Johan Mathiesen has smoked pot recreationally for 45 years. 

"It's my coffee, my tobacco, whatever you want. It's my social drug," says Mathiesen, a 69-year-old deli clerk at New Seasons on Southeast Division Street.

And in a weed-friendly town like Portland, he says, that never posed a problem—until last year, when Kaiser Permanente suddenly cut off his pain medication, citing his marijuana use.

Doctors prescribed Mathiesen oxycodone several years ago to relieve arthritis. Now, Mathiesen says, the Oakland-based insurance giant is discriminating against him based on an arbitrary social stigma around cannabis.

"I also drink half a beer a day. Is that prohibited? They said no," Mathiesen points out.

John Sajo, a longtime marijuana activist in Oregon, says doctors routinely deny pot users access to medication—even when they're in Oregon's medical marijuana program. Pot patients have also been denied organ transplants (see "Organ Failure," WW, May 21, 2008).

"It seems like a lot of healthcare providers have those sorts of rules," Sajo says.

But prompting insurance companies to discuss those rules, if they exist, is an uphill battle. In response to WW requests, the PR departments at Kaiser and Providence Health released only brief statements. Regence BlueCross BlueShield of Oregon says it has no such policy restricting marijuana users' access to medication.

"Generally speaking, we recommend that patients not use opiates and marijuana together," reads an email response from Kaiser spokesman David Northfield. "The doctor chooses 99 percent of the time at Kaiser Permanente Northwest to recommend to the patient to make a choice [between pot and prescription narcotics]."

Mathiesen's story begins about four years ago, when he was briefly hospitalized for heart arrhythmia. Doctors prescribed Coumadin for blood clots. The drug can interact badly with aspirin, Tylenol and other analgesics Mathiesen had been taking for his arthritis, so doctors gave him oxycodone instead.

The powerful painkiller can be habit-forming in some patients, but Mathiesen says he had no problems with the drug. He took it until last summer, when his former doctor left Kaiser and he was assigned a new physician, Dr. Tamara Oren.

Mathiesen says he always informs doctors he uses pot, and after viewing his file, Oren asked him to take a urine test. When the test came out positive for marijuana and oxycodone, Mathiesen says Oren told him he had to choose between the two, citing company policy. 

He refused to give up cannabis, so Oren yanked his prescription for oxycodone. Mathiesen was left with only over-the-counter painkillers, and because Coumadin mixes badly with those drugs, he had to drop the anticoagulant as well.

Numerous online medical sources warn of harmful or fatal interactions between alcohol and oxycodone. But Mathiesen could find none on oxycodone and marijuana. He wrote letters to Kaiser demanding the insurer either justify the policy or drop it.

"Anti-marijuana fever in this country is fuel[ed] by religious and cultural prejudices with no rational or honorable basis," Mathiesen wrote to Kaiser. "What I don't want is to have the remainder of my life put in jeopardy or pain because of cultural/religious prejudice."

Kaiser officials set up a meeting with Mathiesen on April 15 to discuss the policy and his requests for a doctor with an open view on marijuana. But on April 7, Dr. Maureen Wright, an associate regional medical director at Kaiser, canceled the meeting.

"We offered to meet with you to discuss your concerns, which you told me during our telephone conversation was related to discrimination," Wright wrote. "What you outlined in your letter has to do with your wish that we nullify our opioid protocol. That will not be done."

So Mathiesen now is left with no prescription painkiller, no blood-clot pills and no primary care provider.

"They're saying, 'You don't get the best medicine because you smoke marijuana,'" Mathiesen says. “That’s social engineering. I can’t trust a doctor like that.”