WHO'S AFRAID OF MEDICAL MARIJUANA?

Who's afraid of medical marijuana? Opponents' fears go unrealized
with the implementation of Rhode Island's law

Two hits of marijuana in the morning, and two in the evening before
he goes to sleep. That's what it takes to get Bobby Ebert through the day.

But Ebert's not a junkie or a college student looking for a quick
high. He has AIDS -- and is one of more than 240 patients in Rhode
Island whose use of marijuana is protected under state law.

In January 2006, the General Assembly resoundingly overrode Governor
Donald L. Carcieri's veto, thereby making medical marijuana legal in
Rhode Island. The law -- which allows patients suffering from
"chronic and debilitating" medical conditions to use the drug, so
long as they obtain a state-certified physician's permission -- is
scheduled to expire June 30.

The sunset provision was included, notes Representative Thomas Slater
(D-Providence), the prime sponsor of the House effort in 2005,
"[Because] we wanted a trial period to prove there wouldn't be
problems with this kind of legislation." Opponents, including
Carcieri, had cited fears that illegal use of marijuana could
proliferate, and that insufficient controls existed for the
production and distribution of the drug for its intended purpose.

Yet since going into effect in April 2006, Rhode Island's program has
been conspicuous mostly for its lack of controversy. Charles
Alexandre, the state Health Department's chief of Health Professions
Regulation, describes the law as having "worked well and been pretty
uneventful."

Even the police chief in North Kingstown, whose department made the
arrest last fall of a registered medical marijuana user who was
busted after soliciting underage girls on MySpace to smoke pot, calls
that case an "aberration."

Ironically, in contrast to the initial concerns cited by opponents,
the main challenge facing medical marijuana users in Rhode Island is
obtaining access to the drug. Boosters are targeting this need with a
new approach, but more about this later.

As it stands, the state's medical marijuana law enjoys robust public
approval -- a Mason-Dixon poll last September found that 79 percent
of Rhode Islanders support the current program. And perhaps that's
not surprising. In a small state like Rhode Island, where the
traditional six degrees of separation quickly gets streamlined into
relationships far more intimate and immediate, the issue can be
understood quite simply. A coworker with cancer, an uncle with AIDS:
push deeply enough, it seems, and everyone has a story.

And while Carcieri and the Rhode Island State Police oppose
legislation to make permanent the state's medical marijuana law, the
General Assembly appears poised to again override any potential veto.
As the Phoenix was going to press, the full House and Senate were
scheduled to separately consider the measure.

Yet on a national level, the science of the drug, and the social
implications of its medical use, remain hotly contested political
topics. As more than 20 states gear up to consider medical marijuana
bills, it's open season on the issue -- potentially making the
experience of states like Rhode Island more relevant in the ongoing debate.

The new reefer madness Ebert, 41, of Warwick, who spent years on
Vicodin and Percocet, says that marijuana allows him to control the
"pins and needles" pain associated with his neuropathy in a way other
substances never could. "Those drugs were horrible," he says. "They
make you nauseous, so you can't eat, and when you stop, your body craves them."

Like Ebert, approximately 17 percent of the patients enrolled in
Rhode Island's program through the Department of Health have AIDS or
are HIV-positive. Patients with cancer (12 percent), Hepatitis C (12
percent), and those suffering chronic or debilitating conditions (57
percent) -- ranging from multiple sclerosis to epilepsy -- make up the rest.

Backed by advocates' calls for compassion, such patients have become
the face of the medical marijuana movement, which has continued to
gain momentum nationwide since California legalized its use in 1996.

"[Marijuana's] not a panacea," says state Senator Rhoda Perry
(D-Providence), the leader of the effort in the Senate, who watched
her nephew Edward Hawkins waste away to fewer than 85 pounds before
dying of AIDS at age 41. "But what it could have done for my nephew
is offer another option, another way to fight that incredible nausea
and kind of pain."

Federal authorities maintain a hard line. In spring 2006, the US Food
and Drug Administration issued a terse statement -- ironically
enough, on 4/20 -- affirming that marijuana has no "currently
accepted" medical use. Similarly, Tom Riley, a spokesman in the US
Office of National Drug Control Policy, dismisses medical marijuana
as a back-door attempt to push for the drug's overall legalization.
"The public has fallen for activist claims that marijuana deserves a
free pass from scientific and medical safeguards," says Riley.

Dr. David Lewis, director of Brown University's Alcohol and Addiction
Studies Program and a longtime critic of the drug war's
effectiveness, describes the medical community's view of medical
marijuana as "mixed," in part since, "It's hard to have physicians
endorse smoking anything as a therapy." Nevertheless, Lewis, who
calls marijuana's medicinal value "obvious," notes that alternate
methods of delivery, including vaporization, are available.
Government opposition, he says, amounts to "the war-on-drugs
mentality spilling over into the scientific community."

Even House Minority Leader Robert Watson (R-East Greenwich), usually
a faithful ally of Governor Carcieri, is frustrated by the situation.
"I just don't get the logic here," says Watson, an initial sponsor of
the Rhode Island bill in 2005, who nonetheless voted to oppose it in
partisan solidarity with the governor. Still, he says, "We prescribe
far more addictive and lethal drugs to patients all the time.
Morphine will kill you, codeine will kill you. Cigarettes will kill
you. But marijuana?"

Fanning the flames is a study published in Neuropathy this past
February, which found that HIV patients who smoked marijuana
experienced significant pain relief, in one of the first rigorously
controlled experiments of its kind. "I don't see any evidence that
the [federal] policy is driven by science here," says the study's
author, Dr. Donald Abrams of the University of California-San
Francisco, who reports facing repeated federal obstacles in trying to
obtain research-grade marijuana for his study. "It's much too fraught
with emotional baggage and political overlay."

Caught in the middle are patients like Chrissy Neves, 41, of
Riverside, many of whom have been quietly using marijuana for years
to treat their symptoms. "All my life, I heard how horrible marijuana
was," says Neves, whose weight has fluctuated since she had surgery
to remove a brain tumor in 2004. In the time since, she's found that
marijuana is the one drug that stimulates her appetite.

Rhode Island's medical marijuana program has encouraged others, like
Michael Oliver, 39, of Barrington, to try using medical marijuana for
the first time. For Oliver, who suffers severe stomach spasms because
of Crohn's disease, marijuana makes the workday manageable. "One or
two hits," he says, "and my stomach can breathe again."

Legal use, illegal supply To qualify for Rhode Island's program, a
patient's physician must first verify their need in writing to the
Department of Health, which oversees the program (www.health.ri.gov/hsr/mmp/).

The vagaries of this process remain subject to controversy. Last
spring, Governor Carcieri's press secretary issued a statement
critiquing the law as "so broad that it would allow nearly any Rhode
Islander to be a user." And to be sure, among those who think that
only patients suffering end-stage diseases should be able to use
marijuana, obtaining a physician's recommendation to use it for
carpal tunnel syndrome -- as one patient reported he had -- might
raise some eyebrows.

Nevertheless, according to Steven DeToy, spokesman for the Rhode
Island Medical Society (which has long supported the legalization of
medical marijuana), physicians act as gatekeepers for many
treatments, not just marijuana. "The responsibility the law gives
them is no different than that they already have in counseling
patients," DeToy says. Certainly, fear that a handful of "pot docs"
might end up dispensing recommendations to patients en masse has not
been realized. The ratio of patients to doctors participating in the
state program is roughly two-to-one.

Once a patient receives their physician's approval, the Department of
Health processes their application -- none have been rejected thus
far -- and issues an ID card verifying their participant status. From
there on, patients are on their own: the 2005 law famously did not
specify how patients were to obtain the drug. And that, to both the
program's critics and supporters, remains its greatest problem.

As Michael Downs, director of prevention education for AIDS Project
Rhode Island, puts it, the law has been a "great resource" for his
agency's clients, but lack of access places them in "something of a quandary."

Major Steven O'Donnell of the Rhode Island State Police puts the
matter more bluntly. "Basically, we're telling patients to go buy
drugs on the street," O'Donnell says. "Even if the law works on
behalf of people with medical need," he says, "we're asking them to
put themselves in harm's way."

Bobby Ebert, who says he was assaulted in downtown Providence one
night while trying to obtain marijuana, knows that this risk is no
joke. But having dealt with pain for years, it's something he takes
in stride. "After all," he says, "I've got a disease that could kill
me tomorrow."

Patients are permitted to grow their own marijuana, and many do, or
depend on caregivers who do so for them. Yet growing pot indoors can
require a variety of equipment -- humidifiers, fans, and heating
lamps -- not to mention time and significant financial investment.
"You'd think since it's a weed, it would grow easy," says Oliver, who
recently began trying to cultivate his own, with limited success. He
reports having already spent more than $500 on equipment.

This is why the Rhode Island Patient Advocacy Coalition
(www.ripatients.org), which was founded to push for medical
marijuana's passage, has now turned its attention to addressing the
supply issue.

Ideally, says RIPAC founder Jesse Stout, the state would license
dispensaries to provide marijuana to registered patients.
Nevertheless, given Rhode Island's small size, Trevor Stutz, RIPAC's
development director, is hopeful the coalition (which consists of
eight state organizations, including the RI Medical Society and RI
State Nurses' Association) can "successfully develop an informal
network of patients and caregivers to really facilitate patient access."

Such efforts are much-needed. At a recent RIPAC meeting, several
patients, including a 63-year-old retired schoolteacher suffering
AIDS, reported they had gone without marijuana for periods of up to a
month for lack of a steady source.

Stymied by the drug war The question of how to provide patients with
a drug that remains illegal continues to put the program's supporters
in something of a double bind. As Representative Slater puts it, "We
couldn't do more out of fear that the federal government would swoop
down and confiscate the marijuana."

In California, where the law has been interpreted to support the
development of dispensaries selling medical marijuana, the so-called
"cannabis clubs" that have sprouted throughout the state -- Los
Angeles alone has nearly 100 -- continue to be the target of
high-profile federal raids.

In light of federal restrictions, advocates aren't pushing to change
the status quo. "The top priority is keeping the law on the books and
ensuring that patients remain legally protected," says Nathaniel
Lepp, chairman of the board of the Rhode Island Patient Advocacy Coalition.

That goes for doctors, too. While Dr. Kenneth Mayer, director of
Brown University's AIDS program, has prescribed Marinol (a marijuana
substitute containing THC) for patients in the past, he says it
hasn't proved nearly as effective as marijuana. And when it comes to
recommending marijuana to patients, Mayer says, "I'd much rather do
it legally than not."

While the Supreme Court ruled in the 2005 case Gonzales v. Raich that
the federal government can prosecute patients for marijuana use, even
those whose use is protected under state law, no Rhode Islanders have
faced such prosecution.

According to the US Sentencing Commission and the FBI, state-level
authorities are responsible for 99 percent of marijuana arrests. And
as Anthony Pettigrew, a spokesman for the US Drug Enforcement
Administration, told the Phoenix in 2005, "The DEA has never targeted
the sick and dying, but rather criminals [involved] in drug
cultivation and trafficking."

The only prosecution related to the Rhode Island program came last
October, when Steven Trimarco, a registered 48-year-old patient in
Exeter, was arrested after soliciting underage girls on MySpace to
smoke marijuana. He was charged on multiple counts, including
possession of firearms and having marijuana well in excess of the
program's legal limit. (The law permits patients to possess 12 plants
and up to 2.5 ounces of usable marijuana; more than 70 plants were
found in Trimarco's basement.)

"Trimarco certainly gave the act a bad name," says North Kingstown
Police Captain Charles Brennan, whose department oversaw the arrest.
Nevertheless, Brennan maintains that the case was an exception. "Even
if he didn't have a medical marijuana card, he'd probably still be
picking up young girls," he says. "And he was probably doing that
even before he was registered with the program."

What's next for medical marijuana? The smooth implementation of Rhode
Island's law strongly suggests that critics' opposition is more smoke
than substance.

Meanwhile, despite the rigid nature of federal opposition, medical
marijuana's supporters are continuing to pursue -- and win -- the
fight on other fronts. Since 1996, 12 states have legalized medical
marijuana, with governor and presidential candidate Bill Richardson
signing New Mexico's bill into law in April. The other states are
Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Oregon,
Vermont, and Washington. And with patient testimonials continuing to
accumulate, more are on the way: Minnesota and Illinois are moving
closer to passing medical marijuana bills.

As the experience in states like Rhode Island helps to push the
debate forward, medical marijuana may be shedding its dreadlocked
associations with California hippies and going increasingly mainstream.

"It's not a fringe issue anymore," says Bruce Mirken, communications
director of the Marijuana Policy Project, a DC-based advocacy group
(which devoted significant resources to the passage of Rhode Island's
law in 2005).

According to an October 2005 Gallup poll, 78 percent of Americans
support the legalization of medical marijuana, a percentage that's
risen steadily over the past decade. "Win enough states, and
eventually those victories will play a role in moving Congress," says
Ethan Nadelmann, executive director of the Drug Policy Alliance.

To be sure, given the staunch quality of federal opposition, such a
perspective tends toward the optimistic. And while medical marijuana
is a popular issue, high approval ratings don't necessarily translate
into widespread public pressure to change the status quo. In the
final analysis, medical marijuana's backers still face an uphill battle.

For now, it's possible that the courts -- and the science of the
issue -- may prove a better venue through which to make headway.

Earlier this year, medical marijuana boosters won a victory when DEA
judge Mary Ellen Bittner recommended ending the federal National
Institute of Drug Abuse's longstanding monopoly on the growth of
research-grade marijuana.

Such a move, which followed a petition brought by the ACLU on behalf
of University of Massachusetts professor Dr. Lyle Craker, could spur
additional studies on marijuana's therapeutic properties, helping
advocates further their case.

Meanwhile, in February, Americans for Safe Access filed a lawsuit in
northern California, charging the US Department of Health and Human
Services with violation of an act stipulating that federal agencies
must make their policies based on sound science. According to ASA's
chief counsel Joe Elford, the government is denying patient and
researcher access to marijuana "in the face of voluminous scientific
evidence stating its benefits."

Beyond medical marijuana, advocates hope that overcoming some of the
fearful hype in places such as Rhode Island will inject new vigor
into a broader critique of the US war on drugs, which has cost
billions of dollars over the years, to dubious effect. "Medical
marijuana is a legitimate issue in its own right," says Nadelmann.
"Yet for those of us who think marijuana's prohibition should be
reformed in general, our hope is that efforts on medical marijuana
will help move public opinion more broadly as well."

For people like Tom Angell, 25, the issue is simpler. A Warwick
native, Angell grew up watching his mother suffer from multiple
sclerosis, and she was unwilling to use medical marijuana for fear of
legal persecution. Angell, now the government relations director for
the DC-based Students for Sensible Drug Policy, was with her last
year when she tried the drug for the first time: the look of shock
and relief on her face, he says, "was amazing."

Would she stop using the drug if Rhode Island's law is not renewed?
Angell is hesitant. "Considering she wouldn't use it before it became
legal," he says, "I really don't know."

"I just hope," he adds, "that's not a choice she has to make."