Doctors and Medical Marijuana

The tactic the Clinton Administration has chosen to head off the medical use of marijuana in ,California - threatening doctors who recommend Marijuana to their patients - is a dangerous and unwarranted interference with f re6 speech and a patient's right to hear the truth from a doctor. In its effort to enforce Federal narcotics laws, the Administration needs to make clear that it will do nothing to prevent doctors from delivering their best medical judgments to their patients.

Proposition 215, approved by California voters last November, makes it legal under state law for a seriously ill patient to possess or cultivate marijuana for medical purposes if a doctor has advised, either orally or in writing, that the use of marijuana id 'medically appropriate.

The Administration has not challenged the legality of the state statute directly in court. Nor has it brought new prosecutions against buyers' clubs t66t provide marijuana to the seriously ill or against patients suffering -from AIDS, cancer and glaucoma who smoke marijuana for relief from nausea, vomiting and pain.

Instead, the Federal Government has said that it would clamp down on physicians. Threats of losing their right to prescribe drugs, exclusion from ,participation in Medicare and Medicaid, and Federal criminal prosecution have silenced many doctors. Last December the California Medical Association advised its members to make no recommendations on marijuana lest they be prosecuted.

A recent lawsuit brought by prominent AIDS and cancer physicians in California argues that the ministration's threats violate their First Amendment rights and intrude on physician-patient communications. Last Friday the Administration issued a statement saying that doctors may discuss the pros and cons of medical marijuana, but may not intentionally make oral or written statements or II recommendations" -that enable patients to obtain it. That formulation seems to mean that, even if. a doctor thinks marijuana the best treatment for a particular patient, he cannot say so because, under the California law, a patient may use a doctor's recommendation as a defense against state prosecution for possession of marijuana. This is an improper restriction on medical judgment. After all, a doctor's recommendation does not place ,marijuana in a patient's hands. It is still the patient who procures the drug.

Thousands of doctors have recommended marijuana to cancer and AIDS patients, in past years. A: 1990 Harvard survey of more than 2,400 oncologists found that 44 percent of those responding had recommended marijuana to cancer patients undergoing chemotherapy. Doctors making similar statements in California now could become targets of Federal investigations and punishment.

. The Administration's policy issued last December said that any "action of recommending" marijuana would trigger Federal sanctions. Now Justice Department lawyers, facing a fierce counterattack from the medical community, are blurring the issue, saying that only doctors who make recommendations with intent to help patients get marijuana are liable. But how can one distinguish intent to help patients obtain the drug from intent to tell them the best therapy to use? The plaintiff doctors are right to press for clarity on this issue.

The Administration says it does not want to gag doctors, but its stated policies lead in that direction. If there truly is no gag rule, then doctors should be free to say what they want, including advising the use of marijuana, without fear of reprisal, as long as they do not otherwise assist patients in getting the drug, which remains illegal under Federal law.

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