Medicinal Pot Is Doctor’s Specialty

Dr. Phillip Leveque feels his patients’ pain. Ten years ago, an accidental overdose of spinal anesthetic left his feet and tailbone with a burning sensation. He’s also been in three bad auto accidents.

Leveque tried painkillers, but they didn’t work. So he simply lives with it, stoking up on sleeping pills at night. But for patients with chronic pain, Leveque offers another alternative: marijuana. Well more than 1,000 patients have gotten authorization from the 77-year-old osteopath to use the drug under Oregon’s 2-year-old medical marijuana law. That’s 40% of all authorizations in the state and eight times more than any other doctor.

State health authorities would like to know why, and they have launched a controversial inquiry into Leveque’s patient records.

The answer, Leveque said, is simple:

“When you step down on your foot, you feel pressure. When I step, I feel fire. . . . I know exactly what [people who get medical marijuana cards] are going through.”

Oregon’s inquiry has raised troubling questions about doctor-patient confidentiality in a state that, unlike California, maintains a central registry of all medical marijuana patients and the doctors who oversee them.

Under temporary regulations issued in response to Leveque’s hefty client base, new medical marijuana patients in Oregon--including more than 800 who have pending applications for access to the drug signed by the Molalla, Ore., doctor--will have to allow authorities to review their records or face automatic denial.

Leveque’s supporters say that the state is placing roadblocks in the way of a doctor who has been the only resource for many patients turned away by physicians leery of dealing with marijuana cases.

Since Oregon in 1998 became one of nine states with laws allowing patients to use small amounts of marijuana for medicinal purposes, Leveque has run makeshift clinics in towns all over the state. He’s also offered telephone and mail consultations to patients in areas too remote for a personal visit.

“My name has spread through the jungle telegraph: people who know people who know people,” Leveque said. “I have physicians [as patients]. I had a phone call from a dentist who wants to get a marijuana card. Lots of nurses. Lots of doctors’ wives. . . . I must have about 30 ladies with PMS [premenstrual syndrome] that have cards.”

Leveque is so popular that state officials have trouble believing he has the time to act as an actual attending physician on so many cases.

“To qualify for a card, you have to have a debilitating medical condition and you have to have an [attending] physician provide a written statement that says . . . you might benefit from the use of medical marijuana,” said Grant Higginson, Oregon’s public health officer.

When officials moved last month to scrutinize Leveque’s patient records, they were met with stiff opposition from the Oregon Medical Assn. “Our position is, nobody examines a patient’s medical chart, by rule or otherwise, without the patient’s consent or a court order,” said Robert Dernedde, executive director of the physicians’ group.

So temporary rules were adopted this summer requiring patients seeking a medical marijuana card, which grants them access to the drug, to agree to have their records reviewed by the state. That alleviated the medical association’s concerns but not those of medical marijuana advocates who say the rules still are too intrusive and unwieldy.

“It is going to . . . create more burden on these patients. They are sick and suffering, and it’s basically unnecessary,” said John Sajo, who heads Voter Power, the citizens group that backed Oregon’s marijuana ballot initiative.

“We pretty much think this is a witch hunt. . . . They don’t have a single complaint from a patient, or a single patient who’s been harmed or had an adverse impact on their health from Dr. Leveque qualifying them for medical marijuana,” Sajo said.

The state Board of Medical Examiners is conducting a separate inquiry into an allegation that Leveque authorized a medical marijuana card without adequate examination, consultation and follow-up. In one case, Leveque allegedly signed for a patient with a previous history of drug abuse. The osteopath was placed on licensing probation for 10 years in 1986 for allegedly overprescribing pain medications to patients.

To Leveque, the controversies come from a medical establishment unequipped to deal with the ravages of chronic pain and unrealistic about the medical conditions that give rise to marijuana use under the Oregon law.

Almost none of the conditions for which marijuana is authorized in Oregon--cancer, glaucoma, AIDS, Alzheimer’s disease, wasting, severe pain or nausea, seizures and persistent muscle spasms--can be detected with a simple physician examination, he said.

Instead, Leveque requires patients to give him a copy of their diagnosis from another physician, and he makes detailed inquiries about their experiences with other medications.

“I have patients that live nine hours from Portland, 10 hours,” Leveque said. “These people are going to have to endure a nine-hour drive both ways to see me?”

Leveque has received as many as 40 new requests a day from potential patients since last month, when his name hit the Oregon newspapers. “The important part of this story is not that Dr. Leveque has signed [hundreds of] applications but that there are 7,000 physicians in Oregon who haven’t signed one,” Leveque said.

As in California and other states with medical marijuana laws, many doctors fear the prospect of Drug Enforcement Administration action, since federal law considers marijuana an illegal drug. The Board of Medical Examiners’ investigation into Leveque has made other doctors even more reluctant, Sajo said.

Higginson said more than 500 physicians in Oregon have provided authorizations for marijuana cards. “On the other hand . . . that’s one of the most common questions we get asked: ‘Can you tell me where we can get a physician who’s willing to do this?’ In some cases, the doctors of a whole community--or even a whole county--aren’t willing to do it.”

Under the temporary rules, which will be reviewed in public hearings this fall, the state has set minimum standards for qualified attending physicians. They must review medical records, conduct a physical exam, develop a treatment plan and provide follow-up care that is documented in an ongoing patient file.

“If [Leveque] is doing this strictly over the phone, then I don’t think he would qualify,” Higginson said.

Sajo said he thinks most physicians, including Leveque, will be able to meet the standards. Litigation over the rules “seems quite inevitable,” he said, with the American Civil Liberties Union looking at the issue now.

Charles Brookman, a 54-year-old former Green Beret from Salem, Ore., said Leveque signed his marijuana authorization to ease the crippling pain he suffers as a result of Vietnam War injuries and multiple sclerosis, which also has left him blind.

“The big thing about Dr. Leveque is he really goes out of his way to help veterans,” he said. (Leveque is a World War II infantry veteran.) “A vet will go to the VA hospital where they’re getting their primary treatment, and there’s no doctor there that will sign the application form. I went to 12 doctors before I found one that would sign, and that was Dr. Leveque.”