Doctors have
right to suggest pot
for patients,
lawyer insists

But federal officials are
harassing doctors for
doing so, he says

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By Helen Altonn
Star-Bulletin

Doctors should not be afraid to discuss the benefits and risks of marijuana and to recommend it if medically warranted, says an attorney for plaintiffs in a class-action lawsuit against the nation's drug czar and other federal officials.

Jonathan Weissglass, San Francisco attorney who was co-counsel in the Conant v. McCaffrey case, discussed legal issues regarding medical marijuana yesterday at the third annual Hawaii Conference on Addictions, sponsored by the University of Hawaii John A. Burns Medical School.

The two-day event explores medical and social issues of medical marijuana.

Weissglass said that after California legalized marijuana for certain medical purposes in 1996, National Drug Policy Control Office Director Barry McCaffrey responded, "For sure, we're not getting rolled over on this."

The office decided to take action against physicians recommending medical marijuana, although the Controlled Substance Act does not prevent that, Weissglass pointed out. The act simply prohibits doctors from dispensing or prescribing marijuana.

Since the federal government has criminalized marijuana, states cannot make it legal, but they do not have to make it illegal under state law, he explained.

The federal government must prosecute medical marijuana use itself but cannot force states to do the same, he said.

So on Dec. 30, 1996, he said, the federal government began a series of threats against California physicians, saying their license to prescribe drugs could be revoked if they prescribed or recommended marijuana.

In 1997 the federal government began to investigate physicians, he said.

"Physicians were incredibly intimidated from even discussing medical marijuana with patients."

The federal government created serious problems with the physician-patient relationship and with the medical staff, he said.

The federal government exceeded its authority under federal law and violated First Amendment rights of doctors and patients, Weissglass said.

The goal of the lawsuit was "to allow doctors to be doctors," he said.

District JUDGE William Alsup on Sept. 7 granted a permanent injunction prohibiting the federal government from revoking a doctor's DEA registration for recommending medical marijuana to a patient and initiating any investigation on that basis.

The federal government has appealed the decision to the 9th Circuit Court of Appeals, which covers Hawaii. If it stands up, Weissglass said, the decision will also apply here.

He said physicians should feel free to discuss medical marijuana and recommend it, "just as you might recommend red wine or herbal medicines."

But doctors should follow some precautions, he said, suggesting they carefully examine patients and recommend conventional medicines first.

Also, doctors should not tell patients where to obtain marijuana or give it to them, he said. "That's obviously a federal crime and could even be a state crime."

Among those taking notes at the conference was Arlene Buklarewicz, a self-employed registered nurse and certified case manager in Volcano, on the Big Island.

She said she has a patient in his late 50s with non-Hodgkin lymphoma who received a stem cell transplant at a mainland facility earlier this year.

He had eight rounds of chemotherapy the past two years and used marijuana six times to control his nausea, she said. He was nauseous only twice -- when he did not use marijuana, she said.

But he has never told his doctor in Honolulu about using marijuana, which he grows in his yard, she said. His doctor prescribed four different drugs to use as needed for nausea, and he has never used any of them, Buklarewicz said.

A recent CAT scan showed he was "totally clear" of cancer, although he still uses marijuana occasionally for residual effects of chemotherapy, she said.

She said he obtained an application from a Big Island doctor to use medical marijuana under the new state law.

But he was afraid to turn it in after a recent Supreme Court decision that the federal law on illegal marijuana makes no exceptions for seriously ill people, she said.

Ted Sakai, director of the state Public Safety Department, which issues applications for medical marijuana, said that as of May 17, 197 patients and 20 caregivers had applied. Thirty-five physicians had recommended marijuana for medical reasons.

He gave this breakdown:

Oahu: 19 physicians, 49 patients, 10 caregivers.

Big Island: Seven physicians, 78 patients, three caregivers.

Maui: Four physicians, 16 patients, two caregivers.

Kauai: Five physicians, 54 patients, five caregivers.

Dr. Lester Grinspoon, Harvard Medical School psychiatry professor, raised the issue of commercial products from compounds of cannabis or marijuana.

"Will the development of new products make medical marijuana obsolete?" he said. "Will pharmaceutical companies feel it is worth the developmental cost?"

A French group is looking into development of a cannabis chemical to reduce appetite, he said, and various compounds appear to protect brain cells after a stroke or head injury.

However, he said, "whole smoked cannabis" is more effective than a pharmaceutical version of it. He said he has never had a patient who prefers the synthetic Marinol to marijuana.

Commercial products also will be more expensive than natural marijuana, he said. In the end, he said, commercial success will depend how vigorously the prohibition against marijuana is enforced.