HEARING ON MEDICAL MARIJUANA

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House Committee on Government Reform: Subcommittee on Criminal Justice,
Drug Policy and Human Resources Holds a Hearing on Marijuana Medicine

SCOTT: Mr Chairman and members of the committee, I thank you for the
opportunity to be here today. My name is Dr. James D. Scott, I'm an
otolaryngologist, which is more easily known as an ear, nose, throat
physician. I've practiced medicine in Roseberg, Oregon, since 1971.

I am a member of the Oregon Board of Medical Examiners and past chair.
The Oregon Board of Medical Examiners was created by the state
legislature in 1889 to regulate the practice of medicine. The board's
mission is to protect the health, safety and welfare of Oregon
citizens by regulating the practice of medicine in a manner that
promotes quality care.

The board is governed by and enforces the Oregon Medical Practice Act
and Oregon-related administrative rules. The board conducts
investigations, imposes disciplinary actions and supports
rehabilitation, education and research to further its legislative
mandate to protect the citizens of Oregon.

In 1998, Oregon voters adopted Oregon Medical Marijuana Act. This act
creates an exception to state criminal laws by permitting certain
individuals to possess, produce and use small amounts of marijuana,
which may mitigate a disabling medical condition.

The Oregon Health Services Division was assigned the rule-making
authority necessary for the implementation and administration of this
act.

To qualify for protection provided by the law, the patient must apply
for or have a registry identification card.

To obtain this card, the patient is required to have written
documentation from the attending physician stating that the patient
has a qualifying, disabling medical condition.

Attending physician means a physician licensed under the Oregon
Medical Practice Act who has the responsibility --the primary
responsibility for the care and treatment of a person diagnosed with a
disabling medical condition.

The Board of Medical Examiners is responsible for verifying that
physicians are licensed to practice in Oregon with no restrictions
that would legally prevent them from signing an attending physician
statement regarding medical marijuana. The Oregon medical marijuana
program requests such verification from the BME licensing and
investigative staff.

No one representing the Oregon Board of Medical Examiners is prepared
to give any testimony regarding scientific or medicinal value of
marijuana or any social/political issues regarding marijuana. These
issues are beyond our jurisdiction.

Our board's role is to ensure that marijuana is recommended for
medicinal use through the same practice of medicine as any other
controlled substance.

In Oregon, physicians are required to verify patient's identities,
review previous patient medical records, collect current histories,
perform thorough, in-person physical examinations, reach diagnosis and
recommend treatment plans. We also recommend discussion with patients
regarding the benefits and risks of such treatment plans.

Physicians are required to have complete, accurate patient records.
Our board has disciplined an Oregon physician who signed attending
physician statements for the use of medical marijuana without
following the aforementioned procedures.

The board makes no distinction between medical marijuana and any other
controlled substance. Physicians have been and will continue to be
investigated and disciplined for inappropriate prescribing of all
controlled substances, regardless of the nature of the drugs in question.

The Oregon Board of Medical Examiners has made no policy statement,
formally or informally, on the use of marijuana for medical purposes.
The state's voters and legislature approved medical use of marijuana
without the approval of the U. S. Food and Drug Administration, which
has stringent requirements for scientific testing, approval,
manufacture and dispensing of legal drugs.

The people of Oregon have determined, through the process of law, that
using marijuana for medical purposes is part of the standard of care
for the state's doctors. The Board of Medical Examiners is responsible
for seeing that all standards of care under Oregon law are strictly
and fairly enforced.

Thank you very much. I'd be happy to answer questions.

SOUDER: Thank you for your testimony. We'll now move to, did I have
your name, Dr. Jerzak, is that how you?

JERZAK: No. I'm no doctor. I'm Joan Jerzak, that's
fine.

SOUDER: Joan Jerzak. And it's Jerzak is the correct?

JERZAK: Correct. SOUDER: Well thank you for coming today, look forward
to your testimony.

JERZAK: Chairman Sounder and members of the subcommittee, my name is
Joan Jerzak. I'm the chief of enforcement for the medical board of
California, which is a sworn law enforcement position.

Our enforcement program currently employs 90 investigators and
supervisors statewide. The board is legislatively mandated to protect
the health care of consumers through the proper licensing and
regulations of physician and surgeons and through the vigorous
objective enforcement of the Medical Practice Act.

The board licenses and regulates more than 115,000 physicians. Thank
you for the opportunity to speak to you regarding the use of medicinal
marijuana as a treatment modality from California's
perspective.

Although the subcommittee is looking at science-based medicine and
studies on medicinal Marijuana, I've been asked to comment on how
California physicians deal with medicinal marijuana and its
health-related impact on patients from the perspective of a regulatory
agency.

The Compassionate Use Act of 1996 was passed by California voters
through the initiative process and became law in November 1996. The
main thrust of the act was to allow seriously ill Californians to
obtain and use marijuana for medicinal purposes where such use is
deemed appropriate and has been recommended by a physician.

The act provides that marijuana may be used by patients for a wide
variety of medical conditions, and envisions that the physician will
serve as a gatekeeper to ensure that users are indeed patients whose
health would benefit from the use of marijuana.

Since 1996, the board has investigated a small number of physicians
who have had complaints filed against them questioning their
recommendation for medicinal marijuana.

To put this into perspective, the board receives approximately 12,000
complaints each year. At the completion of the triage process,
approximately 2,000 complaints are assigned to an investigator.
Complaints are received from a wide variety of sources and impact all
facets of the practice of medicine.

They include quality of medical care, sexual misconduct, substance
abuse, unlicensed practice, physical or mental impairment and an
assortment of other issues including improper prescribing or handling
of controlled substances.

Of the physicians the board has investigated for medicinal marijuana
issues, four cases were closed. One case remains in the investigative
stage. And the other four cases resulted in charges being filed.

In those four cases where charges were filed, the medical experts were
not critical that medical marijuana was recommended, but rather they
were critical of the overall care and treatment provided by the
physicians, and that there was not a good faith prior exam or medical
indication, the records were inadequate, or there was failure to
obtain proper informed consent.

The board does not pursue disciplinary action against physician merely
for recommending medicinal marijuana. Physicians in California have
expressed concern as to what their role is with regard to medicinal
marijuana and the board's view of physicians who are involved in
issuing recommendations.

The board has taken a proactive approach to educating physician on the
required protocol prior to recommending the medicinal use of marijuana.

After the act passed, the board published an informational article in
its January 1997 newsletter clarifying the role of the physician under
the law.

The board was clear in its expectations that any physician who
recommends the use of marijuana by a patient should have arrived at
that decision in accordance with generally accepted medical standards,
which include a history and physical examination, development of a
treatment plan, provision of informed consent, periodic review of the
treatment and proper record keeping.

In July of 2003, the board published another article discussing a
physician's choice to use medicinal marijuana as a treatment for
patients and the legality of that choice at the state verses the
federal level.

The immunity provision in the California act does not extend the
violations of federal statute. And for that reason physicians
recommending marijuana know that they may be vulnerable to actions by
the federal government.

As you know, the traditional medical model flows from the presentation
of ideas that lead to new emerging medicines. These typically include
studies with positive trial outcomes. And physicians are traditionally
introduced to these new methods through education settings and through
ongoing review of medical journals.

In contrast, alternative medical modalities, such as medicinal
marijuana, are typically consumer-driven, whereby the consumers find
out about a particular modality or treatment and may ask their
practitioner about it.

Physicians must ensure the recommendation is in fact appropriate for a
particular patient and that their recommendation for marijuana has
been arrived at in a manner which is consistent with the standards of
practice for physicians in all other contexts.

To date no court cases have overturned California's Passionate Use
Act. And in October, 2003, the U. S. 9th Circuit Court of Appeals
produced a ruling that first amendment freedom of speech allowed
physicians to legally discuss medicinal marijuana with their patients.
And this decision was upheld by the U. S. Supreme Court.

Again, thank you for allowing me, on behalf of the state of
California, the opportunity to share this information with you.
SOUDER: By the way, once again, it was declined to be reviewed by the
U. S. Supreme Court, which is different.

SOUDER: It was not overturned, which is different than being
upheld.

JERZAK: I'm sorry.

SOUDER: Dr. Jensen?

JENSEN: Hi. Good afternoon, Congressman Souder and members of the
committee. I am very grateful to be here today. I wanted to just tell
you what I've learned about cannabis indica and cannabis sativa, which
is also known as medical marijuana.

I am a 49-year-old mother of two teenage daughters. I've been a
pediatrician for 23 years. I trained at University of Arkansas and I
did my residency training at U. C. Irvine Medical Center. I have
worked 12 years as a managed care physician, staff model HMO doctor
and since 1996 in private practice. I also currently work in a small
community-based clinic servicing primarily Spanish-speaking patient
population.

I was not an advocate of using medical marijuana. However, I was
forced into taking responsibility for caring for some patients a few
years ago because of the suffering that I saw. They were patients with
no money and were unable to seek the aid of some other physicians
because they had transportation difficulties.

So I called the medical board and I asked for some guidance on how to
do this and found that there really weren't systems set up to help
physicians yet. But I elected to go ahead and try and help these
people anyway.

And since then, I have found that this is one of the most fascinating
and challenging fields of medicine that I've ever been involved in. I
have learned so much and I have seen so much that I felt compelled to
come and talk to you about it today. And I greatly appreciate you
asking me to come.

In specific, you asked me about treating children with attention
deficit hyperactivity disorder. To make it clear, I have only two
patients in my practice that have used cannabis for that problem as
children. Both of their parents came to me and asked me to help their
kids.

Both of those children had very, very serious functional problems in
school. One of them was also a social deviant to some level. He was
unable to stay in a normal classroom and he had very serious anger
management issues not quite on the level of Columbine, but he had
trouble at home and at school in maintaining his behavior.

He had been tried on all of the usual drugs that we use to treat for
ADD, which basically are the amphetamines, which I find very
concerning that we treat adolescents who have authority issue problems
with drugs that cause them to have mood swings and irritability and
lack of appetite, which affects their nutritional status, reduces
their ability to sleep properly and are well known to cause seizures,
can trigger mental illness, et cetera.

Albeit small numbers of people are affected negatively by the
amphetamines, but there are some. There are other drugs to use from
ADD, but they are off label. They have not been studied in children,
for example, Wellbutrin and then some of the anti depressants. It says
very clearly in the PDR nothing about treating children with ADD with
those drugs. And yet, physicians all over the years do that. In this
country, we spend over $1 billion annually on giving kids drugs for
ADD.

Now in doing research for this presentation, I discovered that
Americans have spent billions of dollars on medical marijuana. You
stated in your papers that in 1999 Americans spent $10.6 billion
buying marijuana.

My feeling is that that money should be diverted out of the black
market. It should not be funneled into criminal sources. It should be
diverted into health care management systems, teach physicians, give
the regulatory boards the tools that they need to be able to do it
properly, have the money funneled into public health systems, and use
cannabis as a medication under the guidance of physicians rather than
the free-for-all that it is now.

It is clearly not regulated. The American people are not obeying the
government. And I really feel that with what you are doing today,
perhaps we can rectify this. And I am here to answer any questions
that you have that I could that might facilitate that process.

SOUDER: Thanks. And as I said in the beginning, your full statement
will be in the record as well.

JENSEN: Thank you.

SOUDER: Mr. Kampia, good to see you again.

KAMPIA: Good to see you again. Thank you, Mr. Chairman. And thank you
in particular to Congresswoman Sanchez who's been such a strong
supporter of the medical marijuana patients who are suffering in California.

I am Rob Kampia. I am executive director of the Marijuana Policy
Project, which is the largest marijuana policy reform organization in
the United States.

There has been ample research that shows that marijuana is both safe
and effective. It's safer than most prescription medicines. It's safer
than aspirin. And it's certainly medically efficacious.

Patients with MS, AIDS, cancer, chronic pain, have all benefited from
marijuana. And the Institute of Medicine, of course, reviewed all of
that five years ago now for the Congress and for the drug czar.

That said, I will admit that there are insufficient studies to prove
to the FDA that marijuana should be approved as a prescription
medicine. And there is political reasons for this.

One is that the Department of Health and Human Services issued
guidelines which makes it more difficult to research marijuana than to
research any other drug on the planet. It's more difficult to research
marijuana than ecstasy, LSD or any newly developed pharmaceutical. So
that has a chilling effect on research.

In addition, the DEA has been obstructionist again. Currently the
University of Massachusetts is trying to get DEA permission to grow
privately grown, privately funded marijuana up in Massachusetts for
the purpose of studying it. And after three years of waiting, the DEA
still has not given them an answer. And so consequently because there
is no private source of marijuana in this country, no private sector
industry is going to go and try to spend money because you can't get a
privately produced drug approved by the FDA if you can't get a hold of
a drug.

So there is a big political problem. And because of this, it could be
years, if ever, before the FDA would approve marijuana as a
prescription medicine.

Now, this hearing purports to be about science and yet I find that
hard to believe. This Congress in general, and the chairman in
particular, are not exactly bound by science in their statements.

To give you some examples, you know, Chairman Souder here criticized
the state medical marijuana laws today as if it's some new discovery.
Yet a couple of years ago, he asked GAO to do a comprehensive study of
what's going on in the medical marijuana states.

And I just read this last night again. And I say this study came down
on our side. You must not have liked it, perhaps you didn't read it.
But most of the laws are working just fine.

Most of the patients are not abusing. The vast majority of the doctors
are not abusing. And, in fact, GAO said that only one to three percent
of the physicians were recommending medical marijuana in these states.
And those who are recommending, 82 percent of these physicians made
only one or two recommendations.

So the vast majority are the people who are actually abiding by the
program correctly. And yet, in your scientific inquiry, you invited
Dr. Leveque who is literally the only physician in Oregon to have
written an inordinate number of recommendations.

It seems highly biased. Two, you wonder what impact medical marijuana
has on these patients given that it hasn't gone through the FDA, but
yet, you didn't invite any patients to speak today.

You could have invited Richard Brookheiser, the senior editor of the
National Review, who could have told you about his medical marijuana
use.

You could have invited Lyn Nofziger from the Reagan administration who
would have told you about his daughter's use. The federal government
is currently mailing marijuana regularly to seven patients across the
country. And yet, those seven patients who are currently legally using
the federal government's marijuana, they were not invited to testify.

Yet another example is on the House floor a year ago, you said, Mr.
Chairman, "It does not help sick people. There are no generally
recognized health benefits to smoking marijuana."

It is generally recognized. The American Nurses Association, American
Public Health Association, the American Academy of Family Physicians
and dozens and dozens and dozens of other organizations recognize
marijuana's medical value. This information is in the written
testimony I have provided.

So what you said on the House floor was false. Also on the House floor
you said that you met with officials from the Netherlands and they
said, supposedly, to you that they rejected the use of smoked
marijuana for so-called medical purposes.

I don't believe you. Holland is currently allowing physicians to
prescribe marijuana. And patients are currently picking it up at pharmacies.

It hardly sounds to me like the Dutch oppose medical marijuana.
Unfortunately this is not a scientific issue, but a political issue.
And therefore, because of the obstruction of science, we are moving
forward politically.

And we're going to keep passing state bills and state initiatives
until the majority of the states cry out to the federal government to
fix the federal problem.

In closing, I want to quote the DEA's own administrative law judge in
1988. He said, "Marijuana in its natural form is one of the safest
therapeutically active substances known. The provisions of the
Controlled Substances Act permit and require the transfer of marijuana
from schedule one to schedule two. It would be unreasonable, arbitrary
and capricious for DEA to continue to stand between those sufferers
and the benefits of this substance."

I agree with the DEA. And Mr. Souder, to the extent that you are not
helping research go forward and to the extent that you continue to
oppose our legislative efforts, your position on medical marijuana is,
in fact, as the DEA said, unreasonable, arbitrary and capricious.

Thank you.

SOUDER: I want to appreciate you for at least being consistent.... Dr.
DuPont.

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