MEDICINAL MARIJUANA NEARS MAINSTREAM

SEATTLE - JoAnna McKee bustles around her den, handing out pharmacy bottles
of marijuana buds and leaves to visitors. They come and go, usually taking
away 7 to 10 grams - about a third of an ounce, enough to last a week.
Paying is strictly voluntary: Some visitors donate as much as $70 for their
weekly supply, but others pay nothing at all. Occasionally McKee will hand
out small marijuana plants for home cultivation.

The 500 customers McKee serves each week suffer from intractable pain, AIDS,
multiple sclerosis, epilepsy or cancer. Under a new Washington state law,
they're entitled to use marijuana to ease their pain or improve their
appetites.

Medicinal marijuana, highly controversial when it was approved in California
and Arizona in 1996, is going mainstream. Five states in the West now allow
marijuana to be used for medical purposes. Initiatives to legalize medical
marijuana are being put on the ballot in Maine this November and in Nevada
and perhaps in Colorado in 2000. They are under consideration in another
four states: Florida, Massachusetts, Michigan and Ohio.

On Wednesday, the Institute of Medicine, an arm of the National Academy of
Sciences, is expected to release a long-awaited study commissioned by White
House drug czar Barry McCaffrey on the effectiveness of marijuana as a
medicine. Activists hope the report will conclude that at least some uses of
medical marijuana have scientific merit. The report will call only for more
research.

Even in California, where implementation had been impeded because of fierce
opposition from former attorney general Dan Lungren, attitudes are loosening
up. Bill Lockyer, a Democrat who replaced Lungren in January, has announced
that he favors the law and will work to lift all legal obstacles.

"Along the entire Pacific Coast, patients are now freed from state laws
preventing the medical use of marijuana and discovering its capacity to
alleviate pain," says Bill Zimmerman of Americans for Medical Rights. The
group, based in Santa Monica, sponsored most of the ballot propositions
approved so far.

The number of Americans who use medical marijuana is expected to grow at a
rapid pace. The states that have adopted laws - California, Washington,
Oregon, Arizona and Alaska - are issuing guidelines and putting their laws
into effect. Two of these states are starting to issue identification cards
to help patients avoid arrest.

Legal limbo

The laws explicitly permit patients with specific chronic or terminal
diseases to smoke marijuana as long as they have a doctor's recommendation.
But the laws say nothing about how such patients can obtain marijuana,
except by growing it themselves. Selling or giving away marijuana remains a
crime under both state and federal law.

So McKee and the Green Cross Patients Co-op she and a partner have run for
five years operate in a sort of legal limbo. Local law enforcement officials
say they have no plans to shut down the co-op, but McKee is theoretically
vulnerable to prosecution.

Only a few clinics and co-ops like Green Cross operate openly, here as well
as in metropolitan Los Angeles and in the tiny town of Arcata in northern
California. Elsewhere, such operations remain underground because of the
federal ban on possessing, selling or distributing marijuana or because of
opposition from local officials.

McKee, 56, is well-known to the Seattle police department as a passionate
believer in the medicinal value of marijuana who scrupulously insists that
her patients have permission from their doctors. She also uses medical
marijuana herself, "for muscle spasms, epilepsy and constant pain caused by
trauma," she says. "I've had a 'note' from my doctors since 1987."

Whether coasting across the room or down a government corridor in a
wheelchair, McKee is easy to spot with her dog, YuYu, who often pulls her
along. A distinctive patch covers her right eye. The black patch features a
green marijuana leaf extending from a gold medical symbol, the caduceus.

McKee has had brushes with law enforcement. In 1987, she was arrested for
marijuana possession in Kodiak, Alaska. In May 1995, she was arrested in
Washington. The charges were thrown out by a trial judge who ruled that 160
marijuana plants were seized without a proper search warrant.

McKee's biggest problem: "I'm having trouble keeping enough on hand," she
says. Since voters in Washington state approved the use of medical marijuana
last fall, "activity is up 20%. People come from all over."

Doctors are permitted by most of the new state laws to "recommend" the use
of marijuana for specific categories of chronically ill or dying patients.
But under federal drug laws, doctors cannot legally prescribe it.

The U.S. Justice Department continues to prosecute marijuana law violators,
including some medical users, at a record pace. So far, the government has
not prosecuted any doctors who recommend marijuana to patients.

"The Department of Justice is committed to upholding and supporting the laws
passed by Congress," Justice Department spokesman Brian Steel says.

In 1998, as part of the budget process, Congress expressed concern about
"the ambiguous cultural messages about marijuana use" that it said
contributed to growing acceptance of it among teen-agers. By a 310-93 vote,
the House opposed state "efforts to circumvent" federal laws by legalizing
marijuana "without valid scientific evidence." The Senate concurred.

Far bigger worries

Last month, however, McCaffrey signaled a weariness with the issue during a
speech at the University of Washington.

He repeated his insistence that any change in drug policy should be based on
science, not politics, and declared there's no proof marijuana is good
medicine. He also said that the true goal for some in the medical marijuana
movement is to make marijuana legal for everyone.

But frankly, he told the crowd, he has far bigger worries than the debate
over medical marijuana.

"You'll look deep into my eyes and see a guy who doesn't care. We've got
these huge problems out there," he said, citing crack cocaine, heroin and
methamphetamines as well as use of marijuana and other illegal drugs by
teen-agers.

McCaffrey's comments come as medical marijuana seems certain to get renewed
attention in the weeks ahead.

On Wednesday, the Institute of Medicine, an arm of the National Academy of
Sciences, is expected to release the study commissioned by McCaffrey.

Next week, attorneys general from across the country will meet in
Washington, D.C. Lockyer, the California attorney general, hopes meetings
with Attorney General Janet Reno and McCaffrey will include discussion of
medical marijuana.

In JoAnna McKee's den, patients such as Casey Wilbanks, 44, talk about the
importance of marijuana. Wilbanks was a truck driver "before I lost 70
pounds," he says. Diagnosed with AIDS in 1991, he says marijuana has helped
him combat depression and improve his appetite. "Cannabis brings me a state
of balance," he says. "It helped me wake up and say, 'You're not dead. Now
what?'?"

About 75% of Green Cross' patients are HIV-positive, McKee says.

Margaret Denny, 48, of Maple Valley, a Seattle suburb, was hurt badly in an
automobile accident 20 years ago. "I was told I'll never live another moment
without pain, and they were right," she says.

Able to travel in a wheelchair, the part-time computer programmer says she
started using marijuana five years ago for the pain. "It doesn't take the
pain completely away, but it does give me the ability to deal with it," she
says.

Some doctors remain skeptical. The Washington State Medical Association,
which opposed the law, issued a sample recommendation form last month for
doctors to use. The form says in part: "Not all health care providers
believe that medical marijuana is safe or effective, and some providers feel
it is a dangerous drug."

The trickiest question confronting patients today is how to get medical
marijuana legally, other than by growing it.

"It's a big issue, but I don't want to leave the impression that people
can't find it," says Dave Fratello of Americans for Medical Rights. "We
advise patients to just ask around. With 10 million recreational users of
marijuana, most patients aren't more than a couple of phone calls away from
a source."

Until she found Green Cross, "I had to depend on friends of friends of
friends," Denny says. "Sometimes I worried about what I was getting."

Law enforcement is a concern for organizations like Green Cross. But McKee
says that "we have a good relationship with the police. They know we
carefully screen patients and require a doctor's recommendation."

Seattle law enforcement is "in solidarity that the will of the people will
be carried out" concerning medical marijuana, says Dan Satterberg, chief of
staff for the King County's prosecutor office. But the law protects
patients, not suppliers of any kind, he notes.

Law enforcement actions vary from state to state and region to region.

Implementation is "going to depend on local district attorneys and law
enforcement," says Rob Kampia, executive director of the Marijuana Policy
Project, based in Washington, D.C.

Someone allowed to operate a marijuana buyers club in Los Angeles, he says,
"would be arrested for it in Needles," a desert town 100 miles east of Los
Angeles. "I guarantee it."

Perhaps the biggest attitude adjustment on medical marijuana has come this
winter in California.

Lockyer, the new attorney general, supports the law but recognizes that it
is vague and ambiguous in parts. He has appointed a task force to find ways
"to make it more effective."

Lockyer knows something about the suffering of the terminally ill. "My mom
died of leukemia when she was 50; my little sister died of leukemia at 39,"
he says. "It's always seemed puzzling to me that doctors could prescribe
morphine but not marijuana."