GRASS ROOTS

How Medical Marijuana Moved From Fringe Issue to Political Buzz

It's a rainy mid-March afternoon in Annapolis, dimming the grandeur of a
Lowe House Office Building hearing room as state Del. Donald Murphy makes a
case for a bill before an incomplete but sufficient-for-a-quorum portion of
the House Judiciary Committee.

These sorts of hearings are almost purely for show, an opportunity for the
public to get a word in on bills whose fates will be decided in other, less
public circumstances. Still, fellow legislators make a point on commending
Murphy (R-Baltimore and Howard counties) for his courage and vision in
sponsoring House Bill 1222, the Darrell Putman Compassionate Use Act, which
would protect from state imprisonment Marylanders who can prove they smoke
marijuana to alleviate the pain and nausea associated with numerous medical
conditions and their treatments, primarily AIDS and cancer. The bill is
named for a Frederick resident who found marijuana eased the side effects of
chemotherapy for non-Hodgkins lymphoma, a form of cancer. Shortly after
Putman passed away, Murphy filed the measure. This is the third year he has
done so; the first two times, it died in committee.

"As someone who supports the bill, I applaud Murphy's efforts," says Del.
Robert Zirkin, a young, dapper-looking Baltimore County Democrat, before
launching into a question about the bill's possible conflicts with federal
law.

On the other side of the U-shaped formation of wooden tables, Del. Carmen
Amedori (R-Carroll County) joins the praise for Murphy, then asks whether
insurance companies would be liable to cover the costs for the use of
marijuana under the bill. (They would not.)

The medical community itself remains circumspect about the medical value of
Cannabis sativa. The American Medical Association remains neutral on the
matter. And even if Murphy's bill becomes law, medical users in Maryland
would still be looking over their shoulders. The bill passed by the
Judiciary Committee on March 23 and the full House of Delegates March 25
(and now awaiting action by the state Senate) would remove criminal
penalties for medical use of marijuana, making such possession a civil
offense punishable by a nominal fine, with no jail time. But it would not
negate federal laws, which do not differentiate between medical and
recreational use of the drug. Get busted with a baggie by federal
authorities in Maryland--say, national-park police--and you will still face
the full brunt of the law. Such is the case with medical-marijuana laws
already on the books in several states.

That seeming contradiction has not slowed medical marijuana's march from a
fringe sideshow of the pro-pot movement to a standalone political issue that
has generated support even among staunch law-and-order Republicans. This
year's version of the Compassionate Use Act is co-sponsored by 53 of the 141
members of the Maryland House, compared to nine in 2000 and 29 last year.
Alaska, California, Colorado, Hawaii, Maine, Nevada, Oregon, and Washington
state have passed laws allowing individuals to smoke marijuana for medicinal
purposes, and the Vermont and Wisconsin legislatures are considering such
measures this year.

In a nation still purportedly fighting a "war on drugs," legislators attach
themselves to medical marijuana with no apparent political cost. In
discussing his reasons for resurrecting the bill after two defeats, Murphy
goes so far as to note, "It's an election year." He cites a study by the
Marijuana Policy Project (MPP), a Washington-based advocacy group, which
found that 73 percent of Marylanders favor medicinal use of pot. In a poll
commissioned by his office in January, 37 percent of respondents said they
are more likely to vote for a candidate who supports a patient's right to
use marijuana medically, while 18 percent said they are less likely to do
so.

Buttressing the numbers are the personal stories that have become part and
parcel of the political debate. At the March 13 hearing, Del. B. Daniel
Riley (D-Harford County), a co-sponsor of HB 1222, shares a story about a
constituent named Larry who was dying of lung and stomach cancer. Riley says
he visited Larry numerous times and believes that marijuana might have
alleviated the side effects of chemotherapy. "But Larry would not consider
it. 'It would be breaking the law,'" the delegate says, echoing Larry's
words, his voice quivering.

"We buried Larry two months ago," Riley concludes. "I just feel if the
legislative body could have been more compassionate, maybe Larry would be
alive today."

Like many medical-marijuana advocates, Murphy brandishes the green,
hardbound book Marijuana and Medicine: Assessing the Science Base (available
online at http://books.nap.edu/html/marimed), a 1999 summary of existing
research on the subject compiled by the National Academy of Sciences' (NAS)
Institute of Medicine.

Commissioned by the Office of National Drug Control Policy in light of a
growing number of states passing medical-marijuana bills, the book is
considered the most authoritative assessment to date on what is known about
marijuana as medicine. Murphy showed it to members of the House panel as
evidence that there is a scientific basis for using marijuana as treatment
to relieve pain. If any of them read it, however, they'd discover that the
study's own authors don't really agree with Murphy.

"The cases where the report calls for the usage of the drug are so narrow
most patients wouldn't qualify for it," says Janet Joy, the NAS report's
study director.

The passage of Marijuana and Medicine legislators and pro-pot advocates most
like to quote comes from the introduction, which reads, "Research should
continue into the physiological effects of synthetic and plant-derived
cannabinoids and the natural function of cannabinoids found in the body . .
. cannabinoids (of which marijuana is a part) are likely to have a natural
role in pain modulation."

The study does report that some forms of cannabinoids are moderately
well-suited for particular conditions, such as chemotherapy-induced nausea
and vomiting and the wasting-away effects of AIDS. But NAS found that
inhaled marijuana is the best option in only select types of cases for which
there are no other options available. And with the active agents of
marijuana being isolated and delivered in forms ranging from pills to
inhalers (now undergoing clinical trials in Britain), those cases may be
decreasing in number.

"When all options have failed, [smoking pot] should be an option," Joy says.
"But the key is it should be given in a clinical setting where we can learn
from the results." The most common use of medical marijuana now--individuals
smoking it on their own to relieve pain--does little to further
understanding of how the drug works. The NAS report advises that using
marijuana for medical purposes be done under specific conditions--for a
period of six months or less, and only after the "failure of all approved
medications to provide relief has been documented." It further recommends
that medical-marijuana use be overseen by an institutional review board.

Joy says advocates on both sides of the medical-marijuana issue distort the
report's findings. Pro-pot activists who say marijuana is more efficacious
than other commercial medicines are basing their argument on drugs that have
been on the market for years, even decades, she says, adding, "A lot more
refined drugs have come onto the market in recent years." At the same time,
the conservative Drug Free America Foundation cites the report to dismiss
any claims of medical value for pot.

The scientific community generally stakes out a middle ground. A compound
that can simultaneously reduce pain and nausea and increase appetite without
the troubling side effects associated with more common opiate-based
painkillers "would be a bit of a magic bullet," Joy says. The NAS report,
however, notes that "[d]efined substances, such as purified cannabinoid
compounds, are preferable to plant products, which are of variable and
uncertain composition. Use of defined cannabinoids permits a more precise
evaluation of their effects, whether in combination or alone. Medications
that can maximize the desired effects of cannabinoids and minimize the
undesired effects can very likely be identified."

(There are numerous studies underway to more closely evaluate the effects of
marijuana-as-medicine, albeit many conducted by groups closely identified
with the issue. The California Medical Research Center, a Sacramento-area
marijuana dispensary that is legal in that state but was raided last fall by
federal agents, is studying the results of pot use on California patients,
and the International Cannabinoid Research Society, a Burlington, Vt.-based
coalition of more than 200 researchers, is doing similar work worldwide.)

The "undesired effects" include heightened risk of lung cancer, likely
buildup of tolerance to the drug's effects, and, to put it bluntly, getting
stoned. Whether that is an undesired effect, of course, is in the eye of the
beholder, but for patients who have never gotten high, the experience may be
unpleasant or even frightening.

There is also the question of efficacy and safeguards, an issue not usually
noted by pro-pot advocates. "We demand a lot of precaution from the Food and
Drug Administration," Joy notes. "If a drug kills one person in 10,000, it
is instantly pulled off the shelf." With intake levels that vary widely from
person to person and dosage levels that vary widely from plant to plant, the
actual effects of marijuana are virtually impossible to quantify in the way
regulators oversee other medications.

If pot exists on the margins of medical research, and if the public at large
doesn't seem keen on full-on drug decriminalization, how has the issue of
medical marijuana gained such political traction, favored by majorities in
polls and even legalized in some states?

Smart advocacy, primarily by one lobbying group, the Marijuana Policy
Project. Since its formation in 1995 by two former employees of the National
Organization for the Reformation of Marijuana Laws (NORML), MPP has
succeeded in divorcing the medical use of marijuana from the shaggy-haired
ideals of the much older legalization movement. While its larger
goals--overall reform of marijuana laws--don't much differ from those of its
forebear, MPP has put a human face on pot smoking, one that doesn't sport
dreadlocks and red-rimmed eyes.

It's been a hard-won lesson for advocates, three decades in the making. Some
form of campaign to legalize pot for medical use has been underway at least
since 1972, when NORML filed a formal petition with the federal Drug
Enforcement Administration (DEA) to reclassify marijuana under the newly
minted Controlled Substances Act as a drug with possible medical benefits.

Keith Stroup had started NORML two years earlier--not on medical grounds,
but to lobby for the growing league of recreational pot smokers around the
country. But since Congress had made control of marijuana's medical benefits
an aspect of drug-control policy, NORML decided early on to fight for
legalization along those lines.

Under the Controlled Substance Act, passed in 1970, all drugs are placed in
one of five schedules. Schedule I drugs are considered to have high
potential for abuse and no medical value, Schedule V the reverse. The
schedule is overseen by the DEA, which can move substances from one schedule
to another. Marijuana is a Schedule I drug; NORML petitioned the federal
agency to move the drug from Schedule I to Schedule II, meaning high
potential for abuse but some medical benefit. (Cocaine is a Schedule II
drug.)

It would take 16 years for NORML to get a ruling--and it was favorable. In
1988, Francis Young, then DEA's chief administrative law judge, issued a
68-page ruling concluding that "there is accepted safety for use of
marijuana under medical supervision" and recommending that the agency move
the drug to Schedule II. But the victory was temporary: DEA appealed twice
to the courts, and in 1994 the D.C. Circuit of the U.S. Court of Appeals
reversed Young's decision, ruling that there was not enough suitable
scientific research to show marijuana had medical value. While NORML offered
myriad anecdotal evidence of pot providing pain relief, there wasn't much in
the way of large clinical trials supporting its use.

"We fought this issue for about 20 years and frankly we got our asses
kicked," says Stroup, now 58 and still NORML's executive director. "We did
everything right, but in the end we did not achieve the goal we wanted."

These days, NORML distances itself from the issue somewhat, instead focusing
its efforts on other fronts, such as the DEA's recent ad campaign equating
drug use with supporting terrorism.

"We continue to support medical-use bills, but we spend the majority of our
resources trying to move beyond medical use," Stroup says. "Our feeling is
that we got three out of four Americans already agreeing with us; what we
want is to broaden the debate."

"If we took it off the table today, I think everyone here would be more than
happy never to debate the issue of medical marijuana again, but it wouldn't
take away anyone's zeal here for changing the laws," says Allen St. Pierre,
executive director of the NORML Foundation, the organization's educational
arm.

"I'll tell you where I think [medical marijuana] has been most helpful to
the broader issue," Stroup says. "The government has relied on a strategy of
'reefer madness' to maintain the status quo," he says, referring to the
notorious 1936 movie that made outrageous claims about the drug's dangers.
"And for a long time they got by on it, because most people didn't know much
about marijuana. The reefer madness doesn't stick any more. Part of the
reason is that people smoke, but another part of the reason is marijuana's
reputation as a medical therapy."

NORML has always viewed its mission as making marijuana palatable to the
public at large. Stroup, an attorney who prior to starting NORML lobbied for
the American Product Safety Commission and served with Ralph Nader on a
presidential commission, says he organized NORML on a "Naderesque"
model--working within the system, wearing coats and ties.

"At the time, the marijuana was a way of saying, 'We reject your values
system. We don't like what's going on in Vietnam, we don't like corporate
greed, we don't like alcohol, we have our own drugs,'" Stroup says. "Police
couldn't arrest protesters for being against the war, but they figured out
that if there was peace sticker on the back of their car, if they pulled
them over for a taillight being out, they'd probably find a marijuana seed
on the floorboard."

Publicly, Stroup remains every bit the savvy K Street lobbyist, albeit
probably the only one whose office waiting room offers visitors High Times
magazine. Like any good lobbyist, he has a commanding presence and an
ability to slice up arguments at a moment's notice with devastating
precision. NORML raises about $1 million a year, most of it in small
donations from individuals who simply want to legally "enjoy smoking a joint
in the privacy of their own homes," Stroup says. The organization is open in
acknowledging that it supports medical marijuana as a first step toward full
decriminalization.

This casual acknowledgement makes good ammunition for medical marijuana's
detractors, who claims pro-pot groups are merely exploiting ill people for
their own purposes. NORML stocks copies of a videotape made by the Drug Free
America Foundation that includes footage of former High Times reporter Ed
Rosenthal at a speaking engagement. "I have to tell you I also use marijuana
medically," Rosenthal says, to audience laughter. "I have latent glaucoma
which has never been diagnosed." (More laughter). "The reason why it's never
been diagnosed is because I've been treating it." Such wisecracks, the
video's narrator huffs, show "the mockery that legalization advocates are
making of their own medical-use argument," as well as the "blatant false
pretenses of the medical-use campaign."

The camel's-nose-under-the-tent argument has long hung over pot-as-medicine
advocacy like the smell of sinsemilla at a Grateful Dead show. It's a lesson
ex-NORML staffers Robert Kampia and Chuck Thomas took to heart when they
formed the Marijuana Policy Project in 1995, a year after NORML lost its
medical-marijuana case and retreated from the issue's front lines.

Both groups state as their broad mission the reform of laws that put people
in jail for smoking marijuana but delineate subtle but crucial differences
in their respective approaches. NORML "tend[s] to address the issue in the
first person--'We feel this law is unjust,'" Stroup says, whereas MPP will
personalize the issue: "People are being hurt by this law."

More obvious is the way NORML associates itself with recreational pot
smoking while MPP distances itself from the whole notion of getting high.
MPP only works at repealing laws it considers to cause unnecessary harm to
individuals, either by jailing them or thwarting their access to useful
medication. It takes Stroup's coats-and-ties approach a step further,
disassociating itself from activities that carry the whiff of ganja. Events
such as smoke-ins and pro-hemp rallies may be fun for participants, MPP
executive director Kampia says, but they "have about zero value as far as
effecting any sort of legal change."

Kampia says MPP wants to see current laws replaced with those that steer
"responsible marijuana use." Exactly what that would entail MPP doesn't
define. "We leave that purposefully ambiguous," says Bruce Mirken, the
organization's director of communications.

Publicly, MPP is anything but ambiguous. In the political arena it focuses
almost entirely on the question of whether sick people should have access to
something that can cause relief, avoiding the question of whether healthy
people should have access to a particular intoxicant--and thus kicking the
false-pretenses argument out from underneath detractors. If the Drug Free
America Foundation trots out high-living High Times editors, MPP counters
with a parade of regular folks who swear marijuana has helped them cope with
debilitating illness.

MPP's primary patron--to the tune of about half of its $1.1 million budget
this year--is a longtime decriminalization advocate, Peter Lewis, chief
executive officer of the automobile insurer Progressive Corp. (In January
2000, Lewis was arrested in a New Zealand airport and charged with
possession of marijuana--press accounts vary on the amount, ranging from
three to five ounces--but the charges were dropped under an agreement in
which Lewis made a large donation to New Zealand drug-treatment center) The
organization is also supported by a handful of wealthy investors who Kampia
says are split about evenly between those who smoke pot and those who
abstain, and about 6,000 dues-paying members.

Mirken says MPP's approach is "pretty much like any" lobbying organization.
Much of its resources are devoted to fund-raising, what Kampia calls
"mugging people with my words." It has a mailing list of approximately
60,000 people. It has done some advertising (including an ad, in the form of
a letter asking President Bush to support legalization of medical marijuana,
in the March 6 New York Times), but Mirken says MPP generally avoids that
approach because "it is hard to say how effective it is." It also lobbies
Congress, attempting to drum up support for legislation to bar the feds from
interfering with medical use of marijuana in states that allow it. However,
Mirken says he doesn't expect the measure to get out of committee this year.

Mostly, though, MPP works on changing laws state by state. In its early
years, the organization pursued medical-marijuana laws largely through
polling and state ballot referendums--an expensive process, but the only one
likely to succeed at a time when politicians would not touch anything that
could paint them as soft on drugs. MPP's single-minded focus on pot as
medicine paid rapid dividends: In 1996, medical-use laws were approved by
wide margins in California (where a similar measure had been vetoed by the
governor two years earlier) and Arizona. Over the next four years, six more
states followed suit.

In 2000 Hawaii became the first state to have a medical-marijuana bill
passed by its elected representatives, and since then MPP has sought to work
through state legislatures, creating a template for medical-use bills and
looking for willing sponsors. (MPP says that in Maryland Del. Murphy
approached it.) Once a bill is in motion, MPP will employ what Mirken calls
the "usual techniques" to build support: polling people on medical marijuana
and publicizing favorable results; approaching the editorial boards of media
outlets; sometimes advertising in the districts of recalcitrant legislators.
MPP will also do the scut work of rounding up policy analysts, doctors, and
pot-smoking patients to testify at hearings and visit legislators.

The MPP representative at the March 13 Annapolis hearing is Billy Rogers,
the organization's director of state policies. Minus his bushy hair, Rogers
would resemble a younger version of the Charles Emerson Winchester character
from the TV series M*A*S*H. Before joining MPP, he was an experienced
fund-raiser and pol whose resume includes managing Democrat Garry Mauro's
unsuccessful 1998 race against then-Texas Gov. George W. Bush.

Before the hearing, Rogers enthuses over the imminent approval of a
medical-marijuana bill by the Vermont House of Representatives (it passed
two days later), his previous stop before coming to Annapolis. He is
particularly pleased because Vermont's House is Republican-controlled.

While Murphy, bopping about outside the hearing room before testimony
begins, says he is confident that if the bill makes it out of committee it
will be passed into law, Rogers is less certain; medical-marijuana use is
far down on the Maryland General Assembly's priority list in this year of
faltering finances and huge budget deficits.

Still, Rogers maintains, repeatedly running the bill through the legislative
wringer is necessary, particularly as a tool to refine it. Each year the
bill's scope gets narrower, a bit more precise, a bit harder to refute, he
says; each year proponents get a better sense of what it will take to pass
it. After Judiciary Committee chairperson Del. Joseph Vallario (D-Prince
George's County), a staunch decriminalization opponent, derailed the bill on
March 22 by canceling an expected vote (because he realized the bill would
pass, according to MPP), it was quickly amended, resurrected, and approved
the following day.

Murphy's original bill would have created a system by which
medical-marijuana users could receive an ID card from the state Department
of Health and Mental Hygiene that would protect them from arrest by state
and local authorities. Under the new version, anyone caught possessing pot
could still be arrested, but could claim medical use in court. Such a
defense would not preclude conviction, but those found guilty of possession
for medical use would avoid incarceration and pay a fine of no more than
$100 (compared to six months in jail and $1,000 for a standard
marijuana-possession conviction). It would be a civil violation only, akin
to a parking or traffic ticket.

Like any good lobby, MPP declared the retreat a triumph. The amended bill
"makes a clear distinction between patients using marijuana for medical
purposes and recreational users," the organization cheered in a statement
issued after the House committee vote. While medical use would remain
technically illegal, Rogers predicted that Maryland prosecutors and judges
"will not waste their time harassing medical-marijuana patients" to secure
the equivalent of a traffic-ticket fine. "This victory for patients," he
said, "is nothing short of miraculous."

Larry Silberman is a lanky man, 50 years old. About two years ago, he was
diagnosed with non-Hodgkin's lymphoma, the same disease that killed Darrell
Putman. On March 13, he traveled from Burtonsville to Annapolis at Murphy's
invitation to talk to the House Judiciary Committee about it.

Silberman underwent several surgeries and chemotherapy, he tells
legislators, and the treatment almost killed him. The steroids pumped into
his body made him jittery, tense, and unable to sleep. The nausea made it
almost impossible to eat. Prescription medications such as Prozac didn't
help. Other patients at his chemo center suggested he try marijuana.

So two weeks into what turned out to be an eight-month therapy trial,
Silberman started smoking marijuana. It has helped him relax enough to
sleep, he says, and his appetite returned. "It literally saved my life," he
tells the delegates. "You can't live through those therapies. They're
inhuman."

Later in the hearing, Douglas Stiegler of the conservative Family Protection
Lobby voices opposition to the bill. The Howard County-based organization
c0nsiders HB 1222 "just a stepping stone for full legalization of marijuana
and eventually all drugs," according to its Web site. Murphy challenges
Stiegler, asking, "Would you put Mr. Silberman in jail for using marijuana?"
Stiegler does not have an answer.

In the context of this hearing, there isn't one, at least one that doesn't
seem arbitrary or heartless. Rightly or wrongly, that's the space in which
the medical-marijuana movement, in the space of seven years, has lodged the
decades-old pot debate.

Before the hearing, waiting his turn to speak, Silberman dons a novelty hat,
a wreath of fake pot leaves his daughter bought for him at least year's
HFStival. "You have to have a sense of humor about these things," he says,
beaming.

It's like a mirror image of Ed Rosenthal on that Drug Free America
Foundation video--one advocate goofing on marijuana-as-medicine to justify
smoking it for kicks, another goofing on pothead imagery before making an
impassioned plea for medical use. Today's marijuana advocates have figured
out which joke plays to the right crowd.