The San Francisco Examiner - Sunday, Feb. 16, 1997
Lisa M. Krieger, Examiner Medical Writer

Family doctor Robert Mastroianni, who has recommended marijuana to "three seriously ill patients" since the November passage of Proposition 215, was questioned by U.S. Drug Enforcement Administration agents at his office in Pollack Pines, near Placerville, and warned that he was under formal investigation, Mastroianni said in an affidavit in U.S. District Court in San Francisco.

The local pharmacist told the doctor that DEA agents had also contacted him and reviewed Mastroianni's prescription records, according to the affidavit, filed Friday.

"The pharmacist stated that in his many years of business he had never before been visited by a DEA agent," said Mastroianni, who has been a family physician for two decades. "The pharmacist made clear to me that he felt intimidated by the encounter."

Sacramento-based DEA agent Stephen Delgado confirmed that agents had visited Mastroianni but refused to comment further.

In response to the move against Mastroianni, Bay Area Physicians for Human Rights, a group of local doctors and AIDS patients, Friday asked San Francisco's U.S. District Court to enjoin federal drug czar Barry McCaffrey and other senior Clinton administration officials from punishing doctors who discussed or recommended the medical use of marijuana to their patients.

Mastroianni said in his affidavit he had arrived at his office early Jan. 27 to find "two men, casually dressed, waiting to speak to me." One identified himself as DEA senior investigator William Davis, according to Mastroianni.

The agents began questioning the doctor, a graduate of Tufts University Medical School, about his medical education and showed Mastroianni a copy of a "letter of recommendation" for marijuana that he had written for a patient. It's not known how the DEA had obtained the letter.

They also requested his DEA number, a personal number assigned each physician for the purposes of keeping track of prescriptions for narcotics and other controlled substances.

"Agent Davis quoted a passage from an article from 1980's government-sponsored research on the effects of marijuana," according to Mastroianni.

"He asked if I had ever read the article, whether I had studied literature on medical marijuana, whether I had attended any medical courses on medical marijuana (I know of no such courses), whether I offered marijuana for sale, whether I referred patients to sources for marijuana, and whether I had prescribed, as opposed to recommended, it.

"Many of his questions were professionally insulting," he said in the affidavit. "They implied that I had acted unethically and in violation of the law."

The men then told Mastroianni it was "illegal for me to recommend or prescribe marijuana" and that marijuana was a "deadly drug for which there was absolutely no medical use."

"This comment and the questions which preceded it were clearly meant to intimidate me and dissuade me from treating certain of my seriously ill patients in accordance with my medical experience and professional judgment," according to Mastroianni's statement. "I am now reticent and reluctant to recommend the use of medical marijuana even if it is my ethical duty to do so."

Doctors who recommend or prescribe marijuana risk the loss of their federal authority to write drug prescriptions, exclusion from Medicare and Medicaid programs, even criminal charges, under federal policy detailed by McCaffrey in December in response to Prop. 215.

Dr. Virginia Cafaro, an HIV specialist in San Francisco and member of Bay Area Physicians, said she found the agents' treatment of Mastroianni chilling and believed it would hurt sound medical practice and the relationship between doctor and patient.

"But this has far-reaching implication beyond just that of medicine," she said. "Big Brother in Washington is now in your office."

Mastroianni serves 6,000 patients in the Placerville region. During his 20 years of practice, he estimates, 50 patients have told him that they used marijuana to combat the nausea and vomiting caused by cancer treatment, to control muscle spasms or to ease chronic pain.

"Those patients consistently report that no other medications work as well," he said in his affidavit. "They also tell me that when they use medical marijuana, they are able to diminish, if not altogether stop their use of other medications, including prescription drugs."

He has recommended marijuana only three times, he said - and then, only after the passage of California's medical marijuana initiative.

Mastroianni did a stint at San Francisco's Haight-Ashbury Free Clinic as part of his continuing medical education studies. It was his experience at the clinic, under the direction of Dr. David Smith, that "heightened my awareness of substance abuse issues and protocols for prescribing powerful medications to seriously ill persons," he said.

Bay Area Physicians for Human Rights sued last month to block enforcement of federal law against marijuana, and have asked that marijuana be treated the same as morphine, Demerol and other carefully controlled drugs.

The suit "challenges a draconian White House policy of intimidating doctors who simply seek to practice medicine responsibly," said Dr. Graham A. Boyd of San Francisco, attorney for the group, which also filed Friday's action.

U.S. drug czar McCaffrey has so far shown little interest in backing down.

Justice Department attorney Kathleen Muller, speaking for McCaffrey, said: "Doctors cannot . . . claim that they are merely providing their patients with "recommendations' in accordance with their best medical judgment."
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