CannabiNotes 5/14/03
by Fred Gardner
Anderson Valley Advertiser (CA)

Dr. Leveque Soldiers On

Whereas California has at least a dozen doctors who have made a subspecialty of monitoring their patients' cannabis use, Oregon has only one: Phil Leveque, a 79-year-old PhD pharmacologist and doctor of osteopathy. At the time of our last visit (AVA 8/1/01), Leveque had signed some 900 -about 40%- of the applications entitling Oregonians to possess and cultivate cannabis (up to seven plants, 14 with special approval from the doctor). And he had just learned that he was under investigation by the state Board of Medical Examiners for improperly authorizing the use of marijuana. "I look at my investigation by the Board," Leveque had said, "as fire coming from the front."

Leveque was a combat infantryman in World War Two, a forward scout. "I walked most of the way under fire from Luxembourg almost to Dresden. Under fire on a daily basis. I spent more time on the point than anybody else in my battalion and more time on the observation post than anybody except my own six guys. I don't have any idea how I got out of that alive. I couldn't get a commission because I didn't have a trigger finger. [The tips of several fingers on Leveque's right hand were severed in a childhood accident; the index finger was damaged the worst.] You couldn't be an officer if you didn't have a trigger finger, but you could be rifleman. That I couldn't understand, and still don't. I guess I survived because I have good reflexes and I'm not afraid to dive in the dirt."

"What makes me angriest," he'd said, " is that the VA doctors, as federal employees, can't recommend marijuana use because the U.S. government says it has no medical value. Now that's ridiculous! Some of these guys have terrible problems. It must have been a meat-grinder over there in Vietnam - and more of the wounded survived than in any previous war. They have terrible battle wounds. They've been shot to pieces, stepped on mines, exposed to Agent Orange. Many of these people found out for themselves that marijuana is the best thing for post traumatic stress disorder, and that is not on the approved list, so I've had to tell them 'Sorry, the Oregon law is set up only for physical disabilities. If you have any kind of battle wounds I can do it for you, but I can't do it for PTSD, period.' It's an absolute travesty that marijuana can't be prescribed for psychiatric disabilities. These guys have been given a whole bunch of stuff that doesn't work and that frequently makes them worse -Prozac, Paxil, and Zoloft."

The Board's investigators determined that Leveque was not keeping adequate records - in fact, he wasn't keeping records at all, for security reasons- and his license was suspended for 90 days starting May 1, 2002. I knew that Leveque had resumed practice, but I'd assumed he was keeping a lower profile and that other Oregon doctors were filling the breach. Wrong on both counts. Here's what Leveque had to say during a visit to gray-green Molalla in mid-April.

"At the time of my suspension the Board of Medical Examiners created the Leveque Rule -that's what the Oregonian called it. The Board is insisting on a physical exam -a top-of-the-head-to the-bottom-of-the-feet examination, which was added as a requirement.

"Originally it wasn't required that I even see a patient [face-to-face] or do a physical. Then the Board wanted to see my charts. I hadn't been keeping any. I'd been sending them in to the state Medical Marijuana program and not keeping copies in my home. My medical office has been broken into twice. To know the name and address of who has a medical card and can grow marijuana, that seems valuable -not something I'd want to keep in the house.

"The Board of Medical Examiners told me, 'You must see every patient, even if it's a quadraplegic who lives 500 miles away.' I have a lot of patients who literally can't come to see me, and though they're fully eligible, they can't find another doctor. I have a lady in Klamath Falls right now who is bed-ridden. I've signed for her two years in a row but I can't do it now without giving her a physical examination. I told her son to call Mary Leverette at the state Medical Marijuana office and ask straight up, 'What can I do for my mother?'

" I don't know why they think a thorough physical examination will detect any of the nine medical conditions [that Oregon law allows patients to treat with cannabis]. How am I going to look at somebody and say they've got HIV? Impossible. A physical examination by a general practitioner will not detect glaucoma, cancer, nausea, Alzheimer's rage, severe pain, severe nausea, epilepsy and certain spasmic conditions, They all require an examination by a specialist.

"There are 8,500 doctors in Oregon and I'm the only one who has to comply with the Leveque rule. No other doctor has to do a physical exam, as far as I know." At this time there are 950 physicians who have signed applications, according to Mary Leverette. She tells me most of them have signed one or two. They're giving them to people who are dying within a few months but they won't touch anybody else with a 10-foot stick. There are about 6,500 patients registered and I've signed applications from almost 4,000 of them. Only about 25 doctors have signed more than five applications. Nobody knows who they are, When a patient calls the Board trying to find a doctor to sign their application, they can't give out our names but they say 'Look on the Internet.'

"I work with different groups run by advocates for legalization. One in Eugene, one in Roseburg, one in the Ashland-Medford area, one in Brookings on the Coast, one in Klamath Falls, one in Bend, two or three in Portland. What they do is assemble the patients. We try to see about 20 patients a day. That takes me from about 10 in the morning till six in the evening -eight hours of writing time. And I've used up half of my fingers writing. (Shows fingers with tips missing) I travel 2500 to 3000 miles a month, I would guess. It's 300 miles to the California border and we may go to Roseburg twice, we may go to Grants Pass once, we may go to Medford once, we may go to Brookings twice in the course of a month.

"The physical examination is conducted by a nurse practitioner, Phil Allen. He's very good. By law, an MD, a DO a nurse practitioner or a physician's assistant can do the exam. But most of them, like the doctors, are afraid to even touch anything that has to do with marijuana... Phil Allen lives in Roseburg and drives up two or three times a week to the Portland office. He's also arranged for patients to be seen in Roseburg and Grants Pass."

In addition to the doctor and the nurse practioner, the clinic in Portland that Leveque brought me to -run by the Hemp & Cannabis Foundation out of a small, nondescript suite in the Hollywood district- employs four staffers. Two office workers handle a steady stream of patients' phone calls and arrange the appointments. Leveque's son Peter handles the medical side of the intake interview. Patients are given a three-page questionnaire that asks them to list their various conditions, previous doctors' names, medications they've taken, etc. "If you can get past the first sergeant," says Leveque, "you can see the doctor."

Organizer Paul Stanford collects the fee ($150), explains how to fill out and file the necessary paperwork with the state office, and answers questions of an administrative and/or political nature. For many working people, getting sanctioned by the state does not mean they can use cannabis with confidence; most are subject to drug-testing on the job, and marijuana can be detected in the urine for almost a month after its use. Testing positive means you can be fired outright or subjected to humiliating, time-consuming "treatment." Stanford has no reassurance to offer medical-marijuana users who fear for their jobs. There hasn't been a test case yet of a state-approved marijuana user getting fired and suing their employer for reinstatement. Stanford frequently gets asked, "Do you think I should tell my boss I'm using medical marijuana legally?" He typically replies, "You have to use your judgment."

Patients phoning the clinic are asked, "What is your medical condition?" And, "Do you have medical records to verify that condition?" Leveque says, " If you don't have verification, we probably can't help you. If somebody says 'I haven't been to see a doctor in 10 years,' we may ask, 'Do you by any chance have any of your old prescription bottles?' That would confirm that they had the problem. But we do have to turn some people away. We probably turn down between five and 10% of the people who call. I may believe 'em, but not having the paperwork doesn't cut it. I can't put my license on the line. The Board of Medical Examiners is looking over my shoulder -a compliance officer is monitoring me. We have to keep all the patients' charts and have them accessible.

"They didn't require me to do this until the first of April last year. The suspended me for ninety days starting May 1. They said, 'We realize you probably have patients stacked up,' so they gave me till May 1. And they fined me $5,000, which my patients helped pay. My patients also contributed to my lawyer bill, which was over $20,000." There were no complaints by any patients about anything that I had done. If I had harmed one person I just dread the thought! But nobody has ever complained. Well, I take that back. About a month ago I had a very curious experience. One of my patients who has a GI disease that causes nausea and vomiting, also has a bad back -possibly related, it's hard to figure out. But for whatever reason, he had a grand mal seizure and was brought into a hospital in Salem and the ER doctor there said he had a grand mal seizure because of cannabis toxicity. The investigator from the Board wrote me a letter. I wrote back, 'I gave him an approval because he has a bad back. And by the way, I have about 30 epileptic patients who use marijuana to stop their seizures. So this lady is all wet.' And that was that."

Leveque has self-published a memoir, "Gen. Patton's Dogface Soldier: WWII From a Foxhole." (To order, send $20 to him at po box 348, Molalla, OR 97038.) One day he got a call from a high-ranking Catholic priest who said, "Somebody just gave me your book. I'm a combat infantryman myself. And you got it right." Leveque asked, "How did you like the chapter 'Sex and the soldier?'" The priest said, "You got that right, too."

Leveque has signed applications for two other Catholic priests. "One was a green beret, one was a navy seal," he says. "Both of them had been using marijuna for years and wanted to be legal. Ninety-nine percent of the people I interview have been using it on their own for some time. The record so far is 55 years. Obviously they get benefit or they wouldn't bother with it. Wouldn't pay 300 bucks to keep using it -150 to the doctor, 150 to the state. The line I hear over and again is, 'Marijuana works better than any prescription I've been given.'"

The dozen or so California doctors who have made a specialty of monitoring cannabis use report a similar pattern-almost all their patients have been self-medicating and want to do so legally. In both states, "approval" is a much more accurate term than "recommendation" to describe what doctors have been providing to patients.

There is a converse pattern worth noting: Legalization has not led to a wave of naive patients with various conditions experimenting with cannabis to see if it might help in some way, or doctors recommending that they try it. Just as Prohibition doesn't deter people from using drugs, legalization doesn't induce them do so.

Phil Allen's Story

Nurse practitioner Phil Allen, 52, is a tall sandy-haired man with an owlish, bemused look.

Allen: I got busted for manufacturing in '92. Lost my teaching license, lost my job, my wife lost her job although she was able to keep her license -they put her on probation. So there went our retirement. She'd been teaching for 18 years, I'd been teaching for eight- secondary special education. My wife was teaching at the elementary school my son was attending, he was nine.

C-Notes: Good age for a political education.

Allen: Now he's in college, doing well. This last term he didn't have a 4.0 but his lowest grade was a B and he's taking chemistry and calculus... So there I was with a master's degree working in a lumber mill making one-fifth of what I made as a teacher. We had a savings account of about 20 thousand dollars. My wife worked at Penney's and did a little bit of substituting. After a year I made inquiries about getting into nursing at Umpqua Community College in Roseburg. They have an outreach program with Oregon Health Sciences University,,, Eventually my wife got a CNA (certified nurse's assistant) license and was able to work as a CNA. They made me go through a bunch of hoops before I could get my LPN (licensed practical nurse) license, which you're supposed to get after one year of school. I took the test and passed but they still wouldn't let me have the license. I had to have a hearing with an assistant AG. Once I got it, we knew we'd be okay. We both went to work as RNs in hospitals and continued working towards our nurse practitioners' licenses, which we got in 2000.

C-Notes: The hold-up was your marijuana bust?

Allen: Manufacturing is a class-A felony.

C-Notes: How many plants were you growing?

Allen: There were no plants. I had done it in the past, and I still had my lights. They found five ounces of old stuff that was no good in an old fertilizer box. The good stuff that I was smoking -I had about this much (indicates a pinch). Also, they put me into forfeiture. They offered my wife a simple possession charge that she could get expunged, and they'd let me have my house back if I would take the manufacturing charge.

C-Notes: What have you observed medically about people who are using cannabis?

Allen: The people that we see in these clinics are much sicker than people seen in regular practices. Obviously there are certain practices that see even sicker people, but compared to [patients seen by] the average general practitioner, the people we see here are really sick. In general, the main problem is pain. Spasms, usually pain-related but not always. Nausea -a lot of people with chronic Hepatitis C have nausea-related problems and loss of appetite.