Deni Llovet, a family nurse practitioner, organized River City Family Health’s first medical marijuana clinic after a patient with chronic back pain committed suicide.
“Two and a half years ago, I had a client who was really suffering,” Llovet said. “We had tried everything and finally I said, ‘You know, I hear that marijuana could help.’”
When the patient asked if it was legal, Llovet said no. She did not know about the state’s exemption.
“She bought cannabis from her 27-year-old son and it worked wonders,” Llovet said. “But her family did not approve, so she killed herself because her pain was so great.
“I should have known it was legal. That’s when I realized that I was missing the beat.”
Nearly 700 medical studies of cannabis and its derivatives are published each year that confirm their useful medical properties, said Tom Daubert, who led the campaign to establish the Montana law and later founded the patient support group Patients and Families United.
In 2002, adjunct University of Montana professor and local neurologist Dr. Ethan Russo researched the long-term effects, positive and negative, of smoking marijuana as a medical treatment.
Russo’s team, which included a UM grad student, evaluated four remaining members of the FDA’s Compassionate Investigational New Drug program. Though the program no longer accepts new patients, the remaining four are provided with four to eight ounces of government-grown, cured marijuana each week as treatment for serious illnesses such as glaucoma and multiple sclerosis.
“The Missoula Study,” as it was nicknamed, concluded the medical use of marijuana relieved pain, muscle spasms and intra-eye pressure. The researchers recommended that the program be reopened or that states develop laws to accommodate patients in serious need.
“While some 13 American states allow medicinal use of cannabis for certain conditions, it remains illegal under federal law,” Russo said. “One possible solution to this situation would be FDA approval of a cannabis-based medicine so that it could be prescribed. Because of the side effects of smoking and variability in herbal cannabis without standardization, it is extremely unlikely that it could attain FDA approval.”
Most recent research delves into the relationship of phytocannabinoids found in marijuana plants, such as THC, and endocannabinoids, their counterparts produced in the human body. When a medical marijuana patient takes a dose, most of the phytocannabinoids engage with cells of the nervous system in conjunction with the endocannabinoids already present to produce a variety of effects, including pain relief.
Russo continued to research and synthesize these cannabinoids as senior medical adviser for GW Pharmaceuticals to help develop a cannabis-based oral spray. The product, called Sativex, is approved in Canada to treat cancer pain and multiple sclerosis.
But until it is approved in the U.S. or the cost of similar cannabis-derivatives decreases, physicians such as Llovet say they will continue to recommend the leafier medical counterpart.
Llovet said she prefers to recommend marijuana over opiate painkillers because it does not have the side effects, physical addictions or overdoses commonly seen among patients prescribed morphine or Oxycontin, for example.
“If you wanted to kill yourself with cannabis, you would have to smother yourself under bales of it,” Llovet said. “Overdose is easy with prescription pain killers.”
Using medical marijuana or its pharmaceutical derivatives in conjunction with other painkillers can provide superior relief and reduce the risk of developing a tolerance to opiate prescriptions, Russo said.
Sitting at Food For Thought, Llovet was wrapped up in her excitement. Her coffee grew cold as she talked about the clinics where she works with others to identify the best treatments, sometimes including medical marijuana.
Contrary to what she expected, Llovet said the clinics don’t see recreational users looking for a loophole.
“We see the little old ladies, the old man living out in the woods and once we went out to a car to help a quadriplegic. We are seeing people who haven’t seen a health care practitioner in 30 years,” Llovet said. “We really are providing a public service. Our job is to make sure they really do qualify, and we want to give them suggestions on how to improve their health, whether that includes medical marijuana or not.”
At River City Family Health, visiting the clinic costs $200 for the patient, who must also register for an appointment and submit medical records in advance, though qualifying individuals without records are also allowed to attend.
When a prospective patient arrives at the clinic, a nurse gives him a physical before passing the chart to Llovet, who speaks with each individual for at least 15 minutes about his medical history and suggests all possible treatments. The person and chart then move to the final stage for a consultation with Dr. Michael Geci, who may sign a physician’s recommendation for medical marijuana if he believes the patient legally qualifies and the treatment seems appropriate.
After receiving a physician’s recommendation, the person applies for a patient registry card with the state Department of Public Health and Human Services and can designate one person as a caregiver. Each patient is allowed to grow six plants for their medicine and possess one ounce of usable marijuana, and if they name a caregiver, that person can tend six plants and hold one ounce for each patient they assist.
“We are not affiliated with caregivers,” Llovet said. “We do recommend you enter into a relationship with a caregiver you trust.”
Daubert said many people designate a spouse or close friend as a caregiver, but often it is difficult initially because most people do not have experience growing cannabis.
“These are the only patients in the world growing their own medicine,” Daubert said. “Contrary to what a lot of people think, growing medical marijuana is not so simple. It takes months to grow a plant.”
In February, Daubert led a group of patients, caregivers, and activists to the state capitol, where they sought to improve the law’s functionality through Senate Bill No. 326, which died in a House committee after passing Senate.
“The House legislature was evenly divided (between parties) and a lot of bills couldn’t make it out of committee,” Daubert said. “It’s some part political fluke and partly because it was brand new information to many of the representatives. We got more support than I’d expected, however.”
The bill, created by Daubert and other PFU associates, sought to expand the law’s list of qualifying illnesses, allowing patients to obtain medicine from any registered caregiver, establish inventory audits under certain conditions, increase the amount of medical marijuana a patient and caregiver can possess and alter the definition of a mature plant to make it easier for patients to maintain a steady flow of medicine.
“We’ve likened our law to being allowed to have six tomato plants, but only one tomato and needing one in the fridge tomorrow to guarantee your medicine,” Daubert said. “Let me see you grow the plants and follow that rule. That’s what we are asking them to do.”
And for people who choose not to grow themselves, or who need larger amounts for relief, they rely on their caregivers to provide consistently as they, too, abide by the tomato rule.
Sometimes, an even flow of medicine cannot be maintained for other reasons.
Daubert said there is one con artist who travels the state persuading people to fund a large grow operation that he promises will yield large profits, then walks off with the money. He’s also heard complaints about caregivers who charge exorbitant prices or don’t deliver the medicine to patients as promised.
Because the law does not include provisions for punishing negligent caregivers or reasonable oversight that would limit the opportunities of con artists, one anonymous Missoula cardholder said many patients like himself are left without a legal source of medicine and no guarantee of justice.
“There are a lot of people taking advantage of new patients,” he said. “There is no database of reliable caregivers.”
October 6, 2009