The battle over marijuana is shifting from the police station and courtroom to the doctor's office and research lab.
When voters in California and Arizona decided last fall to legalize the medicinal use of marijuana, the federal government vowed to keep sending the message that the weed is a dangerous drug. The administration warned doctors they would face retaliation for recommending a substance that has "no currently accepted medical use."
Now, in the face of rising criticism from the medical community, including a lawsuit challenging the government's stance, the White House is deciding not to interfere with doctors who discuss using marijuana as a treatment.
In a recent letter to the California Medical Association, the administration also acknowledged the need to review scientific research, as well as fund further investigations, on the medicinal benefits of marijuana.
The new stance underscores the complexity of the challenge facing the administration as it tries to deal with a law that it clearly doesn't like but which is popular among many in the powerful medical establishment.
"The White House has declared a truce in its war on California doctors," says Marcus Conant, a prominent AIDS physician and plaintiff in a lawsuit seeking to prevent punishment of doctors who recommend marijuana. "We are once again free to practice medicine without fear of DEA [Drug Enforcement Agency] agents harassing us for simply trying to do our job."
In its letter, the White House left the door open to reclassifying marijuana as a Schedule II drug "when there is adequate scientific evidence" it has legitimate uses. Schedule II drugs such as morphine are illegal, but can be prescribed for medicinal purposes.
Administration officials reject the idea that they have yielded to critics, insisting the letter merely clarifies their previous stance.
When it comes to actively encouraging marijuana use, however, there remains a legal limit, explains an administration official. "Doctors cannot recommend or prescribe marijuana with the intent that a patient run down to the corner to buy drugs," he says.
The letter leaves open a gray area as to what constitutes a "recommendation." Simply advising someone on the efficacy of marijuana for treating a problem is not going to incur the wrath of federal prosecutors, the administration official admits. "These are hard lines to draw," he says.
"The government wants to have it both ways," says Graham Boyd, one of the attorneys for the doctors suing the government. Their aim is to avoid a suit over restricting doctors' freedom of speech while still trying to intimidate physicians, he says.
THE government's leverage comes from the DEA, which can revoke a doctor's prescription authority. According to court documents, DEA agents in January visited Robert Mastroianni, a California physician, and questioned him about his recommendations of marijuana. Thomas Ungerleider, a University of California, Los Angeles medical school faculty member who has done research on medical marijuana for 20 years, says that a DEA agent apologized privately to him for this effort to intimidate physicians. "He said, 'We've been told to get someone and make an example of him,' " Dr. Ungerleider recounts.
DEA officials declined to comment on their investigations. But the administration official did not rule out some legal action against doctors in the future.
Despite the tough talk, the tone of the administration's position has clearly changed. In January, White House drug czar Barry McCaffrey offered to fund a review of existing research on the medicinal use of marijuana. A two-day workshop convened last month by the National Institutes of Heath discussed its use for treating a variety of ailments.
The meeting concluded that certain areas of medicinal use of marijuana are worth further study, says Reese Jones, a psychiatrist who attended the session.