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Pot crusade at a crossroads

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Pot crusade at a crossroads


Fremont (CA) Argus, June 25, 2000
and Oakland Tribune July 01, 2000
By Matthew B. Stannard
SITTING on the mattress in his cheap hotel room, Tod Mikuriya took
his first nervous toke on a reefer and decided everything he had ever
been told about marijuana was a lie.
It was 1959 in Saltillo, Mexico, 189 winding miles south of Laredo,
Texas. Mikuriya, then a 27year-old medical student, was following the
grand American tradition of experimenting with pot out side the laws of
his native land.
But this was no weekend binge. This was re search, sparked by a
book listing historical uses for pot so at odds with conventional medical
wisdom that Mikuriya decided the path to truth led through the drug itself.
"It was definitely an interesting mental state," Mi kuriya recalled
recently in his Berkeley home, sur rounded by books on medicine and civil
rights and pictures painted by the younger of his two children. "But it
was easier than being drunk. It was just overrated as being dangerous."
The path Mikuriya chose also led into the heart of one of to day's
thorniest medical contro versies, where he is seen as leading scholar by
some, arch scoundrel by others. In the near future, as police,
politicians and public struggle to resolve the medical status of
marijuana, his path might lead to victory -- or to the end of his medical
career.
On one recent morning, Mikuriya, now a 67-year-old licensed
psychiatrist, holds an informal clinic in a bedroom in an East Bay senior
center. A sobbing woman describes her chronic back pain, repeated
surgeries and bouts of major depression.
Mikuriya's broad face furrows at antidepressents, tranquilizers,
painkillers the woman is in gesting. Dump some of those medications, he
advises. Cut back on others. Instead, up your dosage of marijuana, a drug
she already is taking and which Mi kuriya himself uses daily.
("Its a good mood modulator," he says. "And it helps me sleep.")
He hands the woman a form certifying she is under his care and that
he recommends she use cannabis, smiling until his ears pull back flat
against the sides of his head and hide behind graying sideburns.
"What does it feel like not to be a criminal anymore?"
The form is less a prescription than a "Get Out Of Jail Free" card.
If a patient produces a phy sician's letter of recommendation as an
explanation for possessing pot, some police -- including those in Oakland
and Berkeley -- might decline to pursue charges, following hazy guide
lines created after Proposition 215 passed in 1996.
Mikuriya signs a dozen letters in a single day, adding to thou
sands he has written in the past few years. Nobody knows how many similar
letters other doc tors have signed in the past four years, but there is
broad agreement that Mikuriya has signed more letters than anybody else
-- many more.
Mikuriya's research on the drug's historical acceptance is cited by
San Francisco Cannabis Cultivators Club founder Dennis Peron, Oakland
Cannabis Buyers Collective director Jeff Jones, former Libertarian
gubernatorial candidate Steve Kubby, and other movement leaders.
More important -- to him -- Mikuriya is the doctor patients turn to
when their own physi cians cannot or will not support their decision to
use marijuana. Critically ill people travel hun dreds of miles to ask for
one of his letters, and he travels hun dreds of miles to deliver them.
"We consider him a real hero," Kubby said. "He is the world au
thority, and no one knows more, has seen more patients, or has been more
involved than Dr. Mi kuriya."
But to many law enforcement officers, federal officials and even
some of his peers, Mikuriya per sonifies the worst excesses of the
medicinal marijuana movement. To them, his letters are a thinly disguised
campaign for mari juana legalization -- he has written extensive essays
against current drug policies -- and a breach of medical ethics.
"He is a true believer," said Humboldt County District At torney
Terry Farmer, a member of Attorney General Bill Lock yer's medicinal
marijuana task force. "He believes marijuana is good for whatever ails
you, and just about anything you can de scribe that ails you, he's pre
pared to give you a recommendation for."
More than 40 years after his Saltillo revelation, Mikuriya's fu
ture and the future of marijuana as medicine have arrived together at an
crossroads of possibility.
One possibility is vindication. Supported by growing public support
for allowing doctors to prescribe cannabis, six states that followed
California's lead and passed laws permitting use of the plant as
medicine, and a 1999 Institute of Medicine report that concurred at least
partly with Mikuriya's long-held opin ions.
But another possibility is re jection, a return to prohibition, and
the end of Mikuriya's med ical career. The federal govern ment still
holds that marijuana has no legal use, and California officials still are
wrestling with applying Prop. 215. Much of Mi kuriya's recent time has
been spent preparing for and de fending against subpoenas calling him to
courts around the state to defend the legitimacy of his pa tients' need for
cannabis.
What's more, Mikuriya says the Medical Board of California and the
California Attorney Gen eral are investigating whether he has departed
from standard medical practice. State officials neither confirm nor deny
that claim, but Mikuriya has a March 24 letter on board letterhead
charging him with failing to meet "basic, even minimal standards of
prescribing a legal psychoac tive medication."
If the board pulls his license, Mikuriya has said, he will stop
signing patients' letters -- he al ways has followed the rules. But until
then, he will continue the work as a "moral entrepreneur" he says has
given him more satis faction than anything so far in his professional life.
"I wouldn't trade in my kind of fear for physicians who are trapped
by HMOs and turned into scrip docs and rubber stamps," he said.
Mikuriya estimates he has for mally recommended marijuana about
4,000 times -- mostly after the passage of Prop. 215. His pa tients have
ranged in age from 6 to 93, suffering from more than 120 ailments,
including alco holism, AIDS, motion sickness and thyroiditis.
So many patients have sought him out, he says, that he was asked to
leave the office where he held private practice. Now, he sees patients at
his home, or at the informal clinics he holds all over the state, where
he charges on a sliding scale, from nothing to $150.
Despite its many uses, pot is not for every patient, Mikuriya
believes. He has warned that it can be harmful if "ignorantly or
imprudently used," and has on occasion turned away patients -- according
to Peron, who was irri tated by the doctor's decision.
"I didn't like it. If a patient wants to use marijuana, the doctor
should give it," Peron said. "But he obviously has re fused people,
because they called me."
Nevertheless, Mikuriya has been sharply criticized as far too
permissive by law enforcement officials struggling to balance Cal
ifornia's somewhat vague law permitting marijuana to be used as medicine
and federal law, which clearly prohibits the same thing.
Critics argue there is no way Mikuriya can establish, in a brief
interview and record review, the kind of physician-patient rela tionship
required for prescribing most drugs. A few cannabis club staffers agree,
albeit anony mously, for fear of spooking pa tients.
Worse, his critics say, Miku riya's willingness to recommend
cannabis for such ailments such as depression or lower back pain harms
the legitimacy of patients with more severe ailments -- cancer, AIDS --
and the medic inal marijuana movement at large.
"To the extent that you have people who are sincerely inter ested
in looking at medical mari juana as a medicine, I think he hurts their
cause," said Hum boldt County's Farmer. "To those who want to achieve de
facto le galization, he may have advanced their cause, because he
certainly throws a monkey wrench in the system -- and maybe that's what
he wants to do."
Such criticisms have hurt Mi kuriya's professional reputation in
some quarters. Organizers of a June cannabis therapy confer ence at the
University of Cali fornia School of Medicine, for example, left Mikuriya
off the in vite list for fear his reputation as a political advocate
would scare off participants promised a purely objective medical course.
"The more someone becomes knowledgeable and devoted to a cause, the
more they lose credi bility of the people they're trying to reach," said
Alice Mead, a Cali fornia Medical Association con sultant organizing the
event. "That's a very unfortunate irony."
That outrages Mikuriya's sup porters, who say his workload comes
from the scarcity of doc tors willing to provide the limited protection
of an official recom mendation to patients who al ready are using the
drug and finding it helpful. To those people, his supporters say, Miku
riya is a literal lifesaver.
"Tod is a doctor who believes his patients. He believes them. If
you come in and say, 'I had this pain in my shoulder and when I smoke
cannabis I don't think about it and it's not so bad ...' he assumes
that's your real expe rience," said Fred Gardner, spokesman for San
Francisco District Attorney Terence Hal linan. Gardner met Mikuriya as
a reporter.
"He doesn't think you're some con artist trying to get around the
law. He thinks you're a grownup."
Mikuriya's patients describe him as a caring, knowledgeable
physician willing to listen to pa tients. Many say they turned to
Mikuriya as a last resort, after their own physicians refused to give
them a signed letter they could show to police and pot clubs, forcing
them to buy from street dealers and live in fear of an encounter with the
police.
"You go to so many doctors and they can't help you for so many
reasons," one patient said, a week after her clinic visit. "Just knowing
you have that piece of paper makes a big difference."
To Mikuriya, that's reason enough to continue. When not at tending
to patients in court or in clinic, he is working on new proj ects, using
grandfather clauses to renew century-old patents on cannabis-based
medicines and organizing a network of medic inal marijuana researchers.
In the end, he would prefer to be remembered not as a rebel --
although he enjoys the role -- but as a physician, a researcher following
in the steps of William O'Shaughnessy, the Irish physi cian who
introduced marijuana to Europe in 1839. He would like to be remembered
for per sistence.
"There are a lot of really evil things going on in society that are
mostly bureaucratic in nature," Mikuriya said. "You have these concepts
that were OK in the middle ages, but have no place in the scientific,
supposedly enlight ened 21st century.
"Eventually, we'll have our
way."


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Dale Gieringer (415) 563-5858 // canorml@igc.org
2215-R Market St. #278, San Francisco CA 94114