GOING TO POT

Why can't we get medicinal marijuana to the patients who need it?

Medical marijuana / Nearly a decade after Hawai'i became the first
state to approve marijuana for medical use, George Cohn and hundreds,
perhaps thousands, of patients like him still have no access to the
medicine their doctors have prescribed. These people, many of them
elderly, most suffering from intense pain, are caught in a Kafkaesque
web.

Hawai'i law allows patients to possess marijuana, but does not create
a way for them to obtain it. Unless a patient or an approved caregiver
can successfully grow their own-no easy task, especially when you
consider that there is no clearly legal path to obtain the seeds with
which to begin-they are out of options.

"I'm legally blind, I can't grow the plants. I can't even get the
seeds! And I haven't been able to find someone to grow them for me,"
says Cohn. "I could turn to the black market, but I can't afford
that." Besides, Cohn says, the law is the law. "I'm not interested in
breaking the law. We're supposed to follow the law, isn't that the
point?"

Jeanne Ohta, executive director of the Drug Policy Forum of Hawai'i,
says she hears from patients like Cohn all the time. "We get various
different questions, but they all go in the same direction. 'I live in
a condo, or on a military base. What can I do? I go to the VA
hospital, the doctors won't recommend medical marijuana for me. I got
my card, where do I go?' They don't know where to get marijuana [and]
they really don't want to go to the criminal market. What people don't
realize is, these are law abiding citizens who want to stay that way.
They want to obey the law."

Today, the law doesn't lead Hawai'i's thousands of medical marijuana
patients anywhere but in circles. And all too often, these people do
turn to the black market. Brian Murphy, a Maui doctor whose non-profit
Patients Without Time organization helped provide medicine to more
than 1,000 people over the past four years before being shut down by
police last year, describes the circumstances his former patients now
face. "Listening to my voicemail is heartbreaking," Murphy says. "A
disabled woman calls me because she gave some guy money in park three
hours ago and she's crying into the phone, asking how long she should
wait. Another guy calls because he's been knocked out of his
wheelchair and had his money stolen. People wanting to know where to
go, how to get the seeds we were using to grow their plants, it goes
on and on."

The law as it is, and as it might be Hawai'i's once-pioneering medical
marijuana law is broken. Policymakers, doctors and patients agree that
it fails miserably to achieve its sole purpose-to create a mechanism
that allows people with physician-approved medical needs for the drug
to obtain it. The Hawai'i State Legislature is currently considering a
bill that would create just such a mechanism, yet HB1191's prospects
for passage are unclear, and Gov. Linda Lingle, citing fealty to
Federal law, has promised to veto any legislation that would make
medical marijuana more accessible to patients.

"It is legal now in Hawai'i," says Maui Rep. Joe Bertram, whose office
is the source of most of the medical marijuana energy at the Capitol.
"We need to make it more available and affordable. We passed a law in
2000," says Bertram, noting that legislators soon realized the system
wasn't working and commissioned a report from the Legislative
Reference Bureau in 2004. "Since then, there has been no effort to
implement any of the recommendations of that report," Bertram says.
"We are interested in creating a logical, rational way to get this
medicine to patients."

Hawai'i law respects the rights of patients to obtain and use the
medicine, up to three ounces per patient at a time. Each approved
patient, of which there were 4,200 last year, is entitled to grow his
or her own plants, but as many patients are disabled, elderly or both,
or simply not professional horticulturalists, the vast majority are
dependent on others (known as "primary caregivers" under the law) to
grow it for them (and thus expose themselves to federal prosecution).
Further complicating matters, there is no clearly legal way for either
patients or caregivers to acquire the marijuana seeds in the first
place, as their sale remains generally prohibited under both state and
federal drug laws.

Ultimately, Ohta and others say, Hawai'i has a production and
distribution problem. "How are patients supposed to get their
medicine," Ohta asks. "Particularly people who live in condos, on
military bases, people who live where their plants would have to be
visible. We don't have an effective distribution system. That's the
number one problem."

Bertram's bill seeks to remedy that problem. The bill establishes a
production of the plants by certified small farms catering to no more
than 14 patients each. It also creates a tax-stamp system designed to
allow caregivers to facilitate access of patients to the medicine. "We
think this is a massive improvement," Bertram says. "Our bill closely
mirrors what New Mexico has done." That state's system, enacted last
year, has won praise from medical marijuana advocates for creating an
effective system of production and distribution and from law
enforcement officials for tightly controlling who is allowed access to
the marijuana.

Perhaps nothing illustrates the unworkability of the current system
quite like the experience of Patients Without Time's Murphy. "We've
worked with over 1,200 patients during the past four years," he says.
"The majority of our patients are senior citizens, to say the least.
These are people, many of them, who come in saying 'I start my
chemotherapy this week.'" Palliative care for the pain associated with
late-stage cancer is one of the main medical applications of
marijuana. "They are looking at what they feel to be a death
sentence," Murphy says. "I am grateful for the opportunity to help,
but at the same time, I've been to 17 funerals over the past four years."

By last November, Patients Without Time was growing plants to serve
more than 400 people. That's when Murphy's relationship with Maui
Police, never smooth to begin with, took a turn for the worse. After
Murphy says he was robbed at gunpoint and had money and marijuana
taken from his home, police began an investigation that ultimately led
to Murphy and several of his associates being arrested and charged
with conspiracy and commercial promotion of marijuana. Murphy insists
the charges amount to retribution. "We were transparent about what we
were doing for years. We took out ads. We put up signs. I don't think
they needed some fancy investigation." Murphy says that the police
raid was motivated by litigation he filed against the department, a
claim Maui cops have dismissed as "absurd."

While Murphy awaits an August hearing and considers the possibility of
jail time for his growing operation, the obvious victims in all of
this are the hundreds of patients struggling to find access to the
medicine they need. Many expose themselves to what one observer calls
the "hand to hand combat of the black market," and many more, unable
to grow their own or find a primary caregiver willing to do it for
them, simply go without.

That may be just what law enforcement officials are looking for-no
Hawai'i law enforcement agency has come out in support of any
proposals to improve the accessibility of medical marijuana. The Drug
Policy Forum's Ohta says the police's thinking, and often that of the
general public, about medical marijuana are impeded by deeply held
beliefs about the drug that bear little relationship to its use as a
palliative medicine.

"There are a lot of myths involved. Law enforcement does not
understand that these patients have tried everything," Ohta says.
"Believe me, it would be a lot easier to take a pill. Many patients
with severe pain simply can't do that."

Ohta says the belief that traditional pain-relief medicines should
suffice for cancer and other terminal patients is misguided. "Some of
them are unable to take opiates, because of the side-effects. They are
able to relieve their pain with a few puffs of marijuana, with no
side-effects at all, [and] the number of pills they need to take is
reduced."

Murphy concurs. He says that perhaps his salient accomplishment at
Patients Without Time was a dramatic reducing in the amount of opiates
his patients needed to consume in order to alleviate their pain.
"Helping to decrease the amount of narcotics these patients are taking
is huge, because overmedicating [patients with severe pain using
opiates] is a huge problem. Our group was able to decrease intake of
20mg OxyContin pills by over 800 doses a month."

If all of this justification of medical marijuana seems strange, given
that Hawai'i already has a medical marijuana law, Ohta agrees. "It's
the same conversation over and over and over again."

A new conversation But there are some signs that may be about to
shift. Bertram's bill is advancing in the Legislature despite Lingle's
recent insistence that it has no chance of becoming law, signaling, at
least, a greater willingness among lawmakers to address the medical
marijuana issue more openly.

Perhaps more important is the changing tone in Washington, D.C., where
marijuana's status as a "schedule 1" narcotic has long made everyone
from state legislators to family physicians reluctant to view the drug
as a medicinal option. Schedule 1 drugs include cocaine, LSD, heroin
and other drugs the federal government views as without medicinal
value. They cannot be prescribed by pharmacies, which are federally
regulated, and the Drug Enforcement Agency continues to prosecute
marijuana users and providers even when liscensed by and in accordance
with state laws.

Rep. Barney Frank (D-Mass), a powerful player in Congressional
circles, has introduced HR5842, which would move marijuana to schedule
2, alongside other drugs considered potentially very dangerous but
approved for prescription by physicians under certain
circumstances.

Also promising is President Barack Obama's stated reluctance to
continue federal raids on state-approved medical marijuana patients
and producers. In a 2007 town hall meeting in New Hampshire, Obama
said, "I would not have the Justice Department prosecuting and raiding
medical marijuana users. It's not a good use of our resources." It's
one in a series of comments during the presidential campaign that
indicate Obama considers prosecution of medical marijuana users a
"waste of resources." In March of last year, after his campaign had
become a phenomenon and his every word more closely scrutinized, Obama
seemed to go even further, casting the issue as one of states' rights.
"'I'm not going to be using Justice Department resources to try to
circumvent state laws on this issue," he told the Southern Oregon Mail
Tribune.

It's too soon to know for certain how those campaign promises will
stand up to the reality of governing. Seattle Police Chief Gil
Kerlikowske, Obama's choice for Director of the Office of National
Drug Control Policy-the "Drug Czar"- draws mixed reviews from local
observers. Murphy notes that Kerlikowske has been moderate on medical
marijuana. Pamela Lichty, president of the Drug Policy Forum, notes
that Kerlikowske is yet another drug czar with a law enforcement
background as opposed to a public health professional.

Back here at home, Gov. Lingle, whose opposition to increased
accessibility of medical marijuana has long been couched in an odd
fealty to federal law at the expense of her own state's statues, shows
no sign of changing her tune now that the signals coming from
Washington have changed. She recently chastised media coverage of the
issue and reiterated her opposition to improving access to medical
marijuana.

Meanwhile, patients like George Cohn are suffering. He does not know
where his next supply will come from, and struggles to keep his hours
as a substitute teacher, which he says is next to impossible without
marijuana's palliative effect. "I've been trying to follow the law,"
he says, "and it's hurting me."

Farmecology Things have been tough on Hawai'i's family and small
farmers for a long time, and the deepening recession isn't making
things any easier. These small operations, sometimes no bigger than a
few acres, are in many ways the lifeblood of Hawai'i agriculture,
their social and cultural meaning transcending the volume of food they
actually produce by maintaining modern Hawai'i's connection to the
'aina, and to a way of life that sustained these islands for
generations. But margins are small in the food business, and while
forward-thinking local restauranters and markets-not to mention an
emerging consumer consciousness of the importance of eating local-make
a difference, many small farms, particularly on the neighbor islands,
are struggling.

Brian Murphy, the Maui doctor whose Patients Without Time organization
has served more than 1,000 medical marijuana patients over the past
four years, has an idea he thinks might represent a path to wellness
for both the people he aims to help and these struggling farmers.

Murphy's idea, known as the Model Family Farm plan, proposes a secure
growing and distribution system for medical marijuana, one that might
be viable under this year's proposed HB1191, which is now making its
way through the Legislature.

Inspired by the Tobacco Allotment Act of 1937, which kept tens of
thousands of family farmers in business by mandating that America's
tobacco needs be met by small farms, Murphy's plan would require that
farms develop five-year organic farming plans based on at least two
crops, one of which would be medical marijuana. The farmers would then
produce medical marijuana in a greenhouse on behalf of licensed
patients, lease the space to the patients and charge a small fee for
service, thus obviating the need for any formal "sale" of the
medicine. The proceeds from this part of the business would, in
theory, subsidize the other organic crop or crops.

"I hate having to invoke the word 'tobacco,'" Murphy says, "but this
was something that worked extremely well in the 1930s to keep family
farms healthy."