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Phil Leveque of Molalla, Oregon, is the first doctor in any of the states that have legalized marijuana for medical use to lose his license for recommending it. Leveque received a formal notice of revocation from the Board of Medical Examiners Oct. 20. He has 30 days to appeal, and will.
The Board’s action came as Oregonians prepare to vote on an initiative to legalize cannabis dispensaries and increase the amount patients can grow and possess.
Leveque, for those of you just joining us, is the Tod Mikuriya of Oregon. Mikuriya, 71, is a Berkeley-based psychiatrist who helped draft California’s medical marijuana initiative in 1996 and then, after the voters enacted it, made himself available to a flood of patients who were afraid to discuss their cannabis use with their regular doctors, or whose doctors had turned down their requests for approval.
Mikuriya was singled out for scrutiny by the state Attorney General’s office. He was investigated by the Medical Board and ultimately found to be violating the standard of care by not conducting physicals, keeping inadequate records, and issuing forms stating that patients were under his care when he was not their primary-care provider. Mikuriya was placed on five years’ probation, during which time his practice must be monitored by a colleague, and order to pay a $75,000 fine.
None of the complaints against Mikuriya had come from a patient or a patient’s loved one -they all came from law enforcement agents. Nor did any of the complaints allege that a patient had been harmed by Mikuriya’s approval of their cannabis use.
Leveque, 81, is a doctor of osteopathy with a PhD in pharmacology, which he spent most of his career teaching at the medical-school level. He was a prominent supporter of Oregon’s 1998 medical marijuana initiative, and when it passed he became the doctor of last resort for thousands of patients. He was investigated by the Board of Medical Examiners and his license was suspended for three months, May-July 2002, for failure to conduct physical exams and keep adequate records. When he resumed practice it was in concert with a nurse practitioner authorized to conduct physical exams, and clinic operators committed to thorough record keeping. By the spring of 2003 some 6,500 Oregonians had gotten medical marijuana cards through the state program, and more than half of them had submitted applications signed by Leveque, who assumed that his problems with the Board were in the past.
In March of this year Leveque’s license was suspended, based on complaints that he had violated the standard of care in his treatment of six patients. None of the patients had complained, and no allegations of harm were made on their behalf. All but one of the complaints came from other doctors objecting to Leveque’s role in helping their patients obtain cannabis. (This is the most notable difference between Leveque’s martyrdom and Mikuriya’s.) At a hearing in May before the Board’s administrative law judge, Leveque’s lawyers called Rick Bayer, M.D. as an expert witness. Bayer’s defense of Leveque’s decision to approve cannabis use, patient by patient, exposed the Board’s bias eloquently and succinctly. Too bad the fix was in.
Patient A was most problematic–a woman employed by a state agency who sometimes drove heavy equipment. Leveque, according to his accusers, "signed a form attesting to the employer that she could safely function on the job while under the influence of marijuana." But, Bayer pointed out, "The BME admits Dr. Leveque told her not to smoke marijuana within four hours of going to work Dr. Leveque was following a standard that any doctor might follow who reads certain references." Bayer went on to cite a few to the effect that cannabinoid levels returned to baseline within four hours after smoking.
Patient B was described by the Board as having "a history of psychosis, hallucinations, multiple admissions to the VA hospital and was frequently noncompliant with medication regimens prescribed by physciains treating his pain." Leveque allegedly "did not request complete medical records, failed to conduct a mental health history, and did not consult with his care providers."
Bayer notes, "Sometimes ‘noncompliance is due to adverse effects, inability to pay, miscommunication or the underlying illness. Noncompliance should not be pejorative." And "Often, patients do not want consultants to share information with other providers and that is within the patient’s right to privacy Dr. Leveque did not jeopardize the health and safety of this patient by signing application to remove criminal penalties for something with a brachial plexus injury who reported good pain relief from therapeutic cannabis. It is also difficult to understand why treating pain and decriminalizing or ‘medicalizing’ anyone for his/her medicine -even if they have a history of substance abuse- is endangering that patient. Patients should never be prohibited from receiving adequate pain and symptom control One might interpret a patient reporting success for three years before signing an application as good evidence of ability to tolerate cannabis It is very important to realize that nearly all of Dr. Leveque’s signatures on application forms are for patients who have reported a history of success with medical cannabis."
Patient C presented "with complaints of chronic pain, a history of marijuana use, and adverse consequences associated with that use, to include prison time sentences for drug related offenses. Patient C said he used marijuana three to four times per day for four years. Patient C’s primary physician contacted licensee [Leveque] to inform him that this patient was not an appropriate candidate for medical marijuana. Nevertheless, Licensee conducted an inadequate history and physical examination, failed to establish a diagnosis or discuss treatment alternatives, risks or benefits, and signed the Attending Physician Statement form attesting that ‘Cannabis gives best relief.’"
Bayer responded, "Dr. Leveque reports the patient has painful spine disease and hepatitis C. He has used regularly for four years and reports success with controlling his pain. It is unethical if prison time related to our prohibitionist politics should determine clinical therapeutics. It is not uncommon that physicians disagree on therapy and patient’s doctor is certainly free to call and talk to the patient as to why marijuana is a bad idea. Ultimately it should be the patient’s decision as to which doctor’s advice s/he chooses Many patients who have seen Dr. Leveque feel they get a good history and physical exam -much more than they get from other doctors."
Patient D, a 19-year-old male, "presented with complaints of chronic pain and nausea and a history of using marijuana six times a day for four years as well as using stolen pharmaceutical opiates and LSD," according to the Board. "Patient D’s history included a pattern of violent outbursts that caused his mother and sister, for their own safety, to leave the house where they resided. Licensee disregarded the patient’s history of possible substance abuse or dependence, failed to conduct an adequate examination, consider treatment alternatives or establish a diagnosis and signed the Attending Physician Statement form attesting that ‘Cannabis gives best relief.’ Licensee failed to follow this patient. Patient D’s mother subsequently observed that Patient D’s pattern of behavior was to smoke marijuana from the time he awoke in the morning until he went to be at night. Patient D was ultimately hospitalized for seizures that may have been related to his use of marijuana."
According to Bayer, "Dr. Leveque reports the patient’s mother brought him in for severe pain from two back injuries. He had used cannabis for pain for four years and tolerated it. Severe pain qualified as the debilitating condition Although cannabis can cause anxiety or even panic attacks, this is usually in new users involved in anxiety-provoking circumstances. Cannabis is also reported to help many persons with chronic epilepsy in case reports These are usually people who have tried everything else Although it may be possible in rare circumstances for THC to contribute to seizures it is not a high probability.
Patient E "presented with complaints of chronic back pain and migraines. Licensee failed to conduct an adequate history or physical examination, disregarded his history of using marijuana two to three times a day for five years, or the patient’s felony conviction of manufacturing and delivering marijuana as possible substance abuse or dependence, failed to consider treatment alternatives, and failed to establish a diagnosis. Licensee authorized marijuana for this patient by signing the Attending Physician Statement form, ‘Cannabis gives best relief.’"
Bayer counters that Leveque did not ignore the fact that Patient E had used cannabis successfully for five years. "As discussed earlier, some think it is unethical that our prohibitionist politics should determine whether or not a patient is treated for pain. A diagnosis of substance abuse requires more than a felony drug charge. And even patients with substance abuse need to have pain treated."
Patient F had been injured in an auto accident and also presented with irritable bowel syndrome and nausea. "Patient F reported a history of smoking marijuana for or five times a day for 15 years," according to the Board. Leveque "failed to conduct an adequate history or physical examination, disregarded his history of extensive marijuana use as evidence of possible substance abuse or dependence, failed to consider treatment alternatives, and failed to establish a diagnosis. Licensee authorized marijuana for this patient by signing the Attending Physician Statement form, writing ‘Cannabis gives best relief.’"
As noted by Bayer, Leveque authorized cannabis use for chronic severe pain stemming from the auto accident. "Again, the 15 years’ use may relate to therapeutic success rather than describe evidence for abuse."
Bayer concludes: "In summary, there are disagreements between Dr. Leveque and the BME. In my opinion, Dr. Leveque does not represent a danger to patients for whom he signs an application form. Nearly everyone who sees Dr. Leveque is a regular user of cannabis who has found therapeutic success managing severe pain or another debilitating illness. They have used cannabis a long time and tolerate it. They are pre-screened to make sure they have a qualifying condition and records to document this Totally removing Dr. Leveque’s license alleging he is a danger to Oregonians based on these cases seems more like anti-medical marijuana politics than science-based medical therapeutics."
Leveque is prepared to fight the Board to the end. He was a combat infantryman in World War Two, a forward scout. "I walked most of the way under fire from Luxembourg almost to Dresden. Under fire on a daily basis. I spent more time on the point than anybody else in my battalion and more time on the observation post than anybody except my own six guys. I don’t have any idea how I got out of that alive I couldn’t get a commission because I didn’t have a trigger finger. [The tips of several fingers on Leveque's right hand were severed in a childhood accident; the index finger was damaged the worst.] You couldn’t be an officer if you didn’t have a trigger finger, but you could be rifleman. That I couldn’t understand, and still don’t I guess I survived because I have good reflexes and I’m not afraid to dive in the dirt."
Leveque has self-published a memoir, "Gen. Patton’s Dogface Soldier: WWII >From a Foxhole." (To order, send $20 to him at po box 348, Molalla, OR 97038.) He’s proud of a call he got from high-ranking Catholic priest who said, "Somebody just gave me your book. I’m a combat infantryman myself. And you got it right."
Leveque has signed applications for two other Catholic priests. "One was a green beret, one was a navy seal," he says. "Both of them had been using marijuana for years and wanted to be legal. Ninety-nine percent of the people I interview have been using it on their own for some time. The record so far is 55 years. Obviously they get benefit or they wouldn’t bother with it. Wouldn’t pay 300 bucks to keep using it -150 to the doctor, 150 to the state. The line I hear over and again is, ‘Marijuana works better than any prescription I’ve been given.’"
The approximately 100 cannabis dispensaries now operating in California fall into two broad categories: those who view their customers strictly as customers, and those who relate to them as potential participants in a political movement or a clinical trial. It’s not merely a matter of semantics or image -everybody calls their customers "patients," and anybody can dub themselves "compassionate" and tack up a marijuana leaf imposed on a red cross. Cannabis dispensaries that merely give lip-service to Dennis Peron’s radical ideals have something in common with the early Christian churches after Jesus was offed and his disciples began the long segue from the sermon on the mount to supremacy in the real estate market.
One club proprietor with a sense of political responsibility is Martin O’Brien, founder of the Berkeley Patients Care Collective on Telegraph Avenue. Over the years O’Brien has attended many a meeting and rally and trial, some of which he recorded on video. Now he has incorporated his high-quality footage -and more, from TV news sources- into a 30-minute documentary called "Regarding Medical Marijuana," produced in association with Americans for Safe Access. It’s available free on-line at http://www.medicalmarijuanainfo.com/.
The trouble is, there are too many snippets and no unifying framework, so the movie is way too choppy for this old print journalist. It’s said that people raised on MTV are accustomed to absorbing information in quick little bites; but not every story can be told in a snappy couple of sentences. I recommend O’Brien’s debut documentary as a kind of video scrapbook, a way for people who have followed their exploits from afar to see close-ups of Dennis and Tod Mikuriya and Phil Denney and Terence Hallinan and Valerie and Mike Corral and Mike Alcalay and Ed Rosenthal and Steph Sherer and Don Duncan and other greats and near greats of the medical marijuana movement in California.
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FRED GARDNER can be reached at firstname.lastname@example.org