OREGON UPDATE: DR. LEVEQUE SOLDIERS ON

Whereas California has at least a dozen doctors who have made a
subspecialty of monitoring their patients' cannabis use, Oregon has only
one: Phil Leveque, a 79-year-old PhD pharmacologist and doctor of
osteopathy. At the time of our last visit (AVA 8/1/01), Leveque had signed
some 900 and cultivate cannabis (up to seven plants, 14 with special approval from
the doctor). And he had just learned that he was under investigation by the
state Board of Medical Examiners for improperly authorizing the use of
marijuana. "I look at my investigation by the Board," Leveque had said,
"as fire coming from the front."

Leveque was a combat infantryman in World War Two, a forward scout. "I
walked most of the way under fire from Luxembourg almost to Dresden. Under
fire on a daily basis. I spent more time on the point than anybody else in
my battalion and more time on the observation post than anybody except my
own six guys. I don't have any idea how I got out of that alive. I couldn't
get a commission because I didn't have a trigger finger. [The tips of
several fingers on Leveque's right hand were severed in a childhood
accident; the index finger was damaged the worst.] You couldn't be an
officer if you didn't have a trigger finger, but you could be rifleman.
That I couldn't understand, and still don't I guess I survived because I
have good reflexes and I'm not afraid to dive in the dirt."

"What makes me angriest," he'd said, " is that the VA doctors, as federal
employees, can't recommend marijuana use because the U.S. government says
it has no medical value. Now that's ridiculous! Some of these guys have
terrible problems. It must have been a meat-grinder over there in Vietnam -
and more of the wounded survived than in any previous war. They have
terrible battle wounds. They've been shot to pieces, stepped on mines,
exposed to Agent Orange. Many of these people found out for themselves that
marijuana is the best thing for post traumatic stress disorder, and that is
not on the approved list, so I've had to tell them 'Sorry, the Oregon law
is set up only for physical disabilities. If you have any kind of battle
wounds I can do it for you, but I can't do it for PTSD, period.' It's an
absolute travesty that marijuana can't be prescribed for psychiatric
disabilities. These guys have been given a whole bunch of stuff that
doesn't work and that frequently makes them worse -Prozac, Paxil, and Zoloft."

The Board's investigators determined that Leveque was not keeping adequate
records < in fact, he wasn't keeping records at all, for security reasons<
and his license was suspended for 90 days starting May 1, 2002. I knew that
Leveque had resumed practice, but I'd assumed he was keeping a lower
profile and that other Oregon doctors were filling the breach. Wrong on
both counts. Here's what Leveque had to say during a visit to gray-green
Molalla in mid-April.

"At the time of my suspension the Board of Medical Examiners created the
Leveque Rule on a physical exam examination, which was added as a requirement.

"Originally it wasn't required that I even see a patient [face-to-face] or
do a physical. Then the Board wanted to see my charts. I hadn't been
keeping any. I'd been sending them in to the state Medical Marijuana
program and not keeping copies in my home. My medical office has been
broken into twice. To know the name and address of who has a medical card
and can grow marijuana, that seems valuable in the house.

"The Board of Medical Examiners told me, 'You must see every patient, even
if it's a quadraplegic who lives 500 miles away.' I have a lot of patients
who literally can't come to see me, and though they're fully eligible, they
can't find another doctor. I have a lady in Klamath Falls right now who is
bed-ridden. I've signed for her two years in a row but I can't do it now
without giving her a physical examination. I told her son to call Mary
Leverette at the state Medical Marijuana office and ask straight up, 'What
can I do for my mother?'

"I don't know why they think a thorough physical examination will detect
any of the nine medical conditions [that Oregon law allows patients to
treat with cannabis]. How am I going to look at somebody and say they've
got HIV? Impossible. A physical examination by a general practitioner will
not detect glaucoma, cancer, nausea, Alzheimer's rage, severe pain, severe
nausea, epilepsy and certain spasmic conditions, They all require an
examination by a specialist.

"There are 8,500 doctors in Oregon and I'm the only one who has to comply
with the Leveque rule. No other doctor has to do a physical exam, as far as
I know. At this time there are 950 physicians who have signed
applications, according to Mary Leverette. She tells me most of them have
signed one or two. They're giving them to people who are dying within a few
months but they won't touch anybody else with a 10-foot stick. There are
about 6,500 patients registered and I've signed applications from almost
4,000 of them. Only about 25 doctors have signed more than five
applications. Nobody knows who they are, When a patient calls the Board
trying to find a doctor to sign their application, they can't give out our
names but they say 'Look on the Internet.'

"I work with different groups run by advocates for legalization. One in
Eugene, one in Roseburg, one in the Ashland-Medford area, one in Brookings
on the Coast, one in Klamath Falls, one in Bend, two or three in Portland.
What they do is assemble the patients. We try to see about 20 patients a
day. That takes me from about 10 in the morning till six in the evening
(Shows fingers with tips missing) I travel 2500 to 3000 miles a month, I
would guess. It's 300 miles to the California border and we may go to
Roseburg twice, we may go to Grants Pass once, we may go to Medford once,
we may go to Brookings twice in the course of a month.

"The physical examination is conducted by a nurse practitioner, Phil Allen.
He's very good. By law, an MD, a DO a nurse practitioner or a physician's
assistant can do the exam. But most of them, like the doctors, are afraid
to even touch anything that has to do with marijuana... Phil Allen lives in
Roseburg and drives up two or three times a week to the Portland office.
He's also arranged for patients to be seen in Roseburg and Grants Pass."

In addition to the doctor and the nurse practioner, the clinic in Portland
that Leveque brought me to small, nondescript suite in the Hollywood district< employs four staffers.
Two office workers handle a steady stream of patients' phone calls and
arrange the appointments. Leveque's son Peter handles the medical side of
the intake interview. Patients are given a three-page questionnaire that
asks them to list their various conditions, previous doctors' names,
medications they've taken, etc. "If you can get past the first sergeant,"
says Leveque, "you can see the doctor."

Organizer Paul Stanford collects the fee ($150), explains how to fill out
and file the necessary paperwork with the state office, and answers
questions of an administrative and/or political nature. For many working
people, getting sanctioned by the state does not mean they can use cannabis
with confidence; most are subject to drug-testing on the job, and marijuana
can be detected in the urine for almost a month after its use. Testing
positive means you can be fired outright or subjected to humiliating,
time-consuming "treatment." Stanford has no reassurance to offer
medical-marijuana users who fear for their jobs. There hasn't been a test
case yet of a state-approved marijuana user getting fired and suing their
employer for reinstatement. Stanford frequently gets asked, "Do you think
I should tell my boss I'm using medical marijuana legally?" He typically
replies, "You have to use your judgment."

Patients phoning the clinic are asked, "What is your medical condition?"
And, "Do you have medical records to verify that condition?" Leveque says,
" If you don't have verification, we probably can't help you. If somebody
says 'I haven't been to see a doctor in 10 years,' we may ask, 'Do you by
any chance have any of your old prescription bottles?' That would confirm
that they had the problem. But we do have to turn some people away. We
probably turn down between five and 10% of the people who call. I may
believe 'em, but not having the paperwork doesn't cut it. I can't put my
license on the line. The Board of Medical Examiners is looking over my
shoulder patients' charts and have them accessible.

"They didn't require me to do this until the first of April last year. The
suspended me for ninety days starting May 1. They said, 'We realize you
probably have patients stacked up,' so they gave me till May 1. And they
fined me $5,000, which my patients helped pay. My patients also contributed
to my lawyer bill, which was over $20,000.. There were no complaints by
any patients about anything that I had done. If I had harmed one person I
just dread the thought! But nobody has ever complained. Well, I take that
back. About a month ago I had a very curious experience. One of my patients
who has a GI disease that causes nausea and vomiting, also has a bad back
a grand mal seizure and was brought into a hospital in Salem and the ER
doctor there said he had a grand mal seizure because of cannabis toxicity.
The investigator from the Board wrote me a letter. I wrote back, 'I gave
him an approval because he has a bad back. And by the way, I have about 30
epileptic patients who use marijuana to stop their seizures. So this lady
is all wet.' And that was that."

Leveque has self-published a memoir, "Gen. Patton's Dogface Soldier: WWII
From a Foxhole." (To order, send $20 to him at po box 348, Molalla, OR
97038.) One day he got a call from a high-ranking Catholic priest who
said, "Somebody just gave me your book. I'm a combat infantryman
myself. And you got it right." Leveque asked, "How did you like the
chapter 'Sex and the soldier?'" The priest said, "You got that right, too."

Leveque has signed applications for two other Catholic priests. "One was a
green beret, one was a navy seal," he says. "Both of them had been using
marijuna for years and wanted to be legal. Ninety-nine percent of the
people I interview have been using it on their own for some time. The
record so far is 55 years. Obviously they get benefit or they wouldn't
bother with it. Wouldn't pay 300 bucks to keep using it <150 to the
doctor, 150 to the state. The line I hear over and again is, 'Marijuana
works better than any prescription I've been given.'"

The dozen or so California doctors who have made a specialty of monitoring
cannabis use report a similar pattern self-medicating and want to do so legally. In both states, "approval" is a
much more accurate term than "recommendation" to describe what doctors have
been providing to patients.

There is a converse pattern worth noting: Legalization has not led to a
wave of naive patients with various conditions experimenting with cannabis
to see if it might help in some way, or doctors recommending that they try
it. Just as Prohibition doesn't deter people from using drugs, legalization
doesn't induce them do so.

Phil Allen's Story

Nurse practitioner Phil Allen, 52, is a tall sandy-haired man with an
owlish, bemused look.

Allen: I got busted for manufacturing in '92. Lost my teaching license,
lost my job, my wife lost her job although she was able to keep her license
teaching for 18 years, I'd been teaching for eight< secondary special
education. My wife was teaching at the elementary school my son was
attending, he was nine.

C-Notes: Good age for a political education.

Allen: Now he's in college, doing well. This last term he didn't have a
4.0 but his lowest grade was a B and he's taking chemistry and calculus...
So there I was with a master's degree working in a lumber mill making
one-fifth of what I made as a teacher. We had a savings account of about 20
thousand dollars. My wife worked at Penney's and did a little bit of
substituting. After a year I made inquiries about getting into nursing at
Umpqua Community College in Roseburg. They have an outreach program with
Oregon Health Sciences University,,, Eventually my wife got a CNA
(certified nurse's assistant) license and was able to work as a CNA. They
made me go through a bunch of hoops before I could get my LPN (licensed
practical nurse) license, which you're supposed to get after one year of
school. I took the test and passed but they still wouldn't let me have the
license. I had to have a hearing with an assistant AG. Once I got it, we
knew we'd be okay. We both went to work as RNs in hospitals and continued
working towards our nurse practitioners' licenses, which we got in 2000.

C-Notes: The hold-up was your marijuana bust?

Allen: Manufacturing is a class-A felony.

C-Notes: How many plants were you growing?

Allen: There were no plants. I had done it in the past, and I still had my
lights. They found five ounces of old stuff that was no good in an old
fertilizer box. The good stuff that I was smoking (indicates a pinch). Also, they put me into forfeiture. They offered my
wife a simple possession charge that she could get expunged, and they'd let
me have my house back if I would take the manufacturing charge.

C-Notes: What have you observed medically about people who are using cannabis?

Allen: The people that we see in these clinics are much sicker than people
seen in regular practices. Obviously there are certain practices that see
even sicker people, but compared to [patients seen by] the average general
practitioner, the people we see here are really sick. In general, the main
problem is pain. Spasms, usually pain-related but not always. Nausea of people with chronic Hepatitis C have nausea-related problems and loss of
appetite.