human genetic material. This DNA is transported to the cell’s nucleus, where it is spliced into the human DNA by the HIV enzyme called integrase. Once it is spliced into the human DNA, the HIV DNA is known as provirus. The provirus may lie dormant within a cell for quite some time. However, when the cell becomes activated, it treats HIV genes in almost the same way as human genes. First it uses human enzymes to convert HIV genes into messenger RNA. The messenger RNA is transported outside the cell nucleus, and is used as a blueprint for producing new HIV proteins and enzymes, much in the same way as the human body normally produce replacement cells.
Complete copies of HIV genetic material is contained among the strands of messenger RNA produced by the cell. These copies combine with newly made HIV proteins and enzymes to form new viral particles, which are then released from the cell. The enzyme protease plays a vital role of the HIV life cycle, as it chops up long strands of protein into smaller pieces, which are then used to construct mature viral cores. At that point the newly matured HIV particles are ready to infect another cell, and begin the replication process all over again. In this way the virus quickly spreads through the human body, and causes its host to become infectious. HIV is passed to others through bodily fluids; some fluids contain more of the virus than others.
Contrary to popular belief, people do not die of HIV, or of AIDS. They die of the opportunistic infections which accompany the complete loss of their immune system. Patients therefore must take a strong cocktail of medications to stop the virus from replicating and destroying their immune system. Some common drugs prescribed for AIDS patients, to stop the virus from replicating, include reverse transcriptase inhibitors, which prevent the viral RNA from being converted into human DNA; protease inhibitors, which prevent the virus from creating new mature viral cores; and integrase inhibitors, which prevent the viral DNA from being spliced into the human DNA within the cells.
Unfortunately, with those life-saving treatments for the virus come life-threatening side effects, from lethal liver damage to an overwhelming nausea which results in starvation and dehydration; when this occurs, it only worsens those same symptoms which can be caused by the virus itself. Over the years many drugs have been discovered to combat the side effects (those same side effects are found in many other medical conditions as well), and to increase the quality of life for those who are infected with the virus; some of those drugs and treatments are pharmaceutical in nature, and some are natural.
One of the non-pharmaceutical drugs, which has proven very helpful in battling the anxiety, overwhelming nausea and physical wasting which comes with the virus and its treatment, is marijuana. So effective is marijuana that scientists have even made a pharmaceutical version of the drug, used in chemotherapy patients as well as AIDS patients, which contains synthetic THC (the active ingredient in marijuana). However, many patients believe that the natural THC in marijuana works better than the synthetic version in Marinol, and science supports this belief. In studies of marijuana usage for medicinal usage, it was found that other chemicals found in marijuana have additional medicinal effects which complement the effects of THC. Furthermore Marinol is extremely expensive (Tom’s Marinol costs about $2200 per month, so severe is his nausea and gastrointestinal symptoms), and thus the drug is far beyond the financial reach of most patients; and for that reason they cultivate and smoke marijuana for medicinal purposes. While the black market cost of marijuana can be high, the plant can be cultivated at home from seeds, at very little cost to the patient.
In some states, it is legal for patients with a valid medical prescription to possess certain amounts of dried and cultivated marijuana for personal medicinal use. However, even in those states, the US Government – which has declared that marijuana is an illicit and therefore illegal drug – refuses to permit patients to use the cultivated form of THC. Patients are regularly arrested for merely possessing the substance which allows them to live a more normal life, and which in cases of extreme wasting seen in AIDS, is actually life-saving. This occurs nationwide, including in the states where marijuana is legal for medicinal use.
I do not advocate the casual use of marijuana (or any other drug, prescription or otherwise) to get “high”. I do strongly advocate the right of physicians and patients to determine the best course of treatment, and I believe the government has no right to interfere in the doctor/patient relationship when the patient is not being placed in untoward danger.
Enter Tom Faltynowicz. When Tom was diagnosed with AIDS in 1990, he was given “maybe a few years” to live. Eighteen years later, he is in a fight for his life, but it’s a fight of a very different kind.
In September 2007, law enforcement officials in his native Meade County received an anonymous call, stating that Tom had between 75 and 100 marijuana plants growing behind a metal building on his property. It is believed that the anonymous call came from Tom’s daughter, who was angry with him because he had recently stated his disapproval of her relationship with a particular man.
When Meade County Investigator Michael Walker and South Dakota Division of Criminal Investigation Agent John Griswold arrived at Tom’s home the next day, there were not 75 to 100 plants on the property, or even anywhere near that many; in fact, there were no plants out in the open at all. However, when asked by those officers about the accusation, Tom immediately admitted to growing marijuana to treat his medical condition. He even invited the officers into his home, so they can see where he was growing it, and he was completely cooperative at all times, even according to the police report regarding the incident. All told, the officers found five plants, and about four ounces of dried marijuana. There was never an allegation that the marijuana was being used for anything but his medical condition, and never an allegation that he was selling the marijuana. It remains undisputed that Tom was using the marijuana to treat AIDS, and the side effects of the many potent medications he takes to fight the virus.
Tom takes a total of four antiretroviral drugs to combat the HIV infection: Combivir (a combination of Retrovir and Epivir), Sustiva, and Viread. Each of these drugs, by themselves, come with potentially fatal side effects. All of these drugs can cause severe nausea, and can result in extreme anxiety as an additional side effect. In addition, Tom has been prescribed Marinol, the synthetic THC drug to combat nausea and vomiting, so there is no question that he suffers the side effects which are treated by marijuana, and there is no question that his side effects are severe based upon his dosage. However, Tom says that the marijuana is far more effective than the Marinol, since Marinol makes him so tired that he cannot function; and his physician is aware of and supports his use of marijuana to treat his symptoms.
Tom, though he has no prior criminal record with the exception of two prior misdemeanor convictions for possession of small amounts of marijuana – both of which occurred after he was diagnosed with AIDS – pled guilty to felony possession of marijuana. He faces a maximum of two years in prison, and a maximum fine of $4000; he could also be given probation. His sentencing date has been set for April 21st, before the Honorable Jerome Eckrich, Circuit Judge. Tom’s Infectious Disease Specialist, Dr. Traub, will speak at the sentencing hearing. The State Attorney has already said that he will not object to anything Dr. Traub might say. It appears that no one is interested in punishing Tom Faltynowicz; at the same time, under the law, his possession of marijuana – regardless of the reason why he possessed it – is a felony in the state of South Dakota.
Tom, however, is an exception to the reason that law was written. It was written to stop people from abusing the drug to get high, and to stop them from selling or otherwise providing it to others for the same illicit purpose. It is extremely doubtful the legislature was aware of the medicinal effects of marijuana when that law was passed, and it’s extremely doubtful the legislature ever intended to punish patients with a deadly disease. It’s even possible that the medicinal effects of marijuana were unknown to them when that law was passed, since it is hardly a new law. Nevertheless, since the law exists, it will be enforced, even against people like Tom who are using marijuana strictly for medicinal purposes.
This raises a number of questions. Even if Tom is merely placed on probation, and even if he stopped smoking marijuana altogether, using Marinol to control his symptoms would result in violation of probation, since he would test positive for THC during required drug tests. If he fails a drug test while on probation, he will be incarcerated.
If he is incarcerated, he will not only not have access to the drug which he needs to survive without excessive suffering due to overwhelming nausea, vomiting, physical wasting, and extreme fatigue; but the South Dakota Department of Corrections will be forced to pay for the extremely expensive antiretroviral drugs which fight the virus as well as the Marinol, at a cost of thousands of dollars per month to the taxpayers, in addition to the increased cost of incarceration for a man with an infectious deadly disease. As you should understand after my explanation of how those drugs work, and how the virus works, missing even one dose of his antiretroviral drugs could be catastrophic for his health, since it would allow the virus to replicate until the drug was again built up to a therapeutic dosage. Yet in a prison environment there is no guarantee that he will receive his life-sustaining medications at all, much less receive them on the schedule those drugs demand.
Tom has said that he will not stop using marijuana, because it allows him to live a relatively normal life. Without it, his body is wracked with pain, nausea, and vomiting; he is unable to eat or drink, and thus his body becomes even more weakened, even more unable to fight the virus, and even more prone to the many opportunistic illnesses, any one of which could easily end his life. This is especially true if he is confined in a jail or prison facility, given that there are large numbers of inmates living in close approximation.
To incarcerate Tom Faltynowicz would therefore place his life at severe risk, and as such would clearly constitute cruel and unusual punishment, as prohibited by the Eighth Amendment of the US Constitution. Furthermore, it would serve no purpose to incarcerate him, since his crime is merely possession of a drug which allows him to live with his disease and to continue take the cruel medications which literally keep him alive. He poses no threat to anyone and he is not selling or otherwise distributing the marijuana, nor has it even been suggested that he is selling or distributing the marijuana. Rehabilitation is also not a valid cause for his incarceration, since he merely uses the drug for medicinal purposes, and thus he is not in need of rehabilitation.
Society would not be served by incarcerating Tom Faltynowicz. The interests of justice would not be served by incarcerating Tom Faltynowicz.
As such, justice demands that the court show mercy by giving Tom Faltynowicz a suspended sentence, no probation, and whatever fine the court sees fit, as long as it is within Tom’s ability to pay said fine.