I, Dr. Richard Gracer, declare as follows:

2. I received my M.D. degree from Albany Medical College in 1973, after which I completed internships and residencies at both Baylor College of Medicine from 1973 to 1974 and the University of California-San Francisco ("UCSF"), from 1980 to 1981. From 1976 to 1977, I was a clinical instructor at Baylor College of Medicine and the University of Texas. Since 1980, I have been a member of the teaching faculty as a Clinical Assistant Professor at UCSF's Division of Community and Family Medicine. Since 1979, I have been affiliated with both John Muir Memorial Hospital in Walnut Creek and Mount Diablo Hospital in Concord. I have admitting privileges at St. Mary's Hospital in San Francisco (since 1985), and San Ramon Regional Medical Center in San Ramon (since 1990), where I served as Vice Chief of Family Practice from 1990 to 1992, then Chief of Family Practice from 1993 through 1994. From 1985 to 1992, I was also affiliated with St. Francis Memorial Hospital in San Francisco.

3. I am a Fellow of the American Academy of Family Physicians, and certified by the American Board of Family Practice. I am also a Diplomate of the American Academy of Pain Management. I am a member in good standing of the Society of Orthopedic Medicine, the American Association of Orthopedic Medicine, the British Institute of Manual Medicine, and the California Medical Association. I present lectures and conduct seminars regionally and nationally in the fields of pain management and orthopedic medicine.

4. Chronic pain is an unrelenting, excruciating, disabling condition which few people can understand unless they have either experienced it themselves or watched a loved one suffer over an extended period. It pervades every aspect of an individual's daily existence, and the physical torment they suffer is frequently (and understandably) exacerbated by the fact that there is little hope for truly effective relief -- chronic pain patients are often doomed to suffer this condition for many, many years, if not for the remainder of their lives.

5. For most chronic pain patients, traditional opiate therapies are the most effective tools physicians can offer their patients for the management of severe, debilitating pain. This involves routine use of powerful narcotics, usually Morphine derivatives. However, for a small number of patients, even aggressive opiate therapies are not sufficient. Unless alternative pain treatments are found for such patients, they will continue to suffer. For those individuals, their daily lives are often tortuous. As a physician, I am acutely aware of the disturbing connection between intractable pain, overwhelming despair, and suicide.

6. I have at least two patients for whom traditional pain management techniques have proven to be in effective. One of those patients is Mr. Michael Ferrucci, who is also a plaintiff in this case. For Mr. Ferrucci and my other patient, marijuana in its natural and/or synthetic forms (marijuana and Marinol, respectively), appears to be an effective analgesic. I have monitored and observed these patients' closely over several months' time, regularly discussing with them their use of medical marijuana and its usefulness in managing their pain. I am not able to explain fully the pharmacological or physiological underpinnings of marijuana's analgesic properties, and indeed there is scant research available to assist me in that understanding. However, I can state confidently, as a physician with an extensive practice and specialized expertise in pain management, that marijuana can prove (and has proven) medically useful to at least some chronic pain patients. Accordingly, I believe that physicians should be able to recommend and/or prescribe marijuana to patients for whom it is medically appropriate. Absent that authority, my ability to treat my patients and provide relief from horrific pain is undermined, as is the trust essential to therapeutic relationship.

7. It is no secret that the Drug Enforcement Agency is deeply suspicious of physicians who prescribe significant amounts of narcotics to specific patients. As a result, pain doctors, who quite properly rely upon narcotics to effectively combat pain, are closely scrutinized by the DEA. The DEA has near absolute power to revoke physicians' prescription licenses for conduct of which it disapproves. Thus, In the current political climate, many physicians specializing in pain management, such as myself, are quite fearful of recommending marijuana to patients who could possibly benefit from it. Revocation of my license would effectively destroy my ability to practice medicine and perhaps deprive hundreds of my seriously ill patients from receiving appropriate treatment. This fear causes me to exercise extreme caution; indeed, it has a chilling effect on my ability to provide frank, thorough, and individualized advice to the patients who rely on me.

8. The effects of the government's recent threats (veiled and otherwise) are already evident in routine medical practice. For example, physicians are able to prescribe drugs for "off-label" purposes -- i.e., for purposes other than that which the drug was originally approved for. This a standard practice throughout the country. However, while Marinol is FDA-approved as an antiemetic, and I would be within my rights to prescribe it in good faith for pain, I have refused to prescribe Marinol for pain for fear of provoking a DEA investigation and placing my license (and my patients' well-being) at risk.

9. Mr. Ferrucci's medical history and the development of (and external obstacles to) our doctor-patient relationship provide excellent examples of both the benefits of marijuana and physicians' reluctance to recommend it. Michael Ferrucci suffered severe injuries to his back in 1981. At the time, he was diagnosed as suffering acute cervical and lumbar strains, injuries which almost always cause severe, long-term pain. Since the initial injuries, he has developed numerous disk herniations, pseudoarthritis, myofascial pain syndrome, and a degenerative disk disease.

10. During the intervening years, Mr. Ferrucci has received the following diagnoses, among others: cervical disk herniation (1988, 1990, 1991); cervical disc extrusion (1988); "ridging or atrophic indentation of the spinal canal" (1990); pseudoarthritis (1991); "left L5 radiculopathy" (1981, 1982); chronic cervical and lumbar strain (1983); disk herniation (1988, 1990, 1991, 1992); "lumbar degenerative changes" (1990); subligamentous disc protrusion (1992, 1994); cervical spondylitis (1990, 1994); "active myofascial trigger points" (1992); "myofascial pain syndrome, secondary to multiple surgical interventions of the cervica spine" (1992, 1993); "spinal degenerative joint disease" (1996); "cervical degenerative disease," "degenerative cervical disk disease" or "degenerative joint disease" (1992, 1993, 1994); "multiple cervical spurs" (1993); "chronic pain behavior syndrome" (1992); "chronic pain syndrome" (1993); and "sleep disorder, secondary to chronic cervical pain" (1992).

11. Patients with these disorders frequently experience a level of constant pain which most individuals would find wholly intolerable. This level of pain is most frequently treated with opiate medications, although even on high doses of powerful medications, it is not uncommon for some degree of pain to persist. This was certainly the case with Michael Ferrucci. Over the past decade, he has been treated with the full range of traditional prescription analgesics available. Again, these include the following:

(a) Opiates: Morphine, Fentanyl, Dilaudid, Tylenol with Codeine, Vicodin, Tylox, Wygesic, Demerol, Talwin, Percodan, MS Contin, Darvocet, Stadol;

(b) Muscle relaxants: Robaxin, Flexeril;

(c) Anti-anxiety agents: Valium, Sinequan, Vistaril, Ativan, Xanax;

(d) Hypnotics: Halcion, Restoril, Chloralhydrate, Dalmane, Doral; and

(e) Anti-emetics: Zofran, Compazine, Benadryl, Phenergan, Tigan, Marinol.

12. In 1995, attempting to wean himself of the heavy doses of narcotics he had relied upon for years, Mr. Ferrucci went through all proper channels in his attempts to secure a prescription for Marinol. Despite repeated requests and well-documented evidence attesting to both his need and his medical history, he was unsuccessful. At that point, he asked me to write a letter, addressed to Mr. Ferrucci, setting forth my medical assessment of his condition and his treatment needs. The substance of that letter is quoted below:

"April 11, 1995

Dear Michael:

At your request, I am writing to you to state the following:

1. You suffer from severe intractable neck pain as a result of multiple neck fusions.

2. Current medications includes high dose maintenance oral Morphine, Tylenol with Codeine, Valium and sleeping medication.

3. During your recent bout with testicular cancer we found that the use of Marinol significantly decreased your need for pain medication.

4. Because of legal questions I have not been able to prescribe Marinol as ongoing therapy for your pain control.

Sincerely,

Richard I. Gracer, M.D.

13. The federal government's threats against physicians in light of the passage of the Compassionate Use Act simply confirmed my fears. At present, many pain physicians feel chilled by the government's threats. If marijuana were medically and legally available, I would consider incorporating it more broadly into my pain practice where appropriate and evaluating its possible benefits on a case-by-case basis, as with any prescription drug.

I declare under penalty of perjury under the laws of the United Stes of America and the State of California that the foregoing is true and correct to the best of my knowledge and that this declaration was executed this _______ day of September, 1997 in ____________________, California.

Richard I. Gracer, M.D.