MEDICAL POT USERS IN LIMBO

Vague Language In Proposition Left Doctors In Sticky Situation

COOL - When Dr. Mollie Fry opened a storefront clinic next to the
only post office in this Gold Country town, she did not think that
telling her patients where to get the medicine she recommended for
pain, depression and nausea would be a problem.

The federal drug agents who raided her home and office thought
otherwise. So did the grand jury that indicted Fry last year on
felony charges of conspiring to distribute marijuana.

"I assumed the fact that I had 'M.D.' at the end of my name gave me
the right to make judgments about people's health," said Fry, who
estimates she has issued thousands of cannabis recommendations since
setting up her thriving practice northeast of Sacramento in 1999.

Since California passed the nation's first medical marijuana law a
decade ago, among the provisions that has been tested in courts, and
proven troublesome in buyer's clubs and clinics like Fry's, was one
requiring ill patients to obtain a doctor's written approval before
they could legally grow or buy pot.

The tension between the mandate and federal drug laws that presume
marijuana has no medicinal value has left room for plenty of errors
and trials, as well as confined the conventional doctor-patient relationship.

Until the stalement is resolved, doctors recommending marijuana do it
with trepidation and a good deal of risk.

A brave contingent Medical marijuana advocates estimate that 1,500
doctors have authorized pot for at least one patient, most of them
oncologists or AIDS specialists. But the vast majority of
recommendations have come from a close-knit cadre of about 15
self-appointed specialists, the so-called "pot docs" who charge $150
and up to walk what the California Medical Association calls "a gray
area between the clearly permissible and clearly impermissible
categories of action."

Following complaints by local law enforcement, just about all have
been investigated by the state board that licenses and disciplines
physicians. Four were doctors who devoted their practices to acting
as medical marijuana consultants and ultimately received sanctions
ranging from the public rebuke that Fry got to having their licenses suspended.

California's medical marijuana law, also known as Proposition 215,
established a pivotal role for doctors in the measure's
implementation, holding that seriously ill patients had the right to
use pot "where medical use is deemed appropriate and has been
recommended by a physician who has determined that the person's
health would benefit."

The law named a host of ailments for which marijuana might prove
helpful in easing symptoms: cancer, anorexia, AIDS, glaucoma,
arthritis, migraine. And unlike the medical marijuana laws that would
eventually be enacted in 10 other states, the California measure also
gave doctors discretion to certify patients with "any other illness
for which marijuana provides relief."

That vague language left it up to doctors to decide what constituted
a serious illness for which marijuana was the best treatment option
and opened the door for recommendations being given to people who did
not need them.

David Thornton, executive director of the California Medical Board,
said an obvious red flag for the agency would be a doctor whose
patients are primarily men between the ages of 18 and 25. But he
allowed that until the board issued guidelines two years ago
outlining what constituted "accepted medical standards" under the
1996 voter initiative, physicians pretty much had to figure it out on
their own. Most concluded it was not worth the risk.

"The role of physicians was not that clearly explained (in the 1996
law), although it was left to physicians to be the ones, in their
informed opinion, to determine whether a patient would benefit from
marijuana," Thornton said. "Until federal and state law are
harmonized, it's going to be difficult."

Although a federal appeals court ruled four years ago that the U.S.
Drug Enforcement Administration cannot go after doctors merely
because they recommend marijuana to patients, the state medical
board's guidelines make it clear the ruling did not amount to
immunity either from prosecution or disciplinary proceedings.

The board advises doctors, for instance, that relying on a patient's
word instead of prior medical records to determine whether a
marijuana recommendation is appropriate could constitute medical
negligence. Failing to conduct an independent exam or to consider
whether another drug would be just as effective could similarly lead
to charges of unprofessional conduct.

The company line The California Medical Association is even more
explicit, warning doctors never to tell patients where to get pot and
urging them to remind patients of possible side-effects. Discussing
dosages with patients, opining on whether they should smoke or eat
marijuana, and signing a form that enables patients to obtain a
state-issued medical marijuana ID card also are steps the medical
association cautions its members to avoid if they don't want to end
up like Fry.

Frank Lucido, a Berkeley family physician who devotes about 30
percent of his practice to working with medical marijuana patients,
said he abides by those recommendations, but thinks pot docs are
being held to higher standards than doctors who prescribe lots of
Viagra, prescription painkillers and other abused medications.
Doctors who prescribe sleeping pills for patients who complain of
insomnia, Lucido noted, are not at risk of being called quacks if
they don't do a hands-on exam or develop a long-term treatment plan.