Marijuana as Medicine

Hawai'i Island has half the registered medical users in the state.

by Don Gronning

In 1979, Dennis Shields' seven-year-old stepson, Ryan Vierra, was suffering uncontrollable vomiting caused by chemotherapy for terminal cancer. According to Shields, the doctor asked him if he could get some grass.
"So I flew to Kona and got some," says Shields. When he returned to Honolulu, he put some towels under the hospital room door at Kapiolani Women and Children's Medical Center and helped the boy smoke marijuana. "One hit stopped the vomiting," says Shields, a long-time marijuana activist who lives in Captain Cook. The boy, whom doctors said would only survive three months, lived another 18 months, something Shields attributes to marijuana. Even if it had nothing to do with prolonging the youngster's life, it made that life more comfortable as the boy struggled through chemotherapy and operations, he maintains.
Shields, 57, thinks use of cannabis or marijuana should be legal, period. He is a Reverend in the Religion of Jesus Church, whose members believe marijuana is a 'holy herb' that augments the worship of God. Shields tried to use a freedom of religion defense when he was charged with misdemeanor possession in the mid 90s. It didn't work.
"I was convicted for my convictions," he says.
In addition to religious use, however, he believes marijuana is effective for a variety of medical conditions. After a couple false starts, in 2000 Hawai'i approved the medical use of marijuana. Since then, people whose doctors certify they have a debilitating medical condition can register with the state Narcotics Enforcement Division and receive a card that allows them to grow and possess small amounts of marijuana.
"I probably got the first card," says Shields, who is disabled with fibromyalgia, a condition that causes severe pain. He adds, "For me and a seven-year-old boy who was in terrible agony, marijuana was a godsend." Shields had testified before the state Legislature and was invited to the governor's office when the bill was signed into law.
Severe pain and severe nausea are two of the debilitating conditions for which people can legally use marijuana in Hawai'i. The other conditions are: malignant neoplasm (cancer); glaucoma; HIV or AIDS; cachexia/wasting syndrome; seizures, including those characteristic of epilepsy; and severe and persistent muscle spasms, including those characteristic of multiple sclerosis or Chrohn's disease. The list is short and specific and not everything that marijuana helps is included, says a Maui physician who has certified about 100 people for medical marijuana. Dr. Robert Ley is a former emergency room physician who opened a clinic in Kihei last February. He specializes in comprehensive pain management. The advertisements he runs in local alternative newspapers on Maui say that he offers diagnostic evaluations and treatment options for chronic pain disorders, including medical marijuana for those who qualify.
"I try to get people off narcotics," says Ley. Many of his patients, including a 75-year-old medical doctor from the mainland, have undergone multiple surgeries.
"He had had seven back surgeries," says Ley, of the physician. "He tells me 'I can take narcotics for the pain' but being a physician, he knows that narcotics are hard on your organs."
Ley says marijuana helped the man to cope with his pain and lessen his use of other pain killers. About half of Ley's patients are 50 or older, he says, although he does have one teenage patient whom he has certified for medical marijuana. That person is a cerebral palsy patient who uses a wheelchair.
"His father says medical marijuana helps his muscle spasms," says Ley. But in general, he says, he is much more resistant to certifying younger patients. For one thing, they don't usually have the medical history that older patients do. Ley says he considers two types of evidence before certifying patients for medical marijuana - subjective and objective evidence. The subjective evidence is what the patient says is wrong. The objective evidence is the patient's medical history, which includes diagnoses from physicians and medical tests that support their claims.
Depression and menstrual pain are among the ailments that Ley believes marijuana can help but aren't covered under Hawai'i law. People with those conditions, documented or not, don't qualify as far as he's concerned.
"Unfortunately, I have to turn them down," says Ley.
According to Keith Kamita, chief administrator of the medical marijuana program for the state's Narcotic Enforcement Division, physicians like Ley, who write dozens of certifications, are rare.
"To have 100 is a lot," says Kamita. Cancer specialists typically certify one to five patients a year, he says.
The Island of Hawai'i has had the most people certified since the law was passed. As of Feb. 1, there were 2,091 people registered to legally use medical marijuana. Of that number, 1,096 were on the Big Island, 359 live in Kauai County, 355 on Maui, 269 on Oahu, five on Molokai, two on Lanai and two on Ni'ihau.
Two physicians on Hawai'i Island account for the majority of this island's patients, Kamita says, with one physician certifying 437 people, and another, 298.
Kamita isn't particularly concerned about the number of certifications a physician writes, only if the physician is a M.D. licensed in Hawai'i to write prescriptions for controlled substances. Naturopaths and other health professionals who aren't licensed medical doctors can't certify patients for medical marijuana. One hundred ten physicians have approved people for medical marijuana use, including 43 on Oahu, 26 on the Big Island, 25 on Maui and 15 on Kauai.
Kamita says the number of people allowed to have medical marijuana has been increasing since the program started. He says the state keeps track by fiscal year - from July 30 to June 1. There were 255 in fiscal 2001, 619 in 2002, 903 in 2003 and 1,787 in 2004.
Patients must re-register annually and Kamita says that the state charges $25 each year to process the form and keep the database updated. He says the program works and that his only criticism is that the $25 isn't adequate to cover the costs.
The database is kept in Honolulu and isn't available to local law enforcement. Police can only check if someone is on the list or not, he says, something they can do 24 hours a day. They don't get a complete list of who is registered.
While Hawai'i and 10 other states have laws allowing marijuana to be used medically, it is illegal according to federal law. So Kamita says people shouldn't try to take their marijuana through an airport, even if they have state approval.
"We don't control the airports and people can and have been stopped," he says.
According to Hawai'i law, patients can possess no more than seven plants and no more than three can be mature plants. They can possess no more than three ounces of usable marijuana. They or a caregiver can grow the marijuana. They cannot sell the marijuana and must register the physical location of the plants with the Narcotics Enforcement Department, Kamita says.
According to the law, patients may not use marijuana if it endangers the health or well-being of another person. They can't use it in any moving vehicle or a school bus or public bus, in the workplace, on school grounds, or at place generally accessible to the public, including parks and beaches.
Marijuana advocates don't have a problem with those restrictions, but say the amount of marijuana allowed isn't adequate. Rhonda Robison is a Hawai'i Island woman who uses medical marijuana for a rare form of muscular dystrophy that causes muscle spasms that dislocate her joints. She says she has been hospitalized 10 times for a dislocated shoulder caused by the spasms, but hasn't had a dislocated shoulder in the last five years.
She says she likes to make marijuana butter, but that requires more marijuana than she normally has. Since she has three children, she only smokes in the evening and then only a bong hit or two.
"I'm responsible," she says.
Rhonda, 33, and her husband, John, 39, are the Kailua-Kona couple who settled a lawsuit with Hawai'i County for $30,000 earlier this year. Police had raided their home and arrested them for having their plants improperly labeled. It was the third time the Robisons had been raided and this time they sued for wrongful arrest. There is no requirement to label plants and police never charged them. John Robison says he got his medical marijuana card the first week they were available. He had undergone two and a half years of chemotherapy for leukemia. While the leukemia is in remission, he says he still suffers after-effects from the chemo. He says marijuana allows him to work as a framer to support his family.
Shields says Hawai'i's law should be more like California's medical marijuana statute, which has no limit. California leaves it up to local jurisdictions to decide how much marijuana patients can have. Shields would like to see Hawai'i drop the mature/immature distinction on plants and permit patients to have up to two dozen plants.
Brian Murphy, 50, is a medical marijuana patient and advocate who has worked for the National Organization for the Reform of Marijuana Laws (NORML). He first got his marijuana card on the Big Island two years ago.
He currently lives on Maui and has started an education and advocacy group called Patients Without Time, headquartered in Pai'a. Murphy says his group will work on the local level to pressure Maui County to expand medical marijuana law. While it's unclear if the counties have the authority to pass such legislation, he would like to see patients allowed to have up to 13 ounces of bud each year and would like to increase the number of ailments that qualify for medical marijuana.
Murphy says his group, which has more than 200 members, will be a for-profit organization. He charges people $100 to belong, although he says he waives the fee for about a third of his members who don't have the money. Murphy provides information on cultivating marijuana and on alternatives to smoking it. There are several ways to ingest marijuana. Ley says most of his female patients prefer not to smoke.
Murphy helps people make a tincture by boiling cannabis in alcohol. It is a dangerous process that he doesn't recommend people try by themselves. Using a tincture allows people to get the full effect of marijuana by placing a few drops on the tongue, although it takes longer than smoking. This was a common way of using marijuana when pharmacies could still sell it before it became illegal in the 1930s.
Murphy also shows people how to vaporize marijuana. One of the criticisms leveled at marijuana use has been about the negative effect smoking has on the lungs and throat. Heating marijuana to the point where its active ingredients turn to vapor, but short of the point at which it combusts, allows people to get the immediate relief without smoking.
No matter how marijuana is used, drug testing can cause problems for patients who want to be employed. Robison's first job after chemo was working for a large retailer and they required a pre employment drug test. When he tested positive for marijuana, the drug testing people called and asked him if there was a reason. He told them there was and provided documentation. He got the job.
That is how it is supposed to work, but Ley says he has had complaints from people who weren't hired after failing drug tests. He says patients tell him they weren't contacted by the drug screening company to find out what type of medication they were taking that may have caused them to fail the test. Ley says the drug screening test results don't go directly to the employer; they initially go to a medical review officer, a physician, who is supposed to contact the patient to see if there is a medical reason for the results. Ley says a medical review officer he spoke with was shocked to learn there was a legal reason to test positive for marijuana.
"He didn't know," says Ley.
Even with its shortcomings, the patients the Journal spoke with say Hawai'i's medical marijuana law is better than no law.
"It's like one doctor said to me," says Murphy. "It's being in jail that's unhealthy."
Using marijuana for medical conditions is natural and effective, believes Rhonda
Robison.
"We believe it is a God-given plant to be used for healing," she says.

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