Pubdate: Wed, 02 May 2007
Source: Providence Phoenix (RI)
Copyright: 2007 The Phoenix Media/Communications Group
Author: Te-Ping Chen
Bookmark: (Cannabis - Medicinal)
Bookmark: (Students for Sensible Drug Policy)
Referenced: RI Patient Advocacy Coalition; Students for Sensible Drug 
Policy; Marijuana Policy Project; Drug Policy Alliance; Americans for 
Safe Access


Who's afraid of medical marijuana? Opponents' fears go unrealized 
with the implementation of Rhode Island's law

Two hits of marijuana in the morning, and two in the evening before 
he goes to sleep. That's what it takes to get Bobby Ebert through the day.

But Ebert's not a junkie or a college student looking for a quick 
high. He has AIDS -- and is one of more than 240 patients in Rhode 
Island whose use of marijuana is protected under state law.

In January 2006, the General Assembly resoundingly overrode Governor 
Donald L. Carcieri's veto, thereby making medical marijuana legal in 
Rhode Island. The law -- which allows patients suffering from 
"chronic and debilitating" medical conditions to use the drug, so 
long as they obtain a state-certified physician's permission -- is 
scheduled to expire June 30.

The sunset provision was included, notes Representative Thomas Slater 
(D-Providence), the prime sponsor of the House effort in 2005, 
"[Because] we wanted a trial period to prove there wouldn't be 
problems with this kind of legislation." Opponents, including 
Carcieri, had cited fears that illegal use of marijuana could 
proliferate, and that insufficient controls existed for the 
production and distribution of the drug for its intended purpose.

Yet since going into effect in April 2006, Rhode Island's program has 
been conspicuous mostly for its lack of controversy. Charles 
Alexandre, the state Health Department's chief of Health Professions 
Regulation, describes the law as having "worked well and been pretty 

Even the police chief in North Kingstown, whose department made the 
arrest last fall of a registered medical marijuana user who was 
busted after soliciting underage girls on MySpace to smoke pot, calls 
that case an "aberration."

Ironically, in contrast to the initial concerns cited by opponents, 
the main challenge facing medical marijuana users in Rhode Island is 
obtaining access to the drug. Boosters are targeting this need with a 
new approach, but more about this later.

As it stands, the state's medical marijuana law enjoys robust public 
approval -- a Mason-Dixon poll last September found that 79 percent 
of Rhode Islanders support the current program. And perhaps that's 
not surprising. In a small state like Rhode Island, where the 
traditional six degrees of separation quickly gets streamlined into 
relationships far more intimate and immediate, the issue can be 
understood quite simply. A coworker with cancer, an uncle with AIDS: 
push deeply enough, it seems, and everyone has a story.

And while Carcieri and the Rhode Island State Police oppose 
legislation to make permanent the state's medical marijuana law, the 
General Assembly appears poised to again override any potential veto. 
As the Phoenix was going to press, the full House and Senate were 
scheduled to separately consider the measure.

Yet on a national level, the science of the drug, and the social 
implications of its medical use, remain hotly contested political 
topics. As more than 20 states gear up to consider medical marijuana 
bills, it's open season on the issue -- potentially making the 
experience of states like Rhode Island more relevant in the ongoing debate.

The new reefer madness Ebert, 41, of Warwick, who spent years on 
Vicodin and Percocet, says that marijuana allows him to control the 
"pins and needles" pain associated with his neuropathy in a way other 
substances never could. "Those drugs were horrible," he says. "They 
make you nauseous, so you can't eat, and when you stop, your body craves them."

Like Ebert, approximately 17 percent of the patients enrolled in 
Rhode Island's program through the Department of Health have AIDS or 
are HIV-positive. Patients with cancer (12 percent), Hepatitis C (12 
percent), and those suffering chronic or debilitating conditions (57 
percent) -- ranging from multiple sclerosis to epilepsy -- make up the rest.

Backed by advocates' calls for compassion, such patients have become 
the face of the medical marijuana movement, which has continued to 
gain momentum nationwide since California legalized its use in 1996.

"[Marijuana's] not a panacea," says state Senator Rhoda Perry 
(D-Providence), the leader of the effort in the Senate, who watched 
her nephew Edward Hawkins waste away to fewer than 85 pounds before 
dying of AIDS at age 41. "But what it could have done for my nephew 
is offer another option, another way to fight that incredible nausea 
and kind of pain."

Federal authorities maintain a hard line. In spring 2006, the US Food 
and Drug Administration issued a terse statement -- ironically 
enough, on 4/20 -- affirming that marijuana has no "currently 
accepted" medical use. Similarly, Tom Riley, a spokesman in the US 
Office of National Drug Control Policy, dismisses medical marijuana 
as a back-door attempt to push for the drug's overall legalization. 
"The public has fallen for activist claims that marijuana deserves a 
free pass from scientific and medical safeguards," says Riley.

Dr. David Lewis, director of Brown University's Alcohol and Addiction 
Studies Program and a longtime critic of the drug war's 
effectiveness, describes the medical community's view of medical 
marijuana as "mixed," in part since, "It's hard to have physicians 
endorse smoking anything as a therapy." Nevertheless, Lewis, who 
calls marijuana's medicinal value "obvious," notes that alternate 
methods of delivery, including vaporization, are available. 
Government opposition, he says, amounts to "the war-on-drugs 
mentality spilling over into the scientific community."

Even House Minority Leader Robert Watson (R-East Greenwich), usually 
a faithful ally of Governor Carcieri, is frustrated by the situation. 
"I just don't get the logic here," says Watson, an initial sponsor of 
the Rhode Island bill in 2005, who nonetheless voted to oppose it in 
partisan solidarity with the governor. Still, he says, "We prescribe 
far more addictive and lethal drugs to patients all the time. 
Morphine will kill you, codeine will kill you. Cigarettes will kill 
you. But marijuana?"

Fanning the flames is a study published in Neuropathy this past 
February, which found that HIV patients who smoked marijuana 
experienced significant pain relief, in one of the first rigorously 
controlled experiments of its kind. "I don't see any evidence that 
the [federal] policy is driven by science here," says the study's 
author, Dr. Donald Abrams of the University of California-San 
Francisco, who reports facing repeated federal obstacles in trying to 
obtain research-grade marijuana for his study. "It's much too fraught 
with emotional baggage and political overlay."

Caught in the middle are patients like Chrissy Neves, 41, of 
Riverside, many of whom have been quietly using marijuana for years 
to treat their symptoms. "All my life, I heard how horrible marijuana 
was," says Neves, whose weight has fluctuated since she had surgery 
to remove a brain tumor in 2004. In the time since, she's found that 
marijuana is the one drug that stimulates her appetite.

Rhode Island's medical marijuana program has encouraged others, like 
Michael Oliver, 39, of Barrington, to try using medical marijuana for 
the first time. For Oliver, who suffers severe stomach spasms because 
of Crohn's disease, marijuana makes the workday manageable. "One or 
two hits," he says, "and my stomach can breathe again."

Legal use, illegal supply To qualify for Rhode Island's program, a 
patient's physician must first verify their need in writing to the 
Department of Health, which oversees the program (

The vagaries of this process remain subject to controversy. Last 
spring, Governor Carcieri's press secretary issued a statement 
critiquing the law as "so broad that it would allow nearly any Rhode 
Islander to be a user." And to be sure, among those who think that 
only patients suffering end-stage diseases should be able to use 
marijuana, obtaining a physician's recommendation to use it for 
carpal tunnel syndrome -- as one patient reported he had -- might 
raise some eyebrows.

Nevertheless, according to Steven DeToy, spokesman for the Rhode 
Island Medical Society (which has long supported the legalization of 
medical marijuana), physicians act as gatekeepers for many 
treatments, not just marijuana. "The responsibility the law gives 
them is no different than that they already have in counseling 
patients," DeToy says. Certainly, fear that a handful of "pot docs" 
might end up dispensing recommendations to patients en masse has not 
been realized. The ratio of patients to doctors participating in the 
state program is roughly two-to-one.

Once a patient receives their physician's approval, the Department of 
Health processes their application -- none have been rejected thus 
far -- and issues an ID card verifying their participant status. From 
there on, patients are on their own: the 2005 law famously did not 
specify how patients were to obtain the drug. And that, to both the 
program's critics and supporters, remains its greatest problem.

As Michael Downs, director of prevention education for AIDS Project 
Rhode Island, puts it, the law has been a "great resource" for his 
agency's clients, but lack of access places them in "something of a quandary."

Major Steven O'Donnell of the Rhode Island State Police puts the 
matter more bluntly. "Basically, we're telling patients to go buy 
drugs on the street," O'Donnell says. "Even if the law works on 
behalf of people with medical need," he says, "we're asking them to 
put themselves in harm's way."

Bobby Ebert, who says he was assaulted in downtown Providence one 
night while trying to obtain marijuana, knows that this risk is no 
joke. But having dealt with pain for years, it's something he takes 
in stride. "After all," he says, "I've got a disease that could kill 
me tomorrow."

Patients are permitted to grow their own marijuana, and many do, or 
depend on caregivers who do so for them. Yet growing pot indoors can 
require a variety of equipment -- humidifiers, fans, and heating 
lamps -- not to mention time and significant financial investment. 
"You'd think since it's a weed, it would grow easy," says Oliver, who 
recently began trying to cultivate his own, with limited success. He 
reports having already spent more than $500 on equipment.

This is why the Rhode Island Patient Advocacy Coalition 
(, which was founded to push for medical 
marijuana's passage, has now turned its attention to addressing the 
supply issue.

Ideally, says RIPAC founder Jesse Stout, the state would license 
dispensaries to provide marijuana to registered patients. 
Nevertheless, given Rhode Island's small size, Trevor Stutz, RIPAC's 
development director, is hopeful the coalition (which consists of 
eight state organizations, including the RI Medical Society and RI 
State Nurses' Association) can "successfully develop an informal 
network of patients and caregivers to really facilitate patient access."

Such efforts are much-needed. At a recent RIPAC meeting, several 
patients, including a 63-year-old retired schoolteacher suffering 
AIDS, reported they had gone without marijuana for periods of up to a 
month for lack of a steady source.

Stymied by the drug war The question of how to provide patients with 
a drug that remains illegal continues to put the program's supporters 
in something of a double bind. As Representative Slater puts it, "We 
couldn't do more out of fear that the federal government would swoop 
down and confiscate the marijuana."

In California, where the law has been interpreted to support the 
development of dispensaries selling medical marijuana, the so-called 
"cannabis clubs" that have sprouted throughout the state -- Los 
Angeles alone has nearly 100 -- continue to be the target of 
high-profile federal raids.

In light of federal restrictions, advocates aren't pushing to change 
the status quo. "The top priority is keeping the law on the books and 
ensuring that patients remain legally protected," says Nathaniel 
Lepp, chairman of the board of the Rhode Island Patient Advocacy Coalition.

That goes for doctors, too. While Dr. Kenneth Mayer, director of 
Brown University's AIDS program, has prescribed Marinol (a marijuana 
substitute containing THC) for patients in the past, he says it 
hasn't proved nearly as effective as marijuana. And when it comes to 
recommending marijuana to patients, Mayer says, "I'd much rather do 
it legally than not."

While the Supreme Court ruled in the 2005 case Gonzales v. Raich that 
the federal government can prosecute patients for marijuana use, even 
those whose use is protected under state law, no Rhode Islanders have 
faced such prosecution.

According to the US Sentencing Commission and the FBI, state-level 
authorities are responsible for 99 percent of marijuana arrests. And 
as Anthony Pettigrew, a spokesman for the US Drug Enforcement 
Administration, told the Phoenix in 2005, "The DEA has never targeted 
the sick and dying, but rather criminals [involved] in drug 
cultivation and trafficking."

The only prosecution related to the Rhode Island program came last 
October, when Steven Trimarco, a registered 48-year-old patient in 
Exeter, was arrested after soliciting underage girls on MySpace to 
smoke marijuana. He was charged on multiple counts, including 
possession of firearms and having marijuana well in excess of the 
program's legal limit. (The law permits patients to possess 12 plants 
and up to 2.5 ounces of usable marijuana; more than 70 plants were 
found in Trimarco's basement.)

"Trimarco certainly gave the act a bad name," says North Kingstown 
Police Captain Charles Brennan, whose department oversaw the arrest. 
Nevertheless, Brennan maintains that the case was an exception. "Even 
if he didn't have a medical marijuana card, he'd probably still be 
picking up young girls," he says. "And he was probably doing that 
even before he was registered with the program."

What's next for medical marijuana? The smooth implementation of Rhode 
Island's law strongly suggests that critics' opposition is more smoke 
than substance.

Meanwhile, despite the rigid nature of federal opposition, medical 
marijuana's supporters are continuing to pursue -- and win -- the 
fight on other fronts. Since 1996, 12 states have legalized medical 
marijuana, with governor and presidential candidate Bill Richardson 
signing New Mexico's bill into law in April. The other states are 
Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, 
Vermont, and Washington. And with patient testimonials continuing to 
accumulate, more are on the way: Minnesota and Illinois are moving 
closer to passing medical marijuana bills.

As the experience in states like Rhode Island helps to push the 
debate forward, medical marijuana may be shedding its dreadlocked 
associations with California hippies and going increasingly mainstream.

"It's not a fringe issue anymore," says Bruce Mirken, communications 
director of the Marijuana Policy Project, a DC-based advocacy group 
(which devoted significant resources to the passage of Rhode Island's 
law in 2005).

According to an October 2005 Gallup poll, 78 percent of Americans 
support the legalization of medical marijuana, a percentage that's 
risen steadily over the past decade. "Win enough states, and 
eventually those victories will play a role in moving Congress," says 
Ethan Nadelmann, executive director of the Drug Policy Alliance.

To be sure, given the staunch quality of federal opposition, such a 
perspective tends toward the optimistic. And while medical marijuana 
is a popular issue, high approval ratings don't necessarily translate 
into widespread public pressure to change the status quo. In the 
final analysis, medical marijuana's backers still face an uphill battle.

For now, it's possible that the courts -- and the science of the 
issue -- may prove a better venue through which to make headway.

Earlier this year, medical marijuana boosters won a victory when DEA 
judge Mary Ellen Bittner recommended ending the federal National 
Institute of Drug Abuse's longstanding monopoly on the growth of 
research-grade marijuana.

Such a move, which followed a petition brought by the ACLU on behalf 
of University of Massachusetts professor Dr. Lyle Craker, could spur 
additional studies on marijuana's therapeutic properties, helping 
advocates further their case.

Meanwhile, in February, Americans for Safe Access filed a lawsuit in 
northern California, charging the US Department of Health and Human 
Services with violation of an act stipulating that federal agencies 
must make their policies based on sound science. According to ASA's 
chief counsel Joe Elford, the government is denying patient and 
researcher access to marijuana "in the face of voluminous scientific 
evidence stating its benefits."

Beyond medical marijuana, advocates hope that overcoming some of the 
fearful hype in places such as Rhode Island will inject new vigor 
into a broader critique of the US war on drugs, which has cost 
billions of dollars over the years, to dubious effect. "Medical 
marijuana is a legitimate issue in its own right," says Nadelmann. 
"Yet for those of us who think marijuana's prohibition should be 
reformed in general, our hope is that efforts on medical marijuana 
will help move public opinion more broadly as well."

For people like Tom Angell, 25, the issue is simpler. A Warwick 
native, Angell grew up watching his mother suffer from multiple 
sclerosis, and she was unwilling to use medical marijuana for fear of 
legal persecution. Angell, now the government relations director for 
the DC-based Students for Sensible Drug Policy, was with her last 
year when she tried the drug for the first time: the look of shock 
and relief on her face, he says, "was amazing."

Would she stop using the drug if Rhode Island's law is not renewed? 
Angell is hesitant. "Considering she wouldn't use it before it became 
legal," he says, "I really don't know."

"I just hope," he adds, "that's not a choice she has to make."
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