After five years of rapid growth in the number of patients certified to use marijuana for medical purposes, enrollment in the state registry dropped sharply last year for the first time since medical marijuana was legalized in 2000.

The number of people registered with the state and certified by a doctor to have debilitating conditions that qualify them to legally use marijuana dropped by almost 22 percent during the past 10 months, according to statistics supplied by the state Department of Public Safety.

Keith Kamita, who oversees the program as administrator of the department's Narcotics Enforcement Division, said people continue to sign up, so he doesn't see the decline as any indication that patients are having trouble getting certified.

"I think there's a lot of people who try it and then don't go back to it," Kamita said.

Pamela Lichty, president of the Drug Policy Forum of Hawai'i, said it's unclear why the number of registered medical marijuana patients is dropping, but the causes may include a lack of publicity for the program in recent years or fewer doctors who are willing to certify patients.

The forum, an organization that promotes a public health approach to drug- and substance-abuse issues, has been urging state lawmakers for years to move the medical marijuana program out of the Department of Public Safety and into the state Department of Health.

Lichty said she will resume that effort in the state Legislature this year because her group believes Public Safety, which enforces laws prohibiting illegal drugs, is the wrong agency to oversee the legal use of marijuana by people who are ill.

Moving the program will encourage more people to use the program and also ease the anxiety of physicians who are asked to certify patients, Lichty said.

The Public Safety Department and Kamita are responsible for overseeing physicians' authority to write prescriptions to ensure there is no abuse, she said.

"He is kind of an overseer of physicians' behavior, and so they're not crazy about the idea of dealing with him," she said.

MOST ON BIG ISLE

More than half the people certified and registered with the state to use medical marijuana are on the Big Island. That, Lichty said, suggests O'ahu doctors aren't aware of the potential benefits of marijuana and aren't familiar with the legal protections under the program.

Under the program, a doctor must certify that the patient has a qualifying medical condition such as cancer, AIDS or glaucoma, and that the doctor believes the potential benefits of medical marijuana use would likely outweigh the patient's health risks.

Kamita said doctors face no risk of enforcement action from his office for certifying patients under the law as long as the doctors do not actually prescribe marijuana or give marijuana to their patients.

With more than 2,000 patients certified and registered by doctors statewide, Kamita said he doubts doctors have a problem dealing with his agency and said the program should stay where it is.

Kamita said he believes specialists in Honolulu rarely certify patients for marijuana use because those specialists are prescribing other, more effective drugs.

FEW TAKERS

One organization that established a clinic on Queen Street specifically to certify patients who are eligible for medical marijuana use has found relatively few takers.

The Hemp and Cannabis Foundation, which also operates clinics in Oregon, Washington state and Colorado, saw only about 200 patients in Hawai'i in its first year of operation, said foundation executive director and founder Paul Stanford.

"Things have gone a bit more slowly than we would have liked," but the organization began radio advertisements in recent weeks to let more people know about the clinic, Stanford said. He said the clinic also began seeing patients in Hilo because there was demand there.

SEEN AS BUSINESS

Stanford said he believes relatively few people sign up from O'ahu because it is impractical for many people to grow their own marijuana for medical use. He said that is less of a problem on the Big Island, where more people live in rural settings.

Kamita said some doctors on the Big Island are involved in certifying patients for medical marijuana use "strictly as a business." He cited one Big Island physician who is responsible for certifying 897 patients, or more than half the people certified on the Big Island.

Kamita declined to identify the doctor but said he believes there should be a cap on the number of patients any single physician can certify. That will help ensure the patients get appropriate follow-up care, he said.

"If you have 897 patients, I'm wondering how much interaction you are having with the patient," Kamita said.

Reach Kevin Dayton at kdayton@honoluluadvertiser.com.