SEATTLE -- Betty Hiatt's morning wake-up call comes with the purr and persistent kneading of 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 tiny 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, a medical 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 odor 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 US 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 potentially potent force in the roiling debate over health, personal choice, and states' rights.
No one knows exactly how many elderly 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 '60s, 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 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 anticancer agents.
A recent AARP poll indicated that 72 percent of people age 45 or older believed adults should be allowed to use cannabis with a physician's recommendation. (The poll indicated a similar proportion staunchly opposed to legalizing recreational pot.) Conservative elders such as commentator William F. Buckley and former Secretary of State George P. 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.
Stories of suffering elders are not lost on John P. Walters, President Bush's point man for the war on illegal narcotics. But as he beats the drum for psychotropic abstinence, the drug czar does not mince words.
''The standard of simply feeling different or feeling better" does not make pot safe and effective medicine, said Walters, director of the White House Office of National Drug Control Policy. 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 not a whiff of 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.