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Originally published May 21, 2008 at 12:00 AM | Page modified May 21, 2008 at 1:00 AM

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Medical marijuana: How much is enough?

A state Health Department proposal that medical-marijuana patients be allowed more than 2 pounds of pot every two months took law enforcement...

Seattle Times health reporter

Diseases and conditions thatqualify a patient for medical marijuana in Washington state

Cancer

Human immunodeficiency virus (HIV)

Multiple sclerosis

Epilepsy or other seizure disorder

Spasticity disorders

Intractable pain, that is pain unrelieved by standard medical treatments and medications

Glaucoma, either acute or chronic, that is unrelieved by standard treatments and medications

Crohn's disease with debilitating symptoms unrelieved by standard treatments or medications

Hepatitis C with debilitating nausea or intractable pain unrelieved by standard treatments or medications

Diseases, including anorexia, which result in nausea, vomiting, wasting, appetite loss, cramping, seizures, muscle spasms, or spasticity, when these symptoms are unrelieved by standard treatments or medications.

Any other medical conditions approved by the state Medical Quality Assurance Commission in consultation with the Board of Osteopathic Medicine and Surgery

Source: Revised Code of Washington, Chapter 69.51A Medical Marijuana

A state Health Department proposal that medical-marijuana patients be allowed more than 2 pounds of pot every two months took law enforcement by surprise and prompted the governor to tell health officials to start over.

Faced with a legislative mandate to spell out what constitutes a "60-day supply" by July 1, the department in February briefed Gov. Christine Gregoire's office on its recommendation: Patients or caregivers could possess up to 35 ounces of cultivated marijuana and be allowed a plant-growing area of 100 square feet.

Gregoire promptly directed Department of Health Secretary Mary Selecky to solicit more comment from law enforcement and medical providers. "I wouldn't say she was upset" by the amount, said Gregoire's spokesman, Pearse Edwards, but she believed input had been one-sided.

The issue of how much marijuana a patient needs remains one of the most contentious parts of the law voters passed in 1998, which allows patients with certain chronic, fatal and debilitating diseases to possess a 60-day supply of marijuana with a doctor's authorization.

Last year, in an effort to help end conflict between law enforcement and patients or their pot-growing caregivers, the Legislature directed the state Health Department to define how much marijuana patients can possess under the law.

In four hearings around the state last fall, hundreds of patients and medical-marijuana advocates lined up to speak. But conspicuously absent from most hearings were the voices of two important "stakeholders": doctors and law-enforcement officials.

Doctors have a stake because under the law, they must authorize qualified patients to use marijuana.

And law-enforcement officers have a stake because they must decide whether to treat pot smokers and growers as patients or criminals.

Why the detour?

Now the Health Department says it can't meet the July 1 deadline for a final rule, though it hopes to have an official draft by then so it can gather public comment during the summer. Once it makes a decision, it isn't subject to a veto by the governor, although Selecky ultimately answers to Gregoire.

Medical-marijuana activists suspect the process got derailed by objections to the amount of marijuana the department planned to propose. Some worry that a process supposed to be guided by science has been hijacked by politics.

Officially, law-enforcement leaders say they just want a number — any number — for the amount of pot qualified users can possess. They say they're not doctors and they wouldn't presume to set an amount any more than they would tell a patient how much cholesterol medication to take.

But when pressed, they express discomfort with the amounts revealed to the governor in the briefing.

Don Pierce, executive director of the Washington Association of Sheriffs and Police Chiefs, said he's been invited to an upcoming "stakeholder" meeting by the Health Department. He said the amounts originally proposed by the department "fly in the face of reasonableness from our perspective."

At 35 ounces, the amount of usable marijuana the health department planned to recommend is nearly a kilogram — 2.2 pounds — Pierce said. "That's a lot."

Cowlitz County Sheriff Bill Mahoney says the whole issue is now "very, very difficult for law enforcement to deal with" because nobody knows what constitutes a 60-day supply.

"From my standpoint as a sheriff, I just need the state to step up and define it. I don't care what the number is."

But, he adds: "Most of our cops, if they were forced to come up with a number, they'd say 3 ounces."

Basis of calculation

How did the state Department of Health (DOH) calculate the amount? According to its briefing memo, obtained through a Public Disclosure Act request, the department began with the average dosages given to a handful of patients enrolled in a federal medical-marijuana program.

It doubled that amount, because some patients might eat the marijuana instead of smoking it.

Sunil Aggarwal, a University of Washington medical and doctoral degree student who studies "medical cannabis" there, says the department's calculation used an incorrect multiplier.

Because "oral administration" of medical marijuana is much less efficient than smoking, the limit should be about 71 ounces for 60-day supply, he has told health officials.

The 35-ounce amount is more than permitted in some places that allow medical marijuana use, but less than others. For example, Oregon allows 24 ounces of usable marijuana and six mature plants, while limits in California counties and cities range from 8 ounces to 3 pounds in Humboldt, Santa Cruz and Trinity counties, the Health Department's memo said.

The federal program, called "Compassionate Investigational New Drug"program, supplies a limited number of patients with 300 to 450 "joints" per month, or about 9 ounces, according to department research.

Karen Jensen, an acting assistant secretary for DOH, said the department is now conducting "informal conversations," with law-enforcement officials and medical providers.

"The rule needs to be something that works for law enforcement and the medical community and the advocacy community," Jensen said, although she and the governor's office deny that the current process is a "negotiation."

Aggarwal says he worries that there is political "backdoor dealing" going on, with law enforcement at the head of the table. "This was supposed to be a public process, and it was supposed to be based on the best available medical science. ... That's why it went to the DOH in the first place."

Jensen maintains "definitive science" is scarce. "We don't have some standard out there that we can go to. There are studies and reports, but no hard-core science out there for us to lean on."

Guidelines

The Legislature told the Health Department to base its decision on research, expert advice and public input. Public input, so far, has been overwhelmingly from patients and advocates.

Tom Curry, executive director of the Washington State Medical Association, says Selecky recently sought some names of doctors knowledgeable about medical marijuana or patients with conditions authorized under the law, such as cancer, HIV, or multiple sclerosis.

One is Dr. Bob Wood, director of the HIV/AIDS Program for Public Health — Seattle & King County.

Wood, who doesn't care for patients directly these days, says he doesn't authorize patients under the law, but he did march to Westlake Plaza during the recent "free marijuana" rally.

Watching a few rail-thin patients in wheelchairs "smoking up a storm," Wood said he thinks there's "a lot of variation" in what patients need. Some may just need the occasional hit to deal with pangs of nausea, but some with serious or fatal diseases may simply want to stay high all the time.

"I would say, if that person isn't driving a school bus or driving down the road in a wheelchair, I don't see how they're hurting anybody," Wood says.

Still, despite state laws allowing medical marijuana use — and the very limited federal program — it remains illegal under federal law.

And because "science has been effectively blocked by the feds," Wood says, it may be hard for the health department to settle on a hard-and-fast number.

Pierce, a former Bellingham police chief, says sheriffs and police chiefs have always maintained that setting a limit on a 60-day supply "is really a medical decision that should be determined by physicians."

His group, he says, has told the department: "You shouldn't be talking to the law-enforcement community to find out what the right number is, any more than you should be talking to the advocate community."

But on this issue, Pierce says, doctors aren't willing to step forward. "Most physicians are reluctant to identify what the appropriate supply is, because many of them don't feel there is an appropriate supply."

Law enforcement's interest is simple, he says. "We don't want folks who are involved in the sale of drugs to be able to hide behind the medical-marijuana law. Because we think that's not good for our community ... [or] for the people who have a legitimate use for medical marijuana."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

Copyright © 2008 The Seattle Times Company

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