Patients Without Time

Cannabis advocacy group empowers patients to manage their own medication

February 2, 2005
by Rob Lafferty

From a small office in the Pa‘ia Plaza, a group of folks who represent both the future and the past are working to bring relief to people whose lives have been altered by pain and disease. They help patients and doctors re-learn an ancient herbal medicine with a 4,000 year history, and they’re changing attitudes about pharmacology in the Western world along the way.

Patients Without Time is a medical cannabis advocacy and advisory organization. Since March of 2004 they’ve been guiding people through the process of obtaining a “Blue Card”, a Hawai‘i state license to legally use cannabis as medicine. They also educate people about state and federal laws concerning medical cannabis; explain the different ways to ingest it; and advise them how to grow their own plants and prepare them for medicinal use.

They don’t provide anyone with cannabis; they don’t sell any, and they don’t keep any in stock for people to sample. (The words “marijuana” and “cannabis” are often used interchangeably, but the plants with medicinal value are properly called cannabis sativa and cannabis indica.)

They are not a “Cannabis Club” like those in California that still operate despite the threat of federal prosecution. Members of Patients Without Time do, however, exchange cuttings to make clones of specific strains of cannabis plants for treatment of specific medical conditions.

Membership now includes more than 240 Maui County residents. Daily operations are being managed by Brian Murphy and a few volunteers, who sign up new members and educate them about the state licensing application.

In 2000, Hawai‘i became the first state to legalize cannabis for medicinal use through the legislative process. The form of administration is a licensing program, which is quite different from registries that other states maintain.

The law in Hawai‘i allows for the medical use of cannabis as a form of “compassionate care” for treatment of cancer, glaucoma, HIV/AIDS, chronic or debilitating disease, wasting syndrome, severe pain, severe nausea, seizures, severe muscle spasms, multiple sclerosis and other neurological conditions. People who’ve had bone marrow transplants or undergone chemotherapy are also likely to qualify for a license. Patients must have a doctor’s recommendation and be approved by the Department of Health.

License holders can grow their own plants and keep an “adequate supply” on hand, which the law states “...shall not exceed three mature marijuana plants, four immature marijuana plants, and one ounce of usable marijuana per each mature plant.” Patients may designate one person as a “primary caregiver” to grow plants for them. Both are required to register and renew their licenses annually with the Narcotics Enforcement Division of the State Department of Public Safety.

Alaska, California, Colorado, Maine, Montana, Nevada, Oregon, Vermont and Washington all have medical cannabis use laws that are similar in intent to the Hawai‘i law. Six of those states administer their programs through their health departments, while Nevada manages theirs with the agricultural department. Only in Hawai‘i is the medical cannabis program considered a matter of public safety instead of public health.

In Oregon, nearly 10,000 cards have been issued. The Oregon Department of Human Services doesn’t question a doctor’s recommendation for medical cannabis – they leave it up to the physician to decide what is best for the patient. That's largely true in Hawai‘i as well, as only a few applications have been rejected, with most of those rejections due to lack of documentation of any qualifying condition.

For those licensees, “Acquisition, possession, cultivation, use, distribution, or transportation for medicinal use” is all perfectly legal. The word “distribution” is further defined and restricted to the transfer of cannabis and paraphenalia from caregiver to patient.

Sensibly, cannabis use is strictly prohibited in any moving vehicle, in any workplace, on any school grounds or in any public place. Any use that endangers the health and well-being of another person is also prohibited, as is the case for most prescription pain relievers. The difference is that a person can take prescription narcotics and drive their car; if they are stopped by police for any reason, they might be charged with driving while impaired – but there is no law stating that a person cannot operate a vehicle after taking Valium.

The law sets limits for medicinal cannabis that are more definite and restrictive than the laws regulating opiate-based prescription narcotics. A doctor or oral surgeon can prescribe as much Vicodin, Percodan or other addictive narcotic as they feel is necessary for their patient’s needs, but no doctor can write a prescription for any amount of cannabis.

This is true despite the fact that powerful pharmaceuticals such as OxyContin and Ritalin can be obtained legally, by illegal “doctor shopping” and prescription abuse, or through a robust black market – methods that conservative radio show host Rush Limbaugh is alleged to have used, first to relieve back pain and later to feed his subsequent addiction.

A Hawai‘i “Blue Card” does not protect anyone from arrest by federal authorities operating under federal narcotics laws, although those laws are being challenged in hundreds of cases across the country. In December of 2003, the 9th U.S. Circuit Court of Appeals set a precedent by ruling that prosecution of licensed users under a 1970 federal law is unconstitutional if cannabis is not sold, transported across state lines or used for nonmedicinal purposes.

That information is just part of what prospective members are taught during their pre-screening at Patients Without Time. It usually takes at least an hour to review their medical history and explain the process so that applicants can, as Murphy says, “decide for themselves if it is worth their time to pursue a license.”

New members are asked to pay a fee of $100 if financially able to do so, or to pay what they can to help defray the costs of running the organization. They can then take their application to a physician, who will complete the forms and submit them to the state along with a $25 processing fee. In about two weeks, if the application is approved, the member will receive their Blue Card.

Murphy is the main educator at Patients Without Time; he has been a cannabis horticulturist and medical user for more than 20 years. His involvement with cannabis began after suffering a stroke at age 34, which led to 13 years of working with NORMAL, the National Organization for the Reform of Marijuana Laws. He was also deeply involved in writing and promoting Proposition 215 in California and Proposition 59 in Washington D.C. – ballot initiatives that made it legal for medical cannabis to be used under those state’s laws.

In 1990 he helped to develop a vaporizer as an alternative to smoking the herb. Further research produced methods to distill a liquid tincture that assures a consistent dosage and also eliminates the need to inhale cannabis smoke.

Murphy especially likes the tincture method of use. “Accurate titration, or dosage, can be exactly produced when making a tincture. That’s not always true with prescription forms of medication,” he says. “A patient may only need 7 milligrams of a drug, but pharmaceutical companies may only make tablets in either 5 or 10 milligram doses. As a result, people are frequently being undermedicated or overdosed.”

The purpose of his research has been to develop varieties of cannabis that are low in intoxicating compounds but retain the cannabanoids that are most effective in treating pain. Recreational users have long defined that difference as being either a “head high” or a “body high”.

The organization has a list of more than 60 strains of cannabis with identifying characteristics of their effect on the mind and body, which they use to help members determine which strain will best relieve their symptoms without significant mental impairment.

Independent researchers like Murphy are needed because the federal government will quickly provide funds for research on the harmful impact of smoking marijuana, but will not fund projects exploring the positive medicinal benefits of cannabis.

Patients Without Time can refer a member to one of 18 physicians here in Maui County who screen and certify a patient’s need for cannabis, but they ask all new members to go and talk with their own family physician first.

“It’s always best that your primary physician knows everything that you are doing medically,” said Murphy. “We’re always available to answer any questions that your doctor may have about medicinal cannabis and the license application.”

A different form of using cannabis is with an oral spray called “Sativex”, an extract which contains the cannabinoids THC and CBD, much like the cannabis-based extracts that were widely available until the plant was made illegal in the US in 1937. Clinical trials conducted by Britain's GW Pharmaceuticals showed that cannabis extracts like Sativex reduced cancer pain in volunteers.

According to GWP spokesperson Stephen Wright, “Patients in this trial were suffering intense pain as a result of their cancer despite using currently available strong opioid treatments, and therefore had a very high clinical need. The data from this important trial further demonstrates the broad potential of Sativex, not only in its initial multiple sclerosis and neuropathic pain markets, but also with cancer and potentially other types of chronic pain.”

In December of 2004, Health Canada issued a “Qualifying Notice” for the approval of Sativex for the treatment of neuropathic pain associated with multiple sclerosis. Its potential for use in other conditions is being reviewed by the Canadian government.

The folks at Patients Without Time agree with GWP chairman Dr. Geoffrey Guy when he says, “Marijuana is indeed a medicine, one that is both effective and remarkably safe. Patients should have access to marijuana in whatever form they and their doctors find most useful. Sativex is to marijuana as a cup of coffee is to coffee beans, and there is simply no justification for arresting patients for using different varieties of the same medication.”

Murphy plans to introduce a proposal soon to the Maui County Council that could lead to a ballot initiative in 2006 that will clarify the cannabis law and bring it into alignment with guidelines set by the federal government for its own supply program, which was established twenty years ago on a very limited basis.

Through the community of healers, doctors and caregivers, they are hoping to encourage a current trend towards using homeopathic herbs whenever possible, and taking the more expensive – and often riskier – pharmaceutical approach only when necessary.

If you or someone you love has a qualifying medical condition and you believe that they might benefit from using cannabis – an ancient herbal medicine that has been badly maligned and criminalized for far too long – give Patients Without Time a chance to explain how cannabis may help. Their new office is in the Pa‘ia Plaza, 71 Baldwin Avenue in Pa‘ia. They’re in Suite C-3. You can e-mail them at bmurphy@msn.com while they await their new phone lines.

In a future issue of Haleakala Times, we’ll take a look at several long-term goals that Patients Without Time are working towards.
We’ll also take readers through the second part of the licensing process, and meet some local folks whose lives have been changed for the better since they began using cannabis to treat themselves instead of being medicated with prescription narcotics.