By Oz Hopkins Koglin
of The Oregonian staff
Defying the law and mainstream medical practice, an outlaw clinic in downtown Portland is dispensing marijuana to sick and dying people.
Patients who suffer from arthritis, multiple sclerosis, AIDS and other chronic diseases can buy an eighth of an ounce of marijuana - about enough for four or five joints - for anywhere from $20 to $50, depending on their income. Marijuana cookies are sold in $2 packs. A brownie goes for $3.
A volunteer wraps marijuana cookies at a self-styled alternative clinic in Portland. [photo credit:] Joel Davis, The OregonianSince the clinic opened six weeks ago, patients have found it through word-of-mouth - friend telling suffering friend, perhaps in a HIV doctor's waiting room or in a pain clinic. Although they consider themselves primarily patients, they also are political activists.
And when they slip from the wheelchair-width elevator into the clinic's lobby, they land in the center of a national debate that last week pitted top drug scientists against pro-marijuana activists.
Critics of legalizing marijuana for medical use have butted heads for years with those who would allow it. Opponents suspect approving medicinal marijuana is a roundabout way of legalizing the drug for everyone.
Supporters - at the least - want controlled scientific studies assessing marijuana's potential benefits, and their cause received a huge boost Thursday when a panel commissioned by the National Institutes of Health recommended that.
At the Portland clinic, patients are not willing to wait. They know what they are doing is illegal. But local authorities acknowledge that, in general, they put a higher priority on dealing with violent crime and flagrant drug dealing than with seriously ill people discreetly
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"It's obvious what we are trying to do here. It might be illegal, but it sure is not immoral," said Joe, 34, who has the AIDS virus and suffers severe low back pain. Like most of the people at the clinic, Joe, a vocational counselor, did not want his full name published.
"Nobody here is acting like an idiot. There is nothing going on here except us trying to ease our lives a bit," he said.
Patients carefully protect the center's secrecy. A reporter, who heard about the clinic from a patient, was allowed to visit on the condition that the location would not be disclosed. The address and telephone number are not published in any public directory.
"We are concerned about vandalism, about our safety when it comes to people thinking that there are a lot of drugs here and a lot of money. And we are afraid of being accosted outside on the street," said Diane R. Densmore, a patient who complains of chronic back pain, irritable bowel disease, scoliosis, arthritis and depression.
If visitors are expected, a 73-year-old cookie-munching security guard waves them inside the doors.
A shelf piled with medical pamphlets, books and magazines slices the room. The reception area is on one side; the other is for treatment.
The patients who come here are not satisfied with the conventional medical care they receive. As a group, they are angry because laws allow doctors to prescribe heavy opiates, but not marijuana, a drug that they say relaxes and comforts and brings back their appetite.
"It's a miracle drug, you can function on it. It really saved my life and kept me alive and actually made it so I am back on the transplant waiting list," said Doug, 41, an insulin-dependent diabetic whose kidneys are failing.
A year ago he was on a waiting list for a kidney but had to be taken off because he was stricken by a rare gastrointestinal complication that prevented him from digesting food.
"I had to smoke marijuana in order to eat, and then smoke some afterward to keep that food down," Doug said.
In addition to consuming marijuana in one form or another, visitors can pick up printed information on marijuana: how to eat it, make tea and tincture and use it as a compress. However, most patients say they prefer a regular pipe or water pipe to better measure the amount that they use.
Clinic organizers prohibit using marijuana on the reception side of the room, but patients can buy their "medicine" at a pickup window.
No one will say how the center gets the drug for distribution or how the center is supported. The only profit is a few dollars from home-baked marijuana-laced cookies and brownies patients sell to one another, Densmore said.
"I only know that we have the promise that if we need medicine it will be here for us. All we know is it is here for us," she said.
To become members, as the center calls its regular patients, visitors must show photo identification. Some patients have a doctor's letter stating a diagnosis, such as multiple sclerosis, arthritis, glaucoma or AIDS. Patients say in some cases their doctors know about their marijuana use, but the letters are simply a statement of diagnosis and are not a sign of the doctors' support of the treatment. New members waive confidentiality so the clinic can verify their diagnoses.
The treatment area is homey. Old chairs and comfortable futon couches are available for resting, and a couple of kitchen tables are stacked with fruit baskets and assorted large bags of potato chips, pretzels and candy suckers. Juice and purified water are free.
Out of consideration for people with asthma, no cigarette smoking or incense burning is allowed in the center. During two visits on separate days, there was hardly a hint of smoke in the room.
A young man, steadying himself with a walking cane, takes a glass water pipe from a shelf, inhales and makes his way back to a chair.
Mike, 30, who was in the catering business, has full-blown AIDS. His treatment is free of charge because he has been unable to work. His weight has dropped from 180 to 139 on his 5-foot-10-inch frame, and his baggy clothes look three sizes too large. He rolls up his sleeve to show fungal sores on his arm.
"I am really sick, but this helps me. I take 19 pills a day, but I think that if all I did was smoke marijuana all day I would feel better," he said. "This is a plant and natural and makes you feel good."
Literature at the clinic, known as the Alternative Health Center, points out some side effects of using marijuana, such as hunger, giddiness, uneasiness, short-term memory loss and drowsiness. It warns patients not to drive an automobile or operate heavy machinery. Critics of marijuana use say it also causes paranoia and severe mood changes.
Another patient, Jan, 44, is a retired registered nurse. She says marijuana relieves the muscle spasms associated with her multiple sclerosis, a chronic nervous system disease.
"Because of my 20 years of medical experience I have no faith in the present medical system at all, and I have to do what helps me," Jan said. She pursued marijuana after seeing a mention of it in an old issue of the Journal of the American Medical Association.
Densmore is among the center's patients who were members of another Portland-area cannabis-buyers group that fell apart because of internal disagreements about how the group should operate. The emphasis this time is on harmony and caring. Each of the 124 patients is a member or volunteer. There are no officers.
Cannabis buyers clubs have cropped up around the country in the past several years as a way for chronically or terminally ill people to buy marijuana. The most prominent one, founded in San Francisco by Dennis Peron in 1991, was an open secret until authorities shut it down last fall. Now under its new name, the Cannabis Cultivators Club, it operates under the protection of California's new law.
The ScienceMost of the few scientific studies completed have found that marijuana is not as effective as conventional treatments for a variety of ailments. But even the National Institute on Drug Abuse has found that in some key areas - pain control, for example - no conclusive controlled studies have compared marijuana to other drugs.
Many Portland doctors know that their patients use marijuana and look the other way. But in some cases, doctors caution patients against the drug's known side effects.
For example, Dr. Mark O. Loveless, director of the AIDS/HIV Program at Oregon Health Sciences University, says that marijuana will make patients with AIDS dementia more confused and that the smoked substance might have ill effects on the lungs.
However, there is no doubt that marijuana has an anti-nausea and anti-anxiety effect and it increases appetite, said Loveless, who has treated AIDS patients since the epidemic began 15 years ago.
Marinol, a legal marijuana extract that doctors can prescribe, works reasonably well in treating nausea, anxiety and wasting syndrome, he said, but some people say that leaf marijuana has more active agents than Marinol and therefore produces additional benefits.
"What we really need, and what we deserve to have - patients and doctors and everyone concerned - is to see evidence for medical indications. We need to have that data," Loveless said.
But Dr. William M. Bennett, a professor of medicine and pharmacology at Oregon Health Sciences University, says all people have to do to study marijuana is submit an acceptable protocol to someone who wants to do the research. But he thinks such studies would be futile because marijuana has been surpassed by superior medicines.
"It is obvious that anybody would be in favor of a treatment that worked and was safe for a patient," said Bennett, a vocal critic of illegal drug use. "However, it is not good medicine or good science to prescribe something that has not been proven to be effective and safe.
"You might as well let anybody do anything they want, which opens the door for impure products. And I think that if one has smoked marijuana they have to be responsible for the consequences of driving under the influence."
Densmore said the goal of the center is to get a federal grant to study the medical properties of marijuana. She said a scientist is working on a grant proposal for the group to submit. Despite her effort, a federal grant for the illegal operation seems an unlikely prospect.
For one thing, Densmore, the closest thing the center has to an official spokeswoman, was convicted in 1990 of possessing a controlled substance, marijuana, in her home and served two years doing community service. She said she was using it for medicinal purposes but would not disclose the amount of drug involved.
Densmore knows she and others who visit the clinic are in the eye of the storm over medical marijuana. But their greatest fear is not the police or the bad publicity, they say, but the chance they will not be taken seriously.
They do not want to be lumped in with people who use marijuana recreationally. In fact, they are against legalizing the drug for nonmedical consumption, and they do not want to be saddled with the druggie image.
To that end, people at the center avoid street terms for marijuana, such as weed or pot. Rather, they almost always refer to it as medicine, product or medical marijuana.
The LawOregon law makes no formal exception for marijuana grown, delivered, sold or used for medicinal purposes.
Somebody with no criminal record who is convicted of possessing more than an ounce of marijuana but less than 5.4 ounces could be slapped with 18 months of probation, according to Oregon's sentencing guidelines. That would include drug treatment and random urine tests to be sure the person has stopped using marijuana. Possession of less than an ounce is punishable by a fine.
The penalty is stiffer for people who possess marijuana and, as would be the case with the clinic, also appear to be selling it.
A conviction for dealing, or "delivering," less than 5.4 ounces of marijuana for someone with no prior record could mean two years' probation and possibly some jail time or a fine.
A larger amount or a more involved drug-dealing operation, where guns, cash or other evidence is found, could net a year and a half in prison for the offender. But the judge could opt for probation and drug treatment.
For most first offenses, particularly in Multnomah County, probation and drug treatment rather than prison time is the norm, said Gary Meabe, senior deputy district attorney in charge of the felony drug and vice unit for the county.
But although Oregon law defines what is legal, the criminal justice system must set priorities. Police tend to go after drug users and dealers who have generated complaints or are otherwise brought to their attention. Prosecutors and judges often look differently at people who can prove they use or sell marijuana for medical reasons.
"Our main focus is in prosecuting drug dealers and marijuana growers. Our focus is not on people who are legitimately using it for medical purposes," Meabe said. "On the other hand, as the DA's office, we're not a policy-making body and those people are breaking the law, and when those cases come to our attention, we have to pay attention to them."
What's Next?The Portland center opened after the recent passage of propositions in California and Arizona allowing physicians to prescribe marijuana for medical purposes.
In Oregon, Rep. George Eighmey, D-Portland, has introduced two bills in support of legalizing marijuana for medical use. One is a resolution that would urge President Clinton and Congress to change the federal classification of marijuana to allow medical treatment.
The second, House Bill 2900, would allow seriously ill Oregon patients to grow their own marijuana for therapeutic use.
Under the bill, a patient would need a doctor's statement - not a prescription - saying that the pa-
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tient might find some relief in smoking marijuana. Patients would then apply to the Board of Pharmacy to find out the amount of marijuana they could grow at home for therapeutic use. The patient would have to consent to inspections by state police, who would monitor whether patients were misusing the authorization.
Eighmey said an editorial Jan. 30 in the prestigious New England Journal of Medicine supporting the use of marijuana in the advanced stages of many illnesses was one of the reasons he drew up the legislation. He also talked with patients who use marijuana and with physicians who are afraid of saying anything favorable about the medical use of marijuana.
"There are those who were willing to tell me, 'Yes. It helps and I would recommend it if I could, but I'm not going to do so because I could lose my license,' " Eighmey said.
Eighmey said the House and Senate could pass his bills and refer them to Oregonians for a vote in the next general election. As for his chances, Eighmey acknowledges his fellow legislators are skeptical.
"They think the subject is not going to make it," he said.
And as much as Densmore wants to see marijuana legalized for medical use, she doesn't like Eighmey's proposal to allow patients to grow their own.
"Frankly, I don't see how it could work," she said.
She noted that patients need different types of marijuana and what works for one person might not work for another. In addition, the average patient would not know how to grow marijuana, she said.
"I would prefer it be regulated by the pharmacies. It is our medicine so it sounds logical to me that the pharmacy could give it to us," she said. "Hopefully it would come from the government or a scientist or the pharmaceutical companies, whatever it takes."
Erin Hoover of The Oregonian staff contributed to this report.
Oz Hopkins Koglin covers medical research for the Health/Medicine/Science Team. Contact her by phone at 221-8376 or by fax at 294-4150.
Oz Hopkins Koglin covers medical research for the Health/Medicine/Science Team. Contact her by phone at 221-8376 or by fax at 294-4150.
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