Medicine or Menace?
The drive to supply marijuana to the sick
By Jennifer Goff
Tony guided his electric wheelchair down Congress Street on a chilly afternoon this past October, his jacket hood cinched tight around his face, a baseball cap brim obscuring his eyes, leaving only his white beard visible. He was clutching a stack of dog-eared and coffee-stained legal-sized papers.
“We need to get 55,000 signatures,” he said, exhaling a cloud of smoke-like breath. “I have 12.”
The signatures were for the Maine Medical Marijuana Act, a citizen-initiated referendum expected to appear on the ballot next November.
Maine voters approved a medical marijuana bill via referendum nearly 10 years ago, by a decisive margin (61 percent in favor). The law allows patients with certain illnesses to possess a limited amount of marijuana without being prosecuted if their doctor recommends the drug as the most effective means to treat symptoms like nausea, loss of appetite, and muscle spasms resulting from cancer, AIDS or multiple sclerosis.
However, doctors cannot prescribe marijuana, and the state has no system in place to provide it to qualified patients, leaving those who can’t grow their own to rely on the black market. The lack of a state-sanctioned distribution system also leaves patients, caregivers and growers vulnerable to drug seizures and prosecution. Many doctors are hesitant to recommend marijuana, given the vague legalities involved.
The new act would address this by creating a system by which qualified patients would receive identification cards enabling them to procure marijuana at non-profit, state-certified dispensaries. It would also expand the types of maladies for which doctors can recommend the drug to include hepatitis C, agitation due to Alzheimer’s disease, and the treatment of chronic, intractable pain, among others. And doctors would be given new protections from disciplinary action or other penalties. Patients would still be limited to possessing no more than two-and-a-half ounces of harvested bud and six plants, no more than three of which can be budding at any given time.
Tony’s experience provides a window into the passions, and confusions, shaping the debate over medical marijuana in Maine. As he navigated his way down the bumpy brick sidewalk, approaching wary pedestrians in business suits and scraggly beards, many pretended not to hear him and hurried past. Others scrawled their names and addresses without asking a single question about the initiative, but mentioned a sick parent or friend. A few practically fell over themselves to sign. Tony’s met guys in their twenties who hear the word marijuana, flash a knowing smile, sign the petition and then invite him to smoke up with them.
He tells them to go on without him.
Tony, who agreed to share his story on condition his last name be withheld, has been drug-free since 1991, when an overdose of cocaine and heroin nearly took his life. He attends both Narcotics Anonymous and Alcoholics Anonymous meetings about 10 times a week to give him the support he needs to stay clean. At a meeting in late October, he received his 17th gold medallion: another year without booze or drugs. He cried, kissed the medallion, and thanked Jesus for helping him stay strong and sober for almost two decades despite crippling health problems and the deaths of his parents and fiancé.
He carries this year’s medallion with him, tucked into his pants pocket, ready to show off at a moment’s notice. Medallions from years past gather in the bottom of an urn at his parents’ grave in Massachusetts. “They were the kindest people. I miss them everyday,” Tony said, shrinking into his chair as he sunk into memories.
He mostly remembers their suffering. Almost 11 years ago, Tony’s father died from a cancerous brain tumor. Three years later, cervical cancer took his mother’s life, her third and final bout with cancer. “I remember them screaming during the night,” Tony recalled. “They were in so much pain from cancer they didn’t want to live.”
Tony doesn’t want other people to suffer like his parents did. That’s why he began working for the political action committee Maine Citizens for Patients’ Rights. He earns about a dollar per signature, but said he’s not doing it for the money. Tony has chronic back and leg problems that make it difficult to stand for any length of time. He gets by on his disability checks, and said that after putting aside some of the petition money for a “rainy day,” he’s been donating the rest to his church and to charity.
The PAC has already collected the 55,000 signatures necessary to put the act on next year’s ballot, and is gathering up to 10,000 more as a “cushion” to ensure that threshold is met after duplicate or invalid signatures are removed.
This past Election Day, Tony collected 950 signatures, the most of any canvasser in the state.
Assuming a sufficient number of petition signatures are certified as valid by the Secretary of State’s office, the Maine Legislature will have an opportunity to pass the act, rather than send it out for a statewide vote, in the coming months.
Almost no one expects that to happen.
Former State Sen. Ethan Strimling, a liberal Portland Democrat, tried and failed to get similar legislation passed in 2007. Strimling recalled that only a handful of legislators supported it. Democratic House Speaker Hannah Pingree did not respond to a request for comment on the initiative.
There are two main issues that stymie efforts to legalize and distribute marijuana for medicinal purposes. One is the ongoing debate within the medical community over whether the drug is the most effective and least harmful method of treating symptoms arising from cancer treatment, AIDS and other afflictions. The other is the federal government’s refusal to reclassify marijuana from an illegal substance with no medical benefit to a drug with recognized benefits that can be researched and provided under controlled circumstances.
There are reasons to believe both those battles are turning in favor of medical marijuana advocates.
Doctor vs. Doctor
Last January, the American College of Physicians released a position paper urging the federal government to reclassify marijuana, protect patients and doctors from seizure and prosecution, and increase research into the drug’s potential as medicine. The paper, “Supporting Research into the Therapeutic Role of Marijuana,” also cited strong evidence of the drug’s efficacy and safety as treatment for a host of debilitating conditions.
The ACP — the second-largest physician association in the U.S., and publisher of the prestigious Annals of Internal Medicine — is one of dozens of medical and health organizations advocating for medical marijuana, including the Institute of Medicine, the American Public Health Association, the American Nurses Association, and the Leukemia & Lymphoma Society.
The American Medical Association — the nation’s largest group of doctors — has also called for more research, but has thus far been unwilling to advocate for the legalization of marijuana for medicinal purposes. Some other major health groups, like the American Cancer Society and the National Multiple Sclerosis Society, are similarly conflicted, especially over the issue of smoking the drug, given the complications associated with that method of ingesting it.
When Strimling’s bill was being debated last year, Andrew MacLean, a lawyer with the Maine Medical Association, was among those who testified against it. “While some individuals may find benefit from the medical use of marijuana,” he said, as quoted by the Bangor Daily News, “the weight of scientific evidence supports the use of prescription [drug] alternatives for each of the conditions covered by the legislation.”
The most prominent — and hotly debated — prescription alternative is Marinol, a pill containing a synthetic form of THC (the major psychoactive ingredient in marijuana). Marinol is trademarked and sold in the U.S. by Solvay Pharmaceuticals, an arm of Solvay, a giant multinational company based in Belgium that also produces chemicals and plastics.
Though the use of Marinol does not carry the risks associated with smoking, many patients find it a less effective and more unpleasant alternative. For those suffering from nausea or persistent vomiting, swallowing a pill may simply not be an option. And as the ACP paper states, oral THC is slower to provide relief and “produces more pronounced, and unfavorable, psychoactive effects that last much longer than those experienced with smoking.”
Among many who signed Tony’s petitions on Election Day at Reiche Elementary School, this debate is already over.
A nurse with dark circles under her eyes, still wearing her scrubs and hospital badge, approached Tony’s folding table that day. “I’m in oncology,” she said. The way she pressed the pen hard against the page as she signed made further explanation unnecessary.
A man in his 40s leaned in close and told Tony he smokes everyday. “I have MS,” he said. “I can eat. I can go outside. I can function as a person. Pain pills don’t do shit.
“I have to get [marijuana] myself,” he added. “I don’t care if I get arrested. I’ll do it till I die.”
The War on the Sick
Besides the health care professionals who oppose medical marijuana, the other principal source of opposition comes from the law enforcement community, though that group is not unanimous in its position, either.
Last February, as the current petition drive was ramping up, Kennebec County Sheriff Randall Liberty was among those voicing opposition on grounds that the legalization of medical marijuana is a step toward legalizing the drug for recreational use. “As a society we have already made the mistake of legitimizing alcohol and tobacco use,” the Morning Sentinel quoted him saying. The paper reported that Liberty claims drug dealers “try to hide behind” Maine’s current medical marijuana law.
That’s exactly why proponents say the state needs a system to identify users with a legitimate need for the drug and growers who harvest it exclusively for patients.
“I’ve had some cases where I’ve been convinced when we were seizing the drug that this person was a patient and this was their strategy to deal with it,” said Cumberland County Sheriff Mark Dion, an early and vocal proponent of medical marijuana. Without a state-issued ID card, it’s difficult to discern patients from ordinary potheads. Once the drug is seized, “the burden shifts to them,” said Dion, “and I guess they can get a doctor [to vouch for them], or they convince the D.A. through some sort of medical history why they were doing what they were doing, then she can exercise her discretion if she chooses to.”
Yet, even if Maine created a state-sanctioned distribution and ID-card system, “You’re still going to run into the shadow of the federal government,” Dion said.
Although 13 states have laws permitting the medicinal use of marijuana, and California and New Mexico have grower-certification systems in place, the federal government does not recognize these laws as valid exceptions to its blanket prohibition of pot, leaving patients, caregivers and growers vulnerable to federal intervention and prosecution.
The Drug Enforcement Administration’s actions against patients and providers have escalated during the Bush administration’s tenure. As University of Southern Maine professor Wendy Chapkis detailed in a recent book she co-authored, Dying to Get High: Marijuana as Medicine, patients with state-recognized documentation have been arrested, homes and dispensaries have been raided, and landlords of registered dispensaries in California have been threatened with property forfeiture if they continue to rent space for cultivation and distribution.
“I think I’m more convinced today than I was years ago that there has to be a fundamental change in drug policy at the federal level,” said Dion. “Now I hope [with] all these states that passed the medical marijuana law that it’s going to create some momentum for somebody who’s taken a deep breath in Washington to say, ‘We should really sit down and sort this thing out.’”
Many proponents expect Barack Obama’s ascendance to the White House will create just that opportunity.
While on the campaign trail in August of last year, Obama reportedly told Scott Turner, a medical marijuana patient in New Hampshire, “I would not have the Justice Department prosecuting and raiding medical marijuana users. It’s not a good use of our resources.” Last May, when asked by a reporter for the Willamette Week if he would stop the DEA raids in Oregon, Obama said, “I would, because I think our federal agents have better things to do, like catching criminals and preventing terrorism.” Obama went on to say that if there is sound science to support marijuana use for medical purposes, he thinks it should be controlled and regulated like other medicines.
The fear that legitimizing marijuana use for medical purposes will be a stepping stone to wholesale legalization played out at Tony’s table at Reiche.
As Tony called out to the steady stream of voters leaving the polls — “Maine medical marijuana!” — a young man’s eyes lit up. “Hell yes!” he said, signing with a lurid smile. As the guy walked away, Tony felt compelled to tell him, “It’s for people who need it, not want it.”
One woman who walked past his table said, “I don’t support that.” Tony motioned to her, calling lightheartedly, “Come on.” She doubled back and glared at him: “If you had neighbors smoking pot all day and night, you would feel the same.” Tony shook his head as she strode away, then shrugged. “You can’t get them all.”
The perception of medical marijuana as a Trojan Horse for legalization is fostered in part by the fact some high-profile proponents of medical marijuana also support decriminalizing the plant. For example, Jonathan Leavitt, lead organizer of the Maine Citizens for Patients’ Rights PAC, is also executive director of the Maine Marijuana Policy Initiative, which advocates for the decriminalization, taxation and regulation of the drug.
And many Mainers still don’t fully understand how the current law works — Tony among them.
“Didn’t we already pass this? I think I signed this before he was born,” a woman said to Tony at Reiche, pointing to her 12-year old son. “Nope,” Tony said. “It didn’t pass.” The woman signed anyway, a look of bewilderment on her face.
Many who sign Tony’s petitions aren’t sure what they’re signing; relatively few ask for a copy of the initiative or additional information. And though Tony is committed to the cause from an emotional standpoint, his strong point is not the legalese. He tells those who ask that it will help folks like his parents who had cancer or his friends who had AIDS — a very effective line that more often than not yields a signature. But he also tells people the only place patients can get marijuana now is in a mental institution or cancer ward, which is false. He rarely mentions the proposed registry for non-profit dispensaries or the state ID cards the initiative would create.
In the end, that may not matter. The emotional pull of an act that promises to help seriously and terminally ill people cope with pain and wasting syndrome tends to override other concerns. “My father died of cancer,” a woman at Reiche told Tony before signing. “I don’t smoke it, but I do approve of it.”
“I personally don’t believe in using drugs,” Tony said. “But if people need it, it’s the best way to go.”
Jennifer Goff is a freelance writer and sailor. She recently graduated from Salt Institute for Documentary Studies, where the roots of the article originated. Bollard editor Chris Busby contributed reporting.