HAWAII'S MEDICAL MARIJUANA PROGRAM

Hawaii's medical marijuana program has sparked fierce debate over the
past decade. Some view it-and use it-as medicine, while others
contend it is a dangerous drug, widely abused. How does the program
work, and who is involved?

Teri Heede pulls out 25 orange, prescription pill bottles from a
cloth bag hanging from the handles of her red motorized scooter. Then
an inhaler, and, from another bag, empty cranberry juice jugs filled
to the top with disposable interferon shots. This used to be Heede's
life living with multiple sclerosis (MS)-pills in the morning,
afternoon and evening. Pills to quell the side effects of her other
pills. Shots Monday, Wednesday and Friday and frequent trips to the
doctor. She's a 55-year-old retired computer engineer who served in
the Navy during the Vietnam War. She had grown accustomed to having
no energy, being violently ill for weeks on end, and losing some of
her motor skills. But 10 years ago, she quit the pills and shots and
opted for something she says finally worked-medical marijuana.

Today, Heede spends her days out of bed; she just finished
volunteering at a Makakilo polling place for the fall elections. She
gets by with Aciphex (for acid reflux), occasionally a few Tums and
medical marijuana. "Nothing works like this," she says, holding up a
small Tupperware of peanut butter cookies made with "cannabutter"
(butter infused with cannabis). She even lets me smell them; the
peanut butter overpowers the skunk-y marijuana-laced butter they were
made with.

"I don't get high. This is not a Cheech and Chong moment," she says.
Heede likens using medical marijuana to taking St. John's wort or any
other herbal supplement. It doesn't bother her that it isn't
federally recognized; she says marijuana helps her more than any of
the FDA-approved pills ever did.

Heede is one of the approximately 8,000 people in the state who has
received a physician's recommendation to legally grow and use
marijuana. Medical marijuana, or cannabis, as medicinal users and
advocates prefer to call it, is a hot-button issue. For example, last
October, Sen. Will Espero established the Medical Cannabis Working
Group after Gov. Linda Lingle refused to convene a medical marijuana
task force, even though it had been approved by the Legislature. The
group released a report in February detailing statewide program
recommendations. Last legislative session, about 20 bills were
introduced to expand the program-none passed. Medical marijuana has
also gained national attention. In July, the Department of Veterans
Affairs formally allowed its patients to use medical marijuana in
states where it's legal, and this month California voters opposed the
Regulate, Control and Tax Cannabis Act of 2010-better known as
Proposition 19-which aimed to legalize and tax marijuana.

Local advocates have been fighting for years for a safe, regulated
distribution system and to increase the amount of marijuana patients
can possess. But there's a hitch. Patients walk a fine line by using
a state-regulated medicine that is also still a federally illegal
drug. That's another reason both Lingle and local law enforcement are
opposed to Hawaii's program. As it stands, there's a big gray area
where contraband cannabis transitions into legal medical marijuana,
without clarity or guidance for anyone.

Legislative Passage

Hawaii approved medical-marijuana in 2000 when then-Gov. Ben Cayetano
signed into law the Hawaii Medical Marijuana Act. Hawaii was the
first state to enact a medical marijuana program legislatively. "It
is a compassionate care program for seriously ill people," says
Jeanne Ohta, executive director of the Drug Policy Forum of Hawaii,
an organization started in 1993 to bring public awareness to Hawaii's
drug issues, and which also provided input for the state's medical
marijuana law.

"Marijuana was legal before the 1930s," explains Ohta. "A lot of what
made it illegal was political and race-based." Marijuana resurfaced
for recreational use in the 1960s and '70s but it wasn't until the
1990s that states began pushing for the use of marijuana for
medicinal purposes. Today, 15 states have medical marijuana programs;
five states allow dispensaries. The state laws vary-California has a
patchwork of county-by-county laws-and Hawaii has one of the more
conservative programs.

"I think the majority of our legislators have tried marijuana," says
Aron Gonsalves. "They should understand that it's not something to be
scared of. ... They need to see someone who is dying of cancer, or
who has AIDS or MS and how much medical marijuana helps them." The
former chef of E&O Trading Co., Gonsalves now owns Green Hands of
Aloha, a Kalihi hydroponics store, where he merged his two
passions-growing local, organic produce and helping medical marijuana
patients grow cannabis. He's a registered user and has been growing
marijuana for 20 years. Seventy percent of his store's customers are
medical marijuana patients. He helps them set up custom hydroponics
systems-costing around $1,500-and teaches free hydroponics classes at
his store twice a month. Medical marijuana isn't handled like other
medicines are-there is no legal, controlled manufacturing and
distributing system. "We don't ask AIDS patients to make drug
cocktails at home. You don't grow an aspirin tree for your headache,
do you?" says Gonsalves.

Opponents believe that marijuana dispensaries in the Islands will
only result in higher crime, a spike in the number of users and a
conduit for pot into school campuses.

Registration and Compliance

If you have MS like Heede, you have to go through a bureaucratic
process to become a medical marijuana patient in Hawaii. First, you
must have one of the specified ailments, including glaucoma,
seizures, HIV, AIDS, severe nausea, pain or muscle spasms. You must
get your condition documented on your medical records. You then have
to find a doctor willing to participate-many physicians don't, for
fear of legal repercussions. Heede's physician didn't, so she had to
find one who did. Then you'd have to transfer your medical records,
set up an appointment and then sometimes pay an office visit fee;
some physicians charge $175.

Under the law, the physician must work with the Narcotics Enforcement
Division, which oversees the medical marijuana program. Unlike most
other states, Hawaii's medical marijuana program falls under the
state Department of Public Safety-the people who run law enforcement,
prisons and jails-not the state Department of Health. After
recommending you for the program, your physician mails an application
to the NED offices, a clerk processes it and sends it back to the
physician, who signs it and gives it to you. After paying $25, you
then receive a blue, business-card-size registration permit with your
personal information. Heede says she was first given a temporary
permit-only one clerk handles the applications, so there's a backlog.
With your permit you can now own and cultivate up to seven marijuana
plants-three that are mature, or flowering, and four that are
immature-and possess three ounces of smokeable marijuana.

Getting the card took Heede six months. "I've never once had my
paperwork processed in a timely fashion, either by the doctors or the
NED. It is not a straightforward process."

Patient Concerns

One of the biggest complaints from growers like Gonsalves and
patients like Heede is the lack of access. While an MS or AIDS
patient can legally grow and possess cannabis, they often have to
acquire it illegally, since Hawaii law does not allow dispensaries.
"Law enforcement would have you believe everyone knows a drug dealer,
everyone knows where to find marijuana. I don't think they've met
these people who are totally legitimate citizens, who have never
broken a law in their life," says Ohta. "The reason they're
registering is they don't want to do something illegal, they want to be legal."

Ohta and others mistrust the NED's supervision. "The Narcotics
Enforcement Division takes an adversarial view of a program it
administers. Its control of the program has been scary for both
patients and physicians," she says.

"We didn't ask for it," says Keith Kamita, the chief of the NED.
Kamita has become the face of the law enforcement's side of the
program. Ohta and Heede say they would love to sit down and debate
Kamita on his attitude toward the program his department runs. "It's
like putting the Klan in charge of civil rights," adds Brian
Shaughnessy, a paraplegic medical marijuana patient who smokes to
alleviate muscle spasms, a condition of his paraplegia. It was the
result of a surgery gone wrong when he was 24.

In Kamita's defense, some people have fudged their applications or
had more than the allotted seven plants. Maj. Susan Dowsett, who
heads the Honolulu Police Department Narcotics/Vice Division,
confirms this; however, there have only been three cases this
year-two people exceeded the plant limit, while a third had an invalid permit.

Kamita also says the NED has noticed a lot of young people utilizing
the program for pain-versus older adults with terminal or
degenerative diseases and disorders for whom he believes the law was
originally intended. "There's a question of whether it's severe
enough for them to be in the program. If you go on the Internet and
punch in 'Hawaii medical marijuana' you'll see a lot of different ads
popping up. Sometimes you'll think, 'What does this have to do with
medicineUKP'" He is also wary of the participating physicians,
especially those on the Big Island. "We have physicians in Hawaii who
do this just as a business," he says. "And you bring in crime with
dispensaries [if we allowed them]. You're not talking about care
here, you're talking about distribution." He specifically mentions
California's program, which has earned the reputation for being the
Wild West of cannabis; you could walk into many dispensaries and buy
pot, no permit required.

"We know what doesn't work with California; we can avoid it," says
Ohta. "Just because California is not running it right, doesn't mean
we can't have a totally regulated process." Ohta says she gets phone
calls and e-mails from patients daily who have their blue cards but
have no idea where or how to acquire cannabis. She recommends
patients try to grow it themselves, or find and register a caregiver
who can grow and harvest it for them. (A caregiver can only grow for
one patient.) Even then, that isn't always successful. Heede says she
was too sick to grow the plants, and admits she bought weed from the
black market before finding a caregiver. But for some, finding a
caregiver-who is trustworthy, isn't already growing for someone else
and can grow marijuana-can be just as difficult. "A lot of patients
[resort to] the illegal market," says Ohta.

"I've tried to talk to my fellow legislators about making medical
cannabis more accessible and it's always very hush-hush," says state
Rep. Joe Bertram III. "We made it legal in 2000! It's still a hard
thing for people to understand." Bertram continues to introduce bills
to amend the law. He also is a registered caregiver for his friend
who has MRSA (a bacterium that causes infections and is harder to
treat because it's resistant to commonly prescribed antibiotics). He
currently doesn't grow marijuana for his friend, another man on Maui
does, but Bertram keeps his caregiver license, just in case. "You
never know. It's very uncertain."

Pushing for Change

Hawaii is one of the few states with long-established medical
marijuana programs that have not been revised since their inception,
essentially operating off the first drafts of a legal structure.
While parts of the Islands' law are clearly defined, several holes
still exist, such as access, exemption from employee drug testing of
patients and bringing medical marijuana aboard interisland flights.
Advocates charge law enforcement with stonewalling any attempt to
revise or expand the law for the past 10 years.

While the NED administers the medical marijuana program, enforcement
also falls to HPD. It, too, polices a program it doesn't think should
be legal. "HPD is against the legalization, decriminalization and
medicinal use of marijuana," says Dowsett. Regardless, officers are
trained by the NED to make sure patients such as Shaughnessy have
only seven plants and a valid registration, and that Heede's
caregiver is growing her plants at the location listed on her card.

Many of HPD's investigations stem from complaints, such as a neighbor
smelling someone smoking cannabis. An officer then verifies the
person's information through NED. Exceeding the seven-plant limit can
result in confiscation or arrest. HPD doesn't receive funding to
enforce the medical cannabis program, but it does get $100,000 to
$250,000 annually for marijuana enforcement and eradication.

"They're not physicians, they don't care," says Dr. Charlie Webb, a
participating medical marijuana physician who practices urgent care.
"They don't realize that a lot of people really do have chronic
pain." Webb and his wife, Sandy, a registered nurse, run the MUM
Clinic (Medicinal Use of Marijuana) in Kailua-Kona on the Big Island.

But the cops have the backing of the federal government-no matter
what the Hawaii medical cannabis law says, marijuana is still
classified as a Schedule I drug established by the Controlled
Substances Act in 1970. There are five schedules; marijuana is in the
highest classification, grouped with heroin, LSD, and MDMA, or
ecstasy, among others. (Meth, however, is a Schedule II.) Advocates
want to change marijuana's classification.

The Hawaii Medical Association (HMA) doesn't officially support or
oppose the state medical marijuana program, but, says HMA executive
director, April Troutman Donahue, "We do have a policy that medical
cannabis should be rescheduled." The HMA endorses moving marijuana to
the Schedule III classification, which includes synthetic THC (the
active compound in marijuana). "In order for it be Schedule I three
criteria must be met," says Donahue. "There must be a risk of abuse,
no medical use in the U.S. and a lack of safely accepted use."
Fifteen states with medical marijuana programs and studies finding no
known fatal cannabis overdoses contradict marijuana's current
classification. Donahue says HMA is considering taking a resolution
promoting the rescheduling of marijuana to the American Medical Association.

Webb, who also participated in the Medical Cannabis Working Group,
helped draft the HMA rescheduling resolution this summer. "I never
saw a hospitalization from marijuana," says Webb, who was an
emergency room physician for more than 30 years. "The most dangerous
thing [about marijuana] is being arrested."

Webb is one of approximately 175 Hawaii physicians who recommend
medical marijuana for qualifying patients. Unlike many of his
colleagues, he isn't afraid to participate in a program that isn't
federally recognized. "I felt like I could do it because I'm older,"
he says, adding that he would have feared federal prosecution if he
was fresh out of medical school.

Taking Matters into Their Own Hands

Although Teri Heede has gotten relief from her MS symptoms over the
past decade by smoking marijuana and eating canna-cookies, she's only
been public about it for two years. In June 2008, the NED
accidentally sent the Hawaii-Tribune Herald, a Big Island newspaper,
information on 4,200 medical marijuana patients, including Heede. "I
had been flying beneath the radar, so to speak, working, volunteering
and smoking," says Heede. "Nobody knew. But then I'm outed by the
NED. I thought, 'Well, now that I'm out, I'll be there for the people
who are afraid to speak up.'" Heede has become a crusader for other
patients, especially those just starting out; she has given cannabis
to patients who have their permits but don't yet have access to
plants. "Yes, I will break the law that way, but I never distribute
it [to people who aren't patients]. I never would."

Like Heede, Shaughnessy says he's also doing his part as a patient
advocate. He says he's hoping to start an online collective in
January called Makahiki, where patients can purchase cannabis and
have it delivered to their homes. "I feel strongly compelled to do
this," he says, but also admits he's fearful of a legal backlash.

Until a safe, regulated distribution system is set up, Heede and
Shaughnessy will continue to run the risk of confiscation or arrest,
despite mostly abiding by the medical marijuana law. As long as the
program remains under the NED, many patients will be stereotyped as
stoners-in-disguise, and have to work with a department that doesn't
support marijuana's medicinal purposes. Ultimately, says Heede,
having a sense of humor helps. "I'm a grandmother, I vote, I work the
polls, I was a soccer mom, I do community service," says Heede.
"We're nothing like the criminals the NED wants to portray us
as."

How Easy is It to Get the Card?

You might have heard how ridiculously simple it is to get medical
marijuana in many California dispensaries-it's one reason Hawaii law
enforcement opposes setting them up here. But how legit are the
medical cannabis clinics in Hawaii? I decided to find out, using my
own real medical condition-migraines.

I attempted to get blue cards from four Oahu clinics- you might have
seen some of these clinics' ads on the back page of the Honolulu
Weekly-and it's not as easy as you might think.

First, walk-ins aren't allowed; you have to set up an appointment. My
first call was to a clinic in Ewa. The friendly woman who answered
said the physician could help me, but first I had to transfer my
medical records. "It says on the website the doctor can help me even
if I don't have medical records," I said. "Oh no, you have to
transfer them first," she replied. I called back the next day and
spoke with someone else but got the same answer.

Same story at the next clinic I tried. The man who answered the phone
wouldn't even tell me where their office was located, aside from King Street.

The last two two Oahu clinics I tried listed 1-800 numbers that went
directly to automated recordings. My messages were returned a week
later by representatives in California and Oregon, again telling me
the same thing.

I never did set up an appointment. If I transferred my medical
documents, I could have secured an appointment and a physician might
well have recommended me for medical marijuana. But it would have
taken a while. Teri Heede, a registered Hawaii user, says it took her
six months to get her card. Not as carefree as California.