Pubdate: Fri, 22 Mar 2002 Source: Portland Tribune (OR) Copyright: 2002 Portland Tribune Contact: http://www.mapinc.org/media/2056 Website: http://www.portlandtribune.com/ Authors: John Sajo, Dr. Phillip Leveque, Grant Higginson Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal) THREE VIEWS: The air still hasn't cleared over the issue of medical marijuana, despite passage of a 1998 act. One doctor feels the heat, while activists rally for improved access. Give People Access, Not Red Tape Marijuana is a safe, effective medicine. Patients who can benefit from it should be able to get it. Oregon voters were right to pass the Oregon Medical Marijuana Act in 1998. Since then, evidence has mounted showing that marijuana helps patients suffering from a wide range of ailments. For many patients, marijuana works better than more expensive pharmaceutical drugs. Some cancer patients report that marijuana is the only thing that controls the nausea caused by their chemotherapy. For some glaucoma patients, marijuana is the only thing that keeps them from going blind. For many chronic pain patients, medical marijuana allows them to end or reduce their use of dangerous drugs such as morphine and Vicodin. This allows them to function far better, which is wonderful for them and their families. Since the act took effect, more than 3,500 patients have been qualified to use medical marijuana by nearly 800 Oregon doctors. Oregon's law has allowed these patients to choose which medicine to use. There have been no reports of any significant adverse reactions to using marijuana as medicine. The problem with the act is that it does not create a supply of medical marijuana. Instead, it requires sick and dying patients to grow their own medicine. This hasn't worked and never will. Some lucky patients have a caregiver who can successfully grow marijuana for them, but most patients have struggled unsuccessfully with gardening and resort to the black market if they can afford it. Another problem with the act is that the health department has failed to follow the law and imposes so much red tape on participants that many patients avoid the program. The act requires the department to issue registry cards within 30 days to patients who submit complete applications. The department virtually never meets this deadline, and patients have been arrested as a result of not having a card. This is intolerable. Other departmental decisions can only be characterized as foot dragging. The level of service is unacceptable for a program that is completely self-funding. Given that marijuana seems to be useful for so many conditions, it is disappointing that the department has done nothing to document the positive results that many patients are achieving. The biggest problem with medical marijuana is the federal government. Voters in 10 states have passed laws legalizing medical marijuana, but Congress refuses to budge from the outdated "reefer madness" position that criminalizes all use. The medical use of marijuana is not going to stop. Far too many patients know that it helps them far too much. It is time for our leaders to follow the people on this issue. The Life With Dignity Committee is sponsoring a statewide initiative petition for the November ballot that would expand the Oregon Medical Marijuana Act. Soon, we will begin passing petitions and expect to get the required 67,000 legal signatures to become eligible for the November ballot. This initiative will create licensed dispensaries, regulated by the health department, where qualified patients can purchase their medicine in a safe environment. The initiative also would make numerous other changes in the Oregon Medical Marijuana Act that would cut through some of the red tape that has denied patients the choices they should have. Marijuana is medicine. Patients should be able to get it. John Sajo is the director of Voter Power and a chief petitioner of the Life With Dignity petition. My Responsibility Is To Help Sick People The medical marijuana hullabaloo is not about patient care. It is all about money! The money not spent on expensive prescription drugs. Marijuana is one of the safest medically active substances known to man. It is easy to grow and safe to use. But it isn't taxed, legally sold, patented, promoted or protected by big-money lobbyists and multibillion-dollar out-of-state corporations, as are big tobacco, alcohol and "legal" prescription drugs. I'm just an old medical college professor with 30 years of teaching pharmacology and toxicology, turned country doctor for 10 years, with far more education on the effects of drugs than most. Cannabis has often been called a miracle drug because of its effectiveness in the treatment of pain and such a wide path of diseases. It has been used in medicine for at least 5,000 years. Marijuana is even mentioned in the Bible, Exodus 30:23, when God ordered Moses to make a holy oil, composed of myrrh, sweet cinnamon and kaneh bosm (cannabis). Marijuana is well-known and used in medicine worldwide. It was one of the most widely used medicines in America before being legally banned in 1937. Oregon voters approved medical marijuana in 1998. Eight states have followed. Oregon patients can now apply to the state, for an annual fee of $150, for a card authorizing their legal use of marijuana for their own medical purposes. Every application must be signed by a physician confirming that, in his or her opinion, the applicant is suffering from an ailment for which the state has approved the use of marijuana for treatment. Doctors do not prescribe medical marijuana. The state approves all medical marijuana cards. The state had anticipated only about 500 applications but already has issued more than 3,500 cards and is months behind in approving new applications. And now the state has added more delay to its multifarious approval processes by requiring a physician's physical exam of all applicants, which I now do. Why? The state has approved marijuana in the treatment of nine diseases, including cancer. All require a medical specialist for detection, not just a regular physical exam. Surely the state's public health officer hasn't the time or staff with the expertise to review thousands of physical exams. I'm but one of nearly 800 doctors who have signed medical marijuana applications. By far, I have examined the most patients: Thus, the state has singled me out, publicly attacked me and threatened my license, even though the law says physicians cannot be prosecuted for giving their opinion. Their goal is to scare other doctors in an attempt to kill medical marijuana in Oregon. The state seems to be saying, "We don't care what the voters want," while ignoring the real victims: the forgotten thousands of Oregonians, the paraplegic vets and others who medically need and want to use marijuana "legally" as an effective alternative medicine for the relief of their pain rather than using expensive and often harmful prescription painkillers. The state doesn't care. But, thank God, others do. And thanks to several brave doctors, hundreds of dedicated advocates and the majority of Oregon voters, there are now more than 3,500 Oregonians legally suffering less medical misery than before. To which I say, "Hurrah!" For that is what doctors should do. Phillip Leveque, a doctor of osteopathy, says he has signed more than 1,600 medical marijuana card applications. He lives in Molalla. State Fine-Tunes Its Nascent System In 1998, Oregon voters passed a law to protect seriously ill patients from prosecution for using marijuana as medicine. The Oregon Medical Marijuana Act is 3 years old, but strong feelings and confusion about it still exist. As a public health officer in the state Department of Human Services, I oversee the medical marijuana program and want to clarify some facts. The act grants legal protection to qualified patients. Those who are registered for the Oregon Medical Marijuana Program are issued a card to show they have met requirements for the legal use of medical marijuana. To qualify for a card, an applicant must be an Oregon resident and suffer from one of nine listed debilitating medical conditions. An attending physician must document the patient's medical condition and confirm that the patient may benefit from medical marijuana. The law allows patients to designate a primary caregiver to legally assist in growing and administering medical marijuana. The law includes a petition process for adding new medical conditions to the list when there is supporting scientific and clinical evidence. The act gave responsibility for creating the registry system to the Department of Human Services. From the beginning, our goal has been to operate a program that is accountable to patients and the public. Here is how we interpret the law: Marijuana is a legitimate medication for some patients, and both they and their physicians are legally protected from prosecution for its use and for discussing its use. Medical marijuana use is restricted to patients who have one or more of the medical conditions named in the law. The decision of whether to use marijuana as medicine is made by the patient with his or her attending physician. Restrictions reduce the potential for abuse of the law and ensure that medical marijuana is not diverted to illegal purposes. For two years, the program worked as intended. Almost 600 patients registered in the first year, and more than 300 physicians participated. We added one medical condition to the list. In 2001, we discovered that an attending physician's signature had been forged on seven applications. We immediately contacted law enforcement and conducted a stringent internal review. This resulted in changes to our management of the program. We also found that there had been a sharp increase in the number of patients and that one physician had signed documentation for 1,642 people, about 40 percent of the applicants. The act states that the attending physician must have "primary responsibility for the care and treatment of the applicant." We questioned whether one individual could fulfill this role for so many patients. Subsequently, we filed new rules to better define attending physician requirements: The doctor must review the patient's medical history, conduct a physical exam, provide for follow-up care and document this in the patient's medical record. The rules give the state authority to review medical records when we question whether a legitimate physician-patient relationship exists. Under these rules, about 300 applications were denied because of insufficient documentation. Patients, advocates and policy-makers have expressed a range of perspectives on these recent changes. Some think that we are becoming too intrusive and erecting barriers to qualified patients. Others think that we should be more restrictive. Our goal is to achieve a balance of providing quality service for patients the act was meant to serve while ensuring that only legitimate patients receive registration cards. Grant Higginson is state public health officer at the Oregon Department of Human Services. - --- MAP posted-by: Josh