REVENGE OF THE NARCS (THE NEVER-ENDING SAGA)

7/11/ was not a lucky day for California cannabis consumers. The
morning papers described a Bush Administration challenge to the ruling
(in Conant v. McCaffrey) that confirmed the right of doctors to
discuss marijuana with their patients. San Francisco AIDS specialist
Marcus Conant, MD, and co-plaintiffs had sought such confirmation in
January, 1997, after the Drug Czar, on behalf of the Clinton
Administration, threatened to revoke the prescription-writing licenses
of any California doctors who approved cannabis use. Federal Judge
Fern Smith (a Reagan appointee!) temporarily enjoined the feds (on
First Amendment grounds!) from carrying out or repeating this threat.
Then Judge William Alsup made the injunction permanent and the 9th
Circuit Court of Appeals upheld his ruling. Now Bush's lawyers are
asking the U.S. Supreme Court to overturn it.

Also on July 11, Tod Mikuriya appeared in an Oakland courtroom trying
to fend off an attempt by the state Medical Board to suspend or revoke
his license. Mikuriya is accused of violating the Board's "standard of
care" in 17 cases (although the Board has yet to issue practice
standards pertaining to the recommendation and approval of cannabis
use).

Mikuriya, 70, has devoted a long, successful career to the study
- -clinical and scholarly-of cannabis. In 1967 he was the first
director of marijuana research for the National Institute of Mental
Health. In 1969 he published a case study of a problem drinker who
successfully substituted cannabis for alcohol. He has resided and
practiced in Berkeley, and consulted at local hospitals, since 1970.
In 1972 Mikuriya published a collection of papers on cannabis from the
pre-prohibition medical literature, keeping alive the flickering flame
of knowledge.

When Dennis Peron launched the San Francisco Cannabis Buyers Club in
the early 1990s, he told Mikuriya "There are people with diseases I
never heard of." Mikuriya signed on as medical consultant and began
interviewing club members. He determined that cannabis was being used
to treat a wide range of conditions, including post-traumatic
arthritis, rheumatoid and osteoarthritis, fibromyalgia, seizure
disorders, degenerative diseases of the central and peripheral nervous
systems, cerebral palsy, multiple sclerosis, post-viral encephalopathy
and neuropathies, post-injury pain, glaucoma, Meniere's disease,
migraine, gastritis, ulcers, Crohn's disease, colitis (spastic and
ulcerative), cystitis, thyroiditis, scleroderma, lupus, premenstrual
syndrome, intractable itching, motion sickness, sinusitis, allergic
rhinitis...

"Cannabis appears to be a unique immunomodulator analgesic that is
useful in the control of automimmune inflammatory diseases throughout
the body," Mikuriya generalized in a 1995 interview.

Mikuriya played an advisory role to Peron and the co-authors of Prop
215. He was one of the few MDs to endorse Prop 215 in '96 (when the
California Medical Association was still opposed) and his quotes added
credibility to the campaign literature. The Drug Warriors came to see
Mikuriya -correctly- as an indispensable figure in the medical
marijuana movement.

Almost immediately after 215 passed, Attorney General Dan Lungren, who
had led the opposition campaign, told an "emergency all-zones meeting"
of California police chiefs, sheriffs, and district attorneys to
ignore doctors' letters of approval and to keep arresting and
prosecuting citizens for marijuana possession and cultivation.
Lungren's objective was to force doctors to testify in open court in
support of every cannabis approval (wasting their time, costing them
money, exposing them to reprisals from the feds and the state medical
board). Lungren's top assistant, John Gordnier, subsequently sent out
a memo to the DAs asking to be notified of any cases in which Mikuriya
testified for the defense.

Lungren flew to Washington in mid-December 1996 to help the feds plan
their opposition to California's new law. (A treacherous thing for
California's top law enforcer to do.) Lungren met with DEA
Administrator Thomas Constantine and top aides to the Drug Czar and
the Attorney General. On Dec. 30, 1996, Gen. McCaffrey -flanked by
Reno, HEW Secretary Donna Shalala, and Alan Leshner of the National
Institute on Drug Abuse-held the nationally televised press
conference at which they threatened California doctors. McCaffrey
pointed to a large chart headed "Dr. Mikuriya's (Prop 215 Medical
Advisor) List of Medical Conditions" that included a misspelling
("migrane") and a crude falsification ("recovered memories").
McCaffrey ridiculed the range of conditions for which Mikuriya
recommended cannabis. "This isn't medicine," he declared, "this is a
Cheech and Chong show." He bluntly threatened: "a practitioner's
action of recommending [marijuana]... will lead to administrative
action by the DEA to revoke the practitioner's registration." And it
might, yet, despite Judges Smith, Alsup and the 9th Circuit and the
former First Amendment.

The Case Against Mikuriya

The Medical Board of California's case against Mikuriya involves no
complaints from patients or caregivers. All the complaints that MBC
Investigators pursued came from district attorneys, police, and
sheriffs (many of whom had failed to put certain citizens in jail
because the citizens had Mikuriya's approval to use and/or cultivate
cannabis).

According to attorney Bill Simpich, "The Conant ruling, which is still
law, and applies to the states, prevents any entity from initiating
any investigation solely on the ground that a doctor recommends
marijuana to a patient based on a sincere medical judgment. The
Medical Board didn't care about Dr. Mikuriya's judgment, they used the
knowledge of his recommendations - obtained from the cops and DAs - to
start the investigation of 46 patients whose records they
subpoenaed."

Mikuriya has approved cannabis use by some 7,300 patients since Prop
215 passed.. He says that "99.9 percent" of his patients had been
self-medicating successfully with cannabis prior to consulting him.
They were treating chronic pain (27%), spasticity (26%), and mental
disorders (26%), and using cannabis as a substitute for alcohol and to
induce appetite. "It is remarkable how there have been no reports of
adverse interactions with any other medications," says Mikuriya. "
There is no comparing the safety of cannabis to any other medication
available."

The MBC accusation against Mikuriya rests on two definitions in the state's
Business & Professions Code. "Unprofessional conduct" is defined as
"Prescribing, dispensing, or furnishing dangerous drugs... without a good
faith prior examination and medical indication..." And "dangerous drug" is
defined as "any drug unsafe for self-use, except veterinary drugs that are
labeled as such, and includes... any drug that bears the legend: 'Caution:
federal law prohibits dispensing without prescription,' 'Rx only,' or words
of similar import."

Mikuriya's lawyers contend that the Medical Board is making an illegal
leap in applying statutes that pertain specifically to prescribing
dangerous drugs to Mikuriya's approval of cannabis. They say it's the
Board's fault -not Mikuriya's-that requirements for physicians'
approving cannabis use have not been specified in the almost seven
years since California voters passed the medical marijuana law.

Mikuriya's lawyers also cite the "absolute immunity" provided by Prop
215: "Not withstanding any other provision of law, no physician in
this state shall be punished, or denied any right or privilege, for
having recommended marijuana to a patient for medical purposes."

According to Mikuriya, who was nearby at the creation, "The authors of
Prop 215 put in this immunity clause precisely because they
anticipated what has happened: a witch hunt aimed at doctors by law
enforcement officials who resent limits being put on their power to
punish." Mikuriya says he's willing to abide by practice standards,
and in fact has drafted and proposed to the California Medical
Association a set of requirements for physicians who consult with
patients about cannabis use.

The 7/11 hearing was conducted by Administrative Law Judge Jonathan
Lew and attended by some 30 Mikuriya supporters, including three other
Bay Area physicians. (It was preceded by an hour-long,
behind-closed-doors settlement conference at which Mikuriya was
offered probation with conditions he considered unacceptable.)

Administrative law judges don't make final rulings, they make
"recommended decisions" to the government agencies that employ them,
which the agencies can then adopt, reject, or revise. If Lew allows
the case against Mikuriya to go forward, he will conduct a hearing on
the facts of the 17 disputed cases. That hearing, at which Mikuriya is
prepared to defend his approach, file by file, is scheduled to begin
on Sept. 3

If Lew decides that the case should be dropped, the Medical Board
could pursue it nevertheless by asking a Superior Court judge to order
or conduct a hearing on the facts.

Add Promising Results for GW Pharmaceuticals

Two papers and a poster presented at the recent International
Cannabinoid Research Society meeting in Cornwall, Ontario described
successful tests of whole-plant cannabis extracts developed by G.W.
Pharmaceuticals in the U.K.

Steve McKerral of the Royal National Orthopaedic Hospital in
Stanmore, Middlesex, reported on a study involving 48 patients (46
men, average age 38.5) who had suffered an extremely painful tearing
away of nerves from the spinal cord (brachial-plexus avulsions).
Treatments such as opioids, anticonvulsants and antipressants are
partially effective at best... Patients in McKerral's study were
allowed to keep using their other drugs. They were given three
different sublingual sprays over three two-week stretches: a placebo,
a high-THC extract, and a THC-CBD mix. Neither they nor the staff
conducting the study knew who was getting what. Subjects' pain levels
and sleep quality were assessed by questionnaire. "Both the THC and
THC:CBD extracts decreased pain and improved sleep," McKerral et al
concluded. "The medications were well tolerated.... Patients' ability
to self-titrate allowed them to take higher doses to promote sleep,
and to avoid dosing if they needed to drive... Given the refractory
nature of this central neuropathic pain, this study shows that
cannabis based medicinal extracts (CBMEs) may represent a significant
advance in treatment."

Ciaran Brady of the National Hospital for Neurology and
Neurosurgery, Queen Square, London, tested GW's CBMEs on 21 multiple
sclerosis patients with lower urinary tract symptoms. He concluded,
"The number of incontinence episodes, nocturia episodes [getting up in
the night to pee], and daytime urinary frequency all decreased
significantly. The incidence of urinary urgency decreased
significantly and the number of 'planned or normal' voids increased
significantly... This open-label study of self-titrated CBME, in a
select group of such patients, demonstrated amelioration of these
problems with few troublesome side effects, suggesting that CBME may
prove to be a safe and effective additional treatment."

Psychologists Richard A. Deyo (Winona State University in
Minnesota) and Richard E. Musty (University of Vermont, Burlington)
assessed the anti-depressant potential of a GW extract rich in
cannabichromene (CBC). They worked with mice whose tails were taped to
a bar to induce "behavioral despair." Anti-depressant effect was
adduced from the extent to which the mice struggled. And sure enough,
mice administered CBC put up high-amplitude resistance. "The present
data suggest that CBC may induce anti-depressive effects," the authors
concluded.

P.S. The radiant Canadian MS patient whose presence at the ICRS
meeting moved many members was named Alison Myrden... The new head of
NIDA (Trotsky's great-granddaughter!) is Nora Volkow, not Nina... I'd
planned a follow-up column on the ICRS meeting, but developments in
the Mikuriya case took precedence this week. Here we have an example
of how, by attacking our movement, the Drug Warriors win even if they
ultimately lose in court. They put us on the defensive, which takes
time, energy, money, and resources (column inches that could have gone
towards an account of scientific progress).

Next week: an interview with Geoffrey Guy of G.W. Pharmaceuticals