inside_ebert
WORTH THE RISK: Ebert says the relief provided by medical marijuana is far greater than the difficulty of getting it.
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.”

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Te-Ping Chen: teping.chen@gmail.com

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