I, Judith Cushner, declare as follows:

1. I am a long-time resident of San Francisco and the director of a pre-school program. I am also the mother of two children, one of them in college and the other just finishing high school. I am an active member of Congregation Sherith Israel. I am also a survivor of breast cancer.
2. In 1989, I was diagnosed with breast cancer. A mass was detected through mammography. I was immediately referred to a surgeon, who performed a biopsy and subsequent lumpectomy and lymph node removal. After a brief period of recovery from the surgeries, I was placed on an aggressive protocol of chemotherapy which lasted for eight months. That protocol was referred to as "CMF," because it consisted of heavy doses of Cytoxan, methotraxate, and 5 fluorouracil.
3. I was 45 years old at the time of my diagnosis. My children were 10 and 13 years old. It was a terrifying time for all of us, and I had very little time to reflect. I depended on my doctors for so many things: the best advice regarding treatment; an accurate and realistic description of how I would feel during treatment; an honest assessment of my chances of surviving this cancer; the implications for my children's health; and (last, but certainly not least), reassurance, understanding and complete candor when I felt alone, powerless and uninformed. I was extremely fortunate to find an oncologist who provided all of these: effective treatment, full advice, genuine human concern, and an unflagging commitment to my well-being.
4. Before I consented to chemotherapy, my oncologist advised me that uncomfortable side effects often resulted from the therapy. In particular, he warned me about severe nausea and retching, which often occurred not only during the treatments themselves, but in the intervening periods between treatments. He also advised that there were several medications designed to reduce or eliminate those symptoms, and that many patients found relief through drugs like Compazine.
5. I was told that the drugs prescribed to cure me could themselves be toxic, and that there were risks associated with all forms of medical intervention. My doctor had been right. The treatment caused severe and persistent side effects which were thoroughly disabling: chronic nausea, joint pain and weakness; a debilitating lack of energy and motivation; loss of appetite and a resulting unwanted weight loss; sleep disruption; and eventually my withdrawal from social situations and interpersonal relationships. The cumulative effect of these symptoms often rendered it impossible (or painfully difficult) to take the huge number of medications essential to my treatment regimen.
6. Right from the start, I was given Compazine as part of my chemotherapy protocol. I took it both orally (in pill form) and intravenously, but it too caused severe adverse side effects, including neuropathy. Moreover, the Compazine provided little, if any, relief from the nausea which had persisted since my treatment began. Hoping for better results, my doctor discontinued the Compazine and prescribed a drug called Reglan. That, too, had no effect on the nausea and we decided to discontinue it after a fairly short time. By then, I had developed chronic mouth sores (also from the chemotherapy) which made it extremely painful to take pills or swallow anything. Rather than providing relief, the Reglan increased my discomfort and pain.
7. Yet another drug I tried was Marinol, which I was told contained a key ingredient found in marijuana (THC). I was not prone to using drugs, nor was I anxious to take another pill, especially one associated with marijuana. However, I was desperate. I knew that my doctor was trying everything possible to relieve the brutal side effects I experienced, and he believed that Marinol might be effective. So I decided to try it. I should say first that it was extremely difficult to obtain. Although it is absolutely legal and I had a proper prescription, I found that most pharmacies did not keep it in stock. When I finally got it, I was already six-to-eight weeks into the treatment. I was extremely disappointed.
8. Marinol gave me no relief from the unrelenting nausea. If anything, taking yet another pill increased my discomfort. The pills themselves irritated the sores in my mouth. It also made me quite groggy, yet my sleep disturbance persisted, in part because my nausea and anxiety were so distracting. My doctor prescribed Lorazepam to help me sleep, but nothing seemed to help. Lorazepam was one more medication with unpleasant effects of its own.
9. When I tried to explain the grogginess caused by the Marinol, people assumed that I was just high from the THC. I think they imagined a mellow feeling, probably because of the drug's similarity to marijuana, but there was nothing mellow or pleasant about my experience. I have since learned that the proper term for this symptom is "dysphoria" -- it is the sensation of anxiety and severe depression in combination. Marinol left me disoriented, disturbed and confused, without affecting my nausea. I could not possibly take care of my children, or even myself, in that state.
10. The unrelenting nausea and discomfort caused by the chemotherapy became increasingly debilitating. I suppose that might have been because my body had been so weakened and vulnerable. Whatever the reason, it reached a point where the "side" effects were simply intolerable; I could not imagine living like that for much longer. It was then that I considered terminating my treatment altogether. I thought that allowing the cancer to go unchecked had to be preferable to the pain and despair of "treating" it. Since my diagnosis, I had met and spoken with many women about the illness, its various stages, the range of treatments, and especially the devastating effects of chemotherapy. It was not uncommon for them to consider stopping the treatments mid- way through the protocol. I know several women who chose to do just that, abandoning medical procedures to find some relief, even knowing that their relief might be short-lived. As far as I know, none of those women are alive today.
11. During this time, a friend of mine (who happened to be a nurse) gave me a marijuana cigarette. She had seen my suffering and thought it might help. I took her advice and it worked. I took just a few puffs and within minutes, the nausea dissipated. For the first time in several months, I felt relief. I also felt hope.
12. I smoked small amounts of marijuana for the remainder of my chemotherapy and radiation treatment. It was not a regular part of my day, nor did it become a habit. I smoked it only when nausea or retching commenced or worsened, usually in conjunction with a treatment session. There were weeks when I smoked it every few days. There were also periods when I didn't smoke for weeks at a time. Each time I felt a wave of nausea coming on, I inhaled just two or three puffs and it subsided.
13. As my nausea decreased, my ability to eat and retain food increased. I saw a marked weight gain and my energy increased. As my general health improved, my sleeping habits also seemed to work themselves out. In retrospect, one of the greatest benefits from the marijuana was that it decreased my use of other, more disabling and toxic medications, including the Compazine, Reglan and Lorazepam.
14. When I started using medical marijuana, I had been suffering extreme nausea for months and my mouth was full of sores. My difficulty swallowing kept me from ingesting marijuana through baked goods, as I would have preferred. Later on, as the adverse reactions were minimized, I was sometimes able to swallow it.
15. As soon as I started using marijuana, I informed my oncologist and the other doctors treating me. I was concerned that it might compromise the prescribed treatments or there might be medical risks of which I was unaware. When I told them that the marijuana had relieved the symptoms, none of then seemed surprised. Indeed, they all expressed (explicitly or in some other way) their approval and support. Since then, I have always informed my treatment providers about my success with medical marijuana. Not one of my doctors -- including oncologists, surgeons, internists, or therapists -- has ever advised me against it.
16. To be sure, there were down sides to using marijuana, despite the medical benefits I obtained. Obviously, there were the risks associated with obtaining it, as well as fears that it might contain impurities that I could not possibly detect. The process of purchasing it was fraught with danger, real and imagined.
17. An equally serious concern for me was my children. I smoked marijuana very discretely -- always in my home and never in front of my children. On the other hand, I did not lie to my kids or deny what I was doing. They desperately wanted me to get well, and I believe that they could (and did) distinguish between medical and non-medical use of marijuana. But the status of my "medication" only increased their heart-felt fear for my safety, knowing that what I was doing was both necessary and illegal.
18. I was quite shocked to learn the degree of their anxiety, as they went through their days knowing that their mother was using an illegal drug. They were taught, in no uncertain terms, that all drugs are bad. A police officer in full uniform was invited to their classes to deliver that message. Teachers and school administrators had a policy of encouraging the children to report any illicit drug use by their friends and their family members. The message was clear and there was apparently little discussion about it: drugs destroy lives, and those who do drugs can go to prison for long periods of time.
19. Throughout this time, my children sat silently, harboring the secret that their own mother smoked pot. They remained silent out of loyalty to me, and because I am blessed with children who are smart enough to understand that right and wrong can be very subjective. Nonetheless, it took a toll on them at a very impressionable age. Both of my children later confided that they were often unable to sleep, fearing that the police would arrest me during the night and take me to jail. They also feared that someone at school would discover their secret, and they would be punished for my actions. My children struggled with the prospect that a painful disease would take their mother from them, while also struggling with the possibility of losing me to prison. I am certain that to 10- and 13-year-old children, these images are extremely vivid. I live with the guilt that their fear and isolation was caused by my illness and my efforts to get well.
20. The guilt and anxiety of breaking the law is too great for some cancer patients to bear. I myself found this is a difficult decision, but I was desperate to live. Others refuse to try medical marijuana, despite the possibility of relief. Faced with the unrelenting side effects of chemotherapy and unable to find a remedy, they cease treatment and quickly succumb to the disease. I know one woman in particular who agonized over this decision and ultimately discontinued her treatments. She died as a result. I believe that, had she responded to marijuana as I did, she might still be alive.
21. My treatment continued in various forms, for many years. Prior to completing chemotherapy, I began eight weeks of radiation therapy. When my illness appeared to be under control, I took the advice of medical specialists and started long-term treatment with Tamoxifen, a drug prescribed to many high-risk patients to prevent recurrence of the cancer. Ironically, long-term use of Tamoxifen apparently increases the risk of cervical-uterine and liver cancer. As with every form of treatment, I have balanced the risks and benefits before making any medical decisions. In the case of Tamoxifen, I remained on the drug for many years until I felt that the risks outweighed the potential benefits. That decision was aided by complete and honest (if sometimes frightening) information from doctors whom I trust.
22. My trust in my doctor was incredibly important in my willingness to withstand the final stages of chemotherapy and fight for my life. Without that trust, and the information he provided, I would not be here today. I truly believe that. My cancer has been in remission now for just under a year. I lived to see my son's Bar Mitzvah, and I am proud to say that the risks I took to save my life, while technically illegal, have earned me the respect of both my children. They have learned the difference between therapeutic treatment and substance abuse, and (unlike many of their peers) that knowledge has helped them resist the temptations of recreational drugs.
23. My decision to use marijuana and save my own life has educated many, including my rabbi and my congregation. My hope is that my example might give strength to others suffering from serious illnesses. The recent announcements of the Drug Czar and other federal officials -- threatening to prosecute physicians who advise their patients regarding medical marijuana -- promises to replace that strength with fear, silence and ignorance. I am walking proof that full and accurate information and guidance does indeed save lives. The government's position can only cause unnecessary suffering.

I declare under penalty of perjury under the laws of the United States of America and the State of California that the foregoing is true and correct and that this declaration was executed this 14th day of February, 1997 in San Francisco, California.

Judith Cushner