Although last fall's passage of ballot initiatives in Arizona and California legalized the dispensing of medicinal marijuana, no doctors or hospitals in either state appear willing to prescribe or dispense the drug.
Physicians and their trade associations in both states are heeding the warning made late last year by Clinton administration drug policy chief Barry McCaffrey that doctors who prescribe marijuana could lose their prescription-writing privileges and be prosecuted under federal narcotics laws. Physicians must register with the U.S. Drug Enforcement Administration in order to prescribe medications, the feds said.
"Along with the Arizona Board of Medical Examiners, we are recommending that physicians not prescribe any Schedule 1 drugs," said Tania Graves, spokeswoman for the Arizona Medical Association.
Bowing to pressure from legalization advocates in its ranks, the association had taken a neutral stance on Proposition 200, which allowed the prescription of marijuana, heroin, LSD and other hard drugs if two doctors concur on its use for a patient and can offer research to support their opinion.
"The federal (laws) supersede state law and could place the licensure of doctors in jeopardy. That will cause patients to suffer even more, because they will no longer have their physicians," Graves said.
She added that she knows of no doctors in the state prescribing Schedule 1 drugs.
The Arizona Hospital and Healthcare Association objected to Proposition 200, but has no plans to lobby the Legislature to amend the law.
Arizona Gov. Fife Symington has said he would take steps toward modifications.
The California Medical Association is taking a stance similar to that of the Arizona Medical Association on Proposition 215, which legalized marijuana prescriptions by doctors and other caregivers in that state.
"Even for medical purposes, marijuana use is still illegal under federal law, and we strongly advise physicians not to break the law," said John Lewin, M.D., the CMA's executive vice president.
The CMA is forming a technical advisory committee to lobby the National Institutes on Health, Centers for Disease Control and other scientific organizations to promote research on whether marijuana actually has any medicinal effectiveness.
A stance similar to the CMA's was recently taken in Massachusetts, where that state's public health council agreed to hold hearings on medicinal use of marijuana.
The NIH has published recent reports claiming that marijuana is carcinogenic, and that its use very early in pregnancy can lead to termination of the fetus.
"We basically support the use of medicinal marijuana if and when studies show its efficacy," said Sandra Bressler, CMA's director of professional and scientific relations. "One of the major tasks is to think about ways to promote studies, what type of protocols should be involved, and the selection of potential nonpartisan researchers to work in this area and explore ways to make it happen."
The California Healthcare Association, which represents hospitals, did not take a position on Proposition 215.
Some physicians on the national level are bristling about the Clinton administration's stance. In its Jan. 30 issue, the New England Journal of Medicine editorialized in favor of allowing doctors to prescribe marijuana. The publication's editor, Jerome P. Kassirer, M.D., condemned the government's position as "misguided, heavy-handed and inhumane."