The number of medical marijuana patients in Hawai'i has grown 87 percent in the past two years, with the biggest gains on Maui and the Big Island.

According to the state Department of Public Safety, 4,200 patients were registered state-wide as of June 30, with 444 more signing up since then.

One reason for the increase is that more doctors have been certifying patients for the program, according to Keith Kamita, head of the department's Narcotics Enforcement Division. Still, a relatively few physicians account for most of the state's medical marijuana patients, he said. One Big Island doctor, for example, accounts for about half of the total certified patients statewide.

"The ones that utilize the program, they have a lot of patients ... this is their primary means of making money," he said. "Most are general practitioners. (Oncologists and other specialists) don't utilize the program because there are better drugs available and marijuana has other problems."

In fiscal year 2008, patients statewide visited 85 on-island physicians to obtain a qualifying diagnosis for medical marijuana use, compared with 62 physicians in fiscal 2006, according to DPS.

Even though doctors only diagnose qualifying illnesses and do not prescribe or supply marijuana to patients, many doctors remain hesitant to participate in the program, according to Dr. Yvonne Conner of Hilo, who has 400 medical marijuana patients.

"Many physicians are still afraid that their medical license might be at risk or they don't want the notoriety," she said.

ACCESS IS A PROBLEM

Despite the growing use of medical marijuana in Hawai'i, access to the drug remains an issue for many patients whose marijuana use is protected by a state law that conflicts with federal and state laws prohibiting any use or distribution of marijuana.

Conner said some patients are physically and mentally unable to grow their own, and others just don't have a green thumb.

"They have a license to grow it, but they don't have an honest way to get supplies," she said.

The head of a Maui group that was openly providing marijuana to patients was arrested Nov. 11 along with six other men for allegedly running a drug-trafficking ring.

Brian Murphy, of Patients Without Time, admits providing startup plants and marijuana to medical marijuana patients, sometimes for a price but in many cases for free. He said the group, which has 1,250 members, has been operating as a de-facto cooperative out of an office in Pa'ia in an act of civil disobedience.

"We've been doing this with transparency for four years, and not one cop has come into the office and told me, 'We don't want you doing this,' " he said.

"I'm not hiding anything. My feeling was that, as in California (where medical marijuana dispensaries have been operating), I assumed the state would be compassionate. To say we're drug dealers is ridiculous. I am not a profiteer. We're just trying to help people."

Murphy, 53, a disabled Navy veteran, obtained a medical marijuana permit in 2002 for an inherited neurological disorder, arthritis and back problems. He said it's inhumane to expect sick people to obtain medical marijuana "on the streets."

"We have a law that says we are allowed to use it. All I'm doing is making the law work, and I don't think that's criminal to do it."

ALL SALES ARE ILLEGAL

Maui Police Capt. Gerald Matsunaga said selling marijuana — even for approved medical use — is illegal under any circumstances. An information sheet provided by the state Narcotics Enforcement Division warns patients as much.

Matsunaga said police are not interested in going after people "with legitimate medical marijuana permits if they are operating within the law." He said Murphy and his group exploited Hawai'i's medical marijuana program to run a drug-trafficking ring that extended beyond the medical marijuana community.

Murphy denies doing anything except helping seriously ill patients.

Hawai'i is one of 13 states that has approved medical marijuana use. Under Hawai'i's law, passed in 2000, patients must be diagnosed by a medical doctor as having a "debilitating" medical condition such as cancer, glaucoma, HIV/AIDS, severe pain or seizures. Qualifying patients must register with the state Narcotics Enforcement Division and renew their participation annually.

The law allows registered patients to keep an "adequate supply" of marijuana on hand, which is defined as three mature plants, four young plants and an ounce of marijuana for each mature plant.

The law also defines "medical use" as the acquisition, possession, cultivation, use, distribution or transportation of marijuana or paraphernalia in connection with its use to alleviate the symptoms or effects of a qualifying patient's debilitating medical condition.

The law is silent on how patients are to acquire marijuana in the first place or continue to supply themselves.

'A CRUEL JOKE'

State Rep. Joe Bertram III, D-11th (Makena, Wailea, Kihei), calls the medical marijuana law "a cruel joke" because it legalizes medical use of marijuana but fails to provide patients safe, easy access to it. Bertram has held a medical marijuana permit since 2005.

During the 2008 legislative session, Bertram proposed creation of a secure growing facility on Maui and expanding the amount of marijuana patients can legally possess, but settled for a bill that would have created a task force to study cultivation and other issues surrounding the medical marijuana law.

The bill was opposed by law enforcement officials, who object to any expansion of the state's medical marijuana program. Gov. Linda Lingle vetoed the measure, calling it "objectionable because it is an exercise aimed at finding ways to circumvent federal law."

George "Greywolf" Klare, 70, of Pahoa, said he uses marijuana to help him tolerate pain from a broken pelvis and the effects of skin cancer. He first obtained a medical marijuana permit in California in 1997 and registered as a patient in Hawai'i last year.

The retired teacher and marijuana advocate said he has been robbed at home by drug-seeking criminals and harassed by police. Klare said the medical marijuana program should be moved from the auspices of the Department of Public Safety to the Department of Health.

"The attitude of law enforcement is that they only see marijuana as a dangerous drug," he said.

LEGAL AMBIGUITIES

A 2004 report by the Legislative Reference Bureau that examined the possibility of a legal distribution system for Hawai'i's medical marijuana program highlighted the legal ambiguities in the state law and said that "severely restricted sources of supply and limitations on its transport" make it likely that many patients and their caregivers break the law to obtain marijuana.

The report and Kamita both said it is unlikely the state will seek to clarify those portions of the medical marijuana law unless federal drug laws change.

However, Kamita favors tinkering with the criteria for "debilitating" medical conditions, which he said are "a little too loose," particularly when it comes to cases of severe pain and similar conditions that are difficult to support with medical evidence.

He noted that "severe pain" is cited as the debilitating condition for two-thirds of registered medical marijuana patients. As of last month, only 50 were using marijuana for cancer, 64 for HIV/AIDS, and 12 for wasting syndrome, he said.

"We have concerns that (the Legislature) may need to look at this law better in terms of debilitating conditions and what they really want to allow. It's a little too broad. The intent when they first passed it was as a last-resort type of thing, and that's not what's happening."

Kamita said there have been no complaints filed against patients or doctors for abusing the program.

Murphy discounted the threat of abuse, saying it's a bigger problem for prescription narcotics.

He said he has attended at least 17 funerals for patients who used marijuana for relief in their final days.

"This is not a joke," he said.

Conner said marijuana taken by various methods can ease a range of symptoms and conditions and boost a patient's sense of well-being.

"It really helps people to deal with their illness," she said. "It relaxes muscles and helps reduce pain. Nausea is a major thing for people with HIV/AIDS, and if they use cannabis, especially if they eat it, it controls the nausea completely.

"It improves the quality of life for everyone who uses it and, in general, makes them feel better and have a positive outlook on life that makes them more readily able to deal with whatever their disease is."