Medical marijuana: Still an outlaw?

February 12, 2006

Clynton Namuo, Pacific Business News

Five years after Hawaii adopted its medical marijuana law, 3,000 people have registered to use the drug but only a handful of doctors -- most of them on the Big Island -- are certifying their need to be treated with it.

Eight physicians, each currently certifying over 100 patients each, account for nearly 80 percent the people who have registered to use marijuana. There are currently 164 doctors who have registered with the state as certifying their patients' need for marijuana.

Patients interested in using marijuana to treat pain and other effects of serious illnesses have begun to flock to this small group of doctors, in many cases sidestepping their primary-care physicians. The majority of Hawaii's medical community, including the Hawaii Medical Association, remains opposed to using marijuana as medicine.

"Everyone they had contact with in the medical field on their island was unwilling to process the paperwork," said Gary Greenly, a Honolulu osteopath who said he has certified hundreds of patients from across the state. "I think I've signed up most of the participants in the program on the island of Oahu."

Under the state law enacted in 2001, doctors cannot prescribe marijuana but they can recommend that a patient use it as part of their medical treatment. Along with the doctor's certification, the patient sends in a $25 fee to the state Department of Public Safety and receives an identification card.

A patient in the program can legally buy marijuana, but the person they get it from cannot legally sell it, one of several catches in the law.

The eight doctors who have made the majority of certifications have attracted the scrutiny of state investigators, but none has been accused of wrongdoing. The death in November of one of the most active doctors, Bill Wenner of the Big Island, prompted the state to send letters to his patients requiring them to find a new doctor by Feb. 1 or risk losing their certification.

Medical marijuana advocates say the state has done little to support the program and that the ideal situation, in which a patient's primary doctor recommends using the drug, has been elusive in the face of opposition by the medical association. Many doctors remain leery of legal complications and unconvinced that marijuana actually helps patients.

"It's the failure of other physicians to step up to the plate," said Pamela Lichty, president and co-founder of the Drug Policy Forum of Hawaii. "It would help to do some more public education."

Keith Kamita, who oversees the state's medical marijuana program and wrote the letter to Wenner's patients, said the law needs to be rewritten to allow increased oversight of doctors and to make sure the program is administered correctly.

"The law needs to be tightened up or a mechanism [created] where this can be looked into," Kamita said. "One of our concerns is if you have a ridiculous amount of patients are you doing doctor-patient treatment."

The state has said it cannot release the names of doctors certifying marijuana use.

Both sides agree the law needs to be fixed, but for different reasons.

Kamita said all he can do is ensure that paperwork is filled out truthfully, but the larger question of whether or not patients have exhausted other avenues of treatment before using marijuana cannot be independently verified.

Lichty said the best way to help the program would be to educate doctors about certifying marijuana for medical use and moving the program into the state Department of Health. Patients and doctors are troubled by having to go through a police agency to obtain medical marijuana certifications.

Greenly, the Honolulu doctor who is one of the eight who have dispensed the most certifications, said he serves a growing community of people who are beginning to recognize the positive effects of the drug and he has no qualms about signing them up.

But he concedes that some people come to him with exaggerated claims of illness simply so they can be certified to use marijuana. After seeing too many unqualified people show up for treatment, Greenly said, he began checking each patient's medical records closely to ensure they were suffering from a "debilitating medical condition," as the law requires.

State officials are troubled by the recent arrival of an Oregon-based organization that began sending doctors to Honolulu about once a month to certify patients to use marijuana.

Doctors with the Hemp and Cannabis Foundation of Portland began seeing patients in Honolulu last September and expected to see 2,000 people in its first year of operation here.

But the number of patients interested has fallen short of expectations and now the group believes it will issue only 500 certifications in the first year. Part of the reason may be that the foundation charges $250.

In its three trips to Honolulu, foundation doctors have certified only 80 patients.

"Over time, it'll pick up," foundation President and Executive Director Paul Stanford told PBN.

The Hawaii Medical Association is especially troubled by the fly-in doctors, saying such superficial treatments undermine the doctor-patient relationship, said association Executive Director Paula Arcena.

Those who use marijuana for medical purposes often say it has changed their lives.

Jim Lucas is a 50-year-old HIV patient who has used marijuana to defeat the side effects of the virus since 1998.

"It's like a miracle drug," he said.

Lucas said he has used marijuana to help alleviate the discomfort of wasting associated with HIV, as well as pain caused by a nerve illness.

Questions about the effectiveness of medical marijuana, particularly for the treatment of glaucoma, also have kept doctors away.

"One of the reasons physicians stay away from this is because they don't feel comfortable that this as a legitimate treatment for disease," HMA's Arcena said.


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