U.S. Threatens Penalties if Doctors Prescribe Pot

WASHINGTON —  Stepping up their attack on the state’s medical marijuana initiative, Clinton administration officials warned doctors in California and Arizona on Monday that they could lose their authority to write many drug prescriptions and may face criminal charges if they recommend marijuana for their patients.

“Our health care professionals need to understand that federal law has not changed,” said Health and Human Services Secretary Donna Shalala. “It continues to be illegal in the United States to prescribe marijuana.”

Although physicians are licensed to practice by the states, they need authorization from the U.S. Drug Enforcement Administration to prescribe controlled substances, including common painkillers. Without that authorization, most doctors “would practically be out of business,” one federal official said.

The announcement culminates an eight-week debate within the administration on how to respond to the drug initiatives that won voter approval in California and Arizona.

Retired Gen. Barry R. McCaffrey, the White House director of drug control policy, worked with federal law enforcement agencies in drawing up the administration’s response, and it was approved by Clinton before he headed for a vacation in South Carolina and the Virgin Islands.

“This is not a medical proposition,” McCaffrey said in condemning the two state initiatives. “This is the legalization of drugs.”

In letters going out this week, federal officials plan to tell medical groups and state agencies that they “unequivocally will seek to revoke the DEA registrations of physicians who recommend or prescribe Schedule 1 controlled substances” such as marijuana. Health officials said these doctors could be excluded from the Medicare and Medicaid programs.

To hammer home the point, Atty. Gen. Janet Reno said federal prosecutors will bring a few criminal cases against doctors who deal in a “high volume” of marijuana or give the drug to minors.

Angry advocates of the medical marijuana initiative accused the government of turning the war on drugs into a “war on doctors.”

“These are scare tactics, and we don’t intend to let this happen without a fight,” said Bill Zimmerman, director of Americans for Medical Rights, a major sponsor of the November ballot initiative.

Approved by 56% of the state’s voters, Proposition 215 removes criminal penalties for possession of marijuana by patients and caregivers if its use was recommended by a physician. Arizona’s Proposition 200 goes one step further by allowing sick people to use stronger drugs, including heroin or LSD, if recommended by two licensed physicians.

Zimmerman said his group plans to go to federal court to seek an order blocking enforcement of the federal policy on grounds that it violates the free speech rights of physicians.

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“I cannot imagine that a doctor, sitting across from a patient, cannot tell that patient that there is medical research indicating that marijuana might be useful in alleviating his suffering,” Zimmerman said.

Dr. Marvin Trotter, the public health officer for Mendocino County and a practicing emergency room doctor, said he has recommended marijuana for some AIDS and cancer patients.

“Many of them get a great benefit from it,” he said. “I still don’t understand why I can legally prescribe a bottle of morphine . . . but can be put in jail for prescribing a much less toxic natural plant.”

Dr. Stephen Brunton, president of the 6,100-member California Academy of Family Physicians, called the administration policy “draconian” and said it presents doctors who treat terminally ill patients with a “moral dilemma.”

“The goal of all physicians is to ease suffering, but do they recommend marijuana if it means losing their medical licenses?” asked Brunton, a Long Beach family physician.

Federal health officials strongly disputed claims that marijuana is an effective medical treatment.

“Let me be clear: There is not a body of scientific evidence that supports these initiatives or the medical use of smoked marijuana,” said Dr. Alan Leshner of the National Institutes of Health. “The scientific community gave up on the study of marijuana as a potential medication in the 1980s.”

McCaffrey and other officials said they are most concerned that teenagers would be led to believe that marijuana is harmless.

Atty. Gen. Dan Lungren, California’s chief law enforcement officer, applauded the administration’s hard-line stand. A vocal opponent of Proposition 215, Lungren said the administration’s announcement gives state officials “some clarity where fog had existed before.”

The California Medical Assn., which opposed the initiative, continues to advise its 35,000 members not to recommend marijuana to patients. Dr. Jack Lewin, executive vice president, said doctors could be held liable if their patients abuse marijuana or are involved in an auto accident while under its influence.

Savage reported from Washington and Warren from Sacramento.