Legal process requires paperwork, overcoming physician resistance

The debate over the legalization of marijuana in Nevada overlooks one significant detail: It's already legal.

An estimated 1,530 Nevadans have obtained permission to lawfully possess and use pot since NRS-453A was signed into law in 2001, according to the Nevada State Health Division. (Nevada is one of 13 states with a medical marijuana program.)

But a medical marijuana card does not read: "Get Out of Jail Free." Medical marijuana can never legally be purchased, or smoked in a public place. It must be grown and inhaled (or ingested via baked goods) at the cardholder's residence.

The process begins with a written request and $50 check sent to the state Health Division in Carson City. This gets prospective patients an application and a physician's statement that must be taken to a doctor willing to recommend marijuana. (According to FDA guidelines, it's a Schedule 1 drug, which makes it illegal to prescribe.)

The legal conditions recognized by Nevada to medicate with marijuana are restricted to AIDS, cancer, glaucoma, weight loss, severe nausea, severe pain, seizures and persistent muscle spasms. (Each has a box on the form for the physician to check.)

If the application is approved by the Health Division, patients then pay a further $150 processing fee, which covers a background check for the one crime that will get them rejected: selling, or intending to sell, a controlled substance.

After fingerprinting, notary public and Department of Motor Vehicles fees of about $20 each, the DMV issues a card good for one year. (The card must be renewed annually for another $150 fee and signed physician's statement.)

The trickiest part is finding a doctor. Most will not sign off on the card, according to Bruce Mirken, spokesman for the Washington, D.C.-based Marijuana Policy Project advocacy group.

Las Vegas ophthalmologist Dr. Kent Wellish, director of the Wellish Vision Institute, and oncologist Dr. Paul Michaels of the Comprehensive Cancer Centers of Nevada have never signed off -- although both are occasionally asked.

Wellish said laser treatment and the eyedrops Xalatan, Lumigan and Travatan are much more effective for glaucoma.

"For marijuana to work, the patient would have to be stoned around the clock," he said. "When you're not stoned, the pressure goes back up, and that's when damage occurs to the optic nerve."

Michaels prefers Zofran and Compazine for the short-term nausea associated with chemotherapy. (He said that marijuana has "no effect whatsoever" on cancer pain.)

Michaels has prescribed marijuana to five of his chemo patients with long-term nausea, but only in the form of Marinol pills, which concentrate the drug's active ingredient, THC, and do not require a medical marijuana card.

"Marijuana inhalation or baking is not a good idea," Michaels said. "Funguses and bacteria grow on plants very easily, and sometimes you don't kill them with heat. And the immune system of chemo patients is shot, so they're more susceptible."

Difficulty finding a doctor is why advertisements for medical marijuana appear in the back of Nevada's alternative weeklies.

"We stand behind you and your right to choose alternative medicine," read a recent CityLife ad from the Hemp and Cannabis Foundation. An ad on the same page from DrReefer.com announced: "Get legal today!"

These companies -- which charge $200 to $300 on top of the required fees -- promise to refer patients to sympathetic physicians such as Dr. Rabia Ahmed, who practices at the Hemp and Cannabis Foundation's clinic at 10161 Park Run Drive. (Ahmed would not respond to the Review-Journal's request for an interview.)

Ivan Goldsmith, an internal medicine physician who operates three valley medical centers, said he has recommended marijuana for all six of the customers referred to him by DrReefer.com.

"They all qualified and have appropriate radiographic or medical records to justify the recommendation," he said.

Goldsmith calls marijuana "highly effective" and said that studies back him up.

"The research is now catching up that the cannabinoid system is very important in a lot of body functions," he said. "They're finding that if you stimulate the cannabinoid system, you can block neuropathic pain."

When asked to respond to the opinions of Drs. Wellish and Michaels, Goldsmith said doctors frequently disagree on diagnoses, and that all safe options should always be available for them to try.

Once Nevadans receive their cards, one step remains. Unlike California, Colorado, New Mexico and Rhode Island -- which permit convenient medical marijuana dispensaries -- Nevada requires that patients grow their own. The law limits each cardholder to seven plants on his or her own property: three mature and four immature. Another Nevada resident can be designated to grow for a marijuana cardholder, but that grower must obtain a card, too.

The difficulty of growing one's own marijuana transcends the plant's finicky light, heat and moisture requirements. It happens to be illegal to sell seeds in the United States. (Not even DrReefer.com or the Hemp and Cannabis Foundation offer to help with this problem.)

The only legal ways for cardholders in Nevada to begin growing, according to Metropolitan Police Department public information officer Barbara Morgan, are to purchase an ounce or less of seeds from another country via the Internet, or to obtain seeds or a cutting from another plant, for free, from another cardholder.

Once cardholders meet all the above requirements, police officers cannot detain them for any suspicious green baggie found during a routine traffic stop -- as long as that baggie weighs less than an ounce and the motorist doesn't appear under its influence.

"I wouldn't be surprised if it happens quite often," Morgan said.

Even if patients don't have their cards on them, they're not arrested, because the DMV notes their existence in its computer record.

This begs the question of how many, if any, medical marijuana patients are actually illegal drug users who exaggerate or fake medical symptoms to get impunity for their habit.

"Every medication has potential for abuse," Goldsmith said. "But a patient can easily go on the street, buy the marijuana and not seek medical evaluation. So if he has enough moxie to come in and want to do it through legal channels, you have to respect that."

When asked for her take, officer Morgan replied: "All we do is enforce the law. We can't personally have our opinions."

Contact reporter Corey Levitan at clevitan@reviewjournal.com or 702-383-0456.