The coming debate about the state's medical marijuana laws
I recently became a legal pot smoker in the state of Colorado, and all it took was an hour of my time, $240 and a good excuse.
I visited a dispensary in the Roaring Fork Valley and told the proprietors I suffered from back and knee pain. That's all it took to get on the state registry, and then turn around and buy an eighth of an ounce of weed and a marijuana-laced cookie for $50, plus tax.
I went through this exercise, in part, to better understand the process of getting on the Colorado Medical Marijuana Registry, which now includes close to 30,000 people, according to the Colorado Attorney General. In addition to those, an estimated 35,000 people have received authorization from a physician and are waiting to be processed by the state.
I was not asked for medical records but I did fill out some paperwork that inquired about my past medical history, my family's past medical history and the problem for which I sought medical marijuana. I have legitimate back and knee pain, and marijuana often helps relax my muscles, but I presented no evidence of my ailment.
The registry and the doctor will not be named in this story because it's not my intention to discredit any “care-givers” or dispensary employees — who are acting lawfully — but rather to answer questions that many Coloradans are asking about the ease or difficulty of becoming a legal marijuana user.
The answer appears to be that just about anyone willing to shell out cash to a doctor and provide a $90 check or money order to the Colorado Department of Public Health and Environment (CDPHE) — the registry's administrator — can then legally buy and possess up to 2 ounces of marijuana.
The dispensaries are operating under Amendment 20, which was approved by voters in 2000. The constitutional amendment allows patients with certain conditions, including HIV, cancer, muscle spasms and chronic pain, to use medical marijuana as long as they get a doctor's approval and register with the state.
As I filled out my patient information sheet, I was asked to list my occupation. Knowing I might be treated differently if I wrote “reporter” on the form, I listed my secondary sources of income and declared myself self-employed, as well as a house cleaner and caretaker, which I occasionally do. I don't often go “undercover” but felt it was necessary for an honest look at this process.
On a personal level, I'm conflicted about chronicling my experience because I do believe marijuana has medicinal benefits and it ought to be legalized because it's a natural herb that grows out of the ground. But the manner in which people are seeking their legal status has become questionable. Many feel that “medical marijuana” is a misleading label for a much broader effort to legalize pot.
The issue is being debated on the street by users and non-users alike. And state regulators get increasingly concerned as more people register. Between 500 and 600 people are registered every day in Colorado, and the state legislature, the governor's office, the CDPHE and the attorney general are taking steps to more carefully regulate the entire process.
But back to my chronic pain, and my visit to the dispensary. One recent episode of back pain was so debilitating that I had to roll off the bed and crawl on the floor in tears before going to work. This landed me in a doctor's office, where I was sent away with prescriptions for Vicodin and Valium after seeing the doctor for a couple of minutes. I believe both of these medications to be more addictive and damaging to my organs than marijuana.
Which was part of the reason I ended up at a dispensary. After spending 20 minutes filling out my application form, patient information and a membership agreement, I was led to a small room where a general practitioner was waiting for me.
The doctor briefly looked at my family medical history, which includes arthritis and alopecia. The doctor suggested a website to learn more about the alopecia disease, which involves hair loss. The doctor also lectured me on the negative effects of smoking cigarettes, and recommended a book to help me quit the nasty habit.
The doctor asked me about my surgical history and I said I had arthroscopic knee surgery in either 1997 or 1998. I also informed the doctor that I have a reoccurring baker's cyst that flares up behind the knee when I run too much, and it causes discomfort and pain.
That's all I needed to say for the doctor to issue a physician certification.
My physical exam consisted of checking my lungs with a stethoscope, looking in my mouth with a light (the doctor told me to floss more) and taking my blood pressure. The doc said I was in amazing shape. My knee was never examined.
After I received my physician certification, I was asked to pay $150 in cash. I gave the doctor $160 and was given $10 back from a wad of cash the physician had on hand.
Then it was on to processing, where a dispensary proprietor had notarized my documents for submission to the CDPHE. I wrote a check to the state and then it was time to buy some weed.
A dispensary staffer brought me to a locked room, where I was shown several strains of marijuana. I was educated on the differences between Sativa and Indica — the first a more energizing, clean and cerebral effect and the latter more a mellow, sleepy and sedative effect.
I've talked to a lot of dispensary owners in the course of my reporting in recent months, and they all say they pride themselves on being local farmers and care-givers. But I wasn't asked what my ailment was or given a recommendation as to what strain would be best for me. I went with the most inexpensive dose, which was $40 for an eighth of an ounce and a cookie for $10.
The prices of the marijuana were competitive with what the black market offers — $40 to $60 for an eighth; $100 to $110 for a quarter and $400 to $420 for an ounce.
No other products, such as edibles or lotions, were offered to me. My purchases were put into a sack and off I went with documentation that made me legal to carry it down the street out in the open — quite a liberating experience, I must admit.
I know that my experience is similar to thousands of others who are now on the registry. A longtime Aspen resident recently shared his experience in obtaining his medical marijuana card from a local dispensary — a process he described as “comical.”
“Not your usual doctor's office,” he said, adding he was seated outside the doctor's office in a bean bag chair in a room decorated with red tapestry.
He obtained a registry card with no problem, citing pain from a torn muscle in his rotator cuff. Despite the odd experience in the dispensary and the ease of obtaining legal marijuana, the patient added, “I truly believe it has its place, [for] everything from anxiety to cancer patients.”
A cause for concern
The loose process of certifying people has raised the eyebrows of state regulators and lawmakers, who plan to push legislation in the upcoming session of the Colorado General Assembly to place restrictions on dispensaries and doctors.
“It doesn't surprise me,” said Colorado Attorney General John Suthers of my recent experience. “Obviously it concerns me the things being gamed.”
Suthers noted that after the law went into effect eight years ago, 1,600 medical marijuana patients registered in Colorado, and they either had a care-giver or they grew the plant themselves.
But in the past 10 months, the number of patients on the registry has swelled to nearly 30,000, and the patients are getting younger, Suthers said.
He added that 75 percent of registered marijuana users were given authorization by just 15 doctors around Colorado, and five of them have provided 50 percent of the certifications.
“Most people are gaming the system,” Suthers said, adding the key issue for reform is clarifying the doctor-patient relationship. His office plans to seek changes to the law so that only physicians in good standing who have a bona-fide relationship with their patients can authorize the use of medical marijuana.
Colorado State Sen. Chris Romer (D-Dist. 23) plans to introduce a bill entitled “Regulation of Medical Marijuana” in the upcoming legislative session. The latest draft of the bill proposes three levels of state licenses: One for clinics with fewer than 300 patients, a second for operations with more than 300 patients, and a third for medical marijuana growers.
The bill would create a medical marijuana licensing authority in the state Department of Revenue, as well as a separate review board to examine applications from patients under age 21.
Romer's legislation also directs the CDPHE to form new standards for issuing registry identification cards, new procedures for primary care-giver applicants, documentation for physicians who prescribe medical marijuana, and sanctions for physicians who violate the law.
Romer has stated in the past that he thinks many people have gotten on the registry based on phony or exaggerated diagnoses.
Suthers said his office has concerns with Romer's bill because it would legitimize dispensaries.
“The debate will be whether to continue to tolerate the dispensary model, which has a business plan that has to create patients,” Suthers said. The attorney general said he opposes legalization of marijuana and that the original constitutional amendment didn't intend for business enterprises to be part of the “care-giver” model.
Mark Salley, communications director for the CDPHE, said Dr. Ned Calonge, the chief medical officer for the agency, recently met with the Governor's Office of Legal Counsel in response to the small number of doctors certifying patients.
While 820 doctors in the state have authorized people on the registry, roughly a dozen have certified most of the patients, Salley said.
On Dec. 14, the CDPHE and the governor's office proposed statutory language to further define the physician-patient relationship.
Under the proposed language, a doctor would complete a full assessment of the patient's medical history and provide follow-up treatment. The doctor also would have to hold a valid, unrestricted license to practice medicine in Colorado, among other proposed changes.
Coloradans for Medical Marijuana Regulation (CMMR), a coalition of medical marijuana patients working with state legislators to establish criteria for regulation, has taken the position that there is no need to create a new regulatory structure because there already are statutes and regulations in place.
“Our position is a lot of this regulation is on the books for other businesses,” said CMMR executive director Matt Brown. “Let's preserve what we have on the books and approach it rationally if it's going to be a business.”
Brown said he has been working with Romer for more than a month to revise the draft bill, and a lot of it has been rewritten and simplified. He added that the draft bill borrowed a lot from the alcohol code and didn't apply.
CMMR also states that the oversight of doctors should stay where it is today — at the state's medical board. The organization also advocates that standards should be set for future licensed medical marijuana health care training and the state should have enforcement authority to prevent unauthorized prescriptions.
Brown said he and others working on regulation hope that Colorado will be the model for 15 states that are now considering some form of legalized medical marijuana. As for the 13 states that now allow medical marijuana, none have regulations worth mirroring, Brown said.
The CMMR is in sync with the CDPHE's effort to clarify the doctor-patient relationship, and possibly tighten the process of issuing authorizations.
“That's certainly what the department of health is addressing and it's worth being discussed,” Brown said of the ease in getting authorization from a doctor. “I don't have the answer.”
Brown said the 2000 law was intentionally written for a business-driven, caregiver model down the road, and that's why it was presented as a constitutional amendment, which can't be easily altered.
Some marijuana advocates admit the system is being manipulated and, as a result, is not functioning the way it should.
“I know it comes across looking like a scam and feeling like a scam,” said Keith Stroup, legal counsel and founder of The National Organization for the Reform of Marijuana Laws (NORML). “The game of getting a doctor's recommendation has become, well, a game.”
As thousands are added to registries in the states where medical marijuana is legal, the case for full legalization strengthens, which helps organizations like NORML win the political battle.
“I don't think it's perfect but anything political never is,” Stroup said.
January 3, 2010
The Aspen Times