What’s the Matter with Oregon?
"In Corvallis, a very progressive community, there is virtually no doctor who will recommend cannabis for cancer pain or for severe nausea or AIDS."
-Nurse Ed Glick
Ed Glick was fired April 18 from his job as an acute-care nurse at Samaritan Regional Mental Health Center in Corvallis. He had been employed there for 12 years. The pretext was his refusal to take a drug test. The real reason, Glick thinks, was the pressure he’d been putting on the Oregon Medical Marijuana Program to accept patients with psychiatric diagnoses.
The Oregon Medical Marijuana Act was created by voter initiative in 1998. Unlike California’s law, passed in ’96, which authorizes doctors to recommend marijuana for "any… condition for which marijuana provides relief," the OMMA created a finite list of qualifying conditions: Cachexia (wasting), Cancer, Glaucoma, HIV+/AIDS, Nausea, Severe Pain, Seizures, including but not limited to epilepsy, and Persistent muscle spasms, including but not limited to those caused by multiple sclerosis.
After OMMA passed, Glick began seeing patients at Samaritan who said they were self-medicating with cannabis to ease various psychiatric symptoms. He would encounter the same people at the Compassion Center in Eugene, where he worked as a volunteer helping patients enroll in the state program. "We assist these people by trying to find a physical correlation to their psychiatric symptom," Glick explains. "For example, if they’re having PTSD symptoms they might be sick and have physical symptoms."
Glick attempted to determine how many people were treating psychiatric symptoms by reviewing 172 randomly selected charts. He presented his results at the Patients Out of Time Conference April 8:
"The average patient age was 43. All the patients were registered in OMMA; 95% were registered for pain. (A very large percentage of Oregon registrants are pain patients. Some 40% had multiple qualifying conditions (not including psychiatric) -physical pain and nausea, for example. Pain with spasticity -they often go together.
"The results: 64% of the patients in the survey showed some kind of significant psychiatric benefit; 39% reported insomnia relief; 5% reported PTSD symptom relief, many of them veterans who go to the VA hospital in Roseburg and are denied. The VA doctors tell them ‘No, I can’t. I’ll lose my DEA license.’ They just don’t want to stand up to it -although they’re beginning to refer patients to us, which is kind of interesting.
"Anxiety, 11%; depressive symptoms, 11%; 15% of the cohort reported that they were using cannabis to decrease the side effects of medications; 56% reported reduced use of medications.
"What these patients report to me is that they’re sick and tired of Vioxx and they’re sick and tired of Flexeril, Vicodin -people are literally sick of these drugs. They can’t sleep, they can’t function, they’re drugged up, they don’t have any enjoyment of life. When they start using cannabis they leave off the Vioxx and they leave off the Vicodin. Vicodin has a place, but for long-term pain management it is really poor. Appetite stimulation -tremendously important for people who are in pain all the time- was 20%.
"I put the survey together as a request to the Oregon Department of Human Services to reconvene the Debilitating Conditions Advisory Panel, which I was a member of in 2000. At that time nine patients had submitted requests to include psychiatric conditions to the list. The state health officer did a fairly good job of bringing together the panel, but the whole thing was skewed from the outset by political manipulation by the governor’s office and by the head of the Department of Health Services. The information that they would allow us to consider had to be filtered through rules stating that if it’s not a double-blind, peer-reviewed clinical trial, it doesn’t get a lot of evidentiary weight.
"We were not allowed to give much weight to patients’ reports. And of course there was no relevant double-blind, peer-reviewed clinical trial. So the panel was set up to fail. A few patients came in and gave very compelling testimonials. And then out of nowhere came a whole bunch of medical experts -psychiatrists from Oregon Health Sciences University and the National Alliance for the Mentally Ill- and they just had fits. "This is quackery," they said.
"The only person who even differentiated between affective depressive-type disorders and schizophrenic thought disorders was one of the patients. None of the doctors even made any differentiation between these two completely different sets of medical problems. After a long, protacted time we all wrote our comments out, and there was a vote, and we voted to add affective disorders -severe agitation and depressive symptoms. Didn’t happen. They finally did add Alzheimer’s agitation. [Fewer than 50 patients have qualified to date for Alzheimer's agitation.]
"So, five years later I brought in the study I’d done with OMMP registrants and asked them to reconvene the Debilitating Conditions Panel based on this new evidence showing that indeed there is some psychiatric effect that people are getting from their cannabis use. And they rejected the request with a ‘summary denial.’
"Then Lee Berger, an attorney in Portland, asked if I’d be willing to sue the Department of Human Services’ OMMP and I said yes. We filed our petition for judicial review in February -a formal request ‘to Add Clinical Depression, Depressive Symptoms, Post-Traumatic Stress Disorder (PTSD), Severe Anxiety, Agitation and Insomnia, to Those Diseases and Conditions Which Qualify as "Debilitating Medical Conditions" under the Oregon Medical Marijuana Act.’ And it worked! I can’t believe it!
"We got word in late March that, because the OMMP doesn’t really want to go to court, they’ve decided to kind of sue for peace. All we’re asking is that they reconvene a panel to evaluate these conditions. So, we’re in the process of negotiating with them to get this thing back on track.
"We want to close some of the loopholes that allow them to skew the evidence base. It’s pretty clear that there are a lot of patients who are using cannabis for insomnia, for mood stabilizing, and for peace. Just for a a very simple, elemental peace, especially with chronic diseases like severe chronic pain. Cannabis is actually a miracle drug for pain, in my opinion.
"There’s no question the last thing the pharmacy industry wants is millions and millions of Americans growing and using their own medicine that covers such a wide array of diseases."
Glick was fired 10 days after giving this account to Patients Out of Time. Perhaps someone at the Oregon Health Sciences University, the dominant institution in Corvallis, did not like the effrontery of a Samaritan nurse criticizing their prestigious "experts."
Washburn Can’t Get His Job Back
The Oregon Supreme Court has ruled against Robert Washburn, a Klamath Falls millworker fired by Columbia Forest Products in 2001 after he tested positive for marijuana. Washburn had a card from the OMMP and used marijuana at home (not "in" the workplace) for insomnia stemming from muscle pain. Before getting his card in 1999 Washburn had been using prescription painkillers. He says that marijuana is more effective and exerts no adverse effects. He requested that the company give him a test to determine if he was actually impaired on the job (rather than one that detects metabolites in the urine). This, his lawyer argued, would be a reasonable accommodation under Oregon’s statute protecting the disabled from discrimination in the workplace. When the company refused, Washburn sued for reinstatement and back pay.
A Multnomah County Circuit Court judge ruled against Washburn, citing a clause in OMMA saying the act shall not be construed to require "an employer to accommodate use of medical marijuana in the workplace." The Court of Appeals then ruled for Washburn and Columbia Forest Products took the case to the state supreme court, which heard arguments in November. Now the Supremes have ruled unanimously that Washburn does not qualify as disabled because the prescription drugs enabled him to sleep (albeit less well and with more side effects than marijuana).
According to Chief Justice Paul De Muniz, Washburn’s pain-related sleep problems did not constitute a "substantial limitation" justifying the use of marijuana. In a concurring opinion, Justice Rives Kistler cited the U.S. Supreme Court ruling in the Raich case that the federal Controlled Substances Act prohibits marijuana possession and use, even for medical purposes.
The state supreme court ruling against Washburn is "narrow" in the sense that workers with more severe disabilities might yet assert the rights he was denied. But attorney Phil Lebenbaum, expressed concern that the ruling limits the definition of a disability, and may affect workers in cases having nothing to with marijuana.
Reform advocate Don DuPay, running for Sheriff of Multnomah county, got 31% of the vote (on a budget of $485), despite being dissed by the Portland media. DuPay is a former Portland cop who has worked extensively with recovering addicts and alcoholics. "Willamette Week was the first paper to talk to me," he recounts. "I spent an hour talking to four of their reporters, explaining my ideas about community policing, getting rid of tasers, getting rid of the SWAT-team-style uniforms, creating a Wapato Treatment center, giving back $30,000 of my salary to social services. ‘Thank you Mister DuPay for coming in,’ they said, ‘And by the way, what kind of a car do you drive?’
"What they printed was that I was a 69-year-old marijuana-smoking grandfather with a cult-following from the Cannabis Common Sense TV Show. Is that all those reporters heard? They went on to endorse a write-in candidate unqualified to take office." Alternative media, indeed.
Can’t You Say Something Positive?
Bees and butterflies were sighted in the Willamette Valley on our O’Shaughnessy’s distribution run. This may mean that the organic movement is reducing the tonnage of pesticides and herbicides drenching that luscious topsoil D.O., the osteopaths’ journal, has a cover story on cannabis in which Philip Leveque (whose license was revoked by the Oregon Board of Medical Examiners) is one of two advocates for the herb in a debate against 12 nay-sayers. Leveque says he’s heard that some 200 Oregon osteopaths have issued letters of approval for their patients to medicate with cannabis.