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Video Offer: Waiting to Inhale

Dear Drug War Chronicle reader:

Many drug reform enthusiasts read on our blog last month about a new video documentary, Waiting to Inhale: Marijuana, Medicine and the Law, and an exciting debate here in Washington between two of my colleagues and a representative of the US drug czar's office that followed the movie's screening. I am pleased to announce that DRCNet is making this film available to you as our latest membership premium -- donate $30 or more to DRCNet and you can receive a copy of Waiting to Inhale as our thanks for your support.

https://stopthedrugwar.org/files/waitingtoinhale-small.jpg
I've known about Waiting to Inhale for a few years, and I am pretty psyched to see it out now and making waves. People featured in the movie -- medical marijuana providers Mike & Valerie Corral and Jeff Jones, patient spokesperson Yvonne Westbrook, scientist Don Abrams -- are heroes whose stories deserved to be told and whose interviews in this movie should be shown far and wide. You can help by ordering a copy and hosting a private screening in your home! Or you and your activist friends can simply watch it at home for inspiration. (Click here for more information including an online trailer.)

Your donation will help DRCNet as we pull together what we think will be an incredible two-year plan to substantially advance drug policy reform and the cause of ending prohibition globally and in the US. Please make a generous donation today to help the cause! I know you will feel the money was well spent after you see what DRCNet has in store. Our online donation form lets you donate by credit card, by PayPal, or to print out a form to send with your check or money order by mail. Please note that contributions to the Drug Reform Coordination Network, our lobbying entity, are not tax-deductible. Tax-deductible donations can be made to DRCNet Foundation, our educational wing. (Choosing a gift like Waiting to Inhale will reduce the portion of your donation that you can deduct by the retail cost of the item.) Both groups receive member mail at: DRCNet, P.O. Box 18402, Washington, DC 20036.

Thank you for your support. If you haven't already checked out our new web site, I hope you'll take a moment to do so -- it really is looking pretty good, if I may say so myself. :) Take care, and hope to hear from you.

Sincerely,


David Borden
Executive Director

Feature: Pain Patients, Pain Contracts, and the War on Drugs

Pain contracts. Pain management contracts. Medication contracts. Opioid contracts. Pain agreements. They go by different names, but they all mean the same thing: A signed agreement between doctor and patient that lays out the conditions under which the patient will be prescribed opioid pain medications for the relief of chronic pain. (To see a standard pain contract, click here.)

https://stopthedrugwar.org/files/oxycontinpills.jpg
Oxycontin pills
For some of the tens of millions of Americans suffering from chronic pain, opioid pain medications, such as Oxycontin or methadone, provide the only relief from a life of agony and disability. But with the Office of National Drug Control Policy's ongoing campaign against prescription drug abuse and the Drug Enforcement Administration's (DEA) ongoing crackdown on physicians it believes are prescribing opiates outside the bounds of accepted medical practice, the medical establishment is increasingly wary of pain patients and adequate treatment of pain is a very real issue for countless Americans.

In recent years, doctors and hospitals have turned increasingly to pain contracts as a means of negotiating the clashing imperatives of pain treatment and law enforcement. Such contracts typically include provisions requiring patients to promise to take the drugs only as directed, not seek early refills or replacements for lost or stolen drugs, not to use illegal drugs, and to agree to drug testing. And as the contract linked to above puts it, "I understand that this provider may stop prescribing the medications listed if... my behavior is inconsistent with the responsibilities outlined above, which may also result in being prevented from receiving further care from this clinic."

"Pain agreements are part of what we call informed consent," said Northern Virginia pain management and addiction treatment specialist Dr. Howard Heit. "They establish before I write the first prescription what I will do for you and what your responsibilities are as a patient. They are an agreement in order to start a successful relationship that defines the mutual responsibilities of both parties. More and more states are suggesting we use agreements as part of the treatment plan with scheduled medications. Such agreements are not punitive; they protect both sides in functional way."

If Heit sees a cooperative arrangement, others disagree. "This is really an indication of how the current DEA enforcement regime has created an adversarial relationship between patients and physicians where the doctors feel the need to resort to contracts instead of working cooperatively with patients," said Kathryn Serkes, spokesperson for the Association of American Physicians and Surgeons (AAPS), which has been a fierce critic of criminalizing doctors over their prescribing practices. "The pain contracts are a tool to protect physicians from prosecution. He can say 'I treated in good faith, here's the contract the patient signed, and he violated it.' It's too bad we live in such a dangerous environment for physicians that they feel compelled to resort to that," she told the Chronicle.

"Patients aren't asked to sign contracts to get treatment for other medical conditions," Serkes noted. "We don't do cancer contracts. It is a really unfortunate situation, but it is understandable. While I am sympathetic to the patients, I can see both sides on this," she said.

"There is no evidence these pain contracts do any good for any patients," said Dr. Frank Fisher, a California physician once charged with murder for prescribing opioid pain medications. He was completely exonerated after years of legal skirmishing over the progressively less and less serious charges to which prosecutors had been forced to downgrade their case. "The reason doctors are using them is to protect themselves from regulatory authorities, and now it's become a convention to do it. They will say it is a sort of informed consent document, but that's essentially a lie. They are an artifact of an overzealous regulatory system," he told the Chronicle.

"When this first started, it was doctors using them with problem patients, but now more and more doctors and hospitals are doing it routinely," Fisher added. "But the idea that patients should have to sign a contract like that or submit to forced drug testing is an abrogation of medical ethics. Nothing in the relationship allows for coercion, and that is really what this is."

The pain contracts may not even protect doctors, Fisher noted. "When they prosecute doctors, they can use the pain contract to show that he didn't comply with this or that provision, like throwing out patients who were out of compliance. The whole thing is a mess."

https://stopthedrugwar.org/files/michaelkrawitz.jpg
Michael Krawitz (photo courtesy Drug Policy Forum of Virginia)
It is a real, painful mess for a pair of veterans trying to deal with chronic pain through the Veterans Administration -- and it is the drug testing provisions and the use of marijuana that are causing problems. Michael Krawitz is an Air Force veteran who was injured in an accident in Guam two decades ago that cost him his spleen, pancreas, and part of his intestine. Krawitz also suffered a fracture over his left eye, received an artificial right hip, and has suffered through 13 surgeries since then. He had been receiving opioid pain medication at a VA Hospital in Virginia, but things started to go bad a year ago.

"Last year, I refused to sign the pain contract they had just introduced there, and they cut me off my meds because I refused," Krawitz told the Chronicle. "Then I amended the contract to scratch off the part about submitting to a drug test, and that worked fine for a year, but the last time I went in, they said I had to do a drug test, and I again refused. I provided a battery of tests from an outside doctor, but not an illegal drug screen. That's when my VA doctor sent an angry letter saying I was not going to get my pain medicine."

Krawitz has provided documentation of his correspondence with the VA, as well as his so far unheeded complaint to the state medical board. As for the VA, some half-dozen VA employees ranging from Krawitz' patient advocate to his doctor to the public affairs people to pain management consultants failed to respond to Chronicle requests for interviews.

For Krawitz, who has used marijuana medicinally to treat an eye condition -- he even has a prescription from Holland -- but who says he is not currently using it, it's a fight about principles. "I will not submit my urine for a non-medical test," he said. "The VA doesn't have the authority to demand my urine. It's an arbitrary policy, applied arbitrarily. The bottom line is that we vets feel very mistreated by all this. Some of us have sacrificed limbs for freedom and democracy, and now the VA wants to make us pee in a bottle to get our pain medication?"

The imposition of pain contracts is not system-wide in the VA. A 2003 Veterans Health Administration directive on the treatment of pain notes that "adherence with opioid agreement, if used" should be part of the patient's overall evaluation.

Krawitz is preparing to file a federal lawsuit seeking to force the VA to treat him for pain without forcing him to undergo drug testing. For Tennessee vet Russell Belcher, the struggle is taking a slightly different course. Belcher, whose 1977 back injury and spinal fusion had him in pain so severe he couldn't work after 2000, was cut off from pain meds by the VA after he tested positive for marijuana. Belcher said he used marijuana to treat sleeplessness and pain after the VA refused to up his methadone dose.

"It's a wonder to me that some vet ain't gone postal on them," he told the Chronicle. "They pushed me pretty close. To me, not signing the substance abuse agreement is not an option. If you sign it you're screwed, if you don't sign it, you're screwed. I complained for months about the dose being too low, but they said that's all you get and if you test positive for anything we're kicking you out. When the civilian doctors would find marijuana on a drug screen, they told me they would prefer I didn't do that because it was still illegal, but they didn't kick me out of the program. I was using it for medicinal purposes. I have tremendous trouble sleeping, muscle cramps that feel like they'll pull the joint out of the socket. I had quit using for a long time because of this mess with the drug testing, but then they wouldn't increase my pain medicine. I thought I have to do something; it's a matter of self preservation," he said.

"The pain clinic at the VA has discharged me from their care and said the doctor would no longer prescribe narcotics for me unless I attend the substance abuse program," Belcher continued. "They aren't going to be satisfied until I spend 30 days in the detox unit." While Belcher would like to join Krawitz in taking on the VA, in the meantime he is looking for a private physician.

When asked about the veterans' plight, Dr. Fisher was sympathetic. "They made Krawitz sign a contract under duress with forced drug testing as a condition of his continued treatment," he pointed out. "That violates basic rights like the right of privacy. There is no suspicion he is a drug addict. They want to treat all patients as if they were criminal suspects, and that has little to do with what the nature of the doctor-patient relationship should be."

Dr. Heit, while less sympathetic than Dr. Fisher, was decidedly more so than the VA. When asked about the cases of the vets, he explained that he would be flexible, but would also insist they comply with the terms of their agreements. "In the end, you have to choose whether you want me to do pain management with legal controlled substances or you want to use illicit substances, but you don't get to choose both," he said. "I don't disagree that marijuana may help, but the rules are it's an illicit substance. I can't continue to prescribe to someone who is taking an illicit substance."

And here we are. Patients seeking relief from pain meet the imperatives of the drug war -- and we all lose.

Medical Marijuana Turns 10: New Report to Examine Impact of California's Landmark Proposition 215

First Comprehensive Analysis of Medical Marijuana's Impact to Feature New Polling From All 11 Medical Marijuana States CONTACT: Bruce Mirken, MPP director of communications, 202-215-4205 or 415-668-6403 WASHINGTON, D.C. -- With the tenth anniversary of America's first effective medical marijuana law, California's Proposition 215, coming up Nov. 5, the Marijuana Policy Project (MPP) in Washington, D.C. is preparing to release the first-ever comprehensive analysis of the law's impact. Prop. 215 started a wave of medical marijuana laws now covering 11 states, including over 20 percent of the U.S. population. The report, to be issued approximately Oct. 26, will include: **New polling in all 11 medical marijuana states -- Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, Rhode Island, Vermont, and Washington -- examining voter approval of the laws now that they have lived with them for a number of years. **Analysis of predictions made by Prop. 215's opponents, including then-White House Drug Czar Gen. Barry McCaffrey and U.S. Sen. Dianne Feinstein (D-CA), that the measure would increase teen drug use and effectively "legalize marijuana for everyone." **Profiles of real patients who have benefited from state medical marijuana laws, as well profiles of patients in states lacking such legal protection, who have "come out" in an effort to reform their states' laws. Journalists wishing to receive an embargoed copy of the report in advance of the official release date should contact MPP Director of Communications Bruce Mirken at [email protected]. With more than 20,000 members and 100,000 e-mail subscribers nationwide, the Marijuana Policy Project is the largest marijuana policy reform organization in the United States. MPP believes that the best way to minimize the harm associated with marijuana is to regulate marijuana in a manner similar to alcohol. For more information, please visit http://MarijuanaPolicy.org. ####
Location: 
United States

Marijuana May Help Stave Off Alzheimer's; Active Ingredient in Pot May Help Preserve Brain Function

Location: 
United States
Publication/Source: 
Reuters
URL: 
http://msnbc.msn.com/id/15145917/

Documentary: Waiting to Inhale

Dear Drug War Chronicle reader:

Many drug reform enthusiasts read two weeks ago on our new blog about a new video documentary, Waiting to Inhale: Marijuana, Medicine and the Law, and an exciting debate here in Washington between two of my colleagues and a representative of the US drug czar's office that followed the movie's screening. I am pleased to announce that DRCNet is making this film available to you as our latest membership premium -- donate $30 or more to DRCNet and you can receive a copy of Waiting to Inhale as our thanks for your support.

https://stopthedrugwar.org/files/waitingtoinhale-small.jpg
I've known about Waiting to Inhale for a few years, and I am pretty psyched to see it out now and making waves. People featured in the movie -- medical marijuana providers Mike & Valerie Corral and Jeff Jones, patient spokesperson Yvonne Westbrook, scientist Don Abrams -- are heroes whose stories deserved to be told and whose interviews in this movie should be shown far and wide. You can help by ordering a copy and hosting a private screening in your home! Or you and your activist friends can simply watch it at home for inspiration. (Click here for more information including an online trailer.)

Your donation will help DRCNet as we pull together what we think will be an incredible two-year plan to substantially advance drug policy reform and the cause of ending prohibition globally and in the US. Please make a generous donation today to help the cause! I know you will feel the money was well spent after you see what DRCNet has in store. Our online donation form lets you donate by credit card, by PayPal, or to print out a form to send with your check or money order by mail. Please note that contributions to the Drug Reform Coordination Network, our lobbying entity, are not tax-deductible. Tax-deductible donations can be made to DRCNet Foundation, our educational wing. (Choosing a gift like Waiting to Inhale will reduce the portion of your donation that you can deduct by the retail cost of the item.) Both groups receive member mail at: DRCNet, P.O. Box 18402, Washington, DC 20036.

Thank you for your support. If you haven't already checked out our new web site, I hope you'll take a moment to do so -- it really is looking pretty good, if I may say so myself. :) Take care, and hope to hear from you.

Sincerely,


David Borden
Executive Director

Feature: More California Medical Marijuana Raids: The New Status Quo?

At least five California different medical marijuana dispensaries have been raided in the last ten days, bringing the total so far this year to more than 30, according to medical marijuana supporters. But that means nearly 200 existing dispensaries have not been raided, suggesting that what is occurring is more like a low-level battle of attrition than an all-out assault by the US Drug Enforcement Administration (DEA) and its allies among recalcitrant state and local law enforcement and elected officials.

Here is the latest casualty list:

https://stopthedrugwar.org/files/ca06raid1.jpg
photo courtesy ASA
Last Wednesday in Modesto, one day after the city of Modesto voted to repeal a municipal provision exempting nonprofits from its ordinance banning dispensaries, DEA agents raided the nonprofit California Healthcare Collective, one of only two remaining dispensaries in the area. A DEA spokesperson told Drug War Chronicle this week the Modesto Police Department began investigating the dispensary, then handed the case over to the feds. Four people were arrested on federal marijuana distribution charges.

The following day, DEA and local law enforcement agents raided the North Valley Discount Caregivers dispensary in Grenada Hills and seized all the medicinal cannabis at the site. The two operators were arrested on state marijuana charges.

That same day, Stanislaus County Sheriff's deputies raided the 2816 Collective in a rural area near Modesto using a state search warrant. Police seized about two pounds of dried marijuana and patient files. The collective had closed the day before because of the Modesto raid. With both California Healthcare in Modesto and the 2816 Collective gone, the entire region is now destitute of dispensaries, leaving hundreds of patients in the lurch.

On Tuesday, the DEA raided at least eight locations in the San Francisco Bay area, seizing more than 12,000 plants, $125,000 cash, and a fancy sports car. Despite somewhat hysterical initial reports in the local media, all the raids were connected with the New Remedies dispensary in San Francisco, which involved the same people involved in Compassionate Caregivers, which was raided by the DEA in Los Angeles in May 2005, when the feds found more than $300,000 in cash, sparking the investigation that culminated in the Monday raids.

On Wednesday, DEA and local law enforcement officers raided the Palm Springs Caregivers dispensary in Riverside County, seizing medicinal cannabis, but not making any arrests at the time. The raid came one day after the Riverside County Board of Supervisors voted to ban dispensaries in unincorporated county areas, which does not include Palm Springs, and one month after Riverside County District Attorney Grover Trask issued a white paper arguing that dispensaries are illegal under both state and federal law.

The raids triggered the Emergency Response Project of the medical marijuana defense group Americans for Safe Access, which brought out protestors last Friday at DEA headquarters in Los Angeles, as well as Modesto, Oakland, Sacramento, San Diego, San Francisco and Santa Ana. Demonstrators also greeted the Tuesday raids in San Francisco, and more actions are set for today.

"With our emergency response program, every time there is a federal raid -- and we can usually find that out in a matter of hours -- we activate our local response, as we did in San Francisco this week," said ASA's Caren Woodson. "But now, we're activating the national emergency response for Friday. It's a call-in day. We are urging everyone to call in to DEA administrator Karen Tandy and let her know how they feel about these raids. Karen Tandy has a lot of discretion, and she needs to exercise it."

While ASA is leading the immediate battle, it is not alone among movement groups in trying to figure out just what is going on. According to the DEA, it's nothing special, just enforcing the federal marijuana laws. "The two cases in which our office was involved, Modesto last week and here in the Bay area this week, were both the culmination of long-term investigations," said San Francisco DEA public information officer Casey McEnry. "In Modesto, the Modesto police began investigating and then passed it on to us, and with New Remedies, we had served warrants on them as Compassionate Caregivers in LA in May 2005, and we learned in December 2005 that they had changed their name and set up shop in Oakland," she told Drug War Chronicle.

"We can't read the DEA's mind, but there is no sign of an all-out offensive," said Bruce Mirken, director of communications for the Marijuana Policy Project (MPP). "These guys in San Francisco were already in the crosshairs -- they were victims of their own success -- but there are certainly plenty of other places operating openly. If the DEA wanted to, it could go after them with little effort, but it seems like a decision has been made not to do that."

https://stopthedrugwar.org/files/ca06raid2.jpg
photo courtesy ASA
The DEA's McEnry did not respond directly to questions about whether the agency had taken a political decision to not aggressively crack down on the state's roughly 200 dispensaries, but she did issue a warning. "The magic plant count number is zero, the distribution number is zero if you want to be safe from us possibly knocking at your door," she said. "Anyone who cultivates or distributes marijuana is at risk."

While that may be bluster given the agency's limited resources, it is worrisome for dispensaries and their supporters. "These state-certified legal cannabis dispensaries look to the DEA like drug distribution havens," said Woodson. "If a dispensary is serving 150 people a day, the operator looks like a drug kingpin to them. They're like sitting ducks, they're listed in the phone book. And now some of these people are facing very severe sentences, some of up to life in prison.

It isn't just the DEA. "We have sporadic local police involvement in raids, mostly in counties where local government is not supportive, like Modesto or Riverside County, which is where Palm Springs is," said Mirken. "That tells us it is really important that local governments understand Proposition 215 and hear from their constituents that access to medicinal cannabis is important."

"They're picking locations where local decision-makers don't have a friendly attitude," said ASA's Woodson.

"These raids are really a drop in the bucket when you have 200 dispensaries out there," said Dale Gieringer, head of California NORML, "but we don't want to see them spread. I fear this is going to be a battlefield for awhile here until we come up with a regime that allows for better systems of dispensaries and production. The lack of a legal production system causes a lot of problems, and everybody in the dispensary business is operating in the black or grey market and vulnerable to legal uncertainties."

While medical marijuana dispensaries remain numerous in Los Angeles and the Bay area, the raids are having a very real impact on availability in some areas of the state. "In San Diego, a few months ago there were a dozen dispensaries in operation, but after the raids, they're gone and access to medical cannabis is largely gone," said Woodson. "There are only a handful of delivery services now, and they can't handle the demand. It's a similar situation in Modesto -- there aren't any dispensaries in the area now."

"I think it's going to continue for the short term, until something happens politically to change the dynamic," said Mirken. "That might not be until there is regime change in Washington, and maybe not even then, depending on how smart the Democrats are. It doesn't seem like anything is going to change drastically in California in the near term. Most people in the state government some local governments at least pay lip service to supporting Proposition 215, but we haven't seen much strong action from state officials with the clout to try to stop the raids. I really don't see anything moving on the state level," he said.

ASA's Woodson wasn't quite ready to give up on state government. "Here in California, we need to see more state officials standing up and denouncing these raids," she said. "The state legislature as a whole needs to take this issue on and create guidelines or craft prohibitions directing state and local law enforcement not to participate in these medical marijuana raids. The legislature is not doing its job if it is not properly protecting patients."

Another thing the legislature could do is restate and expand on its support for Proposition 215. "They should re-codify it and take a stand against the federal raids," said Woodson. "And they should demand our federal delegation pay more attention to this issue. All Diane Feinstein can talk about is meth; she and Barbara Boxer haven't raised a finger to help on medical marijuana. We would also like to see more law enforcement officers trained on the medical cannabis issue."

"California will do nothing statewide until federal law changes," predicted Gieringer. "I see this pattern of sporadic raids continuing until there is a change in the federal law. Two or three years ago, I would have said we were in mortal danger, but in fact, we've had nothing but an increase in the number of dispensaries even after we lost two Supreme Court decisions. Somehow I have a hard time believing that this is going to be reversed, especially given what happened in LA. Two years ago, there weren't any clubs in LA, now there are a hundred. It looks to me like the nation's second largest city is firmly infected with dispensaries. When it was just the Bay area, I was concerned the feds could shut it down, but they blew their chance. Now all they can do is bust someone every once in awhile and try to tarnish the image of the dispensaries, but they are here to stay."

Feds Raid Medical Marijuana Dispensary (This one in Palm Springs)

Location: 
Palm Springs, CA
United States
Publication/Source: 
Desert Sun
URL: 
http://www.poughkeepsiejournal.com/apps/pbcs.dll/article?AID=/20061005/NEWS05/61004013/1009

BAY AREA: Drug agents arrest 15 in raids on major marijuana club (San Francisco Chronicle)

Location: 
United States
URL: 
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/10/04/POT.TMP

Documentary: Waiting to Inhale

Dear Drug War Chronicle reader:

Many drug reform enthusiasts read two weeks ago on our new blog about a new video documentary, Waiting to Inhale: Marijuana, Medicine and the Law, and an exciting debate here in Washington between two of my colleagues and a representative of the US drug czar's office that followed the movie's screening. I am pleased to announce that DRCNet is making this film available to you as our latest membership premium -- donate $30 or more to DRCNet and you can receive a copy of Waiting to Inhale as our thanks for your support.

https://stopthedrugwar.org/files/waitingtoinhale-small.jpg
I've known about Waiting to Inhale for a few years, and I am pretty psyched to see it out now and making waves. People featured in the movie -- medical marijuana providers Mike & Valerie Corral and Jeff Jones, patient spokesperson Yvonne Westbrook, scientist Don Abrams -- are heroes whose stories deserved to be told and whose interviews in this movie should be shown far and wide. You can help by ordering a copy and hosting a private screening in your home! Or you and your activist friends can simply watch it at home for inspiration. (Click here for more information including an online trailer.)

Your donation will help DRCNet as we pull together what we think will be an incredible two-year plan to substantially advance drug policy reform and the cause of ending prohibition globally and in the US. Please make a generous donation today to help the cause! I know you will feel the money was well spent after you see what DRCNet has in store. Our online donation form lets you donate by credit card, by PayPal, or to print out a form to send with your check or money order by mail. Please note that contributions to the Drug Reform Coordination Network, our lobbying entity, are not tax-deductible. Tax-deductible donations can be made to DRCNet Foundation, our educational wing. (Choosing a gift like Waiting to Inhale will reduce the portion of your donation that you can deduct by the retail cost of the item.) Both groups receive member mail at: DRCNet, P.O. Box 18402, Washington, DC 20036.

Thank you for your support. If you haven't already checked out our new web site, I hope you'll take a moment to do so -- it really is looking pretty good, if I may say so myself. :) Take care, and hope to hear from you.

Sincerely,


David Borden
Executive Director

Riverside County Bans Medical Marijuana Centers

Location: 
CA
United States
Publication/Source: 
San Jose Mercury News
URL: 
http://www.mercurynews.com/mld/mercurynews/news/local/states/california/northern_california/15619242.htm

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