MARIJUANA DILEMMA

Many Patients Cannot Afford To Get The State's Medical Card.

Like many disabled Oregonians, John Malaer discovered that the biggest
obstacle to smoking medical marijuana isn't a cop or a courtroom -- it's his
checkbook.

Paralyzed from the waist down, Malaer scrapes by each month on $520 in
disability payments and $86 in food stamps, not enough to pay the annual fee
of $150 for a medical marijuana card plus the costs connected with growing
the plants. If not for a charitable foundation that helped pay for the card
he obtained in December, he couldn't smoke the marijuana that blunts the
pain of his broken back.

The manager of the state Health Division's medical marijuana program says
the income hurdle is one of the biggest challenges to making the program
successful.

"The costs are a barrier for low-income people," said Kelly Paige, who is
preparing renewal notices and reviewing the budget as the program nears its
one-year anniversary. "A lot of the people who are extremely ill fall into
that category."

Oregon's medical marijuana law, passed in November 1998, allows Oregonians
who suffer from cancer, glaucoma, HIV and other physical ailments to
register with the Health Division to use marijuana. But the law can be more
pipe dream than panacea to many of the Oregonians -- including military
veterans -- who need it most. They can't afford the registration fee, and no
insurance companies cover the expenses of medical marijuana use.

The law prohibits buying and selling marijuana, so patients have to grow
their own or get it for free. Start-up costs for an indoor marijuana garden
- -- plants, grow lamps, electricity and fertilizer -- can range from $700 to
$1,000, Paige said.

Under the law, patients must have their physician complete a form that says
marijuana may mitigate their symptoms. The patient then mails this form, an
application and a $150 check to the Health Division. After reviewing the
application, the Health Division issues a card exempting the patient from
state laws that prohibit possessing and growing marijuana.

Of the five states, plus the District of Columbia, that allow seriously ill
people to smoke marijuana, only Oregon and Alaska charge fees for an
identification card. Alaska's fee, however, is $25. When Oregon advocates
were pushing for the initiative, they expected a similar registration fee,
Paige said.

But the program's $75,000 budget is funded solely by the registration fees
- -- more than 400 of an expected 500 cards have been issued -- which pay for
Paige's salary, printing and postage costs, legal counsel and incidentals.
The law stipulates that patients, not taxpayers, must fund the program.

Paige estimates another 100 people might apply for a registration card if
not for the cost barrier. "I recognize it's a hardship, and I feel really
bad about it," Paige said of the fee, "but we need a registration fee to
support the program."

Insurers Don't Cover Costs

The law does not require government programs or private health insurers to
reimburse the costs of marijuana use.

"It's not being looked at, not being evaluated, not being considered," said
Jim Gersbach, a spokesman for Kaiser Permanente. "It would be outside the
purview of the health plan to pay for a state registration fee. And
marijuana is not treated as a pharmaceutical, so it doesn't come under
pharmaceutical benefits."

Many insurance companies do pay for the federally approved drug Marinol, a
synthetic version of THC, the key chemical component in marijuana. Doctors
generally favor prescribing Marinol, because the capsules come in
physician-approved doses rather than patient-rolled joints. But proponents
of medical marijuana say patients who smoke it get the benefits of dozens of
other agents, or cannabinoids, beyond Marinol.

The Oregon Health Plan covers Marinol, which can cost $2,000 a month, but
not marijuana, because it's not approved by the Federal Drug Administration.

Rick Bayer, a retired Portland internist and a chief petitioner of Oregon's
medical marijuana initiative, said the lack of access to medical marijuana
for lower-income patients parallels their lack of access to health care
across the board.

"The people who are trying to get medical marijuana are people with chronic
illnesses," Bayer said. "Whenever you're talking about people with chronic
disabilities, you find lower income. And that decreases access to health
care."

The Veterans' Quandary

Lower-income military veterans find it almost impossible to get medical
marijuana. Because Department of Veterans Affairs medical centers are
federal institutions, VA doctors are prohibited from completing the medical
marijuana form. They are, however, allowed to prescribe Marinol.

Dr. Thomas P. Carr, a staff physician at the Portland VA Medical Center,
said three or four patients have approached him with the medical marijuana
form. He would have been willing to complete the form, he said, but because
of the conflict between the state process and the federal law, he did not.

That conflict forces veterans such as Richard Blacklidge to go outside the
VA system. Although he's uninsured, Blacklidge sought out and paid for a
private physician's signature on the medical marijuana form -- a hassle and
expense that he said aggravated his post-traumatic stress disorder and
degenerative disk disease.

"The year I spent in Vietnam, I didn't beg to go over there," said
Blacklidge, 51. "I didn't beg to get these injuries. Why should I have to
beg to feel better now?"

Financial Help

At Our House of Portland, the only advanced-stage AIDS care facility in
Oregon, residents with a registration card can smoke marijuana outside. But
many live on as little as $75 a month.

"Most people who really need it don't have the money to pull it off," said
Judith Rizzio, the facility's community relations director. "The law's set
up so that the fees are difficult for people living on benefits. People
don't understand what it means to be this ill."

But the Blanche Fischer Foundation does. Established in 1981, the foundation
provides assistance to physically disabled Oregonians who show financial
need. So far, the foundation has co-paid for about a half-dozen medical
marijuana cards.

John P. Dziennik, the foundation's executive director, said he's
uncomfortable paying for the cards -- the foundation would never pay for
grow lamps or marijuana -- and he'd like to see insurance policies or the
state cover the program's costs.

"I understand the need for licensing, but $150 for people living on turkey,
franks and ramen is not a realistic figure," Dziennik said. "It frustrates
me to step up to the plate and fund a state program."

The foundation gave Malear $125 toward his registration card. Malaer
struggled to come up with $150 for grow lamps, but he still considers
himself lucky.

"It's not economically feasible for the people who need it to take advantage
of it," Malaer said. "It's almost more of a hassle than it's worth."

That's not what medical marijuana advocates like to hear. Although several
said a network of compassion has evolved out of the foundations helping,
many are uneasy about the program becoming dependent on foundations and
grants.

Instead, advocates would like to increase doctors' awareness of the medical
marijuana option. Paige is inviting physicians to attend a satellite
conference in early April for the First National Clinical Conference on
Cannabis Therapeutics, which will focus on science, not politics.

As the Health Division considers expanding the law to apply to conditions
such as anxiety, depression and sleep disorders, advocates want to persuade
more patients to try the treatment.

"The more patients who participate, the lower the fees will be," said Gina
Pesulima, a spokeswoman for the California-based Americans for Medical
Rights. "The one thing we're continuing to be concerned about is doing
whatever we can to strengthen the system and offset the cost." CRRH is
working to regulate and tax the sale of cannabis to adults like alcohol,
allow doctors to prescribe cannabis through pharmacies and restore the
unregulated production of industrial hemp.