Waiting for medical marijuana

The antidrug mafia makes sure Washington state keeps off the grass.

BACK IN 1996, an odd couple of state senators, Seattle liberal Democrat Jeanne Kohl-Welles and Spokane conservative Republican Bob McCaslin, introduced a bill allowing physicians to prescribe marijuana for patients suffering from conditions no other drug could treat. The bill didn't make it through both houses, but funding to explore the feasibility of such a program did.

Kohl-Welles, who has seen up close how marijuana can alleviate the agonies of cancer patients, was disappointed that her bill did not pass but satisfied that at least a start toward addressing the problem had been made. Four and a half years later, she is far from satisfied. Furious might be a better word to describe her feelings about the combination of bureaucratic inertia, academic fecklessness, and deliberate administrative obstructiveness that have rendered impotent the clearly expressed will of both the Legislature and the people of this state.

The $130,000 the Legislature allotted was to be split between two projects. $70,000 of the appropriation was spent on an experimental-protocol design from Mahmoud Abdel-Monem, then the dean of Washington State University's pharmacy program. "That turned out to be a total waste of money," Kohl-Welles says today. "All the experts we had look at the plan said it was so flawed that it would be scientifically useless."

The rest of the money was supposed to be devoted to determining guidelines and soliciting permission from federal authorities for a pilot medical-marijuana program. This facet was made the responsibility of the executive director of the state Board of Pharmacy, Donald H. Williams. "I kept checking with Don over the ensuing months," says Kohl-Welles, "and he kept telling me that his office was in the process of getting a proposal to the feds together.

"After a year of this, I was getting very upset that nothing apparently was being done. It turned out that the Board of Pharmacy members had not even been informed of the project. I wrote a letter expressing my feelings to Don's boss, [then-Secretary of the Department of Health] Bruce Miyohara, who directed Don to get to work on a study." Thus goaded, Williams engaged University of Washington pharmacy professor Allan Ellsworth to put together the long-delayed application.

As spring 1997 turned to summer, Williams repeatedly assured the senator that Dr. Ellsworth's application to the FDA was taking shape, that the attitude at the National Institutes of Health was encouraging, and that he was "optimistic that we can get approval for our study." Still, nothing happened and continued not to happen. Kohl-Welles learned that Williams had been seen and heard in the audience at one of Ken Schram's televised Town Meetings on KOMO TV inveighing against any relaxation in marijuana laws. Finally a tip from one of Ellsworth's UW colleagues led Kohl-Welles to e-mail the pharmacy professor directly to inquire about the status of the application for conducting the clinical trials. "As it's now been one and a half years (as I recall) that you've been working on the application," Kohl-Welles wrote, "I'm beginning to wonder what's going on."

Once again, "nothing" was the answer. "Sorry I haven't prioritized this project as high as you would like me to," Ellsworth replied, but, "I run hot and cold. The reality of the balance of work it takes to prepare an NIH proposal vs. the high likelihood of rejection for bureaucratic hoops certainly dampens the enthusiasm."

Not to worry, though, Ellsworth continued, "The application is 75 percent prepared. Needs some updating, support letters, etc. and it could be ready to go. . . ." Ah, but go where? Despite assurances from Williams that $60,000 the Legislature had appropriated for the marijuana study would be rolled over into the health department's budget for the following year, Kohl-Welles learned that the money had been returned unspent to the general fund.

At this point the people of the state of Washington intervened. In November 1998, voters passed Initiative 692 authorizing physicians to prescribe marijuana when medically appropriate. Surely such a clear citizen mandate would make the bureaucracy sit up and take notice. All that was needed was for the State Department of Health to present to the federal government the terms and guidelines of how a scientific, therapeutic research program on medical marijuana would be carried out in the Evergreen state. Still, nothing happened.

After another year-plus listening to the sounds of silence from the Department of Health, a group of more than two dozen state legislators returned to the attack. In an April 27 letter to new Health Secretary Mary Selecky, they demanded to know why, now that the voters had approved I-692 and the federal government had issued clear, concrete guidelines for studies of the efficacy of medical marijuana, her department continued to balk at instituting such a study.

Selecky's May 26 reply barely condescends to respond to the legislators' demand for an answer. Instead it reviews, in highly selective and defensive fashion, the impediments that contributed to its failure to act in the past, the difficulties inherent in gaining federal approval for such studies, and niggling imprecisions in I-692 (How must a physician document the decision to prescribe marijuana? What is "a 60-day supply"?). "After review of current federal guidelines for medical-marijuana research," Selecky writes (without supporting her assertion) "we are convinced that the obstacles to a therapeutic research program as you propose are formidable."

In bolstering her position, Selecky also refers to "a report entitled Implementation of Initiative 692: The Washington Medical Use of Marijuana Act." This "report" is certainly worthy of study, not so much for the support it offers the Secretary's arguments as for the evidence it provides of how legislative and popular will can be obstructed under the guise of nonpartisan community consultation, with the taxpayers footing the bill for their own disempowerment.

The report in question was the work of a group called "The Governor's Council on Substance Abuse," which operates bizarrely under the auspices of the Department of Community, Trade, and Economic Development. As its title suggests, the group's membership of 24 is dominated by police officers, social service professionals, and antidrug program representatives, and includes not one person active in the therapeutic field.

Although the 23-page document issued by the group in January 2000 is described on its cover as "a report to the Legislature," legislators did not receive copies of it, nor did Governor Locke, despite his name above the title, request any such report be made to him. "The Council decides what subjects it wants to advise the governor on," says the group's staff coordinator Dr. (of Education) Carol Owens, whose salary, along with the rest of the Council's expenses, is covered by federal block-grant monies. "They felt this subject was one [on which] they had something important to contribute."

The contribution, apart from some commonsense advice for clarifying I-692's vague reference to "60-day supplies," is restricted to four recommendations: to further emphasize (and fund) programs publicizing the dangers of marijuana, to provide more programs to break young "abusers" of their vice, to clarify the status of a hypothetical patient affected differently by state and federal law, and, finally, "to track the consequences of the initiative"—assuming there ever are any to track.

"What leaves me so outraged and offended looking at this report and at everything that's been going on all these years is the total silence about the people [I-692] is supposed to help," says Kohl-Welles, "the total lack of any consideration for the painfully ill and terminally ill. There's no mention of them, no consideration for them." And no Governor's Council on Patient Needs and Rights to speak for them, either. No one to make the case that, in Kohl-Welles' words, "pain and suffering are nonpartisan."

For more on medicinal marijuana, visit this pro-medical marijuana site, or access this article regarding federal attitudes on the subject.

 
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