cannabisnews.com: Doctors Tread a Thin Line on Marijuana Advice





Doctors Tread a Thin Line on Marijuana Advice
Posted by CN Staff on October 27, 2003 at 15:41:39 PT
By David Tuller
Source: New York Times 
For doctors who want to discuss using medical marijuana with their patients, the line between advice and advocacy remains almost as blurred as it was before a recent court decision guaranteed a physician's right to address the issue openly.Some doctors are relieved that the United States Supreme Court let stand a lower-court decision two weeks ago that barred the federal government from punishing doctors who advised patients that marijuana might ease some symptoms.
But some doctors are also perplexed, and even inhibited, by part of the underlying court decision at the center of the case. That decision essentially affirms the federal government's right to hold physicians accountable if they actually take steps to help patients obtain marijuana."This decision says that it's fine and appropriate to talk with patients about medical marijuana, and I can even say, `I think you can benefit from it,' " said Dr. Steve O'Brien, who estimates that a fifth of his H.I.V. patients at the East Bay AIDS Center in Oakland, Calif., use marijuana for medical purposes. "But does that mean I can now sign a form from a medical pot club or write, `I recommend marijuana,' on a prescription pad? I don't know. It's still kind of murky."The governing language is found in a decision in 2002 by the United States Court of Appeals for the Ninth Circuit. Of the nine states in that circuit, seven have laws on medical marijuana. The court stated unambiguously that doctors had a First Amendment right to discuss with patients the possible benefits of marijuana for relief of pain, nausea and other symptoms suffered by people with ailments like cancer, H.I.V. and glaucoma.The court also clearly left open the possibility that doctors could be charged under federal drug statutes."If, in making the recommendation," the court wrote, "the physician intends for the patient to use it as the means for obtaining marijuana, as a prescription is used as a means for a patient to obtain a controlled substance, then a physician would be guilty of aiding and abetting the violation of federal law." The ruling stemmed from a suit by California physicians and patients after the federal government had threatened legal action against doctors who recommended medical marijuana. The government issued the warnings in 1996, after voters had approved Proposition 215, the initiative that protected the right of patients to use marijuana for medical indications.Although doctors are regulated by the states, they receive their authority to prescribe controlled substances through the federal Drug Enforcement Administration.Dr. Jack Lewin, chief executive of the California Medical Association, acknowledged that the Ninth Circuit's decision and the Supreme Court's refusal to review it left some questions unresolved. Dr. Lewin said he hoped that at least some concerns about discussing marijuana with patients would be reduced."The verbal position of the Department of Justice," he said, "was very threatening and put an absolute chilling effect on doctors' communications with their patients. And most did not want to talk about marijuana, much less recommend it." Doctors in states with medical marijuana laws have long tried to balance state and federal laws that conflict. This month, Gov. Gray Davis of California signed a bill that establishes a state-sponsored identification card for users of medical marijuana, to protect them from arrests, even as the federal government insists that doctors cannot help their patients obtain it. Because of the legal uncertainties, doctors, as well as medical organizations, have struggled to devise ways to avoid running afoul of the law.The Oregon Medical Association has advised doctors to record only on patients' charts any suggestion that marijuana could help with some symptoms. If patients photocopy that part of the medical record and use the documents to obtain marijuana, the president of the association, Dr. Colin Cave, said, the doctor cannot be held responsible."We have told physicians to avoid at all costs writing it anywhere else," Dr. Cave said. "They should not write it on a prescription pad. They should not write it on a separate letter, because that leaves them absolutely vulnerable to prosecution by the Drug Enforcement Administration."The language in the Ninth Circuit ruling, Dr. Cave said, does nothing to change those recommendations. "The D.E.A.," he said, "is still out there, and we know the federal government is not going to give up on this." With some doctors fearful or reluctant to address the issue, 12 or so physicians from California have in the last few years emerged as consultants on medical marijuana. Those doctors routinely issue recommendations to hundreds of patients who see them expressly for that purpose.Their activities have drawn intense scrutiny from the Medical Board of California, which regulates medical licenses for the state. The board has investigated at least nine physicians, according to Ana Facio, its deputy chief of enforcement.The Supreme Court action has no direct bearing on these cases, Ms. Facio said, because the board respects California law and is not seeking to prevent doctors from recommending marijuana. But the board's mandate is to ensure that doctors behave ethically and follow correct standards of care, she added."I don't know that I would consider it appropriate medicine to simply sit there and issue recommendations for a fee without a medical history and a physical," Ms. Facio said.Some doctors view the board's inquiries as overzealous. Dr. Tod Mikuriya of Berkeley, who said he had issued about 20 marijuana recommendations a week, called the investigation of his practice a vendetta. Dr. Mikuriya said he had conducted an extensive review of medical history for each patient and had required documentary proof of illness."The prosecutorial mind is boundless in its ways of applying different parts of the law," said Dr. Mikuriya, whose case is still pending before an administrative law judge.In the region covered by the Ninth Circuit, seven states — Alaska, Arizona, Hawaii, Nevada, Oregon and Washington, as well as California — have medical marijuana laws. Despite the lingering questions, some doctors in the region consider the Supreme Court decision not to review the appellate ruling as an unmitigated victory."I'm home free now," said Dr. William Wenner, 77, a retired surgeon who lives on Hawaii's Big Island and estimates that he has issued more than 400 "certifications" to use medical marijuana in the last few years. "Who's going to come and get me, and for what?" Dr. Wenner asked. "I'm listening to these people and evaluating their complaints, and I've got three file drawers with their charts."Three states outside the Ninth Circuit — Colorado, Maine and Maryland — have some form of medical marijuana law. Although the ruling is not strictly binding outside the Ninth Circuit, advocates for medical marijuana predict that it will strongly influence authorities elsewhere, especially given the Supreme Court decision to let it stand."Frankly, lawyers are ready to pounce on the government as soon as they start harassing doctors anywhere outside the Ninth Circuit," said Daniel Abrahamson, a lawyer for the plaintiffs who is legal affairs director of the Drug Policy Alliance.Federal officials have promised to continue enforcing the drug laws, reiterating their view that Marinol, an oral prescription drug that includes a form of THC, the psychoactive component of marijuana, precludes the need for using marijuana itself as a medication.Marijuana contains dozens of ingredients besides THC, and doctors say many patients report that smoked marijuana works better and has fewer side effects than the drug. "Smoking marijuana is shorter acting, and it's easier to control the dose," Dr. Stephen Becker, an H.I.V. physician in San Francisco, said. "But I'm not indiscriminate. I have to be convinced that the patient has failed the conventional pharmacopeia. I think physicians have a responsibility not to abuse this and get themselves and their colleagues and patients in trouble."Some doctors are pressing forward with research into medical marijuana, hoping to strengthen the scientific basis for proclaiming its medicinal benefits. Dr. Donald Abrams, a professor of clinical medicine at the University of California at San Francisco, is one of several investigators with the Center for Medicinal Cannabis Research, which is affiliated with the University of California. Dr. Abrams is studying whether marijuana can relieve the sharp pains that some people with H.I.V. experience in the feet and hands. He is also recruiting cancer patients for a clinical trial on whether marijuana can increase the analgesic effects of other painkillers. Dr. Abrams said he had discussed medical marijuana with patients since beginning his practice more than 20 years ago. "People have been using marijuana as medicine for thousands of years," he said. "It's only been in the last 60 years that it hasn't been available in the United States." Source: New York Times (NY)Author: David TullerPublished: October 28, 2003Copyright: 2003 The New York Times Co.Contact: letters nytimes.com Website: http://www.nytimes.com/Related Articles & Web Sites:Dr. Tod Mikuriyahttp://www.mikuriya.com/Drug Policy Alliancehttp://www.drugpolicy.org/Physicians Can Now Talk Freely http://cannabisnews.com/news/thread17668.shtmlBackers of Medical Marijuana Hail Rulinghttp://cannabisnews.com/news/thread17566.shtmlHigh Court Lets Stand Ruling Over Medical Pot http://cannabisnews.com/news/thread17565.shtml 
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Comment #8 posted by ekim on October 27, 2003 at 20:45:20 PT
"It's ---only---------- been in the last 60 years 
Verg --Russia maintains the largest hemp germ plasm collection in the world. At the NI Vavilov Scientific Research Institute of plant VIR. Konoplya is Hemp.hey Verg when ever I see you post I think of the fence line you are stringing up here:)tonight on access show we had on the asst prosecutor. said that the laws have changed to allow the judge to collect money from person being taken to court. like the Leo time off street to book and time to come back to court and prosecutors time spent on case.said that there were over 5000, misdemeanors and 2000, felonies he was asked how many cannabis arrests last year he said he did not know. he was asked how much he could save if he could issue fines like Ann Arbor has for 32 years.said he must obey the law, went into the law that allows for first time offence to be dismissed after much red tape. said that the whole department was taking a big budget cut. ------this prosecutor has been in Kalamazoo for 23 years and he rattled off more detailed information on the changing of the dwi laws for offenders for less blood alcohol levels, and new change that any amount of unlawfull drug in ones blood will be charged with dwi. many many other laws that have effected minors. and he said he does not know how many cannabis arrestes last year, also the jail is too small.
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Comment #7 posted by Virgil on October 27, 2003 at 18:05:05 PT
The power of the Internet
There were a couple of postings at hempcity worth copying. I asked this guy from Russia to tell us how he sees the cannabis situation in Russia. Also an American wrote about his take on Paris. I will thank them for their comments and include this link. Hopefully, we will be hearing more reports from around the world to the dismay of those people that bring us the informational blockade and one hell of a stone wall.From Gnom at http://www.hempcity.net/forum/viewtopic.php?t=18&highlight= -First a few words about oneself: My name is Boris, 26 years, i work on TV (archivarius). Recently I has finished university on a speciality "psychology". I have friendship with a grass about 4 years. I respect `shrooms too... 
What`s about law and situation with MJ in our country: as well as in all other policy and economy, there is deep chaos. According to the federal law, it is forbidden to have MJ, to trade, to smoke, but most of 50 % of the population are smoke. The problems with authority are decided with help of money - to take bribe and to give is almost officially. Also use add of a package with a grass in a pocket of detained, for extortion money, (it`s correctly words ?) " น ****; %; ": " นน; %!!!! You know, what I want to tell... : ( 
But to buy a grass it is easy enough, we are boil the milk with a plenty of a very weak grass ("Bespontovka"), which grows in some areas nearby from cities, and hidden grow in a house, too. Many teenagers also have some troubles with they parents, though, as far as I know, many of those have agreed with the parents already, and those know about enthusiasm of their smoke, me and my mother for example. A few time ago I very thoroughly have smoked my own mum (for the man with "kommunizm"-education and self-consciousness this is serious change of a vision of reality (minding ? Thinking ? Please, use correct word. )) So, 5 years of psychology I have not passed for nothing... 
The attitude for a grass in mass consciousness gradually varies: the year back I was visit to my friend, and sow crowd of the people, beer, vodka, drunk people fight, etc... Now I went this man - and what I see? Very pleased visitors sit near the table, on which lays a pipe and grass, they are many laugh and eat ice-cream !!! Its more good, than before. 
I think, in the nearest future our law will change, and the grass will be legal. Situation in Europe, and so likely propensity of our government copy anything from ther west, I think it will take place as soon, as possible. Though, may be I am too much optimistically... However, on TV smoke 90 % of the workers... I think, if it is possible to convince one adult and reasonable man, it is possible to convince and 10, 100, 10000, etc... 
I know, that breaking the law, but I nevertheless do not break the nobody's rights and I do not bring harm to the people, so I could not be condemned. 
I very-very much want to go to Holland and look to my own eyes, how the people live there. Still I want by all my forces to promote process of legalization of a grass, in spite of my insignificant social role and status. IMHO, "...and the stone on the road may rule a cart... 
Approximately it is situation for today. One more sorry for my english - i learn it right now, in process... 
------------------------------------------------ 
I've seen the nations rise and fall 
I've heard their stories, heard them all 
but love's the only engine of survival... (c) L.CohenFrom Reggie Dog...BRUFF at http://www.hempcity.net/forum/viewtopic.php?t=18&highlight= I live in Paris and people smoke hashish and grass in public all over the place. They just do it in the form of joints (usually hash mixed with tobacco(yuk) which is terrible for this American. At least i found a few stores selling glass and marble pipes to smoke. Also hashish is easy to score on the streets all over the city. I have also seen people using harder drugs in public too, people snorting coke and shooting heroin in the metro stations and the like especially since the weather got cold. I get the feeling that the police do not arrest people for personal use of drugs here but I am new so i dont know for sure
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Comment #6 posted by FoM on October 27, 2003 at 17:16:21 PT
The GCW
Thank you for posting the article.
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Comment #5 posted by Virgil on October 27, 2003 at 17:14:58 PT
39.9% of drug arrest are for MJ possession
That is in table 28 on page 4 of this PDF file- http://www.fbi.gov/ucr/cius_02/pdf/4sectionfour.pdf In table 29 also on page 4 it says drug abuse arrest were 1,538,813 So here is the calculation .399 x 1,538,813= 613,986.I just do not believe it.
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Comment #4 posted by The GCW on October 27, 2003 at 17:13:53 PT
Has this been posted?
American citizen jailed in Canada on a 30 year old cannabis charge http://www.hempbc.com/articles/3129.htmlby Dana Larsen (25 Oct, 2003) Ethiopian Zion Coptic Church member wan not allowed religious defense in court
 
On September 19th, 2003 Ilene Schecter was seized at the Peace Arch Border Crossing when entering into Canada on a 30 year old Canadian Cannabis Charge.Ilene Schecter, an American citizen, was arrested in Canada 1970 for bringing roughly a kilo of marijuana into Canada. At that time, Ilene declared herself to be a member of the Ethiopian Zion Coptic Church, and that the marijuana was her sacrament.A religious legal defense was not permitted, and Ilene served 14 months of a 24 month sentence, before escaping while on a Day Pass in 1973.Now Schecter is back in a Canadian prison, 30 years later, with the same defense. Less than a year was left on the original warrant for Schecter's arrest, and likely by today's standards the 14 months served would be a considerably harsh sentence.The Ethiopian Zion Coptic Church was chartered by the Queen of England and the government of Jamaica in 1976, and claims to have used ganja (marijuana) for their sacrament for many generations. They use ganja for divine worship and prayer.Ilene Schecter has lived a quiet life for 30 years as a working mother of two, and continues to live her life according to the doctrine she adopted in 1971. She is currently being held at the Burnaby Correction Center for Women.For more information:Ilene Schecter's husband Gary: 954-242-5639Watch an interview with Gary Schecter on Pot-TV: www.pot-tv.net/archive/shows/pottvshowse-2249.html
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Comment #3 posted by Virgil on October 27, 2003 at 17:04:23 PT
MJ arrest must be another secret
This appears to be the best the FBI.gov website could do on the Uniform Crime Report for the year that ended 10 months ago- http://www.fbi.gov/pressrel/pressrel03/ucr2002.htm It does not include MJ arrest, but I will keep looking.
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Comment #2 posted by Virgil on October 27, 2003 at 16:59:05 PT
FBI Uniform Crime Report Released
All I see is what is in this article- http://www.sfgate.com/cgi-bin/article.cgi?file=/news/archive/2003/10/27/national1705EST0679.DTL I wonder if the PTB decided to report more or less MJ arrest. My guess is it will be down about 2000 since we have primaries starting the first of the year.
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Comment #1 posted by Virgil on October 27, 2003 at 16:28:07 PT
Let me ask you this?
What is taking so long for the states rights issue that contest the expansive view of the commerse clause? I mean the Compassionate Use Act was passed 7 years ago, and this vital issue still has no ruling. Good grief.
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