Prop. 215 Passed, but Uncertainty Hasn’t

The network of bruises and scars on Chris Smith’s legs map the history of her falls, all those moments over the past 20 years when painful spasms from multiple sclerosis shot though her petite frame and left her collapsed on the ground.

At times, the Trabuco Canyon woman found the pain so debilitating she begged off family gatherings, staying in her room in tears. Now, the 43-year-old marketing consultant who lovingly raises African gray parrots has found respite in an occasional marijuana cigarette or cannabis brownie.

Cautiously, fearfully, Smith and others like her have ventured out in search of support and found the Orange County Cannabis Buyers Club, which has gained strength in the wake of the November passage of Proposition 215. The “Compassionate Use Act of 1996” makes it legal for patients or their caregivers to grow and use marijuana on the recommendation of a physician, in blunt contradiction of federal law.

In the months since the initiative’s passage, patients have been pressing their doctors for marijuana recommendations, with mixed results. Along with the physical relief they say the drug bestows has come confusion and anxiety about whether the new law really protects them, and concern that doctors will balk.

Smith secured a letter from her doctor just days after the Nov. 5 election and purchased her first doses of the drug through the nascent buyers club, a floating semi-underground group that is cranking out membership cards and making marijuana available to those who can produce a physician’s note.

Smith used the drug daily during a one-week period of piercing muscle spasms, and credits it with providing a relief that her prescription pills did not.

“It felt like it just melted the problem away,” said Smith, who agreed to be interviewed only if her full name was not used so her identity would be protected. “My leg stopped jumping. It stopped the stabbing pain.”

But new federal sanctions could make those medical notes much harder to obtain.

Federal officials last week vowed to pursue California physicians who recommend marijuana for their patients. Doctors could be excluded from the Medicare and Medicaid programs, lose their licenses to prescribe approved drugs, or face criminal prosecution, U.S. Atty. Gen. Janet Reno warned.

Many patients say that jittery physicians--even those who supported the controversial initiative--increasingly refuse to recommend the use of marijuana out of fear.

In addition, a Northern California Superior Court judge ruled on Dec. 17 that an epileptic who smoked pot on the recommendation of his doctor cannot avoid prosecution.

So where does the law leave patients?

Smith is terrified of growing the cannabis plant herself, hasn’t mustered the nerve to tell her mother about her sporadic use, and nervously jokes that she has mistaken El Toro planes flying over her home for drug surveillance.

Since federal officials made their announcement, she says, she has been too afraid to attend the patient support group or to pick up her supply of the herb.

“I’m feeling more frightened now,” Smith said recently, taking a break from feeding and weighing a trio of newborn parrots at her elegant South County home. “I thought this [initiative] was going to be the answer to a lot of my problems. But to see the response to 215 . . . “

Passage of the proposition has raised the hackles of marijuana critics nationwide--from federal officials, who say no research shows the drug to be more effective than already legal treatments, to Orange County’s own Sheriff Brad Gates, who led the fight against the initiative and sees it as a masked push for drug legalization.

“I think patients and physicians have been put in a very awkward position,” said Dr. Juan Carlos Cobo, a Mission Viejo general surgeon and president of the Orange County Medical Assn. “Personally I think it’s been a disservice all around. As far as the practical aspect, [the initiative] has not changed anything.”

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The Cannabis Buyers Club is the one-man mission of Marvin Chavez, a 42-year-old former movie extra from Santa Ana.

Chavez arrived at his current role of supplier to the sick through personal experience with the drug. He says he suffered a back injury in a bus accident, followed by a slip and fall on a cafeteria floor. Then, his medical records show, he was diagnosed with classic ankylosing spondylitis, a degenerative condition that fuses the spine.

Depressed, anxious, in pain and unable to sleep, Chavez said he was swallowing a panoply of prescribed pills and hiding in his room. Last April, he turned to marijuana, and launched a personal crusade to run a local Cannabis Buyers Club, modeling it on a similar club in Hollywood.

Once a week now, a group assembles at Java Garden, a cramped coffeehouse with a checkered floor in a Huntington Beach strip mall, crammed with old sofas and glass-topped tables.

A disheveled elderly man with long stringy hair shuffles in wearing a pair of old cowboy boots. He has advanced lung cancer, he says, and is desperate for relief.

Others include pony-tailed youths who advocate the full legalization of marijuana but say they also suffer medical problems; a woman who rattles off a litany of back surgeries and other ailments and shakes a nasal morphine dispenser at the crowd to warn them of the addictive properties of prescribed medicine; occasional thirtysomething professionals; and more conservative pain sufferers like Smith, hungry for information.

Chavez is quick to stress that the weekly gathering is not for the Cannabis Buyers Club per se. There will be no dealing from the coffeehouse. Instead, he says, it’s a support group for like-minded patients who need information on how to approach their doctors.

He takes the cafe’s low stage, wearing a tweed sport coat over his spinal brace, an enormous silver and turquoise belt buckle gleaming. “The war has begun,” he tells a recent gathering of supporters. “It’s not over with.”

The law requires only the oral recommendation of a physician, one of several points that critics attack as ripe for abuse by people who just want to get high or apply the drug to marginal medical conditions.

But Chavez is keenly aware that a loose approach could sink his efforts. He runs the Cannabis Buyers Club with his own set of rules, requiring a doctor’s note and recruiting members to help him verify the notes by phone.

Each patient gets a membership card--Chavez said “dozens” have been issued but he declined to release an exact figure--and their names will soon be made available to other clubs around the state, to avoid double dipping, he said. The clubs might issue photo IDs.

“If you’re a casual smoker, stay away,” Chavez told a visitor as he completed a transaction recently in a buyer’s kitchen. “This is too important to the patients to get mixed up with you.”

Yet his mission by its very nature brings Chavez into dark corners. A curious breed of donor provides for free the marijuana that he distributes--illicit dealers who offer him an ounce or two without charge to help out the sick. Chavez in turn charges only what people can pay, providing the drug for free if the patient is indigent.

Patient records are locked in a box at an undisclosed location.

All bags are embossed with a sticker that reads: “Marijuana Provided by Prescription Only to Club Members and Patients. Not For Sale. To Be Taken For: Pain, Nausea, Muscle Spasms, Arthritis, Glaucoma and Loss of Appetite.”

On a recent day, Blake Medina met Chavez at the Huntington Beach condominium that the 18-year-old shares with his father and stepmother. The deal looked oddly out of place in the bright, well-kept kitchen with a faux marble floor, as Medina plopped $4 and some odd change on the counter top for a quarter-ounce of marijuana--his donation to Chavez’s sliding-scale cause.

Medina said his mother saw him in constant pain since an October 1995 car accident and encouraged him to seek a marijuana recommendation from his doctor; he secured a prescription from his neurologist. But his father has a more reserved view on the matter.

“I think he feels that now that I have a prescription, I’ll just smoke all the time and won’t get a job,” said Medina. “But that’s not going to happen. I need to get out of here and live my life.

“This is what I need to get rid of my back pain, to make my day go,” he said. “I think there are going to be people out there faking it, but I pray it doesn’t ruin it for the rest of us.”

Medina’s doctor, like other doctors who have recommended marijuana, declined through his patient to be interviewed. Some doctors have jotted quick notes for their patients, like one for a man who suffered a traumatic head injury in a motorcycle accident several years ago. The man carries in his wallet a folded piece of paper on his doctor’s letterhead simply stating that he “can be prescribed marijuana due to a medical necessity.”

Many others--including Smith’s doctor--sign a form provided by the buyer’s club, certifying the patient’s name and medical condition. “This person reports that cannabis/marijuana is providing otherwise unattainable relief from his/her symptoms. We have discussed the risks and benefits of cannabis/marijuana use as a treatment for this condition,” the form says.

“I have no objection to her/him using cannabis/marijuana for this purpose. I would consider prescribing cannabis/marijuana for this person’s condition if I were legally able to do so.”

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The question of who is a real patient and who isn’t disturbs critics of the proposition and some patients alike.

For one thing, there is no agreement even on the medical question of what conditions marijuana helps, if any.

Federal officials say no studies prove marijuana’s efficacy over existing drugs. Fact sheets from the National Institutes of Health acknowledge that patients have anecdotally reported relief from chronic pain and from muscle spasms due to multiple sclerosis, but that no controlled studies exist to back up those reports.

But the fact sheets indicate that the drug does help patients with nausea and wasting associated with AIDS and chemotherapy, although they recommend the already approved drug Marinol, the synthetic form of marijuana’s active ingredient.

Advocates say the anecdotes from the families of the sick and dying make for compelling evidence on their own.

In Sheriff Gates’ view, however, the verdict is in: No studies support the drug’s medicinal value.

Gates and the Washington-based Community Anti-Drug Coalition of America are paying for a study to determine if any aspects of the initiative can be legally challenged, he said. They are also joining forces to form a national lobbying group “so we can get into the political war that is brewing.”

His deputies have been instructed to make arrests for possession or cultivation as they would have before the initiative passed, if a patient can provide no proof of a physician’s recommendation. If they do provide a doctor’s note, however, “then we’re going to have to continue the investigation. . . . In most cases, we’re going to [end up] in a courtroom trying to resolve that.”

The law opens the door to marijuana use for a wide range of conditions, saying only that the patient must be seriously ill, Gates and Cobo said. And it allows so-called “caregivers” to grow marijuana and provide it to patients.

But who is a caregiver? And what qualifies as a serious illness? A headache? Stress?

Brian, a 45-year-old professional from South Orange County, admits he has grown the herb for years illegally. Just recently, he said, he has become “a caregiver,” selling it to three patients, two with cancer and one with AIDS. The law says a caregiver is the individual who has consistently assumed responsibility for the housing, health or safety of the patient. The way Brian argues it, he is a caregiver simply because he supplies marijuana to sick people.

None of his “clients” have doctors’ notes, and neither does Brian, who has smoked marijuana since age 14 and says he uses it nightly for back pain and anxiety.

Inside his South County home is a sophisticated growing operation invisible from the suburban calm outside. Healthy mother plants 2 feet tall reach for the light in a bedroom closet, where dozens of clones and seedlings take root on upper shelves.

In a separate growing room, he positions seedlings under a thousand-watt bulb for a two-month growth spurt that yields about half an ounce of high-grade sinsemilla per plant.

Already, Brian concedes, he sells buds on the side for nonmedicinal use to help finance his operation. His vision of the future sees “caregiver” as a profitable new career opportunity. The Cannabis Buyers Club, with its sliding scale of fees, is for the “welfare crowd,” not for a “professional” such as himself, he said.

“What I want to do is provide directly to the patients and consult with them on what they are getting,” Brian said.

Some users freely admit to having been recreational pot smokers for years, even decades, before they turned to the drug for what they call medical reasons.

Others--like Smith, with multiple sclerosis, and Marjorie Niland, who suffers from a rare neurological disorder--worry that the association with casual use attaches an unfair stigma to their use of it for more serious illnesses.

“Look at the negativism,” cried a disheartened Niland, shaking a copy of a San Francisco newspaper emblazoned with a photo of bearded, pot-smoking men in screaming tie-dyed T-shirts, celebrating the passage of Proposition 215. “This looks like potheads from the ‘60s. What’s the public going to say?”

Niland, a 63-year-old former art instructor who lives in federally subsidized housing and fears eviction, says she has never used the drug at home and has tried it only under the direction of a doctor for her dystonia. Nor does she smoke it, she said, instead steeping it in alcohol and applying it as a poultice to twitching muscle masses in her neck and shoulders.

She has nevertheless been a staunch promoter of decriminalization for patients and has lobbied legislators as well as the national Dystonia Medical Research Foundation, for which she heads the Southern California support group.

Dystonia is a neurological disorder characterized by severe muscle contractions and so-called “sustained postures.” Difficult to diagnose, it affects an estimated 250,000 people in North America, according to the foundation.

It can seize on the throat muscles, leading to strained and breathy speech; cause grimaces or facial distortions from muscle spasms in the face and jaw; or, in cases such as Niland’s, cause severe contraction of neck muscles.

Once a printmaker and painter, Niland now has little control of her neck muscles, which are in constant spasm. In conversation, her head jerks fiercely and often, causing her bright red hair to sway and her green eyes to assume a quizzical expression.

The spasms cause severe headaches and spread pain down her arms. She can no longer wash her own hair. But the journey to her present state is filled with far greater horrors and humiliations.

She suffered through several years of toxin injections into her muscles--part of a National Institutes of Health study that left her with constant flu symptoms. There was a suicide threat six years ago, and the ever-growing collection of opiate painkillers that did little to help.

The nadir came in Pass Christian, Miss., with Niland curled in a ball on her sister’s bed in morphine withdrawal.

“The pain was incredible. There was so much perspiration, vomiting, cramps and diarrhea,” said Niland, who dropped 12 pounds in a week. “Death would have been merciful at that point.”

When a California pharmacy finally shipped her a refill, Niland had left for home. “I said ‘Throw it away. I’m never taking that again.’ ”

Niland says marijuana helps. She has written an account of her experiences for an upcoming book by Dr. Lester Grinspoon, professor of psychiatry at Harvard Medical School and a prominent advocate of medicinal marijuana.

“Right now I’m afraid I’m damaging my liver,” said Niland, who still takes other medication. “Marijuana doesn’t do that. It’s something that God has given to us, and God gave it to us for a purpose.”

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Laying Down the Law on 215

Controversial Proposition 215, passed in November, allows cultivation and medical use of marijuana if recommended by a doctor. Here are the major components of the law and what critics are saying and threatening to do:

LAW’S PROVISIONS

“Seriously ill” Californians have the right to obtain and use marijuana for medical purposes.

Use must be deemed appropriate and be recommended by a doctor who has “determined that the person’s health would benefit from the use of marijuana” in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine or any other illness for which marijuana provides relief.

No California doctor shall be punished or denied any right or privilege for having recommended marijuana to a patient for medical purposes.

Patients and their primary caregivers who obtain and use marijuana for medical purposes upon the recommendation of a physician are not subject to criminal sanction or prosecution in state courts.

Sections of the state health and safety code that prohibit possession and cultivation of marijuana shall not apply to a patient or to a patient’s primary caregiver who possesses or grows marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician.

Note: “Primary caregiver” is the individual who has consistently assumed responsibility for the housing, health or safety of the patient.

CRITICISMS AND CRACKDOWNS

Some in the medical establishment say “seriously ill” is too vague and could specify any illness, whether or not there is evidence that marijuana is the most appropriate medication.

The recommendation need not be written, and critics say the law doesn’t specify doctors need even note the recommendation in their records.

U.S. Atty. Gen. Janet Reno vowed last week to pursue California doctors who recommend marijuana use to patients. Doctors could be excluded from Medicare and Medicaid programs, lose licenses to prescribe approved drugs, or face criminal prosecution in federal courts, officials said.

A Municipal Court judge in Santa Rosa ruled on Dec. 17 that a man who smokes pot on the recommendation of a physician to ease symptoms of epilepsy cannot avoid prosecution--the first major ruling on the criminal application of the new law. The designated caregiver also must face trial.

Source: Times reports; Researched by LEE ROMNEY / Los Angeles Times