AIDS patient runs into medical marijuana gridlock

May 06, 2005

Linda Halstead-Acharaya, Helena Independent Record

Jim Hartford knows how marijuana eases his AIDS symptoms. What he doesn't know is how to get a physician's approval so he can register to use it.

Hartford, of Billings, was diagnosed with HIV nearly 11 years ago. He takes a cocktail of drugs to manage what has developed into AIDS.

He knows that AIDS is one of the conditions for which medical marijuana can be approved, and he believes that cannabis can relieve some symptoms — nausea, lack of appetite, a feeling of restlessness in the legs — in ways that other drugs cannot.

‘‘There are four drugs, essentially, that I can cut out by using marijuana,'' he said.

Hartford was born in Lewistown and grew up between Missoula and Billings. He later moved to Oregon where he was a registered user of medical marijuana and then last year — after Montana voters passed the state's Medical Marijuana Initiative — he decided to move back home.

‘‘I wanted to be close to my family,'' he said. ‘‘It was time. The fact that Montana had backed me on this issue, I thought it was great. I could come back and maintain my health.''

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But Hartford ran into a roadblock. His physician at Deering Clinic told him he cannot sign the paperwork required for Hartford to register with the state to be a medical marijuana user.

Hartford understands the doctor's reluctance, given that the physician is following a directive. He also understands that the process takes time. In Oregon, it took Hartford six months to get his registry card. But he's irritated at the options he was given.

He was told to write a letter.

‘‘But to where? Nobody said,'' he said.

He was told he could go to another doctor.

‘‘That doesn't work because you have to have the doctor treating the illness sign the papers.''

Finally, he said, he was told to wait until the federal and state governments agree on the matter. To date, Montana has approved the use of medical marijuana, but the federal government has not.

‘‘I just don't have time to wait,'' he said. ‘‘I've dealt with this too long.''

Above all, Hartford is frustrated that he doesn't know what to do next. Ideally, he said, he would like to go before a judge to present his case.

Hartford believes most of the confusion over medical marijuana stems from a lack of information and education. When a physician signs an application, he or she is merely attesting to the fact that the patient has one of the conditions listed in the statute and that the benefits of using medical marijuana would likely outweigh the risks, he said.

‘‘It's the state of Montana giving the permission, not the doctor,'' he said.

But the state-versus-federal question continues to plague some patients, physicians and clinics. Answers are not easy to come by.

At Montana's Veterans Administration facilities, the question has already been decided. Because the physicians there are federal employees, they abide by federal law and will not sign, explained Ruth Linfield, assistant to the chief of staff at the VA in Helena.

‘‘It's pretty cut and dried for us,'' she said.

As for physician liability — some physicians fear losing their licenses — Bruce Mirken, director of communications for the Marijuana Policy Project, said that matter was resolved in October 2003. That's when the Supreme Court let stand a decision preventing the federal government from revoking a physician's license for ‘‘recommending'' the use of medical marijuana.

Still, physicians at Deering Clinic, which receives federal funding, feel some gray areas remain.

Uncertain whether they would jeopardize their federal dollars, they decided to err on the side of caution. With advice from legal counsel, officials there decided not to sign applications until the matter is definitively resolved.

‘‘It's hard to risk the support for 14,000 patients'' for a few who request approval for medical marijuana, said Dr. Jim Guyer, the clinic's director. ‘‘We're just kind of waiting for the issue to clear.''

As it stands, Deering advises anyone wanting authorization to look outside the clinic for a physician willing to sign. However, the clinic does not have a list of providers willing to do so. Patients are also informed of prescription alternatives that can treat their symptoms.

Hartford, who would rather take fewer medications than more, doesn't see that as a viable option. He is also surprised by Deering Clinic's stand because his first authorization came from a physician at a county health clinic in Oregon.

The Marijuana Project's Mirken said he knows of no court case directly related to federally funded clinics.

Officials at two federal agencies, one that deals with Medicaid and another that deals with community health clinics, said the question has not come up before. But they do not foresee any threat to federal funding.

‘‘Because there is no illegal drug being dispensed, because a prescription is not even being written and because there is no state cost involved and no federal costs involved, there are no violations of conditions of participation we could figure out,'' said Mary Kahn, a spokesperson for Medicaid.

A call to the Montana Attorney General's office for clarification on state-federal issues is directed to Roy Kemp, bureau chief of the licensure bureau of the Montana Department of Public Health and Human Services. Kemp is charged with establishing the state's medical marijuana registry, protecting the anonymity of the individuals listed on that registry and providing information related to the state's program. He declined to speak on federal issues or interpret legal matters.

Whether statute allows Hartford to seek the signature of another physician, Kemp says that's a question for an attorney. Mirken says he is unaware of anything in Montana law that would prevent Hartford from doing so.

‘‘In some states, it's a relatively common practice,'' he said. ‘‘Of course the second doctor would be expected to follow appropriate standards of medical care.''

And, as Kemp points out, there are 72 physicians from 20 Montana counties who have done so to date. There are currently 100 Montanans listed on the registry.

Kemp also offers that, under Montana's statute, Hartford's Oregon card would qualify him to use medical marijuana in Montana, provided the card is current — which it is not.

Meanwhile, Hartford wonders where to turn.

‘‘I never wanted to be the one to take this up,'' he said. ‘‘I just wanted to live my life. The people of Montana were very brave to vote this in, but now nobody's letting me know what's going on. And I don't know where to go with it.''



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