Tokin' Resistance

Proposition 200 -- the Drug Medicalization Act -- is causing high anxiety among politicians and lawmen

"The voters have spoken," Lundgren said. "We must now act responsibly to carry out this law, as the voters intended. We must realize voters meant that marijuana should be used only as an occasional exception, for someone who is seriously suffering and under the direct supervision of a physician."

Arizona lawmen have been slower to respond.
"Frankly, we're not at the point where we can make that kind of statement," says Romley spokesman Bill FitzGerald, adding that "there's still too much that needs to be ironed out" before prosecutors advise police on how to follow the new law.

The physician is a busy man, with a successful practice and a case load of more than 125 patients.

He is an oncologist, a specialist at fighting the cancers that will afflict one in five of us, and he has agreed to talk--briefly--about drugs, a topic about which he knows a great deal. With a flourish of his hand, he can summon forth the newest, most expensive, most heavily regulated substances known to man and bring them to bear on his patients' miseries.

His comments come with one condition: that his real name not be used. "So, you're gonna call me 'Dr. Smith'?" he jokes. "I think I like the sound of that more than 'the Pot Doctor.'"

His request for confidentiality is understandable. Marijuana and its medical use is still a topic of debate within the corridors of medicine. According to a 1991 study published in the Journal of Clinical Oncology, 44 percent of cancer specialists like Dr. Smith supported marijuana as an effective treatment for the nausea that often accompanies chemotherapy.

So, are members of the medical profession itching to exercise their newly won powers to prescribe joints to their patients? The doctor laughs.

"I'll just say we're all watching it all very closely," he says. "I don't think anyone is willing to put their licenses or their professional reputations on the line over this just yet."

Part of the problem, he says, is that Proposition 200 requires doctors to cite scientific research supporting the prescription. "And the fact is, that research just isn't out there right now," he says.

But, hey, 44 percent of oncologists can't be all wrong.
Dr. Smith says he first learned about marijuana's peculiar qualities, which include a calming of the stomach and a stimulation of the appetite, during an uncontrolled experiment in college. "Let's just say I inhaled," he says. The first time he ever "prescribed" it to a patient, though, was during his residency, more than a decade ago.

"Really, the guy approached me about it first," he says. "He was mid-40s, pretty advanced case of pancreatic cancer. Just miserable. And one day he just asked me flat-out, 'What if I smoked marijuana?' None of the other antiemetics [stomach-soothing drugs] were doing him much good, so I figured, well, it certainly couldn't hurt."

And it didn't, Smith says. Though the man later died, the marijuana went a long way toward easing his suffering. Since that time, Smith says, he has suggested it to "more than a few" patients, but with caution.

"Obviously, if it's some babushka who looks like she's never seen it before, I'm not going to come out and say, 'Hey, grandma, you know how to roll a joint?' But if it's someone who looks like they're probably pretty familiar with it, grew up around it, then I might ask, 'Hey, can you get pot?' And usually, it's not that tough."

Smith's opinion of the drug is a stark contrast to that of another physician who admits to inhaling, Dr. Michael Loes, director of the Arizona Pain Institute at Maricopa Medical Center. Loes says pot complicates things because of its interaction with other painkilling drugs. He feels so strongly about it, in fact, that he's likely to tell patients who get high to take a hike.

"There are patients who tell me they smoke pot for pain, and if that's the case, it alters our relationship," he says. "I will not prescribe opiates [drugs derived from opium such as morphine and Dilaudid] to a patient who smokes pot. Period.

"Marijuana is a mind-altering drug, and it's problematic in any pain-management program, especially when you start getting into the potency of the stuff [pot] that's out there today."

Loes adds that approved drugs such as the latest batch of powerful antiemetics and synthetic forms of THC obviate the need for doctors to prescribe pot.

Not surprisingly, the Arizona Medical Association remained officially neutral throughout the election and has yet to state an official position on the matter.

"I don't think you're going to hear too much from us until the Legislature is finished fleshing it out," says Tania Graves, ArMA spokesperson. "There's just too much up in the air right now."

It is not clear what, if anything, the Legislature--or anyone else--can or will do to tweak Proposition 200 now that it has become law.

On December 6, Governor J. Fife Symington III announced that he would not veto Proposition 200, as he had threatened to do on election night. In "allowing" the law to take effect (there were compelling arguments that Symington lacked the authority to veto a voter-approved initiative), the governor declared that the Legislature could make needed adjustments to the law.

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