KEITH STROUP STEPPING DOWN

The National Organization for Reform of Marijuana Laws holds its annual
conference in Washington, DC April 22-24. Keith Stroup will announce his
resignation as executive director and the NORML board of directors will
commence a search for his successor.

Stroup was a young lawyer with some experience working for Ralph Nader when
he founded NORML in1970. "Keith decided to take the notion of consumerism
seriously when it came to pot smoking," according to Dale Gieringer, who
runs the California NORML chapter. Stroup is widely credited with promoting
"decriminalization" bills that were enacted in about 20 states and cities
in the '70s. He left NORML in 1979 after an infamous episode in which Dr.
Peter Bourne, Jimmy Carter's allegedly liberal drug-policy advisor
allegedly did cocaine at a Washington party and Stroup allegedly confirmed
it to a reporter. Stroup returned as executive director in 1994.

NORML has only about 5,000 members nationally, and its budget is a fraction
of that of the Marijuana Policy Project and the Drug Policy Alliance.
("We're the reform group that doesn't have the backing of any
billionaires," Stroup has taken to saying, wistfully, in recent years.) But
NORML has the best name recognition, and the best name, and to this day
citizens call the national office out of the blue and announce that they
want to set up a UC Santa Barbara NORML chapter or an Eastern Montana NORML
chapter...

Journalist Eric Schlosser will be a featured speaker at this year's
conference. His book"Fast Food Nation" was so well aimed and timed that
- -like "The Jungle" and "Silent Spring"- it appears to have achieved
substantive reform on its own. Very soon after "Fast Food Nation" came
out, McDonald's et al stopped supersizing and introduced salads -finite
steps in the right direction.

The American Society of Addiction Medicine -whose members provide the
intellectual rationale for the war on drugs-is convening in Washington at
the same time as NORML. A rumor that the two groups would be meeting -and
staying- at the same hotel turned out to be false, but it could be the
premise for a not-bad comedy with Nick Nolte as addiction expert David E.
Smith, MD, and Barbra Streisand as a wisecracking MS patient.

Shilling for O'Shaughnessy's

I'm going to distribute O'Shaughnessy's at both gatherings. O'Shaughnessy's
is the journal of a small group of specialists who have written almost half
the letters of approval authorizing Californians to medicate with
cannabis. The Spring 2004 issue, with its mostly positive news, will be
sent to thousands of doctors who may be on the verge of writing
recommendations for more patients, more readily.

The lead article, written by Frank Lucido, MD, with Mariavittoria Mangini,
PhD, FNP, is an insightful account of how Lucido conducts his practice. A
lot of thought has gone into every aspect of his interactions with
cannabis-using patients. For example, here's Lucido weighing the pros and
cons of requiring documentation that a patient has a serious pre-existing
problem.

My arguments for requiring documentation include:

* It is common in other situations in health care.

* It enhances patient protection, both medical, legal and financial.

* It gives me more confidence that, if called upon to do so, I could
successfully defend a patient's appropriate medical use in a court of law.

If law enforcement calls me to verify compliance with Prop 215, I am able
to say: "Not only did I assess the patient, but I have independent
documentation of the diagnosis for which the patient uses cannabis."

In most cases, law enforcement officers have been polite and replied
something to the effect of: "Thank you, doctor, we just wanted to make sure
it was a valid recommendation."

The following arguments have been made against requiring documentation:

* It is not necessarily consistent with the long tradition in medicine of a
trusted doctor/patient relationship.

* It may imply that it is less than acceptable for a doctor to do his or
her own evaluation, and determine that cannabis will or won't benefit a
particular patient.

* Records may be unavailable or difficult to obtain. Consider the situation
of a patient who suffered a traumatic injury many years ago, and doesn't
have ongoing care for chronic pain. The patient has been self-treating
effectively, and now wants to comply with state law. In this situation, the
history and physical examination might be enough to make me feel
comfortable without further documentation of the diagnosis."

Here's Lucido on the question of confidentiality:

Many patients seek out cannabis consultants because they don't feel
comfortable disclosing to their primary care providers doctors that they
have been self-medicating with cannabis.

Although I do require that the patient's primary provider or other
appropriate practitioner be aware of, and follow, the serious illness for
which cannabis is used, I do not require that the patient disclose his or
her medical cannabis use to these providers in all cases.

The wording I generally use in explaining this is: "In a perfect world, you
should be able to tell your physician everything. But unless, and until the
federal government, employers and insurance companies no longer
discriminate against medical cannabis users, there is valid reason not to
have cannabis mentioned in your medical records."

I ask the patient to assess whether he or she feels safe in telling their
doctor 'off the record' that they're using cannabis medicinally. If the
answer is yes, I encourage them to do so. Your own doctor knows you best,
and in a perfect world, one should be able to tell his or her doctor
everything.

The Spring 2004 O'Shaughnessy's also includes:

* A "poster session" on the regulatory role of endocannabinoids.
(Investigators have found endocannabinoids -neurotransmitters that activate
the same receptors as plant cannabinoids-in each of these bodily systems:
cardiovascular, digestive, endocrine, extretory, immunological, nervous,
reproductive, and respiratory.)

* A compendium of conditions that GW Pharmaceuticals expects its
cannabis-based medicines to ameliorate (citing all the studies that
substantiate their optimism).

* A thorough review of the significant court rulings to date (with
references) plus a concise chronology by the Medical Marijuana Patients Union.

* A feature story about the popular but pricey "Volcano" vaporizer.

And, as they say, much, much more. The CCRMG mailing address is p.o. box
9143 Berkeley CA 94709. Subscriptions are $12 for four issues. Single
issues by mail are $4. Send O'Shaughnessy's -or direct us to send it - to
any doctors, patients, caregivers, or concerned citizens you think might be
interested.

Homage to Herb

Now that the Socialist president of Spain is taking their soldiers out of
Iraq and religion out of their public schools, Rosie Barnes thinks our
public-school lunch menus should change "Spanish rice" to "Freedom rice."
And what about Spanish fly?... In a recent Chronicle piece, Patricia
Unterman did not correct an "expert" who misstated the real danger of food
irradiation. It's not that irradiation will make the food radioactive,
Patty; it's that irradiation destroys nutrients. You've got to watch those
experts like a hawk.

Rehearings, Please... The Medical Board of California is requesting a
rehearing of their case against Dr. David Bearman, and asking that the
appeals court ruling be "de-published" so that it does not set a precedent.
On March 31 an appeals court panel ruled that the Medical Board's subpoena
ordering Bearman to hand over a patient's chart was illegal. According to
Bearman's attorney, Seymour Weisberg, the Board is challenging four minor
technical aspects of the decision and will probably not get a rehearing.
Their next option will be to appeal the decision to the state supreme
court... Tod Mikuriya, MD, whose prosecution by the Medical Board resulted
in punishments due to take effect April 29, is requesting an indefinite
stay and petitioning for a rehearing based in part on the Bearman
precedent. Appeals specialist Charles Bond is also arguing that the
investigation of Mikuriya was illegal under the Conant decision, and that
the prosecution should not have preceded the Board's issuance of new
guidelines governing doctors who consult on cannabis use.