The Pew Charitable Trusts

WASHINGTON - Nearly one person in five in this country lives in a state that exempts patients who use marijuana under a physician's supervision from prosecution for illegal drug use. In last November's elections, voters approved referenda authorizing medical marijuana use in Alaska, Nevada, Oregon and Washington. Arizona voters reaffirmed an initiative passed two years ago and rejected a legislative requirement banning physicians from prescribing the substance until it receives Food and Drug Administration approval.

All of these states followed the lead of California, which passed the first medical marijuana initiative. But advocates say residents of these states should think again if they believe their state's law assures access to pot for therapeutic reasons. The White House Office of Drug Control Policy says federal authorities will not sanction it until scientific evidence shows that medical benefits outweigh risks.

"These laws are on the books, but the simple fact of the matter is that these laws are not used. Physicians are afraid to prescribe marijuana," said Jacob Herstek, a policy associate with the Health Policy Tracking Service of the National Conference of State Legislatures.

Marijuana is still categorized by the federal government as a Schedule I drug, along with LSD, heroin and PCP. Federal authorities have not approved it for any medical use, and it is against federal law for physicians to prescribe it. The White House Office of National Drug Control Policy, directed by retired Army general Barry McCaffrey, sent a clear message to the five Western states that passed initiatives in November: "The results of these referenda in no way alter the status of marijuana under federal law."

McCaffrey's office said the U.S. "medical-scientific" process has not closed the door on medical use of marijuana, but it should not be approved until "scientific evidence is sufficient to demonstrate that the benefits of a substance outweigh associated risks."

That evidence might or might not be forthcoming later this month, when the National Institute of Medicine, an arm of the National Academy of Science, is set to release a study reviewing the scientific research that has been done on medical marijuana's effectiveness.

The medical marijuana ballot drives in every state were funded by New York financier George Soros, Cleveland insurance executive Peter B. Lewis and Phoenix entrepreneur John Sperling.

Their intention was to tell the White House that the "war on drugs" is being abused, according to Dave Fratello, a spokesman for Americans for Medical Rights, a political action group that coordinated the ballot drives in every state but Arizona.

Fratello said that Soros, Lewis and Sperling differ about a national marijuana policy. Lewis is "flat-out in favor of legalizing" it and Sperling of Phoenix favors medicalizing all "Schedule I" drugs, which the Arizona initiative accomplished. Soros is against legalizing marijuana.

Advocates say marijuana use can help AIDS, cancer, multiple sclerosis and glaucoma patients by mitigating such symptoms as loss of appetite, chemotherapy-induced nausea, chronic muscle pain and internal eye pressure.

"To get to the point of having a legal supply, there is still a big hill to climb," Fratello said. "The first step we had to take is to take away the criminality of it."

In states where an initiative has passed, a patient who has a doctor's oral or written recommendation (depending on the wording of the state's initiative) can buy marijuana on the black market or grow it at home. While there is still a chance that they could be arrested for possession of the drug, advocates say their doctor's recommendation would provide a legal defense.

"If voters think they are voting for medical marijuana, and that in a reasonable time after the election, a bonafide medical patient can benefit from the drug then they are wrong. These people don't have access to it in this country," said Allen St. Pierre, executive director of the National Organization for the Reform of Marijuana Laws Foundation (NORML).

Fratello said at least three states will have medical marijuana ballot initiatives in the next two years: Maine, Nevada and Colorado. Maine, one of the few states that permits an off-year initiative, will have a medical initiative on the ballot this year. Although Nevada voters approved the use of medical marijuana in 1998, the use of it depends on a second "yes" vote in 2000.

On the federal level, Massachusetts Democratic Rep. Barney Frank will submit a bill in early March that would reschedule marijuana from Schedule I to Schedule II, and set aside federal restrictions which currently interfere with an individual state's decision to permit the medical use of marijuana.

"With the Republicans in charge there is not a chance that it will pass," said NORML's St. Pierre.