THE MEDICAL MARIJUANA MUDDLE: A CLEAR DECISION, A HAZY OUTCOME

Last November, 62 percent of Montana's voters approved the use of
marijuana for medical purposes.

That means that all a patient has to do is ask his or her doctor for a
prescription, and if stopped by a police officer the patient is let
off the hook.

Not quite.

While the margin of support for Initiative 148 was clear, the
aftermath is anything but.

Law enforcement officers, physicians and even the 82 Montanans already
registered as qualified patients are all wondering what Montana's new
law means to them.

Currently, a doctor can't prescribe marijuana because it's still
categorized as an illegal, Schedule 1 drug. The new statute does,
however, allow a patient to seek the signature of a physician
affirming that the patient suffers from one of the conditions listed
under the statute, such as cancer, glaucoma, AIDS and chronic diseases
such as severe pain, nausea, seizures and muscle spasms.

But even with the signature, there's no legal way to buy marijuana.
Patients in Montana now smoking it still have to get it the
old-fashioned way, illegally.

Doctors like Jim Guyer, the medical director at the Deering Clinic in
Billings, don't plan to approve requests for medical marijuana until
the gray areas are clarified. Since the initiative passed, he's had a
handful of requests.

"Because we are a federally qualified community health center, we fall
under federal guidelines," he said. "There's some concern that if we
prescribe it, it could jeopardize our grant funding."

Guyer refers to an incongruity between state law, which apparently
allows medical marijuana, and the federal law, which prohibits it.

He's not the only one wondering which law will prevail. That issue is
currently before the United State Supreme Court, where a decision is
expected soon.

Others physicians, like Billings oncologist Patrick Cobb, question the
benefits of marijuana.

"We have so many alternatives to marijuana that work significantly
better for nausea," he said. "And we have some of the same concerns
about marijuana (as we do about) smoking cigarettes. And cancer
patients are more susceptible to lung problems."

Cobb said he's had some patients ask about it, but they have been
satisfied with his answer.

"We don't think we're shortchanging our patients at all," he
said.

Dr. Doug Moore, medical director of the City County Health Department,
said the law was written so broadly that he doesn't know how to
respond from either a medical or legal standpoint.

"The guidelines are so broad, anybody could qualify," he said. "And
there's the issue, will the DEA (Drug Enforcement Agency) come back at
us?"

Even if the court rules in favor of the states, Moore is not sold on
medical marijuana.

"People who are on marijuana for a long time, their brains work
different," he said. "From my clinical experience, marijuana is not a
safe drug. And, from a public health perspective, it's a bad drug -
it's a gateway drug."

No rush to puff

When the initiative passed, Dr. John Oakley, a physician with the
Northern Rockies Pain Center, expected to be bombarded by requests.

"We're in a position where we would be the ones who would see most of
the petitions," he said. "I've only signed one."

And that request came from a patient in Missoula. The man, who suffers
from chronic pain associated with failed back surgery, wanted to use
marijuana to boost the effectiveness of medications he received
through a pain pump.

"Rather than take more narcotic medicines for it, the marijuana
sounded like a good thing to him," Oakley said. He continues to follow
the patient, who is doing well on the combination.

Oakley said he did not feel particularly exposed when he chose to
follow state law over federal law. But he expects most of his
colleagues will take the safer route.

That might explain why only 82 Montana residents, of the 196 people
who have requested forms from the Department of Public Health and
Human Services and the countless others who have downloaded their own
forms from the department Web site, are on the state's registry list.

One of those on the list is Robin Prosser, a 48-year-old Missoula
resident who has suffered from systemic lupus for 20 years. Prosser,
who uses marijuana to ease her symptoms, actively campaigned for the
passage of I-148. She is concerned about the discrepancy between the
numbers.

"It indicates to me there are people not getting them (petitions)
signed," she said.

'Pot Doctor'

Prosser understands the reluctance on the part of physicians. She
knows they don't want to be flagged as a 'pot-favorable doctor,' and
she knows many physicians don't know how the statute applies to them.

"It's such a new territory for everybody," she said. "They don't know
where they stand legally, but it's all spelled out in the initiative
very clearly."

Roy Kemp, bureau chief of the Licensure Bureau of the DPHHS, agrees
that the statute protects physicians.

"As long as they're in compliance with this, they cannot have an
action taken against their license," he said.

To register, the patient submits that certification, along with an
identification form and a $200 annual fee to the DPHHS. Kemp
determines whether the forms and the signing physician meet the
requirements of the law. The signing physician can only be a medical
doctor or doctor of osteopathy - no naturopaths, chiropractors or
physician assistants qualify. If everything checks out, the bureau can
add the patient to its confidential list and issue a registry card.

Tell it to the judge

But a registry card isn't necessarily a free pass to smoke marijuana.
Yellowstone County Undersheriff Jay Bell said a registry card would
put a different spin on a situation, but he would rather let the
courts figure it out.

With no guidelines other than the wording of the new statute, Bell
said he can only guess how police will react.

If a routine traffic stop revealed someone in possession of marijuana,
he said, most likely the drug would be confiscated and the individual
would have his day in court. If the county attorney determined the
individual had the legal right to possess the drug, it would probably
be given back and no charges would be filed, he said.

"If they have a trunkload (of marijuana), they'd probably go to jail
with or without a card," he said. "If they have a small amount and a
registry card, it'd probably be confiscated and that would go into the
report."

Even having a registry card leaves some questions unanswered. For one,
he said, law enforcement would have to consider whether the marijuana
was legally obtained.

"Right now, there's no legal outlet in the state of Montana, as far as
I know," he said. "And even transporting seeds is against federal law."

There also are questions about whether a renter can be evicted for
using medical marijuana. Can a qualified patient live within 1,000
feet of a school, the standard school drug-free zone? And, can a
patient still grow or possess medical marijuana? What should an
employee tell his employer if he is subjected to a drug test?

"It's just too gray for law enforcement and for people who think
they're in the clear," Bell said.