The number of Oregon patients allowed to use the drug soars to nearly 10,000, which some see as a success and others a problem

Sunday, January 23, 2005
DON COLBURN

Nearly 10,000 Oregonians carry medical marijuana cards, about 20 times more than officials predicted when the program started six years ago.

The fee-based program, which gets no money from the state general fund, has grown so fast that it built up a cash surplus of nearly $1 million last year.

To reduce the surplus, officials slashed the annual fee for a medical marijuana card from $150 to $55 this month. For Oregon Health Plan patients, the fee dropped to $20.

The number of cardholders has doubled in less than two years. Between 80 and 100 new or renewal applications arrive on a typical day, said Pam Salsbury, who manages the state's medical marijuana office in the Department of Human Services.

"I don't think anybody in their wildest dreams thought there would be this many people in the program," Salsbury said. "We're hearing from other states that have a program and wonder how we do it."

Critics say the unforeseen growth shows that medical marijuana cards can serve as a cover for recreational drug use. Defenders say it reflects growing acceptance, by doctors and patients, of marijuana as an alternative to mainstream medicine.

Oregon is one of 10 states where medical marijuana use is legal. The others are Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Vermont and Washington. The laws vary widely.

Oregon's Medical Marijuana Act, approved by voters in 1998, allows residents to use a small amount of marijuana for medical purposes. They must grow their own or designate a caregiver to do so for them.

A doctor must verify that the patient has a "debilitating medical condition" such as cancer, glaucoma or AIDS, or a symptom such as nausea or severe pain. The doctor's signature does not count as a prescription.

More than 1,500 Oregon doctors have signed at least one patient application, according to state figures through 2004. But 10 doctors account for two-thirds of the current and pending marijuana card requests.

Each of those 10 physicians has signed more than 100 applications, and the top two have signed 2,796 and 1,783 apiece. The state does not divulge the names of participating doctors.

"Loopholes for abuse"

"Unquestionably, people are taking advantage of a system that was created for individuals with medical problems," said Ken Magee, the Drug Enforcement Administration's agent in charge of operations for Oregon and Idaho.

The federal agency, he noted, considers marijuana a dangerous drug with no medicinal value.

Oregon's medical marijuana program has a "very lax system of review and oversight," Magee said. "The law is riddled with loopholes for abuse."

Qualifying conditions such as "severe pain" or "persistent muscle spasms" are so vague that they allow little rigorous control over misuse, he said.

More than 80 percent of the current cardholders cited severe pain on their applications. About 30 percent cited persistent muscle spasms, and 22 percent cited nausea. Applicants often give more than one medical reason.

Colorado's 4-year-old medical marijuana program is modeled on Oregon's. Despite a larger population, Colorado has only 504 cardholders, about one-twentieth as many as Oregon.

After an Oregon patient's application for a medical marijuana card is complete, Salsbury said, the state sends the signing doctor a letter. The doctor must sign a second form verifying that he or she did see the patient and did approve the card request.

Once the application is complete and verified, she said, the state issues a card. Under the law, officials don't evaluate motives.

"That's not for us to question," she said.

State disciplines two doctors

Two doctors -- Dr. Phillip Leveque of Molalla and Dr. Larry Bogart of Roseburg -- have been disciplined by the Oregon Board of Medical Examiners for inappropriate recommendation of medical marijuana. The board regulates medical practice.

Leveque, an 81-year-old osteopath, had his license suspended in March and revoked in October. He said he had signed several thousand medical marijuana requests.

The board in October also stripped Bogart, a 66-year-old psychiatrist who said he has signed more than 1,000 medical marijuana applications during the past five years, of his ability to treat children, prescribe controlled drugs or sign marijuana card applications. He retains his license.

The Oregon Medical Association, the largest physicians group in the state, stayed neutral on the original medical marijuana law in 1998. The association opposed a ballot measure last November that would have broadened the law, easing restrictions on allowable limits and creating state-regulated dispensaries to sell marijuana to cardholders.

A federal appeals court in California ruled in 2003 against the Bush administration's bid to punish doctors who recommend medical marijuana to their patients. Since that court opinion, fewer doctors in Oregon are afraid to sign medical marijuana card requests, said Jim Kronenberg, the medical association's chief operating officer.

"We continue to encourage our members to be very circumspect about how they participate," he said. Doctors are urged to keep careful records and avoid even the appearance of prescribing an illegal drug.

Advocate sees more acceptance

John Sajo, who heads Voter Power, an advocacy group for medical marijuana users, attributed the rapid growth in the Oregon program to increasing acceptance by doctors. He said marijuana helps some patients avoid more potent and expensive prescription drugs.

"It's not just the patients saying they feel better," he said. "It's also the patients saying: 'And don't write me the morphine prescription anymore.' "

Others say marijuana is a "gateway drug" that can lead to using more addictive drugs.

"We're making a big mistake in making marijuana available," said Walt Myers, Salem police chief and head of Gov. Ted Kulongoski's task force on methamphetamine. "There are enough drugs on the market that will relieve the pain of any disease known to mankind, without resorting to marijuana."