Pubdate: Sun, 26 Oct 2003
Source: Bulletin, The (OR)
Copyright: 2003 Western Communications Inc.
Contact:  http://www.bendbulletin.com/
Details: http://www.mapinc.org/media/62
Author: Kelly Kearsley
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)

CONTROVERSIAL HERBAL REMEDY

Every day Redmond resident Shaun Heuston is greeted by 18 pills, large and 
small, green and white, in a tin canister that he keeps on the shelf next 
to the window in his mobile home.

He takes six or seven of them before breakfast, lunch, dinner and before he 
goes to bed. The pills numb his lips, leave a copper taste in his mouth and 
make him throw up.

But above all, the pills promise every day to shore up Heuston's immune 
system and battle HIV/AIDS, which would eventually allow another illness to 
kill the 42-year-old.

Heuston uses medical marijuana through a state program to quell his nausea 
and boost his appetite. More than 140 Central Oregonians participate in the 
program, which voters placed into law in 1998.

"Half the battle is just keeping the medication inside of you," said 
Heuston, who was diagnosed in 1997 with the virus. "You have to do whatever 
helps you to keep that medication in your system, because it keeps you alive."

Local medical marijuana patients say they use the drug as part of their 
daily medical routine to lessen side effects from other medications, stop 
painful muscle spasms or replace other prescription drugs.

Patients interviewed said they were thankful the law allows them to legally 
use marijuana as medicine, but also pointed to holes in the program that 
can make access to the drug difficult.

Oregon is one of nine states that has legalized marijuana for medical use, 
with others including California, Washington, Maine and Alaska. About 6,000 
people participate in Oregon's program.

Under the voter-approved law, Oregonians "suffering from debilitating 
medical conditions should be allowed to use small amounts of marijuana 
without fear of civil or criminal penalties when their doctors advise that 
such use may provide a medical benefit."

Those debilitating medical conditions include cancer, glaucoma, HIV/AIDS 
and Cachexia, which is severe malnutrition or wasting. Severe pain, severe 
nausea and seizures, including those caused by epilepsy and muscle spasms, 
are also on the list.

Whether marijuana does have medical benefits has been much debated.

It's been difficult to conduct many clinical studies on the drug because of 
various federal regulations, according to a 1999 report from the Institute 
of Medicine titled "Marijuana and Medicine: Assessing the Science Base."

"Scientific data indicate the potential therapeutic value of 
(cannabis-derivative) drugs, primarily THC (the active ingredient in 
marijuana), for pain relief, control of nausea and vomiting and appetite 
stimulation," a summary of the report states. "Smoked marijuana, however, 
is a crude THC delivery system that also delivers harmful substances."

The Oregon Medical Association remains neutral on the subject, leaving it 
up to individual physicians to decide whether they would recommend 
marijuana for medical use.

The Federal Drug Administration has approved Marinol pills, which contain 
synthetic THC, and is used for patients with anorexia, AIDS or cancer 
patients who have chemotherapy-induced nausea and vomiting, according to 
the Marinol Web site.

Heuston had tried Marinol, but said it didn't help with the nausea caused 
by his other medications.

Increasingly health conscious, Heuston started exercising and stopped 
smoking cigarettes years ago because of his health. He said the smoke from 
his medical marijuana does bother him.

Both Heuston and his partner, Charles King, 37, also diagnosed with 
HIV/AIDS, are on disability and have a fixed income.

Other patients said they used medical marijuana because they didn't like 
the side effects of other prescribed drugs.

Martin Halsey, 47, a quadriplegic, uses medical marijuana to control muscle 
spasms in his arms and legs. The Bend man said he broke his back almost 20 
years ago after falling while skiing at Mount Bachelor.

His muscle spasms are particularly bad when it's cold.

"(My arms) get really tight," he said. "Sometimes I can't drive because I 
can't even move the steering wheel."

He's tried muscle relaxant and prescription pain medications. But they 
leave him tired and unable to think clearly, he said.

"I get zombified," Halsey said.

Though he had smoked marijuana before, Halsey applied for a medical 
marijuana card soon after the law went into effect.

To participate in the program, the state requires people to send 
documentation from their attending physician of their qualifying medical 
condition and, if it's their first application, documentation that the 
physician said marijuana may be a helpful medicine.

The program costs $150 the first year and then $100 each year to renew the 
application. Beginning this summer, the program lowered the cost to $50 if 
a person is on the Oregon Health Plan or receiving supplemental security 
benefits.

"We estimate about 35 percent of the participants qualify for that lower 
amount," said Mary Leverette, program manager of the Oregon Medical 
Marijuana Program. The program is administered by the Department of Human 
Services.

As of March 2002, the laws are more restrictive about who is considered a 
patient's attending physician. Physicians must have an established 
relationship with the patient, be primarily responsible for the patient's 
care and have reviewed the patient's medical charts.

The changes followed the Board of Medical Examiners investigation of a 
Molalla physician, Dr. Phillip Leveque. Leveque, according to an Associated 
Press report in 2001, had signed more than 40 percent of approved 
applications for the state's medical marijuana program.

"The primary way abuse (of the law) is supposed to be avoided is that it's 
a decision made between a patient and his attending physician," said Dr. 
Grant Higginson, the Department of Human Services public health officer.

Possessing marijuana remains illegal under federal law, making some 
physicians nervous about prescribing or even talking with their patients 
about medical marijuana, according to the Oregon Medical Association (OMA).

Jim Kronenberg, OMA associate executive director, said in the past the 
organization has advised its physicians to give patients inquiring about 
medical marijuana a copy of their medical records, showing they discussed 
the topic and that medical marijuana could help the patients' conditions.

The OMA advised physicians against signing the state application form or 
writing a prescription for medical marijuana on a notepad.

"The main goal was staying out of trouble with the feds," Kronenberg said.

A recent decision by the United States Supreme Court now makes the previous 
recommendations moot, he said. The high court rejected a request by the 
Bush administration to consider whether the federal government can punish 
physicians for talking about medical marijuana with their patients.

Upholding a previous decision by a California federal district court, the 
decision allows physicians to talk about and even recommend the use of 
medical marijuana as part of their freedom of speech.

The OMA has yet to revise its recommendations, but Kronenberg said they 
will likely be brief.

"(The new recommendations) will probably be 'here's the provisions of the 
Oregon law, here's what the courts said, and if you want to do it it's 
nobody's business,' " he said.

Dr. Stephen Kornfeld, a Bend oncologist, said he feels the law makes it 
irrelevant whether he believes in the medical benefits of marijuana or not.

"It just asks whether the patient has any of the following conditions and I 
have to confirm that they have chronic pain or a cancer," he said. "I'm not 
writing a prescription for marijuana and the state is allowing them to do it."

Kornfeld said the few of his patients who do use medical marijuana use it 
as a last resort, after they've tried other medications to control their 
nausea and increase their appetite. He estimated 1 percent to 2 percent of 
his patients participate in the state program.

In Prineville, Dr. Michael Knower, medical director of Pioneer Memorial 
Hospice, said he's recommended other prescription drugs as an alternative 
to the few patients who have inquired about medical marijuana.

"We have medications that are more effective (for controlling nausea, 
vomiting, etc.)," he said. "So why go with something that is not as effective?"

Dr. David Sandoval, a rheumatologist, said he hasn't encountered a 
situation with his patients where conventional medications didn't work for 
their arthritis pain.

Heuston, the medical marijuana patient, said problems with the state law 
lie with the little amount of information the state can give medical 
marijuana patients.

The state program is prohibited by law from referring patients to 
physicians who will recommend medical marijuana, supplying the patients 
with marijuana seeds or informing them where to buy the seeds or who else 
is growing medical marijuana.

"We review applications and determine if people qualify, nothing allows us 
to do anymore than that," said Leverette, the Oregon Medical Marijuana 
Program manager.

The lack of information can leave patients in a bind.

Heuston said most people turn to the Internet for information and use word 
of mouth for where to get marijuana. And many resort to the black market 
for the drug.

"At some point in your participation you are going to have to (break the 
law) if you want to have a constant supply," he said.

Halsey, of Bend, said he obtained his medical marijuana from the street for 
the first six months he was in the program, while he was getting plants and 
then waiting for them to grow.

Heuston said he and his partner have also had to do the same thing, 
particularly if they end up harvesting less from their plants than they 
anticipated or if more of their plants turn out to be males instead of 
females. The leaves and flowers of both plants are useable, but the male 
plants tend to have less THC and are usually discarded, he said.

Rick Szymanski, founder of Central Oregon Medical Marijuana Network 
(COMMN), said the program works best when patients take care of themselves. 
Szymanski is both a registered caregiver and medical marijuana patient. He 
has chronic pain from several back and neck surgeries, he said.

"Those are the success stories," he said.

Becoming a care giver, or having a caregiver can also pose problems for 
medical marijuana patients, patients said. Care givers are designated by 
the state to grow marijuana for medical marijuana patients.

The state allows care givers or medical marijuana patients growing their 
own to grow three mature plants and four immature plants at one time, 
though the law does make room for exceptions. Both Halsey and Heuston said 
the number of plants isn't enough to produce enough medicine for a year.

And those growing marijuana worry about thieves and have expensive security 
systems in place to protect their crop. Szymanski said his former home in 
Crook County was burglarized and people stole his marijuana plants.

Leverette, manager of the state's program, said the state's rules are 
unlikely to change unless the law changes.

For now, patients are happy the law exists.

Sitting Tuesday in his small living room, surrounded by bookshelves stacked 
with HIV/AIDS magazines and wooden furniture handmade by his partner, King, 
Heuston packs a colorful glass pipe with his homegrown marijuana.

Lighting the pipe, he recalled how skinny and sick both he and King had 
been before and shortly after each were diagnosed with HIV/AIDS. King had 
weighed 97 pounds.

"I was at 124 pounds," said Heuston, still slim at 150 pounds.

It was few minutes before lunchtime.

The couple hits of marijuana will give both men an appetite for lunch. 
Heuston will be able to keep down his next round of pills before heading 
off to his doctor's appointment that afternoon.

The drug makes each day a little more tolerable.

"When you are looking at 20 years of medication, (medical marijuana) makes 
looking down that road a little easier," Heuston said.
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MAP posted-by: Larry Stevens