Jeff Swensen did not tie down his legs late Tuesday night before climbing in bed to watch his favorite television shows.
A car accident when he was 16 paralyzed him from the nipples down, which makes his legs “flop uncontrollably.” He used to worry about falling asleep in front of the screen without properly restraining them. For the past several years, however, the 27-year-old Helena man hasn’t worried as much because a regimen of smoking medical marijuana, or cannabis, prevents the spasms, reduces chronic pain in his arms and helps him sleep.
“I started out using recreationally, but then I noticed it cut back on my muscle spasms,” Swensen said. He smoked pot illegally in Minnesota, a state that makes no exceptions to harsh criminal punishments for medical use. There, Swensen self-medicated when he could, but it was difficult to maintain a steady supply of marijuana.
When his wife Jana wanted to move back to her home state of Montana three years ago, Swensen agreed. He began looking for a doctor who would recommend him for the state’s medical marijuana program so he could medicate regularly and receive full relief of his symptoms without worrying about criminal prosecution.
Though Swensen admits that initially he didn’t smoke marijuana for medical benefits, he now does so as a state-registered patient and wishes, like many other cardholders, that more people would respect the privileges the law grants to deserving, suffering individuals.
“The law’s very serious and shouldn’t be pushed or tested,” Swensen said. “These privileges could be taken away eventually if it’s abused enough.”
One Missoula man literally would not know how to live without medical marijuana if the law were unexpectedly repealed.
“At one time, I was on 22 pills a day. I wasn’t physically or mentally awake for anyone,” he said of the years following a severe beating in a high school locker room that damaged his brain and left him dysfunctional. “I slept for the first year and a half. I would wake up to eat and take my meds, that’s it.”
This article will refer to the 26-year-old man as “Smith,” since he feared his family might become victims of the stigma associated with cannabis if he were to share his name.
Smith’s brother was troubled by his sibling’s pain and the resulting suicidal thoughts, so he encouraged Smith to light up with him because he hoped it would help him relax and enjoy his company, if only briefly.
But he inadvertently found an incredible solution to Smith’s struggles. With regular use of medical-grade cannabis, Smith’s once-regular seizures subsided, his pain dissipated and blocked pathways in his brain cleared to allow him to communicate. The regained freedom gave him reason to live.
“I can feel alive,” Smith said. “I can’t express how much of a freedom it is to have this medicine. I’m now more interactive with my community and my family. I’m getting out. I can hold conversations.”
Smith pauses to grab his nearly 2-year-old son away from stacks of free postcards near a table, now fluttering to the café floor, and chuckles before he adds, “And I’m able to watch my kid get into stuff.”
The origin of Initiative 148
Tom Daubert, who earned a master’s degree from UM in 1979, earned a reputation for transforming public opinion on underdog issues.
For example, his work with the state’s mining industry successfully convinced Montanans that they should not pass the Clean Water Initiative of 1996, which showed more than 80 percent support about a year before the final vote.
In 2004, when the national nonprofit Marijuana Policy Project asked Daubert to help write and organize the campaign for Initiative 148, he faced the challenge of convincing largely conservative Montana voters that marijuana was not a dangerous gateway drug but a safe and legitimate medical solution for some individuals with severe illnesses.
“I came of age in the ’60s, and I thought I knew marijuana,” Daubert said. “But I didn’t know any of the science until I started working on the campaign.”
Daubert said he was incredibly moved by people he met during the campaign who were forced to self-medicate with street pot or forgo the treatment because of possible criminal charges, even though they suffered daily from serious conditions such as terminal cancer, multiple sclerosis and severe chronic pain.
“Contrary to what people think, patients I know don’t get high. They get relief,” Daubert said. “This law is so precious to really sick people that it’s really important to understand it fully.”
In November 2004, voters set a national record for the highest level of public support for a state medical marijuana program when 62 percent approved the initiative, making Montana the 10th of 13 states with similar programs.
“People are becoming more open-minded,” Swensen said. “Ten years ago, we never would have seen it as it is today.”
Part 2, originally published 10/6/09
Doctor recommendation needed
Deni Llovet, a family nurse practitioner, organized River City Family Health’s first medical marijuana clinic after a patient with chronic back pain committed suicide.
“Two and a half years ago, I had a client who was really suffering,” Llovet said. “We had tried everything and finally I said, ‘You know, I hear that marijuana could help.’”
When the patient asked if it was legal, Llovet said no. She did not know about the state’s exemption.
“She bought cannabis from her 27-year-old son and it worked wonders,” Llovet said. “But her family did not approve, so she killed herself because her pain was so great.
“I should have known it was legal. That’s when I realized that I was missing the beat.”
Nearly 700 medical studies of cannabis and its derivatives are published each year that confirm their useful medical properties, said Tom Daubert, who led the campaign to establish the Montana law and later founded the patient support group Patients and Families United.
In 2002, adjunct University of Montana professor and local neurologist Dr. Ethan Russo researched the long-term effects, positive and negative, of smoking marijuana as a medical treatment.
Russo’s team, which included a UM grad student, evaluated four remaining members of the FDA’s Compassionate Investigational New Drug program. Though the program no longer accepts new patients, the remaining four are provided with four to eight ounces of government-grown, cured marijuana each week as treatment for serious illnesses such as glaucoma and multiple sclerosis.
“The Missoula Study,” as it was nicknamed, concluded the medical use of marijuana relieved pain, muscle spasms and intra-eye pressure. The researchers recommended that the program be reopened or that states develop laws to accommodate patients in serious need.
“While some 13 American states allow medicinal use of cannabis for certain conditions, it remains illegal under federal law,” Russo said. “One possible solution to this situation would be FDA approval of a cannabis-based medicine so that it could be prescribed. Because of the side effects of smoking and variability in herbal cannabis without standardization, it is extremely unlikely that it could attain FDA approval.”
Most recent research delves into the relationship of phytocannabinoids found in marijuana plants, such as THC, and endocannabinoids, their counterparts produced in the human body. When a medical marijuana patient takes a dose, most of the phytocannabinoids engage with cells of the nervous system in conjunction with the endocannabinoids already present to produce a variety of effects, including pain relief.
Russo continued to research and synthesize these cannabinoids as senior medical adviser for GW Pharmaceuticals to help develop a cannabis-based oral spray. The product, called Sativex, is approved in Canada to treat cancer pain and multiple sclerosis.
But until it is approved in the U.S. or the cost of similar cannabis-derivatives decreases, physicians such as Llovet say they will continue to recommend the leafier medical counterpart.
Llovet said she prefers to recommend marijuana over opiate painkillers because it does not have the side effects, physical addictions or overdoses commonly seen among patients prescribed morphine or Oxycontin, for example.
“If you wanted to kill yourself with cannabis, you would have to smother yourself under bales of it,” Llovet said. “Overdose is easy with prescription pain killers.”
Using medical marijuana or its pharmaceutical derivatives in conjunction with other painkillers can provide superior relief and reduce the risk of developing a tolerance to opiate prescriptions, Russo said.
Sitting at Food For Thought, Llovet was wrapped up in her excitement. Her coffee grew cold as she talked about the clinics where she works with others to identify the best treatments, sometimes including medical marijuana.
Contrary to what she expected, Llovet said the clinics don’t see recreational users looking for a loophole.
“We see the little old ladies, the old man living out in the woods and once we went out to a car to help a quadriplegic. We are seeing people who haven’t seen a health care practitioner in 30 years,” Llovet said. “We really are providing a public service. Our job is to make sure they really do qualify, and we want to give them suggestions on how to improve their health, whether that includes medical marijuana or not.”
At River City Family Health, visiting the clinic costs $200 for the patient, who must also register for an appointment and submit medical records in advance, though qualifying individuals without records are also allowed to attend.
When a prospective patient arrives at the clinic, a nurse gives him a physical before passing the chart to Llovet, who speaks with each individual for at least 15 minutes about his medical history and suggests all possible treatments. The person and chart then move to the final stage for a consultation with Dr. Michael Geci, who may sign a physician’s recommendation for medical marijuana if he believes the patient legally qualifies and the treatment seems appropriate.
After receiving a doctor’s recommendation, the person applies for a patient registry card with the state Department of Public Health and Human Services and can designate one person as a caregiver. Each patient is allowed to grow six plants for their medicine and possess one ounce of usable marijuana. If they name a caregiver, that person can tend six plants and hold one ounce for each patient they assist.
“We are not affiliated with caregivers,” Llovet said. “We do recommend you enter into a relationship with a caregiver you trust.”
Daubert said many people designate a spouse or close friend as a caregiver, but often it is difficult because most people do not have experience growing cannabis.
“These are the only patients in the world growing their own medicine,” Daubert said. “Contrary to what a lot of people think, growing medical marijuana is not so simple. It takes months to grow a plant.”
In February, Daubert led a group of patients, caregivers and activists to the state capitol, where they sought to improve the law’s functionality through Senate Bill No. 326, which died in a House committee after passing Senate.
“The House legislature was evenly divided (between parties) and a lot of bills couldn’t make it out of committee,” Daubert said. “It’s some part political fluke and partly because it was brand new information to many of the representatives. We got more support than I’d expected, however.”
The bill, created by Daubert and other PFU associates, sought to expand the law’s list of qualifying illnesses, allowing patients to obtain medicine from any registered caregiver, establish inventory audits under certain conditions, increase the amount of medical marijuana a patient and caregiver can possess and alter the definition of a mature plant to make it easier for patients to maintain a steady flow of medicine.
“We’ve likened our law to being allowed to have six tomato plants, but only one tomato and needing one in the fridge tomorrow to guarantee your medicine,” Daubert said. “Let me see you grow the plants and follow that rule. That’s what we are asking them to do.”
And for people who choose not to grow themselves or who need larger amounts for relief, they rely on their caregivers to provide consistently as they, too, abide by the tomato rule.
Sometimes an even flow of medicine cannot be maintained for other reasons.
Daubert said there is one con artist who travels the state persuading people to fund a large grow operation that he promises will yield large profits, then walks off with the money. He’s also heard complaints about caregivers who charge exorbitant prices or don’t deliver the medicine to patients as promised.
Because the law does not include provisions for punishing negligent caregivers or reasonable oversight that would limit the opportunities of con artists, one anonymous Missoula cardholder said many patients like himself are left without a legal source of medicine and no guarantee of justice.
“There are a lot of people taking advantage of new patients,” he said. “There is no database of reliable caregivers.”
Part 3, published 10/7/09
Gray areas and law enforcement
Mark Long’s regular duties for Montana’s Division of Criminal Investigation kept him busy even before the creation of the Medical Marijuana Act.
When asked for a job description of his position as Narcotics Bureau Chief, he laughed and said he does “a lot.” Last Wednesday, he went through a Q&A with the Valley County attorney general and the local police force, who were uncertain about how to appropriately enforce the state’s medical marijuana law.
“Up here in Glasgow, for example, they looked at somebody’s house where they were growing more than the law allowed and took them all,” he said. “In other cases, we leave the plants we deem to be the legal amount at the time.”
Long, who sometimes devotes his free time to educating departments about the Medical Marijuana Act, drove east to Glasgow this past week to answer questions as best he could, even though law enforcement currently has no statewide procedures for the law, only individual judgments.
Everyone he met that day was eager to understand the proper procedures for handling “gray area” cases, Long said. The interest was so great, the meeting lasted an extra hour.
“It’s open to a lot of interpretation,” Long said, noting he will be doing more research into questions he couldn’t answer, possibly because there is not one to be found.
One example of uncertainty commonly encountered is how much cannabis a patient can possess at any given time.
“There’s a definition in the law that patients can have one ounce of ‘usable’ marijuana. What’s that? I don’t know,” Long said. “The patients might have a pound of a medical marijuana product such as a cake and say their one ounce is baked in, but law enforcement often gets there and says, ‘No, it’s a pound.’”
Because universal guidelines do not yet exist, officers are left with their personal judgments when handling situations involving medical marijuana, Long said.
“Many people are under the impression we are jackbooting thugs that aren’t happy until we throw somebody in jail for having a plant in the closet,” he said. “We want to administer the law as the public wishes. However, with a lack of guidelines, what else do you have to operate under other than your personal judgment?”
Law enforcement is not the only group regularly confronting uncertainties, said Jon Masterson, the founder of statewide marijuana policy group Montana National Organization for the Reform of Marijuana Laws. Since the law was passed, he said MT NORML has spent less time pursuing its real passion of legalizing marijuana for adult recreational use and more time answering calls and e-mails about medical cannabis.
“Six years ago, one person would call asking for help finding a lawyer because he was busted smoking,” Masterson said. “That’s changed. Now 90 percent of what we do is answer questions about the medical marijuana law. We recently received two stories that said in the course of arrest an officer told them he did not believe in medical marijuana. In one instance, he took the person’s (registration) card and threw it in the trash.”
Long said that most departments he has spoken with want to follow the law, though it can be easier said than done for some long-serving officers.
“Law enforcement, in their defense, have always destroyed all the plants,” he said. “I think law enforcement has difficulty with that. It hasn’t really been in our experience to leave behind what we still see as contraband.”
Despite Montana’s law, most other states and the federal government still consider marijuana an illegal drug, and some patients find themselves facing harsh realities as a result.
“I know of one instance where a woman is in a custody battle with a state that doesn’t recognize medical marijuana,” Masterson said. “She’s in compliance here, but could lose her kids because of a urine test.”
And though many patients and caregivers also fear federal raids of their homes, Long said that if they are following Montana’s law, they should not worry about national involvement. He said raids in California were different because, unlike Montana, California allows dispensaries and those locations were connected to sales on the black market.
However, Craig Shannon, a Missoula criminal defense attorney, said federal authorities could become involved in cases in which a firearm was stored in the same house as a cannabis grow.
“First of all, it is illegal federally to grow marijuana,” Shannon said. “If somebody has a firearm in the house where they are growing their medical marijuana, it’s another federal violation and they will end up spending five years in a federal prison if they are caught.”
Statewide, Long said that while law enforcement seeks to apply the law appropriately, it is concerned about the potential for medical plants to reach the street.
“If 100 percent of that marijuana was going to a legitimate market, it would be okay, but it’s not,” Long said.
In the past, some larger medical growers have been burglarized, while some undercover agents also hear stories about people illegally buying from registered caregivers, Long said.
“There’s no way of knowing if that’s the exception or the rule, but it happens frequently,” Long said. “As law enforcement, anything that increases the amount of criminal action is tough for us to embrace, even if it is a side effect and not the intent.”
The light of promise and shadow of stigma
To reduce the number of patients faced with the difficult decision of whether to illegally grow more plants to effectively treat their condition, Patients and Families United, a support and activist group for patients and caregivers, lobbied the state legislature earlier this year to improve the law’s details.
Senate Bill No. 326, created in part by PFU founder Tom Daubert, narrowly passed the Senate, then failed amid party debate in its House committee.
In the last legislative session, however, not all the bills seeking to amend the medical marijuana program focused on patients’ access to medicine.
For instance, House Bill No. 473, which failed in committee, sought to instantly revoke the cards of patients convicted of a felony drug offense and remove the medical licenses of doctors who recommended felons to the program.
Daubert believed the intent of the bill “was to create a chilling effect on the whole program” and unfairly ask doctors to double as lawyers who know both the person’s medical and legal records.
While Daubert said he is pleased with the progress made this year at the legislature, he acknowledged the difficulties ahead.
“Three-quarters of Americans think medical marijuana should be legal, but the fear of elected officials to appear soft on crime makes it difficult to make it happen,” Daubert said. “Drug war propaganda continues to obstruct the practice of medicine in these circumstances.”
Divergent social perceptions of cannabis create challenges both at the capitol and in patients’ daily lives, and for the state’s 4,189 registered patients and 1,316 registered caregivers, some of the consequences are serious and real.
Those who grow more plants than legally allowed, whether because of medical need or monetary greed, can face the standard criminal charges for manufacturing or intent to distribute, said Shannon.
“Some of these people are trying to grow more because they have really sick friends and are giving it away,” Shannon said. “Unfortunately, they lost sight of the black and white of the law.”
Advocates and patients seek to maintain a respectful image for the campaign to improve the law despite current difficulties, but not everyone in the state agrees on what is appropriate and effective.
Jason Christ, patient and founder of Montana Caregivers Network, compares the development of the state’s program to the struggles of the American Civil Rights Movement.
“Rosa Parks had to quietly do it first and walk to the front of the bus before Malcolm X had his say,” Christ said. “I’m one of those guys who likes to get out and set precedence. If people keep it behind closed doors, it won’t get better. This is medicine, man. I’m not out here being a punk.”
But some advocates and officials worry public displays of bold confidence could undermine the progress so far.
“I don’t want to see a diabetic shoot insulin in the middle of a store,” Daubert said. “It’s a personal medical issue.”
“For so long it’s been stigmatized and suddenly it’s now legal and public perception has not caught up with the law yet,” Shannon said. “Once it’s used in a disrespectful, arrogant, or confrontational way, the public perception is not going to favor medical marijuana.”
Despite the slow process of changing public perceptions, Daubert said he believes he will live to see those barriers stripped down and medical marijuana legalized nationally.
One anonymous patient, too, looks forward to the day when speaking publicly about his medicine won’t create negative consequences for his family.
“I wish to get rid of the black shadow of criminalization,” he said.
Story by Jayme Fraser
October 7, 2009
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Exploring the state’s medical marijuana law after five years