Pubdate: Mon, 1 Mar 2004
Issue: Spring 2004, Issue 29
Source: Alternatives (Eugene, OR)
Copyright: 2004 Get Real Inc.
Author: Rick Bayer, MD
Bookmark: (Cannabis - Medicinal)


Cannabis or marijuana has been an important and effective herbal
medical therapy for thousands of years.

In our life and times, we now call it medical marijuana (mmj), and
federal prohibition laws make it very dangerous to prescribe, produce
or use. But this is slowly changing.

State medical marijuana laws granting limited access to the herb and
safety from police interference now cover about 20% of all Americans.
The first state to remove criminal penalties within limits for mmj use
was California in 1996. Oregon voters passed the Oregon Medical
Marijuana Act (OMMA) in 1998.

The Oregon Medical Marijuana Program (OMMP), a part of the Oregon
Department of Human Services (DHS), was created to administer the
OMMA. If a patient has a debilitating condition, as defined in the
OMMA, that patient applies by having his/her physician certify the
qualifying condition and that mmj "might help". (For more information,
go to the website, This site has a link to DHS OMMP.)

Debilitating conditions include cancer, glaucoma, HIV infection, or
symptoms of wasting (cachexia), severe pain, severe nausea, seizures,
or persistent muscle spasms, including but not limited to spasms
caused by multiple sclerosis. OMMP issues a one-year permit to
qualified applicants who pay the permit fee. Registered patients and
caregivers then enjoy limited exceptions from certain areas of Oregon
criminal law or are "decriminalized" within limits if there is a valid

Successes of the OMMA are numerous.

At the end of 2003, there were over 10,000 patient and caregiver
cardholders registered with the OMMP. Applications continue to rise as
more Oregonians learn about the OMMA. Over 1200 Oregon physicians
participate in the OMMP--an encouraging number, but more would be
better, given the need. There are many who suffer from debilitating
conditions who cannot find a doctor to help them because they live in
areas where no physician participates in the OMMP.

It is gratifying to realize how the OMMA has helped many suffering
Oregonians. Because of confidentiality concerns or costs, not all mmj
patients register with OMMP, so the actual numbers of mmj patients are
higher than records show. The estimated revenue per biennium to the
OMMP from patient permit fees tops $1 million now. This pays for the
administration of OMMP, which has never cost taxpayers a dime.
Recently, OMMP announced fee reductions.

The most commonly reported debilitating condition reported in
applications to the OMMP is severe pain. (It must be noted here that
in 1997, the American Society of Addiction Medicine affirmed that
physicians are obligated to relieve pain and suffering of their
patients, including those with concurrent addictive disorders.) Yet of
the approximately 9000 MD/DOs who engage in active clinical practice
in Oregon, only a fraction of them routinely serve patients with
terminal and chronic illness and, as noted above, only 1200
participate in OMMA. Only a minority routinely prescribes opioids and
other scheduled drugs for chronic pain.

In spite of glowing data at the 5-year mark, the OMMA still faces
opposition, particularly from law enforcement and politicians. Some of
the most entrenched opposition comes from the administrators of OMMP
itself. While OMMP management has consistently failed to issue permits
within 30 days (as required by law), they always seem to have time to
work for changes in the OMMA that would decrease patient access to
pain and symptom management. OMMP also is attempting to become more
involved in the practice of medicine while seeking to increase the
reporting burden on physicians without proof of improving public health.

Finally, spending patients' money without adequate benefit to patients
is a recurring irritation.

In the 2003 Oregon Legislative Session, Law Enforcement (LE) and DHS
collaborated to pass House Bill 2939 in the Republican-controlled
House but fortunately it was stopped in the split Senate. It would
have permanently denied an OMMP permit to anyone with a drug crime.

This sort of legislative gambit seeking to overturn the will of the
people is unethical.

As affirmed by the American Society of Addiction Medicine (noted
above), sick persons should never be prohibited from receiving
adequate pain and symptom control. People caught with illegal
quantities of prescription drugs (e.g. Rush Limbaugh) are still
legally eligible to receive pain control in their future, so why the
discrimination? There is never a valid reason to revoke, suspend, or
deny an OMMP permit to a patient, regardless of record, when his/her
physician says it might help.

There are other challenges rising.

For instance, even though the OMMA was written so each patient can
have his/her own garden of 3 mature and 4 immature plants, LE seeks
change so there would be no more than one garden per address.

This would mean spouses and roommates could not each be patients and
grow a garden together.

Naturally, patient advocates oppose these efforts by LE and DHS.
Recently, Democratic Senator Bill Morrisette asked DHS to chair a
legislative advisory committee to see if there is consensus among
proponents and opponents about the OMMA that can be presented to the
2005 Oregon legislative session.

An Oregon poll showed over 76% of Oregonians support "seriously ill
patients to use and grow their own medical marijuana with the approval
of their physician". A new mmj ballot initiative, the OMMA2 is
collecting signatures for the
2004 ballot.

Ten states: Oregon, Washington, California, Alaska, Arizona, Colorado,
Hawaii, Maine, Nevada, and Maryland now have medical marijuana
legislation. The conflict between state and federal laws has spawned a
series of court fights and federal bills concerning questions of
states' rights, medical necessity, and drug policy enforcement. A
federal bill to cut funding to federal drug enforcement authorities
for raiding facilities where marijuana is grown or distributed for
purported medical use was defeated partly because of the anti-mmj
stance of local prohibitionist and Democratic Congressman David Wu, of
Oregon. He was quoted in the Los Angeles Times as saying the "use of
marijuana is medically unnecessary and prone to abuse." Of course, Wu
has no medical credibility, but remains an obstacle to adequate pain
management among sick and dying Oregonians.

Outside of federal raids orchestrated by the Bush/Ashcroft
administration and legislative failures described above, recent court
rulings have been more favorable to mmj. The US 9th Circuit Court of
Appeals held that the federal Controlled Substances Act (CSA) doesn't
necessarily dominate state laws. This means the state mmj laws in the
9th Circuit (including Oregon) are federally valid for the moment, but
that ruling may be appealed to the US Supreme court.

The US Supreme Court decided not to hear appeals of a 9th Circuit
ruling that rejected the US Justice Department's claim the CSA
empowered the feds to revoke the narcotics prescribing licenses of
doctors who recommended marijuana.

This preserves freedom of speech for doctors and patients--for

Things have progressed since a small group of us wrote the OMMA and
pursued the political campaign that resulted in the November 1998 victory.

Over the last 5 years, many patients have benefited from the OMMA.
Oregon taxpayers have saved money through less marijuana prosecutions
and because of a completely patient-funded OMMP. Most importantly, we
are a little closer to a world where pain and symptom management of
chronic and terminally ill persons can make progress without the
heartless bludgeon of reefer-madness era prohibition.

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Rick Bayer, MD is board-certified in internal medicine, a fellow in
the American College of Physicians, and practiced in Lake Oswego for
many years. Co-author of Is Marijuana the Right Medicine For You? A
Factual Guide to Medical Uses of Marijuana, he was a chief petitioner
for the Oregon Medical Marijuana Act in 1998, and manages that includes a medical cannabis/marijuana
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MAP posted-by: Richard Lake