August 12, 1998
By Patty Wentz pwentz@wweek.com
DOPE WITH DIGNITY

A Portland internist is the unlikely leader of the effort to legalize medical marijuana in Oregon. Richard Bayer says the feds should keep their war on drugs out of the examining room.

Seated at the conference table in his makeshift office on Northwest 23^rd Avenue, Dr. Richard Bayer flips through the medical file that holds his notes. While doing so, he keeps his left leg elevated on a chair. He apologizes for the casual pose, explaining it’s the only way to control the flow of blood through the damaged vein in his leg.

Bayer, 43, stops at a marked-up piece from The New England Journal of Medicine. As he reads it, his voice tightens. It’s an article about physicians of courage, physicians who will defend "the rights of those at death’s door" over the "bureaucrats whose decisions are based more on reflexive ideology and political correctness."

To Bayer, it’s a mission statement.

To Oregonians, it is partly the reason they are going to be asked to join California and legalize marijuana for medical purposes. Bayer is the chief petitioner for Ballot Measure 67, one of five similar measures in Western states that will be on ballots this November. As dedicated as Bayer is to making an illegal drug available to the sick, however, he is hardly your average hemp hustler. Bayer’s crusade is markedly different.

Oregon has never seen a cannabis activist like Bayer. For more than 20 years, people with different agendas have tried to decriminalize marijuana or make it legally available to the sick. Some are libertarians who argue that the government has no business regulating personal drug choices. Others emphasize economics and believe the war on drugs—particularly a drug as inoffensive as pot—is a waste of resources. Others, who in a different era would have been called hippies, see pot as a central part of their lifestyles and treat it with an almost religious reverence.

One of the most tireless Oregonians active in legalization efforts is Portlander and sometimes state representative candidate Paul Stanford, who touts cannabis as a miracle crop that can be used for food, clothing, paper and medicine.

Another activist is Phil Smith. For two years he operated a cannabis buyers club in Portland, providing some 300 medical customers with pot while the Multnomah County District Attorney looked the other way. His operation was shut down and Smith was arrested for possession when a patient turned him in to the police. Smith is currently reported to be under house arrest in San Francisco, where he can get a legal supply of marijuana to treat the symptoms of depression.

Outside Oregon, perhaps the most outspoken activist in the country is Dennis Peron, of San Francisco, who was the chief petitioner on California’s Proposition 215, which last year legalized marijuana for medical purposes. Peron, who has been dubbed the Peter Pan of Pot, has been openly defiant of drug laws and has been arrested 15 times for possession of marijuana.

The differences between Bayer and these and other traditional pot activists are dramatic. Bayer doesn’t smoke pot—his drug of choice is Mountain Dew. He knows little about the larger hemp culture he is now a part of, and he is against the legalization of marijuana for recreational purposes.

What drives him to join the pot battle has little to do with marijuana. It has more to do with his sense of a doctor’s responsibility to advocate for patients. "It’s all about respecting patients and giving them autonomy over their bodies," he says.

In 1996, he worked as the medical spokesman in the campaign to defeat Ballot Measure 51, which would have overturned the Death with Dignity Act. That same year, California passed Proposition 215, which decriminalizes possession and cultivation of marijuana for medical purposes. Shortly thereafter, Clinton’s drug czar Barry McCaffrey threatened to take away the licenses of California doctors who recommended marijuana to their patients. That threat incensed Bayer, who now wryly credits McCaffrey for recruiting him into working on the Oregon initiative. "The examination room is a sanctuary...the war on drugs does not belong there," he says.

Until 1996, Bayer was an internist at a Lake Oswego clinic. His colleague there, Dr. Dan Bouma, says Bayer had an intimate connection with his patients. "He was the kind of doctor that patients love," Bauma says. He specialized in critical care, spending as much time at the hospital as in the clinic.

Bayer also had a reputation for being both a strong advocate for patients—especially against insurance companies that would deny them treatment—and one of the more academic physicians on the staff, spending hours poring over the most recent medical research and studies. What little human rights work he had time for was limited to a membership in Physicians for Social Responsibility and giving occasional speeches on the dangers of nuclear weapons.

But Bayer’s professional and personal life changed suddenly in 1996, with the return of a childhood medical condition.

When he was 16 years old, he developed a massive blood clot in his left leg, probably as a result of influenza. The clot was removed, and other than wearing a compression sock around his left ankle to help the blood flow back up to his heart, he experienced no problems for nearly 20 years.

But over Memorial Day weekend two years ago, after being on call more than two days, Bayer says he felt a familiar and intense pain. He removed the compression sock and saw a pencil eraser-sized indentation below the bone on the inside of his left ankle: an ulcer resulting from oxygen depletion. The valves in the major vein in his leg had completely disintegrated, a condition called venous insufficiency. Without constant circulation, the skin would continue to ulcerate and die.

Gravity is the enemy, so Bayer has to keep his leg elevated above the hip. He can stand only for a few moments without a compression sock—with it, maybe 10 to 20 minutes. As the blood gathers at the ankle, the pain is blinding. His ankle feels "like it’s being filled with a giant bicycle pump," he says. Treatments for the condition are experimental and risky.

The nature of Bayer’s practice—spending hours on his feet at the hospital—forced him to make a decision. "It was either my leg or my practice," he says.

By the end of summer that year, he had retired, turning his patients over to other physicians. He considered becoming a jazz musician, a childhood dream of his. He plays the trumpet and idolizes Miles Davis, whom he describes as someone who was "constantly exploring, changing and creating."

Not having enough musical talent, however, Bayer started working with Physicians for Social Responsibility on a lead-screening program for low-income kids in north Portland. He now serves on the program’s board of directors. In August of 1996, Bayer read a statement from the Oregon Medical Association in support of Measure 51, which would have repealed the physician-assisted suicide law. Bayer says the research he read counters the OMA’s position; he found the majority of Oregon doctors support helping their terminally ill patients with assisted dying. He joined the campaign and became a voice for the medical community against the repeal, debating opponents throughout the Willamette Valley and doing interviews with local and national media.

One morning during the campaign, he was listening to KBOO and heard Sandee Burbank, leader of Mothers Against Use and Abuse, talking about the effort to pass a medical marijuana law in Oregon. His pique with McCaffrey combined with his own experiences with chronically ill patients who had successfully used marijuana led him to dash off a check to support the effort.
(Ed. note: Sandee Burbank is one of the finest people in the marijuana reform movement.)

That winter, he attended a planning meeting for the marijuana initiative with the drafters of the bill, among them state Rep. George Eighmey, who that year had tried to get a similar bill through the Legislature. By that time, Bayer says, he’d done extensive research on the issue and had met with several patients who had used medical marijuana to treat a variety of conditions. "They needed a doctor who is not afraid of being politically active to tell the truth," he says. He agreed to sign on as chief petitioner—along with a multiple sclerosis patient, Stormy Ray—and as chief spokesman for the initiative.

While Bayer may be the most public doctor supporting medical marijuana, the fact is that many doctors and nurses, especially those who work with AIDS and cancer patients, agree with him.

Dr. Mary O’Hearn, an HIV specialist at OHSU, says marijuana usage is common among her most advanced patients because getting the munchies helps fight the wasting away associated with AIDS. While smoking marijuana is not good for the respiratory system, O’Hearn, 40, says she will vote for Measure 67 and believes that most of the doctors her age will, too. "I don’t know any of my peers who wouldn’t support this," she says.

Jo Whitlow, an oncology nurse at Legacy Health Systems, says she has seen the value of marijuana in stemming the nausea that chemotherapy causes in her patients. She will vote for Measure 67 if she is convinced that there will be strict controls over supply. While she believes there are medications that work better than marijuana, there are some patients for whom it is the only solution.

There are other doctors who agree that pot should be made available to patients but plan to vote against Measure 67. Dr. Charles Hoffman, a Baker City internist and past president of the Oregon Medical Association, thinks that patients should probably be given access to marijuana if they need it. But, he says, only after the Federal Drug Administration has approved it.

Dr. Hoffman concedes that FDA approval for marijuana is far in the future, and as a doctor, he takes some responsibility for that. "It’s political. People are afraid of the evil weed, reefer madness....Organized medicine has to take some of the blame. We should have been pressing [for scientific study] earlier." While the merits of medicinal marijuana have been recorded at least anecdotally for, some say, thousands of years, it was only last year that the American Medical Association came out with a statement urging government study of marijuana.

Until the research is done, the AMA is against allowing patients to use marijuana. Bayer says, "The AMA has a position I scientifically and ethically disagree with." He is satisfied with the studies that have been done on marijuana and believes that, for patients, the benefits outweigh possible risks. His goal is for marijuana to be reclassified by the federal government so that physicians can prescribe it. "All I want," he says, "is for patients to have one more option."

It isn’t science or compassion that is keeping the medicine from patients, Bayer says. It’s politics, fear, and ignorance. "Many people have been taught there is no difference between drug use and abuse. Doctors know better."

By agreeing to be chief petitioner and spokesman of Oregon’s initiative, Bayer has signed on to a national campaign. Americans for Medical Rights, based in Santa Monica, Calif., has funded signature gathering drives in Oregon and four other states—Washington, Alaska, Colorado and Nevada. Dave Fratello, executive director of the group, which also coordinated Proposition 215, says the group’s goal is to eventually persuade the FDA to reclassify the drug.

Locally, the campaign is being run by the Sugarman Group, which ran the Death with Dignity campaign in 1996. (The Sugarman Group is also heading the opposition to Measure 57, which, if passed, would recriminalize possession of less than one ounce of pot.)

Geoff Sugerman says he expects the campaign to cost anywhere from $250,000 to $500,000.

While it’s still early in the campaign, the legislative committee of the Ecumenical Ministries of Oregon, which represents more than 1,400 Oregon churches, has endorsed the initiative, as has the ACLU and the Coalition of Black Men.

Bayer’s role in the campaign has been central. He has debated the measure on talk radio, spent countless hours giving television and newspaper interviews and asked for support from a variety of special-interest groups. He plans to debate opponents of the measure this fall and says his experience in medical school—being forced to argue the risks and benefits of treatments—makes him particularly suited for that. So does his experience playing in a jazz band. Debates, he says, are all about improvisation. "You pull on your creativity in a debate," he says. "I never know what’s going to happen."

He can be certain of one thing: Law enforcement is going to line up against him.
See
Review of All The Proposed Oregon Marijuana Initiatives –  Which Do Police Fear Most?

Opposition to Measure 67 is still forming. It is currently headed by Multnomah County Sheriff, Dan Noelle. Oregonians Against Dangerous Drugs has so far signed up the Oregon Association of Police Chiefs and some anti-drug activists.

Noelle argues that it doesn’t matter how tightly the initiative is written—it’s still drug dealing. He is skeptical of the cover of respectability being draped over the bill.

"If I’m a cancer patient and I convinced myself a bourbon and a cigar made me feel better, it would."
(Ed. note: Of course, a bourbon and a cigar would make him sicker, but he wouldn’t be arrested for having them. This fellow doesn’t think to clearly.)

Dr. Cornelia Taylor, a Salem internist who in September will be starting as assistant vice president of medical affairs at Blue Cross/Blue Shield, opposes Measure 67 and will be working on the campaign. She maintains that there is no medical reason to use marijuana. She says THC, the active ingredient in cannabis, is available in the pharmaceutical form Marinol (though medical marijuana advocates say it is a poor substitute for the real thing). "I think medical technology and pharmacology has advanced enough that they can treat any of the conditions listed in this measure," Taylor says. "In my opinion, this is an attempt to legalize marijuana in the name of medicine and compassion, which is not truthful."

Noelle says Bayer is more of a dope dupe than a Dr. Welby. He points out that no matter how deeply dedicated to helping patients Bayer may be, he’s still acting as the front man for a well-organized drug lobby. "People like Dr. Bayer may be perfectly nice, but they are being used," he says.