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The Honolulu Advertiser

Posted on: Monday, December 20, 2004

Doctors express concern over marijuana use

By Robbie Dingeman
Advertiser Health Writer

The number of people in Hawai'i who have registered to use marijuana for medical purposes continues to grow, reaching almost 2,000 since the state Legislature created the program four years ago.

And the number of patients signed up has increased steadily every year, according to Keith Kamita, administrator with the state Narcotics Enforcement Division, which oversees the program.

Yet patients and doctors have some concerns with the state's system, and the U.S. Supreme Court is weighing whether laws such as Hawai'i's are valid.

Last month, the high court heard arguments in a case in which two California women have filed a complaint to prevent the federal government from confiscating their medical marijuana and prosecuting them for its use.

Dr. Inam Rahman, head of the Hawaii Medical Association, said many members of the physicians association are wary of recommending marijuana to their patients precisely because of that conflict between the federal laws that criminalize marijuana use and the state laws that allow its use for certain medical conditions.

Rahman said physicians worry that "the federal government can always come after the doctors." Hawai'i is one of 10 states that have passed medical marijuana laws since 1996.

The system isn't working for every patient.

Kailua resident Ruth Hendrix, 46, said she was disappointed to find that getting access to medical marijuana is more difficult here than it was in California.

"We had stores where you just went to buy it," Hendrix said.

Hendrix said she has used medical marijuana for two conditions: chronic pain and hepatitis C, "which comes with extreme nausea."

She said she went to a local doctor who ran some tests after she arrived in October but the doctor did not want to go through the procedure of registering with the state law enforcement office.

In California, she said she went to the doctor who diagnosed her and wrote a one-page recommendation. Then she went to the store to register, they confirmed the information with the doctor and she could get her marijuana.

She expected a similar setup here. "I was surprised they were so far behind," she said."I have not been successful."

Hendrix said she will wait until after the holidays and then pursue finding a doctor who is willing to register patients.

"I probably made a hundred phone calls," she said.

From his perspective, Kamita said the Hawai'i program works pretty well with only a few complaints each year, usually from patients who criticize doctors who are reluctant to register patients for marijuana.

Kamita said his office does get some complaints from people who report that their neighbors are growing marijuana or calls from police who get those reports. Being part of law enforcement means that his agency will check around the clock.

"If they are registered, we'll verify that with law enforcement."

Another complaint is that Kamita's office won't provide a list of doctors who issue medical marijuana certificates because no state agency should be recommending a specific business or doctor over another.

Here's how the system works in Hawai'i, according to Kamita: A patient visits a physician who indicates that the person has a debilitating medical condition, fills out the application which is reviewed by his agency, and then a medical marijuana certificate is issued.

Kamita said the doctor's role works as a recommendation.

"You can't write a prescription for marijuana," he said.

The patient or a caregiver can grow up to three mature or flowering plants and four immature plants up to one ounce per plant.

Rahman, who practices internal medicine, said many doctors are reluctant to recommend marijuana over other available pain treatments. He said marijuana that's smoked is harder to monitor than pills and "there's always a potential for abuse."

Most of the registered patients are on Neighbor Islands, despite the fact that many more people live on O'ahu.

Kamita said that's because there are "a few pockets of physicians who are the major utilizers of this program."

For example, one Big Island physician has 436 patients in the program. Two other doctors have more than 200, one who lives on the Big island, the other on Kaua'i, Kamita said.

And those few shape the island-by-island breakdown. "Most of the physicians participating in this program have about five to six patients," he said. "Some have one or two."

Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.