Medical marijuana's unlikely activist
Prosecutor with AIDS advocates for patients

SAN FRANCISCO Keith Vines considers himself a foot soldier in the war on
drugs.

An assistant district attorney in San Francisco and a former Air Force
captain, he served two years on the DA's federally funded Drug Strike Force.
In 1993, the Connecticut native successfully prosecuted one of the city's
largest marijuana busts.

But last spring, Vines, 47, became a participant in another battle: to
legalize the medical use of marijuana.

Diagnosed in 1983 with AIDS, he had been smoking marijuana several evenings
a week to counter the effects of his illness. It was the federal
government's response to Proposition 215 that prompted Vines to become a
poster boy for the cause.

Proposition 215, also called the Compassionate Use Act, was approved last
year by 5.2 million Californians, about 56 percent of the vote. The act made
it legal for seriously ill patients to grow and use marijuana if their
doctors recommended the drug.

The measure has increased tensions between federal law enforcement officials
and the prescribing doctors and suppliers. US Customs Service spokesman
Louis Semon expressed the federal government's view of the state law
succinctly: ''Proposition 215 doesn't affect us.''

The federal government has made it clear that it considers the act an
affront to its war on drugs. On Dec. 30, President Clinton's chief of drug
policy, General Barry McCaffrey, and other officials announced they would
prosecute physicians who recommended medical marijuana, revoke their
prescription licenses, and deny them participation in Medicare and Medicaid.

Dr. Robert Mastroianni, a 1977 graduate of Tufts Medical School who has
recommended medical marijuana to three of 6,000 patients, was grilled by two
Drug Enforcement Agency officials and told his actions were illegal. Doctors
around the state alleged government harassment, and contacted the San
Francisco law office of Altshuler, Berzon, Nussbaum, Berzon & Rubin, which
specializes in First Amendment, labor, and social justice issues.

Vines was outraged. He believed marijuana had been essential in his battle
against AIDSwasting syndrome, a condition that had ''reduced me to a shell
of my former self in a matter of months.''

Thus, when contacted by the San Francisco attorneys last winter to lend his
name to the cause, Vines joined four other patients, 11 doctors, and two
nonprofit groups in a classaction lawsuit against McCaffrey and other
government officials. The suit alleged that the government's threats
violated their freespeech rights.

US District Court Judge Fern M. Smith found in favor of the patients and
doctors in round one of the battle last spring, issuing an injunction that
prohibited the federal government from threatening or prosecuting
physicians, revoking their licenses, or excluding them from Medicare and
Medicaid.

She also granted class status to all Californians ''who, in the context of a
bona fide physicianpatient relationship, communicate with their physicians
about the medical use of marijuana.''

The suit is scheduled for hearing next June. Until then, Vines will be
speaking publicly, a role he never expected to fill.

''I hadn't come out about my illness in a big way. I told my parents and my
son and a few colleagues about my condition. But I had never taken a public
role on any of the issues,'' said Vines.

With a son about to enter college, Vines was concerned about losing his job.
But his boss's approval ''gave me the courage to go forward,'' Vines said,
though he no longer works in the drug enforcement division to avoid a
conflict of interest.

In 1983, Vines's doctors prescribed Marinol, a legal form of synthetic
marijuana. But Vines said Marinol left him foggy, without improving his
appetite. That's when Dr. Lisa Capaldini, Vines's primary physician, told
him some people had experienced better results with fewer side effects from
smoking marijuana.

''It was like a miracle,'' Vines said of the marijuana he bought at Dennis
Peron's San Francisco Cannabis Buyers Club, the most wellknown source of
medical marijuana in California. He found that it calmed the nausea and
stimulated his appetite. With food in his stomach, he could take his
medications 12 to 15 pills a day. Best of all, food provided the fuel he
needed as he injected himself with human growth hormone, then an
experimental treatment that now is approved for people with AIDSwasting
syndrome.

''I wish I could sit down with General McCaffrey,'' Vines said. ''And say
... what if your son or wife or daughter were dying ... what would you do?''