PATIENTS CAUGHT IN A CLOUD OF CONFUSION

Steve Sarich had just finished watering hundreds of marijuana cuttings
and stepped into the shower in January when he heard a commotion
downstairs. He managed to slip on a bathrobe before a cop walked
through the door.

It was Roy Alloway, a drug detective from Kitsap County, armed with a
search and seizure warrant for Sarich's crop of about 1,500 marijuana
plants.

Sarich wasn't surprised. As executive director of CannaCare, a medical
marijuana advocacy group in Everett that supplied patients with
clippings to grow their own, Sarich thought he might run afoul of the
law one day.

Washington, like 11 other states, allows marijuana to be used as
medicine. But the state law doesn't say how much marijuana a resident
can possess.

Sarich is confident that his operation was legal. Alloway, a member of
the West Sound Narcotics Enforcement Team, or WestNET -- tasked with
carrying out what many say is an ambiguous law -- begs to differ.

Nearly a decade since Washington voters legalized marijuana as
medicine, the issue remains clouded in confusion and controversy.
Counties interpret the law inconsistently. In medical circles, the
subject is awkward to the point of taboo, with few doctors willing to
recommend marijuana for patients. And patients live in a clandestine
world, fearful to say where they got their medicine, or even that they
use it at all.

An overarching problem is that the federal government does not
recognize a medical value to Cannabis sativa, the plant from which
marijuana is derived. The state law also is fuzzy on logistics. For
example, while a patient with a doctor's note may legally possess
marijuana, there is no clear way to obtain the drug.

"It's a pretty odd law, from my perspective," said Jim Carlson,
director of pharmacy, clinical health and plan services for Group
Health, the state's largest medical provider. "It's one of the only
laws that I am aware of that states that something is legal, in the
face of there being no legal way to do what is legal."

Clarifying the Law

Recognizing the conundrum, the state Legislature this year amended the
law, tasking the state Department of Health with resolving two basic
questions: What is a 60-day supply of medical marijuana? And how can
patients safely obtain it?

The initiative's "60-day" language is a failing peculiar to Washington
- -- other states that allow marijuana as medicine specify limits on both
numbers of plants and ounces of usable plant material.

Because of the state law's ambiguities, law enforcement agencies in
all of the state's 39 counties take situations on a case-by-case basis
and likely consult their respective prosecutor's offices for advice.

"Obviously a search warrant served at a house where 200 plants are
found would hardly be a medicinal use case," said Al Townsend, chief
of the Port Orchard Police Department. "But until the law gets fixed
to make it more clear for us on how we will proceed with these cases,
we will continue to look at each of them individually."

WestNET's bust of CannaCare, for example, was rooted in its own
interpretation of the medical marijuana act. The team follows a study
done by Detective Alloway -- who drew from several studies, including
federal ones -- defining a 60-day supply as a maximum of 27 plants:
nine starts, nine growing, and nine budding at any one time.

Alloway had "received an inquiry" from an assistant U.S. attorney in
August 2006 about CannaCare members. The drug task force, which often
tracks leads well outside Kitsap County, conducted the search and
seizure. "Our job is to dismantle mid-to high-level drug trafficking
organizations," WestNET Sgt. Carlos Rodriguez said.

Under Alloway's definition, the 1,500 plants at CannaCare was a clear
violation. The case, still pending, was referred to the U.S. Drug
Enforcement Administration, which views as illegal the possession of
marijuana in any amount, anywhere.

"From a legal standpoint, it makes no difference under federal law if
you have a two-day supply, 60-day supply or 60-year supply," said Jeff
Sullivan, U.S. Attorney for Western Washington.

As a former elected prosecutor of Yakima County of 25 years, however,
Sullivan said he empathizes with state prosecutors and police wanting
a clearer medicinal marijuana law. He called the Washington Department
of Health-led effort "a great one that should have been done a long
time ago."

The health department's answers are due July 1. Last month, it held
four public meetings around the state to gather ideas and comments.
Testimony from a gathering in Seattle, which drew about 100 people
from both sides of Puget Sound, underscored the difficulty of
producing tidy answers.

For example, one idea for a 60-day supply is 99 plants or fewer, a
figure driven not by science but practicality -- federal law imposes a
mandatory five-year prison sentence on those with 100 or more plants.

But counting plants isn't sensible, Sarich said. At the Department of
Health's meeting, the CannaCare director, who has yet to be charged in
the January bust, held up a potted plant to make his point.

"Take a guess how many pounds of tomatoes that plant can produce,"
Sarich said. "We don't know when we start a plant what we're going to
get off it. A plant is a zero-day supply of medication."

Mason County Prosecutor Gary Burleson believes patients' individual
situations vary far too much to apply a one-size-fits-all solution.
"Anybody can come up with quantifiable term," Burleson said in an
interview. "But come on, is that really going to be
meaningful?"

For instance, different marijuana strains produce different amounts of
THC, or delta-9-tetrahydrocannabinol, the chief psychoactive
ingredient in pot. And people respond differently to the drug: Some
need more pot than others to feel its effects.

Another wrinkle: Smoking, while the most potent, fast-acting way of
delivering the effects of marijuana, is only one way to take it.
Patients also inhale its vapors, eat it in food, drip tinctures under
their tongues, rub ointments into their skin, even soak in bubble
baths made from marijuana. Each application has its own dose.

"How are you going to plug those kinds of things into health
standards?" Burleson asked.

Clubs on the Legal Fringes

The question of access is equally tricky. State law allows each
patient to grow his or her own marijuana plants or designate a
caregiver to grow on his or her behalf. Medical marijuana advocates
say the provision presumes that all patients have the know-how and
energy to grow their own.

Carolyn Welch of Seattle was diagnosed with advanced ovarian cancer
this summer. She said she was fortunate to have a friend in the
medical marijuana movement who helped her obtain the tinctures, rubs
and foods she needed to cope with the effects of surgery and
chemotherapy.

"I couldn't grow my own," Welch told state health representatives. "I
had two days from the time I got out of the hospital until I started
chemotherapy. ... I don't know how much green stuff I need to make a
tincture or a massage oil... I was a mess."

Even for people who feel well enough to garden, growing pot is not a
simple exercise, said Monte Levine, a 61-year-old Bremerton resident
experienced in cultivating marijuana to combat fatigue caused by
Hepatitis C.

"It's very complicated," Levine said. "Growing plants indoors requires
special light bulbs. ... The electricity's expensive. There are
different plant strains for different ailments. You have to know how
to fertilize them. How to get a good strain. These are all issues."

So, again, are vagaries in the law. Levine was the target of busts in
2001 and 2002. First local authorities, then federal agents, raided
his two-bedroom home in Bremerton, where he grew marijuana in an attic
over the garage. Charges in both cases were dropped, but the threat of
prosecution continues to loom.

A letter from Assistant U.S. Attorney Douglas Whalley to Levine's
lawyer in 2002 warned: "... if we receive a new marijuana case
referral concerning your client ... from state or local authorities,
we will accept the case for federal prosecution no matter what
quantity of marijuana is involved."

Many medical marijuana advocates say "group grow" is the way to go --
forming clubs or cooperatives where patients share their marijuana and
knowledge. But as the CannaCare raid illustrates, keeping marijuana in
substantial quantities, whether as plant cuttings or dried,
ready-to-ingest medicine, is legally risky.

Of a half-dozen or so cannabis clubs in Washington, most are in
Seattle because of that city's philosophy of tolerance, as expressed
by Initiative 75, a measure approved by voters in 2003 that makes
arresting and prosecuting individuals with less than 40 grams of
marijuana the "lowest law enforcement priority."

One club in Seattle is Emerald Cross, managed by Sue Watson of Port
Orchard. Watson said she wanted to locate the club in Kitsap County,
but the county prosecutor's office told her the operation violated the
one patient-one caregiver rule and therefore would not be welcome.

"In a co-op arrangement, where more than one patient is supplied, or a
patient shares his or her 60-day supply, they are in violation of the
statute," Kitsap County Prosecutor Russ Hauge confirmed in an interview.

Emerald Cross occupies the second floor of a nondescript office
building in an industrial zone in the shadow of Interstate 5. About
900 people belong to the club, Watson said, all patients with doctor's
notes. Staffers are patients who volunteer their time in return for
medicine. The other members pay for their medicine by donation, Watson
said, because selling medical marijuana is illegal.

The club has a conference room, a playroom for patients' children, a
dispensary and a lounge where members may use their marijuana, relax
and visit with others. A cabinet near the dispensary is filled with
dozens of colorful glass pipes that tinkle like wind chimes when
someone opens the drawer.

Through the open door of her office, Watson watches people come in and
out of the lobby. "Usually when they walk out, they're smiling," she
said, smiling herself.

Watson's experience with medical marijuana began about 20 years ago
after two car accidents injured her back and uncovered a spinal birth
defect that makes her prone to vicious headaches.

"I couldn't do anything except cover my eyes, cry and throw up, and
have someone take me to the hospital to take something to knock me
out," said Watson, 56.

At one point, Watson said, she was taking three Vicodin a day, which
caused such severe constipation that not even a tub of prunes could
help.

Now she takes no prescription painkillers; she uses just marijuana,
smoking an average of a fourth of an ounce a day. She also takes
pleasure in inventing new forms of the medicine, including ointments
to rub on the skin and, most recently, bubble bath.

Patients come from all over the state to Emerald Cross. Stevan Hall
drives from Silverdale to Seattle once a month to pick up medicine for
himself and his wife. Hall, 52, was a plumber before he was disabled
by an arthritic back. His wife also has a bad back and glaucoma.

"It helps us," he said after fetching a small brown bag from the
dispensary. "In the days of our youth, it was to get high, but it's
gotten a lot further than that."

Like Hall, many marijuana patients freely admit to having smoked
recreationally before using pot as medicine. Although that is not true
of every patient -- one advocate estimated that one-third start out as
"naive" users -- the fact that some have smoked pot for fun diminishes
the credibility of pot as medicine.

Roger Roffman, a University of Washington professor of social work
with expertise in addictive disorders, said the medical marijuana
movement is hampered by its ties to the movement to legalize marijuana
for all uses.

"While there's enormous legitimacy to this issue -- many, many
patients, I think, really benefit from the use of marijuana -- on the
other side, there is enormous potential for this issue to be co-opted
as a way of getting ultimate legalization of marijuana for
recreational use," Roffman said. "The fact that they're not being done
separately, I think, has been part of the controversy."

The lure of marijuana for illicit uses also endangers patients. One
Kitsap County patient said that after word got out in her small town
that she used marijuana to control chronic pain, she was approached by
strangers who wanted her to get them drugs.

Levine, the Bremerton patient, said patients who grow their own
marijuana are particularly vulnerable. "The first three rules of
growing are: Don't tell anyone. Don't tell anyone. Don't tell anyone,"
he said. "You open yourself up to thievery."

Doctors Fearful, Too

Dr. Robert Killian, a physician in Seattle who wrote Washington's
medical marijuana initiative, is proud of the law but disappointed in
two ways over how it's played out.

In an exchange by e-mail, Killian said he had hoped that the states'
push to make marijuana available as medicine would influence the
federal government to do the same, setting consistent standards
nationwide and giving patients reliable access to the medication. That
hasn't happened.

Fellow doctors have let him down as well. "I am disappointed in my
colleagues within medicine that have not educated themselves and who
avoid this issue," Killian said. "I am very disappointed that my
medical colleagues who refuse to protect their patients by not signing
the necessary forms are putting their fears above protecting their
patients from prosecution."

Third-year UW medical student Sunil Aggarwal, who hopes to write his
doctoral thesis on medical marijuana, said he's heard repeatedly from
physicians that they'd rather not get involved. "They just don't know
what the repercussions are," he said.

In Poulsbo, Narinder Duggal is a rare physician willing to write
recommendations for medical marijuana -- and discuss it publicly. An
internist and pharmacologist, Duggal was trained in Canada, where
marijuana is legal as medicine. Duggal said he treats marijuana like
any other potentially addictive pain drug. He asks patients to sign
agreements that they will not abuse the drug and not visit multiple
doctors -- a common ploy to score extra medication. He runs urine tests
to screen patients' drug levels and requires frequent visits for close
monitoring.

"I've never in my life been in fear (of prosecution) because I never
sell a drug," Duggal said. "I think you feel vulnerable if you're not
educated enough."

Duggal said he would like to see a discussion among doctors, lawyers
and law enforcement on the topic "so they can all be on the same page.
There should be a collaboration," he said. "I wouldn't center the
stage on marijuana, I'd center the stage on pain control. That would
be a great forum to have."

It's not a forum the Washington State Medical Association has ever
considered, said spokeswoman Jennifer Hanscom. "There hasn't been a
lot of interest," she said. "We just don't get calls from physicians
struggling with the issue."

The few physicians who do inquire are told that "they are at their own
risk if they recommend medical marijuana," Hanscom said. "We give them
all the information that the state allows (it), but they are
forewarned about the federal law, as well."

Because of the federal prohibition, anything the state does to address
shortcomings in its law will fall short, Killian said. "The only
improvements will come when federal laws are changed to allow for
access and distribution of this drug," he said, adding that the state
changes "are trivial, but necessary because law enforcement in general
has never been a supporter of this law."

Despite the flaws in the system, medical marijuana advocates are not
discouraged. "It's slowly getting more and more open and legal, and
patients don't have to be afraid," said JoAnna McKee, who runs Green
Cross, a medical marijuana information clearinghouse in Seattle.

McKee has been at the leading edge of Washington's medicinal cannabis
movement since before it was legal. She used to run an impromptu
cannabis club out of a trailer on Bainbridge Island, supplying about
70 patients until police raided the place in 1995. She continued the
work in Seattle for a while. Today, she said, she supplies only
information, not marijuana, from her home in the city.

From McKee's perspective, things are much improved. "When we first
started, if I was talking about medical marijuana, I had to be careful
I wasn't overheard because somebody might get the wrong idea and call
police," she said. "I don't think the law is as good as it could be
right now, but it's better than it was 10 years ago."