Medical Leaders Seek Truce in Battle Over Marijuana

Top leaders of the medical establishment are asking a group of physicians and the federal government to stop their bitter legal battle over California’s new medical marijuana law. In a March 14 letter to the warring doctors and government officials, the presidents of the American Medical Assn. and the California Medical Assn. said a prolonged court fight may only create “an intolerable period of uncertainty” for physicians and the public.

The letter from Dr. Jack E. McCleary, the CMA’s leader, and AMA President Dr. Daniel H. Johnson Jr. also said that continued disputes over the interpretation of Proposition 215, the medicinal marijuana law approved by state voters in November, could hurt cooperative efforts to promote more research into pot’s medical effectiveness.

Although it is now legal under state law for doctors to recommend marijuana for patients who need it, the drug remains illegal under federal law.

Faced with federal threats of a crackdown, a group of doctors filed a lawsuit in January to block U.S. officials from punishing physicians who recommend marijuana for sick people in their care. Meanwhile, many physicians around the state have refrained from even discussing pot with patients.

The federal government has recently stated that it has laid down no such gag order, and McCleary and Johnson said that should ease “any reasonable fears” physicians might have. As a result, they said, “We believe that further litigation will serve no productive purpose.”

But several other medical officials said it was too early to call for a truce because the federal government hasn’t backed off threats to punish physicians who recommend pot to patients.

“As a practical issue, if you are a doctor who wants to recommend marijuana to a patient, you are left up in the air,” said Steve Heilig, director of the San Francisco Medical Society. “There may be a place for this lawsuit still.”

Heilig said breaking off the fight now would also leave needy patients frustrated.

“You’ve heard pot helps you, then you’re faced with the choice of do you go out in the street and break the law to acquire some marijuana,” he said. “Until there is a formal statement from the federal level clarifying what they think is allowable, we’re all just groping for an interpretation. I don’t think they even know yet.”

Along with its joint letter with the American Medical Assn., the CMA issued a list of guidelines for physicians to interpret the law.

It advises that a doctor can discuss the risks and benefits of pot as medicine, but should not make a recommendation on whether to use it and should remind a patient that marijuana remains illegal under federal law. The guidelines also tell doctors to avoid cooperating in any way to help a patient get pot from a buyer’s club or provide a recommendation that could, under the terms of Proposition 215, be used by the patient as a defense in court.

The guidelines recommend that physicians document discussions about pot with patients, but suggest such records cannot be used against a doctor if a patient attempts to use them as a defense in court against a possession or cultivation charge.

In their letter, McCleary and Johnson asked that federal officials embrace the guidelines.

An attorney for the physicians suing the government said the guidelines provide a good springboard for a possible settlement--if U.S. officials embrace them.

Graham Boyd, a San Francisco attorney handling the case against the federal government, said the guidelines don’t give doctors carte blanche, but are a significant step. He suggested that the guidelines give a physician leeway to advise patients “that medical marijuana is appropriate and then testify in court about that fact” without facing sanctions.

A spokesman for the Office of National Drug Control Policy said that Boyd was “entitled to his interpretation,” but that a more careful reading of the guidelines indicated that it remains illegal under federal law for doctors to recommend pot.

Advocates of medical marijuana said the guidelines are an important step for the California Medical Assn. because it marks the first time the group has told doctors to do anything except avoid pot as a topic.

“Now we’re beginning to see guidelines for physician behavior that dance on the edges of federal law,” said Dave Fratello of Americans for Medical Rights.