San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Tuesday, December 24, 1996 - Page A1
Louis Freedberg, Edward W. Lempinen, Chronicle Staff Writers

Under the proposal sent to President Clinton on Friday by his drug czar, General Barry McCaffrey, doctors would be subject to the loss of their federal licenses to prescribe controlled drugs. In some cases, they would be subject to criminal prosecution. The program would rely on standard crime-detection techniques, including surveillance and informers, federal officials said.

The focus on doctors would be part of a broad federal response to the passage of medical marijuana measures in California and Arizona. McCaffrey and other federal officials say the measures contradict federal anti-drug policy.

"We are going to continue to find ways within the administration to fight legalization and the notion of legalization," Rahm Emanuel, a key Clinton drug-policy adviser, said yesterday. "We're against the message that the initiative sends to children. Marijuana does not come cost-free. It is illegal and it is dangerous."

In California, however, some doctors called the federal policy misguided.

"I think it's an outrage that the government would be spending taxpayers dollars on pursuing honest physicians for trying to care for very sick people," said Dr. Toni Brayer, president of the San Francisco Medical Society.

Dr. Tod Mikuriya, an East Bay physician who has recommended marijuana to dozens of seriously ill patients, said the effect on doctors of such a policy would be "extremely chilling."

But, he added: "I will not stop doing what I've been doing . . . because I am definitely in compliance with all definitions of good- faith medical practice for the state of California."

The federal proposal was a response to California voters' approval last month of Proposition 215, the medical marijuana initiative, and to approval of a similar measure in Arizona.

BENEFITS CITED

Backers of Proposition 215 -- including many influential medical officials and organizations -- say marijuana relieves nausea and stimulates the appetite of patients who are wasting away with cancer, AIDS and other serious illnesses. The measure was designed to make cultivation, sale and possession of marijuana legal for certain medical purposes, and it included specific protections to assure that doctors would not be punished for their recommendations.

But Proposition 215 does not supersede federal law that makes it nearly impossible to prescribe marijuana and certain other controlled drugs.

The strategy sent to Clinton last week also was approved by Attorney General Janet Reno, the FBI, the Drug Enforcement Administration and the secretaries of Education, Transportation, the Treasury and Health and Human Services.

FIRINGS POSSIBLE

One element of the plan is a campaign to convince the public of pot's therapeutic ineffectiveness. Government agencies also would warn employees that they could be fired for a positive drug test, even if they argued they had taken drugs for medicinal purposes.

"Frankly, we don't think most responsible doctors will think that smoking marijuana is a solution to the best care they can give their patients," said Donald Maples, a spokesman for McCaffrey's Office of National Drug Policy. For those who do, he said, "federal law in all its forms, including those that pertain to Schedule 1 drugs, remain in force."

Fearing a potential federal crackdown, the California Medical Association has already warned its 35,000 members of the risks of recommending marijuana. The association is working with the Clinton administration to set up studies to assess pot's medical usefulness.

Dr. Jack Lewin, executive vice president of the medical association, estimated that 50 percent of doctors who deal frequently with HIV-positive and cancer patients "are probably interested on behalf of their patients in participating in some way" in such studies.

SOME IMPATIENT

Others, however, expressed impatience with the Clinton plan.

"I think it's absolutely absurd," said Dr. Virginia Cafaro, senior physician in San Francisco's Conant Medical Group, which says it has the largest AIDS-related medical practice in the country. "I seriously doubt that there are any physicians recommending it as a party drug."

If the president accepts the proposals, Cafaro predicted, doctors will "dance around" its provisions to assure that patients get the best possible care.
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