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Monday, February 12, 2001

Fear stymies
demand for medical

With U.S. and state laws at odds,
doctors are afraid to take part,
and patients cannot acquire
pakalolo legally

By Helen Altonn

Patients wanting to use medical marijuana aren't knocking any doors down to apply under the law passed by last year's Legislature.

Only 27 people statewide have registered to use marijuana for medical purposes since the program began operating Dec. 28, said Keith Kamita, head of the Narcotics Enforcement Division, state Department of Public Safety.

They include six on Oahu, four on the Big Island and 17 on Kauai.

"There is a lot of nervousness," says Pamela Lichty, board president, American Civil Liberties Union of Hawaii Foundation.

"'Paranoia' might not be too strong a word."

A patient referred to the Star-Bulletin by Lichty, for example, would identify himself only as "Green Throat" because of concerns about federal arrest.

Hawaii is the only place in the country allowing medicinal use of marijuana that requires applicants to register somewhere other than a health department, Lichty noted.

The Narcotics Enforcement Division handles the registry here.

Kamita said the process takes five to seven days and is set up with the physician basically in control.

If the doctor feels marijuana is necessary for a patient, he or she fills out forms developed for the registry.

The narcotics division verifies the information and sends the doctor a certificate to sign and present to the patient.

By Ken Sakamoto, Star-Bulletin
Keith Kamita, chief of the Narcotics Enforcement
Division, holds a medical marijuana certificate.

Certificate 'isn't worth much'

Kamita said mainland doctors have called wanting to certify someone for medical marijuana over the Internet or telephone. Anticipating that, he said, the law requires the doctor to be registered in Hawaii, and out-of-state registration is not honored.

Lichty said it was estimated originally that 300 to 500 islanders might qualify for medical marijuana, based on Oregon's experience.

About 700 people are participating in Oregon's program, which has been running since May 1999, and laws in the two states are similar, she said.

However, Hawaii patients are running into several obstacles.

Physicians are reluctant to participate because they are unclear about the relationship between federal and state laws, she said. "And the Hawaii Medical Association has not encouraged their participation or educated its membership."

Also, patients cannot get marijuana legally, even if they are authorized to use it for debilitating medical conditions.

"Green Throat" said the registry identification certificate authorizing a patient to use marijuana "isn't worth much."

"It doesn't really give a patient access to medical marijuana. Most of us are in the same situation as last year."

He said he thought he could "go shopping" for marijuana in San Francisco, but was told he cannot fly with pot.

Authorized patients are allowed to grow their own marijuana, but it takes at least six months to get flowers or buds, "Green Throat" said. "And there is nowhere we can legally get seeds."

The state House committees on Health and Public Safety and Military Affairs have passed a bill (HB 707) to the Judiciary Committee that eliminates some loopholes and tightens the law.

Does state law protect docs?

Among provisions, it adds new definitions for "adequate supply" and "registry identification certificate," calls for criminal background checks of potential patients and caregivers, and mandates information on the location of marijuana owned or controlled by the patient or caregiver.

Advocates of medical marijuana said the bill is premature, but public safety chief Ted Sakai said it addresses concerns raised during hearings on rules for the program.

The measure was revised after he and Lichty agreed to some changes, such as removing the physician's name from the patient's identification card.

"Green Throat" also protests putting the address for growing medicinal marijuana on the dollar-size identification card.

"To put the location of the grow site right on the card to show to people is ridiculous," he said, adding that it is like saying, "'Go ahead and arrest me, you federal agents.' It's self-incrimination."

As far as access to marijuana for authorized use, Sakai said the law would have to be changed to address that. "We're simply enforcing the law passed."

He said it is designed to protect patients because they can show their identification card if a policeman stops them and asks why they have marijuana.

Kamita noted that the narcotics division has a 24-hour hot line to respond to enforcement officers if they stop somebody and want to verify a medical marijuana certificate. "We have had a few calls already from police."

Sakai is encouraging people who need medical marijuana to apply for it, pointing out that Gov. Cayetano advocated it to relieve pain and suffering. "The most important step is to get his physician to authorize," Sakai said. "State law will protect physicians who sign off on this."

More than 300 physicians are participating in Oregon, and there have been no problems, Lichty said.

In a newsletter to members last August, however, the Hawaii Medical Association pointed out that federal law still prohibits possession or use of marijuana.

While exempt from state criminal penalties, physicians who recommend marijuana to patients are in danger of losing their federal license to prescribe controlled substances and could be subject to federal penalties, the HMA said.

Court ruling protects doctors

A federal judge in the 9th Circuit, which covers Hawaii, recently ruled that the government cannot penalize doctors who recommend marijuana by revoking their licenses to dispense medicine.

The Conant v. McCaffrey case stemmed from a federal class-action lawsuit on behalf of physicians and seriously ill patients who need medical marijuana.

Dr. Philip Hellreich, Hawaii Medical Association president, said the HMA is not telling physicians not to recommend marijuana. "We're saying, if you do do that, we can't guarantee absolutely there are no risks as far as the feds are concerned."

"Ninth Circuit notwithstanding, physicians realize it is against federal statutes." The 9th Circuit decision can be appealed, he pointed out.

"It's not true that we're anti-marijuana. We're just pro-scientific study," Hellreich added.

Large, controlled studies are under way at the National Institutes of Health and elsewhere to see if marijuana is effective for medical purposes, he said. "If those studies come out that it is effective ... I'll be for it."

"The best delivery system" also is an issue, he said. Whatever the results of the studies, he said, physicians will never support smoking as the route to using medical marijuana because it is damaging to health.

The studies are evaluating methods of administering marijuana orally, by patch and aerosol sprays, he said.

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