THREE VIEWS:

The air still hasn't cleared over the issue of medical marijuana,
despite passage of a 1998 act. One doctor feels the heat, while
activists rally for improved access.

Give People Access, Not Red Tape

Marijuana is a safe, effective medicine. Patients who can benefit
from it should be able to get it.

Oregon voters were right to pass the Oregon Medical Marijuana Act in
1998. Since then, evidence has mounted showing that marijuana helps
patients suffering from a wide range of ailments. For many patients,
marijuana works better than more expensive pharmaceutical drugs.

Some cancer patients report that marijuana is the only thing that
controls the nausea caused by their chemotherapy. For some glaucoma
patients, marijuana is the only thing that keeps them from going
blind. For many chronic pain patients, medical marijuana allows them
to end or reduce their use of dangerous drugs such as morphine and
Vicodin. This allows them to function far better, which is wonderful
for them and their families.

Since the act took effect, more than 3,500 patients have been
qualified to use medical marijuana by nearly 800 Oregon doctors.
Oregon's law has allowed these patients to choose which medicine to
use. There have been no reports of any significant adverse reactions
to using marijuana as medicine.

The problem with the act is that it does not create a supply of
medical marijuana. Instead, it requires sick and dying patients to
grow their own medicine. This hasn't worked and never will. Some
lucky patients have a caregiver who can successfully grow marijuana
for them, but most patients have struggled unsuccessfully with
gardening and resort to the black market if they can afford it.

Another problem with the act is that the health department has failed
to follow the law and imposes so much red tape on participants that
many patients avoid the program.

The act requires the department to issue registry cards within 30
days to patients who submit complete applications. The department
virtually never meets this deadline, and patients have been arrested
as a result of not having a card. This is intolerable.

Other departmental decisions can only be characterized as foot
dragging. The level of service is unacceptable for a program that is
completely self-funding. Given that marijuana seems to be useful for
so many conditions, it is disappointing that the department has done
nothing to document the positive results that many patients are
achieving.

The biggest problem with medical marijuana is the federal government.
Voters in 10 states have passed laws legalizing medical marijuana,
but Congress refuses to budge from the outdated "reefer madness"
position that criminalizes all use.

The medical use of marijuana is not going to stop. Far too many
patients know that it helps them far too much. It is time for our
leaders to follow the people on this issue.

The Life With Dignity Committee is sponsoring a statewide initiative
petition for the November ballot that would expand the Oregon Medical
Marijuana Act. Soon, we will begin passing petitions and expect to
get the required 67,000 legal signatures to become eligible for the
November ballot.

This initiative will create licensed dispensaries, regulated by the
health department, where qualified patients can purchase their
medicine in a safe environment.

The initiative also would make numerous other changes in the Oregon
Medical Marijuana Act that would cut through some of the red tape
that has denied patients the choices they should have. Marijuana is
medicine. Patients should be able to get it.

John Sajo is the director of Voter Power and a chief petitioner of
the Life With Dignity petition.

My Responsibility Is To Help Sick People

The medical marijuana hullabaloo is not about patient care. It is
all about money! The money not spent on expensive prescription drugs.

Marijuana is one of the safest medically active substances known to
man. It is easy to grow and safe to use. But it isn't taxed, legally
sold, patented, promoted or protected by big-money lobbyists and
multibillion-dollar out-of-state corporations, as are big tobacco,
alcohol and "legal" prescription drugs.

I'm just an old medical college professor with 30 years of teaching
pharmacology and toxicology, turned country doctor for 10 years, with
far more education on the effects of drugs than most.

Cannabis has often been called a miracle drug because of its
effectiveness in the treatment of pain and such a wide path of
diseases. It has been used in medicine for at least 5,000 years.
Marijuana is even mentioned in the Bible, Exodus 30:23, when God
ordered Moses to make a holy oil, composed of myrrh, sweet cinnamon
and kaneh bosm (cannabis).

Marijuana is well-known and used in medicine worldwide. It was one of
the most widely used medicines in America before being legally banned
in 1937. Oregon voters approved medical marijuana in 1998. Eight
states have followed.

Oregon patients can now apply to the state, for an annual fee of
$150, for a card authorizing their legal use of marijuana for their
own medical purposes. Every application must be signed by a physician
confirming that, in his or her opinion, the applicant is suffering
from an ailment for which the state has approved the use of marijuana
for treatment.

Doctors do not prescribe medical marijuana. The state approves all
medical marijuana cards.

The state had anticipated only about 500 applications but already has
issued more than 3,500 cards and is months behind in approving new
applications. And now the state has added more delay to its
multifarious approval processes by requiring a physician's physical
exam of all applicants, which I now do. Why?

The state has approved marijuana in the treatment of nine diseases,
including cancer. All require a medical specialist for detection, not
just a regular physical exam. Surely the state's public health
officer hasn't the time or staff with the expertise to review
thousands of physical exams.

I'm but one of nearly 800 doctors who have signed medical marijuana
applications. By far, I have examined the most patients: Thus, the
state has singled me out, publicly attacked me and threatened my
license, even though the law says physicians cannot be prosecuted for
giving their opinion. Their goal is to scare other doctors in an
attempt to kill medical marijuana in Oregon.

The state seems to be saying, "We don't care what the voters want,"
while ignoring the real victims: the forgotten thousands of
Oregonians, the paraplegic vets and others who medically need and
want to use marijuana "legally" as an effective alternative medicine
for the relief of their pain rather than using expensive and often
harmful prescription painkillers. The state doesn't care.

But, thank God, others do. And thanks to several brave doctors,
hundreds of dedicated advocates and the majority of Oregon voters,
there are now more than 3,500 Oregonians legally suffering less
medical misery than before. To which I say, "Hurrah!" For that is
what doctors should do.

Phillip Leveque, a doctor of osteopathy, says he has signed more than
1,600 medical marijuana card applications. He lives in Molalla.

State Fine-Tunes Its Nascent System

In 1998, Oregon voters passed a law to protect seriously ill patients
from prosecution for using marijuana as medicine.

The Oregon Medical Marijuana Act is 3 years old, but strong feelings
and confusion about it still exist. As a public health officer in the
state Department of Human Services, I oversee the medical marijuana
program and want to clarify some facts.

The act grants legal protection to qualified patients. Those who are
registered for the Oregon Medical Marijuana Program are issued a card
to show they have met requirements for the legal use of medical
marijuana.

To qualify for a card, an applicant must be an Oregon resident and
suffer from one of nine listed debilitating medical conditions. An
attending physician must document the patient's medical condition and
confirm that the patient may benefit from medical marijuana.

The law allows patients to designate a primary caregiver to legally
assist in growing and administering medical marijuana. The law
includes a petition process for adding new medical conditions to the
list when there is supporting scientific and clinical evidence.

The act gave responsibility for creating the registry system to the
Department of Human Services. From the beginning, our goal has been
to operate a program that is accountable to patients and the public.
Here is how we interpret the law:

Marijuana is a legitimate medication for some patients, and both they
and their physicians are legally protected from prosecution for its
use and for discussing its use.

Medical marijuana use is restricted to patients who have one or more
of the medical conditions named in the law.

The decision of whether to use marijuana as medicine is made by the
patient with his or her attending physician.

Restrictions reduce the potential for abuse of the law and ensure
that medical marijuana is not diverted to illegal purposes.

For two years, the program worked as intended. Almost 600 patients
registered in the first year, and more than 300 physicians
participated. We added one medical condition to the list.

In 2001, we discovered that an attending physician's signature had
been forged on seven applications. We immediately contacted law
enforcement and conducted a stringent internal review. This resulted
in changes to our management of the program.

We also found that there had been a sharp increase in the number of
patients and that one physician had signed documentation for 1,642
people, about 40 percent of the applicants. The act states that the
attending physician must have "primary responsibility for the care
and treatment of the applicant." We questioned whether one individual
could fulfill this role for so many patients.

Subsequently, we filed new rules to better define attending physician
requirements:

The doctor must review the patient's medical history, conduct a
physical exam, provide for follow-up care and document this in the
patient's medical record. The rules give the state authority to
review medical records when we question whether a legitimate
physician-patient relationship exists. Under these rules, about 300
applications were denied because of insufficient documentation.

Patients, advocates and policy-makers have expressed a range of
perspectives on these recent changes. Some think that we are becoming
too intrusive and erecting barriers to qualified patients. Others
think that we should be more restrictive. Our goal is to achieve a
balance of providing quality service for patients the act was meant
to serve while ensuring that only legitimate patients receive
registration cards.

Grant Higginson is state public health officer at the Oregon
Department of Human Services.