Hawaii's Medical Marijuana Program

Hawaii’s medical marijuana program has sparked fierce debate over the past decade. Some view it—and use it—as medicine, while others contend it is a dangerous drug, widely abused. How does the program work, and who is involved?

Teri Heede relieves the symptoms of multiple sclerosis by smoking medical marijuana. She says a specific cannabis strain (sativa) works best for her.

Photo: Elyse Butler

Teri Heede pulls out 25 orange, prescription pill bottles  from a cloth bag hanging from the handles of her red motorized scooter. Then an inhaler, and, from another bag, empty cranberry juice jugs filled to the top with disposable interferon shots. This used to be Heede’s life living with multiple sclerosis (MS)—pills in the morning, afternoon and evening. Pills to quell the side effects of her other pills. Shots Monday, Wednesday and Friday and frequent trips to the doctor. She’s a 55-year-old retired computer engineer who served in the Navy during the Vietnam War. She had grown accustomed to having no energy, being violently ill for weeks on end, and losing some of her motor skills. But 10 years ago, she quit the pills and shots and opted for something she says finally worked—medical marijuana.

Today, Heede spends her days out of bed; she just finished volunteering at a Makakilo polling place for the fall elections. She gets by with Aciphex (for acid reflux), occasionally a few Tums and medical marijuana. “Nothing works like this,” she says, holding up a small Tupperware of peanut butter cookies made with “cannabutter” (butter infused with cannabis). She even lets me smell them; the peanut butter overpowers the skunk-y marijuana-laced butter they were made with.

“I don’t get high. This is not a Cheech and Chong moment,” she says. Heede likens using medical marijuana to taking St. John’s wort or any other herbal supplement. It doesn’t bother her that it isn’t federally recognized; she says marijuana helps her more than any of the FDA-approved pills ever did.

Teri Heede's medical marijuana and patient permit.

Photo: Elyse Butler

Heede is one of the approximately 8,000 people in the state who has received a physician’s recommendation to legally grow and use marijuana. Medical marijuana, or cannabis, as medicinal users and advocates prefer to call it, is a hot-button issue. For example, last October, Sen. Will Espero established the Medical Cannabis Working Group after Gov. Linda Lingle refused to convene a medical marijuana task force, even though it had been approved by the Legislature. The group released a report in February detailing statewide program recommendations. Last legislative session, about 20 bills were introduced to expand the program—none passed. Medical marijuana has also gained national attention. In July, the Department of Veterans Affairs formally allowed its patients to use medical marijuana in states where it’s legal, and this month California voters opposed the Regulate, Control and Tax Cannabis Act of 2010—better known as Proposition 19—which aimed to legalize and tax marijuana.

Local advocates have been fighting for years for a safe, regulated distribution system and to increase the amount of marijuana patients can possess. But there’s a hitch. Patients walk a fine line by using a state-regulated medicine that is also still a federally illegal drug. That’s another reason both Lingle and local law enforcement are opposed to Hawaii’s program. As it stands, there’s a big gray area where contraband cannabis transitions into legal medical marijuana, without clarity or guidance for anyone.

Legislative Passage

Hawaii approved medical-marijuana in 2000 when then-Gov. Ben Cayetano signed into law the Hawaii Medical Marijuana Act. Hawaii was the first state to enact a medical marijuana program legislatively. “It is a compassionate care program for seriously ill people,” says Jeanne Ohta, executive director of the Drug Policy Forum of Hawaii, an organization started in 1993 to bring public awareness to Hawaii’s drug issues, and which also provided input for the state’s medical marijuana law.

“Marijuana was legal before the 1930s,” explains Ohta. “A lot of what made it illegal was political and race-based.” Marijuana resurfaced for recreational use in the 1960s and ’70s but it wasn’t until the 1990s that states began pushing for the use of marijuana for medicinal purposes. Today, 15 states have medical marijuana programs; five states allow dispensaries. The state laws vary—California has a patchwork of county-by-county laws—and Hawaii has one of the more conservative programs.

“I think the majority of our legislators have tried marijuana,” says Aron Gonsalves. “They should understand that it’s not something to be scared of. … They need to see someone who is dying of cancer, or who has AIDS or MS and how much medical marijuana helps them.” The former chef of E&O Trading Co., Gonsalves now owns Green Hands of Aloha, a Kalihi hydroponics store, where he merged his two passions—growing local, organic produce and helping medical marijuana patients grow cannabis. He’s a registered user and has been growing marijuana for 20 years. Seventy percent of his store’s customers are medical marijuana patients. He helps them set up custom hydroponics systems—costing around $1,500—and teaches free hydroponics classes at his store twice a month.  Medical marijuana isn’t handled like other medicines are—there is no legal, controlled manufacturing and distributing system. “We don’t ask AIDS patients to make drug cocktails at home. You don’t grow an aspirin tree for your headache, do you?” says Gonsalves.

Opponents believe that marijuana dispensaries in the Islands will only result in higher crime, a spike in the number of users and a conduit for pot into school campuses.

175—The number of physicians who participate in the state medical marijuana program.

Keith Kamita holds up a 3-ounce bag of marijuana. He shows the bag to Legislative and neighborhood board members to demonstrate how much three ounces is.

Photo: Elyse Butler

Registration and Compliance

If you have MS like Heede, you have to go through a bureaucratic process to become a medical marijuana patient in Hawaii. First, you must have one of the specified ailments, including glaucoma, seizures, HIV, AIDS, severe nausea, pain or muscle spasms. You must get your condition documented on your medical records. You then have to find a doctor willing to participate—many physicians don’t, for fear of legal repercussions. Heede’s physician didn’t, so she had to find one who did. Then you’d have to transfer your medical records, set up an appointment and then sometimes pay an office visit fee; some physicians charge $175.

Under the law, the physician must work with the Narcotics Enforcement Division, which oversees the medical marijuana program. Unlike most other states, Hawaii’s medical marijuana program falls under the state Department of Public Safety—the people who run law enforcement, prisons and jails—not the state Department of Health. After recommending you for the program, your physician mails an application to the NED offices, a clerk processes it and sends it back to the physician, who signs it and gives it to you. After paying $25, you then receive a blue, business-card-size registration permit with your personal information. Heede says she was first given a temporary permit—only one clerk handles the applications, so there’s a backlog. With your permit you can now own and cultivate up to seven marijuana plants—three that are mature, or flowering, and four that are immature—and possess three ounces of smokeable marijuana.

Getting the card took Heede six months. “I’ve never once had my paperwork processed in a timely fashion, either by the doctors or the NED. It is not a straightforward process.”

Photo: Elyse Butler

Patient Concerns

One of the biggest complaints from growers like Gonsalves and patients like Heede is the lack of access. While an MS or AIDS patient can legally grow and possess cannabis, they often have to acquire it illegally, since Hawaii law does not allow dispensaries. “Law enforcement would have you believe everyone knows a drug dealer, everyone knows where to find marijuana. I don’t think they’ve met these people who are totally legitimate citizens, who have never broken a law in their life,” says Ohta. “The reason they’re registering is they don’t want to do something illegal, they want to be legal.”

Ohta and others mistrust the NED’s supervision. “The Narcotics Enforcement Division takes an adversarial view of a program it administers. Its control of the program has been scary for both patients and physicians,” she says.

“We didn’t ask for it,” says Keith Kamita, the chief of the NED. Kamita has become the face of the law enforcement’s side of the program. Ohta and Heede say they would love to sit down and debate Kamita on his attitude toward the program his department runs. “It’s like putting the Klan in charge of civil rights,” adds Brian Shaughnessy, a paraplegic medical marijuana patient who smokes to alleviate muscle spasms, a condition of his paraplegia. It was the result of a surgery gone wrong when he was 24.

In Kamita’s defense, some people have fudged their applications or had more than the allotted seven plants. Maj. Susan Dowsett, who heads the Honolulu Police Department Narcotics/Vice Division, confirms this; however, there have only been three cases this year—two people exceeded the plant limit, while a third had an invalid permit.

Kamita also says the NED has noticed a lot of young people utilizing the program for pain—versus older adults with terminal or degenerative diseases and disorders for whom he believes the law was originally intended. “There’s a question of whether it’s severe enough for them to be in the program. If you go on the Internet and punch in ‘Hawaii medical marijuana’ you’ll see a lot of different ads popping up. Sometimes you’ll think, ‘What does this have to do with medicine?’” He is also wary of the participating physicians, especially those on the Big Island. “We have physicians in Hawaii who do this just as a business,” he says. “And you bring in crime with dispensaries [if we allowed them]. You’re not talking about care here, you’re talking about distribution.” He specifically mentions California’s program, which has earned the reputation for being the Wild West of cannabis; you could walk into many dispensaries and buy pot, no permit required.

“We know what doesn’t work with California; we can avoid it,” says Ohta. “Just because California is not running it right, doesn’t mean we can’t have a totally regulated process.” Ohta says she gets phone calls and e-mails from patients daily who have their blue cards but have no idea where or how to acquire cannabis. She recommends patients try to grow it themselves, or find and register a caregiver who can grow and harvest it for them. (A caregiver can only grow for one patient.) Even then, that isn’t always successful. Heede says she was too sick to grow the plants, and admits she bought weed from the black market before finding a caregiver. But for some, finding a caregiver—who is trustworthy, isn’t already growing for someone else and can grow marijuana—can be just as difficult. “A lot of patients [resort to] the illegal market,” says Ohta.  

“I’ve tried to talk to my fellow legislators about making medical cannabis more accessible and it’s always very hush-hush,” says state Rep. Joe Bertram III. “We made it legal in 2000! It’s still a hard thing for people to understand.” Bertram continues to introduce bills to amend the law. He also is a registered caregiver for his friend who has MRSA (a bacterium that causes infections and is harder to treat because it’s resistant to commonly prescribed antibiotics). He currently doesn’t grow marijuana for his friend, another man on Maui does, but Bertram keeps his caregiver license, just in case. “You never know. It’s very uncertain.”

958—The number of caregivers growing medical marijuana in Hawaii.

Aron Gonsalves, the owner of Green Hands of Aloha, stands in his display hydroponics grow room. Seventy percent of his customers are medical  marijuana patients and caregivers. The rest are everyday gardeners.

Photo: Elyse Butler

Pushing for Change

Hawaii is one of the few states with long-established medical marijuana programs that have not been revised since their inception, essentially operating off the first drafts of a legal structure. While parts of the Islands’ law are clearly defined, several holes still exist, such as access, exemption from employee drug testing of patients and bringing medical marijuana aboard interisland flights. Advocates charge law enforcement with stonewalling any attempt to revise or expand the law for the past 10 years.

While the NED administers the medical marijuana program, enforcement also falls to HPD. It, too, polices a program it doesn’t think should be legal. “HPD is against the legalization, decriminalization and medicinal use of marijuana,” says Dowsett. Regardless, officers are trained by the NED to make sure patients such as Shaughnessy have only seven plants and a valid registration, and that Heede’s caregiver is growing her plants at the location listed on her card.

Many of HPD’s investigations stem from complaints, such as a neighbor smelling someone smoking cannabis. An officer then verifies the person’s information through NED. Exceeding the seven-plant limit can result in confiscation or arrest. HPD doesn’t receive funding to enforce the medical cannabis program, but it does get $100,000 to $250,000 annually for marijuana enforcement and eradication.

“They’re not physicians, they don’t care,” says Dr. Charlie Webb, a participating medical marijuana physician who practices urgent care. “They don’t realize that a lot of people really do have chronic pain.” Webb and his wife, Sandy, a registered nurse, run the MUM Clinic (Medicinal Use of Marijuana) in Kailua-Kona on the Big Island.

But the cops have the backing of the federal government—no matter what the Hawaii medical cannabis law says, marijuana is still classified as a Schedule I drug established by the Controlled Substances Act in 1970. There are five schedules; marijuana is in the highest classification, grouped with heroin, LSD, and MDMA, or ecstasy, among others. (Meth, however, is a Schedule II.) Advocates want to change marijuana’s classification.

The Hawaii Medical Association (HMA) doesn’t officially support or oppose the state medical marijuana program, but, says HMA executive director, April Troutman Donahue, “We do have a policy that medical cannabis should be rescheduled.” The HMA endorses moving marijuana to the Schedule III classification, which includes synthetic THC (the active compound in marijuana). “In order for it be Schedule I three criteria must be met,” says Donahue. “There must be a risk of abuse, no medical use in the U.S. and a lack of safely accepted use.” Fifteen states with medical marijuana programs and studies finding no known fatal cannabis overdoses contradict marijuana’s current classification. Donahue says HMA is considering taking a resolution promoting the rescheduling of marijuana to the American Medical Association.

Webb, who also participated in the Medical Cannabis Working Group, helped draft the HMA rescheduling resolution this summer. “I never saw a hospitalization from marijuana,” says Webb, who was an emergency room physician for more than 30 years. “The most dangerous thing [about marijuana] is being arrested.”

Webb is one of approximately 175 Hawaii physicians who recommend medical marijuana for qualifying patients. Unlike many of his colleagues, he isn’t afraid to participate in a program that isn’t federally recognized. “I felt like I could do it because I’m older,” he says, adding that he would have feared federal prosecution if he was fresh out of medical school. 

Photo: Elyse Butler

Taking Matters into Their Own Hands

Although Teri Heede has gotten relief from her MS symptoms over the past decade by smoking marijuana and eating canna-cookies, she’s only been public about it for two years. In June 2008, the NED accidentally sent the Hawaii-Tribune Herald, a Big Island newspaper, information on 4,200 medical marijuana patients, including Heede. “I had been flying beneath the radar, so to speak, working, volunteering and smoking,” says Heede. “Nobody knew. But then I’m outed by the NED. I thought, ‘Well, now that I’m out, I’ll be there for the people who are afraid to speak up.’” Heede has become a crusader for other patients, especially those just starting out; she has given cannabis to patients who have their permits but don’t yet have access to plants. “Yes, I will break the law that way, but I never distribute it [to people who aren’t patients]. I never would.”

Like Heede, Shaughnessy says he’s also doing his part as a patient advocate. He says he’s hoping to start an online collective in January called Makahiki, where patients can purchase cannabis and have it delivered to their homes. “I feel strongly compelled to do this,” he says, but also admits he’s fearful of a legal backlash.

Until a safe, regulated distribution system is set up, Heede and Shaughnessy will continue to run the risk of confiscation or arrest, despite mostly abiding by the medical marijuana law. As long as the program remains under the NED, many patients will be stereotyped as stoners-in-disguise, and have to work with a department that doesn’t support marijuana’s medicinal purposes. Ultimately, says Heede, having a sense of humor helps. “I’m a grandmother, I vote, I work the polls, I was a soccer mom, I do community service,” says Heede. “We’re nothing like the criminals the NED wants to portray us as.”               

8,067—The number of medical marijuana patients in Hawaii.

How Easy is It to Get the Card?

You might have heard how ridiculously simple it is to get medical marijuana in many California dispensaries—it’s one reason Hawaii law enforcement opposes setting them up here. But how legit are the medical cannabis clinics in Hawaii? I decided to find out,  using my own real medical condition—migraines.

I attempted to get blue cards from four Oahu clinics— you might have seen some of these clinics’ ads on the back page of the Honolulu Weekly—and it’s not as easy as you might think. 

First, walk-ins aren’t allowed; you have to set up an appointment. My first call was to a clinic in Ewa. The friendly woman who answered said the physician could help me, but first I had to transfer my medical records. “It says on the website the doctor can help me even if I don’t have medical records,” I said. “Oh no, you have to transfer them first,” she replied. I called back the next day and spoke with someone else but got the same answer.

Same story at the next clinic I tried. The man who answered the phone wouldn’t even tell me where their office was located, aside from King Street.

The last two two Oahu clinics I tried listed 1-800 numbers that went directly to automated recordings. My messages were returned a week later by representatives in California and Oregon, again telling me the same thing.

I never did set up an appointment. If I transferred my medical documents, I could have secured an appointment and a physician might well have recommended me for medical marijuana. But it would have taken a while. Teri Heede, a registered Hawaii user, says it took her six months to get her card. Not as carefree as California.

3—The number of patients who violated the Medical Marijuana Law in 2010.

Infograph data sources: the Narcotics Enforcement Division (June 2010 statistics) and the Honolulu Police Department (August 2010 statistics).