Pubdate: Fri, 30 Apr 1999
Source: Seattle Times (WA)
Copyright: 1999 The Seattle Times Company
Author:  Carol M. Ostrom, Seattle Times staff reporter


Gregory Sheffield, an HIV-positive patient who is crippled by arthritis,
asked his doctor for a letter allowing him to legally smoke marijuana to
decrease his pain and increase his appetite.

He heard conflicting answers.

One was that his doctor supported his using marijuana for those medical
problems. The other was that the doctor, who works at Harborview Medical
Center, had been told by his medical director not to sign such letters.

Voters in Washington last November passed a law legalizing the use of
marijuana by certain patients, allowing a physician to write a letter or
statement "qualifying" a patient to legally possess a 60-day supply.

Many voters said they wanted to protect cancer and AIDS patients, among
others, from being arrested for using the drug for pain or nausea relief.
But nearly six months later, these patients are finding that in the real
world, it's not so simple.

Today, a group of patients who receive care at Harborview's HIV/AIDS clinic
plan to protest in front of the building. They say that while their medical
care there has been top-notch, their doctors have left them legally
vulnerable by refusing to sign letters authorizing their marijuana use.

Thomas Hartley, 47, who has AIDS, said an elderly aunt with cancer first
told him about smoking marijuana to control his nausea. But without a letter
signed by his doctor, he said, he has been hassled by a neighbor and by
police. "A letter would get the police off my back."

Dr. John Sheffield, Gregory Sheffield's physician (not related) at the
HIV/AIDS clinic, confirmed he was told by the medical director not to sign
any letters "pending the development of a policy by the UW on this issue."

Personally, he has no problem writing the letters for some patients, he
said. "I think there are many patients for whom marijuana provides relief in
a way we haven't found any other substitutes for. We're talking about
(relief of) nausea, relief of medications' side effects - and I don't think
that contributes to any societal ills."

But like many physicians, he believes it's still unclear ". . . whether the
statute is binding, whether the feds would prosecute people for using
marijuana, or prosecute physicians somehow involved in that."

Dr. Thomas Hooton, medical director of Harborview's HIV/AIDS clinic, has
similar worries. Hooton told clinic providers inquiring about writing
authorizing letters for their patients "to sort of hold off until we get a

Hooton said the clinic has drafted a policy he has sent to the Attorney
General's Office for review. But now, he has been asked to head up a joint
Harborview-University of Washington task force to write guidelines for
doctors throughout the system. That group, formed in response to physicians'
worries, has yet to meet.

"The bottom line is everybody's not really sure what we should be doing,"
Hooton said. Threats by the federal government to lift doctors' licenses to
prescribe, though the government has never followed through, are frightening
to most doctors, he said.

"It's a doc's livelihood," he said. "Without a DEA license, you're sort of

Some patients and their supporters wonder why the UW could respond so
quickly to voters' undoing of affirmative action in the last election but
still be muddling around with a policy on medical marijuana.

"Now they're telling my sickest patients, `Just sit here, honey, and we'll
get back to you,' " complained Dale Rogers, director of Capitol Hill
Compassion in Action, which delivers marijuana to qualifying patients.

Passage of the medical-marijuana initiative took UW doctors by surprise,
Hooton responded. "I don't think anybody thought we would need to prepare a
response. For one thing, most people thought the initiative wouldn't pass.
And the other thing is, they thought the initiative would clarify what we
need to do."

One health-care provider, the Veterans Affairs Puget Sound Health Care
System, had no problem sorting out possible conflicts between state and
federal law.

"Since possession of marijuana is illegal under federal law, (doctors) can't
do anything inconsistent with federal law," said George Tady, assistant
regional counsel for the Department of Veterans Affairs. Since federal law
doesn't recognize medical use of marijuana, he said, "a VA doctor in his or
her official duties could not prescribe it."

The initiative, however, does not ask a doctor to "prescribe" marijuana, but
to document that he or she has advised a qualifying patient that the
potential benefits of marijuana would likely outweigh the risks.

Nevertheless, Tady said, he has advised veterans-hospital physicians that ".
. . they are not to recommend its use, because possession of marijuana is
illegal under federal law."

At least a "couple of dozen" doctors in the area are writing letters for
patients, said Rogers, Compassion in Action's leader.

The Washington State Medical Association has created a sample letter for
doctors, said John Arveson, director of professional affairs.

"What we wanted to do was provide something that really mirrors what is
provided for in the law," said Arveson, "and also to remind physicians:
Don't provide the documentation on your prescription pad."

The state medical association ran the draft letter past several agencies,
Arveson said, including the FDA, the state Department of Health and the
Medical Quality Assurance Commission, which licenses physicians, "to see if
somebody's hairs were looking to get on fire over this."

No hairs ignited, so the letter was completed and published by the medical

The Washington State Department of Health has also come up with a "Questions
and Answers" sheet. But questions seem to outweigh the answers.

For example, it's unclear how much marijuana or how many marijuana plants
make up the "60-day supply" specified in the initiative, or how patients are
supposed to get marijuana since it cannot be legally purchased, distributed
or supplied.

Several problems with the initiative involve police and prosecutors, said
Jerry Sheehan, legislative director for the American Civil Liberties Union
of Washington. "What should be the police officers' response when they come
upon someone (smoking marijuana) who says, `I have documentation.' "

In meetings, law-enforcement representatives have asked doctors if they want
to be awakened in the night to verify a patient's identity and that the
letter isn't forged, Hooton said. "We don't want that."

Graham Boyd, who directs the national ACLU's drug-policy-litigation project,
wants to protect doctors from interference by the federal government.
Litigation in California, Boyd said, made it clear the federal government
can't stop communication between doctors and patients about marijuana.

But if doctors don't stick strictly to their role as physician - if they try
to help patients find marijuana, if they "prescribe" marijuana, for
example - they could be in legal jeopardy, Boyd said.

"We want to make very, very certain that not even a single doctor gets even
investigated," he said. "Because if that happens, it will send a chilling
message throughout the whole profession."

Carol M. Ostrom's phone message number is 206-464-2249.

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