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Massachusetts voters may legalize medical marijuana this November

worcestermag.com

The Auburn Plaza in Auburn, Maine, looks like an average shopping mall. It has a movie theater, dollar store, dental practice and Bed, Bath & Beyond. Every one of the stores has a large overhead sign, except for Remedy Compassion Center, tucked away in an unassuming corner next to Craft-Mania and Big Lots.

The space once housed a furniture store, with a big, open floor-plan and tall ceilings, but now it’s brightly lit and spotlessly clean like a pharmacy. The walls are a purplish-blue and a counter juts out into the middle of the spacious room with a cash register, pipes and a glass case that you’d typically see holding cookies, brownies or cake at a coffee shop.

Somewhere in the building, likely behind an otherwise inconspicuous white door in the back corner, are containers filled with two dozen different strands of marijuana to cover the needs of hundreds of patients.

Remedy Compassion Center is one of Maine’s eight medical marijuana dispensaries sanctioned by the state’s Department of Health and Human Services in 2010, and one of the first established in New England, a program that John Thiele, Maine’s Medical Marijuana, Mental Health and Substance Abuse Programs Manager estimates could serve as many as 6,000 residents suffering from cancer, glaucoma, HIV/AIDS, ALS, Crohn’s disease or debilitating symptoms like nausea, pain and seizures. (The state used to register each patient, but after the program reached 3,000 in September of last year, there were concerns that the state was getting too involved in the patient/doctor relationship, he says.)

(PHOTO: Owner of Remedy Compassion Center Tim Smale. Steven King/Worcester Mag)

Remedy is run and owned by Tim Smale and his wife Jenna. Tim, a former competitive swimmer, uses medical cannibis to keep his migraines in check. Originally from Maine, he has a history with medical marijuana. Formerly an executive at Harborside Health Center in the San Francisco Bay area, he and his wife moved back to start Remedy when Maine legalized the drug for medical purposes.

“I just want to help people understand it’s okay. It’s going to be fine,” he says.

So far, so good, says Thiele, whose department regulates the state’s dispensaries that can have hundreds of patients, and 767 “caregivers” who can grow marijuana for no more than five patients, including themselves.

“I think it’s because we only have eight dispensaries, and we watch them,” Thiele says about the lack of hassle from the United States government, which has continued to raid legalized medical marijuana grow operations in other states. “We’re keeping the number of dispensaries at a level where we’re able to keep an eye on things.”

Maine’s legalization of medical marijuana came as the result of a ballot initiative similar to one that Massachusetts voters will choose “yes” or “no” on in November. Like Maine, the ballot would establish nonprofit medical marijuana centers and their affiliated grow houses for access by patients with prescription notes from their doctors. These programs would be regulated by the state’s Department of Public Health. Also like Maine, it does not require health insurance companies to cover the cost of the drug, and there are restrictions as to where the drug can be smoked, grown and sold.

Dispensary patients pay sales and food taxes, and marijuana costs about $10 to $15 per gram (slightly cheaper than at West Coast dispensaries). Tinctures – liquid dropped under the tongue – and salves, each without the high that comes from smoking marijuana, also cost $15 to $20 each. Tim Smale uses the cream on his sore joints. “It replaces the need for Advil,” he says.

In Maine, Remedy and other dispensaries answered Requests for Proposals from the government, which limits one dispensary to each of Maine’s eight “public health zones,” antiquated boundaries established decades ago. Nonprofits whose RFPs were accepted had to pay a $15,000 fee and find licensing like a standard business, including permission to have a bakery and take-out because the dispensary sells marijuana in edible forms.

The citizen petition Massachusetts residents may vote into law has similarities to Maine’s law. Like our neighbors to the north, Massachusetts’ medical marijuana law will allow for nonprofit centers to cultivate and sell marijuana to patients with a “bona fide” relationship with their prescriptionwriting doctor for similar ailments as listed in Maine’s registration rules (HIV/ AIDS, hepatitis C, ALS, Crohn’s disease, Parkinson’s disease, multiple sclerosis “and other conditions as determined in writing by a qualifying patient’s physician”).

(PHOTO: Products available at Remedy Compassion Center in Maine. Steven King/Worcester Mag)

Applications to run a dispensary in Massachusetts will need to include the addresses of the center as well as the address of one location where marijuana will be cultivated, operating procedures that include security plans for facilities where marijuana will be stored, and the names of every officer and board member.

While Maine, with it’s population of 1.3 million, has allowed only eight dispensaries (and no limit on caregivers), if the Massachusetts legislation passes as written, it will allow up to 35 medical marijuana treatment centers, with some caveats: each county must have at least one, but no more than five. Individual growers won’t be allowed to cultivate their own unless their access to a nearby treatment center is hindered by finances, disability or transportation.

Even if population ratios support it (Massachusetts’ population is 6.6 million), 35 is still an eye-popping number, and it’s just one factor leading to controversy over this this bill.

IGNORING THE ISSUE

It’s not much of a prediction to say that this ballot question will pass. Polls over the past decade indicate Massachusetts voters overwhelmingly support the legalization of medical marijuana—if not legalization of the drug, plain and simple—and those numbers buoy when put on the ballot on during a presidential election that will turn out younger voters.

Since 2000, there have been nearly 60 nonbinding ballot questions polling various state representative and state senate districts with variations on the legalization theme. All of them, including 2008’s decriminalization law, have passed handily. Ones asking for the legalization of medical marijuana have all passed with 59 percent or higher approving.

These are not numbers to ignore, no matter how much the state legislature has tried.

“It’s only because the legislature didn’t do their job that we have to go to the ballot box,” says Bill Downing, a spokesman for the Massachusetts Cannabis Reform Coalition, the state chapter of the National Organization for the Reform of Marijuana Laws.

It’s not as if law-makers didn’t have the chance. The past few legislative sessions have seen bills related to legalizing marijuana for medical use (and even for legalizing it completely) languish in committee.

“I always prefer that laws be written through the legislative process,” says Amherst Democrat Stanley Rosenberg, who sponsored a bill legalizing medical marijuana this term.

While he says the bill in the legislature is similar to the bill that residents will vote on in November, there are some differences. For instance, the legislature’s version would only allow 15 to 18 dispensaries rather than 35 and, Rosenberg says, less flexibility for doctors to prescribe the drug.

Despite these discrepancies, Rosenberg supports the ballot question.

“We have a very specific public-health goal here,” he says, adding that the polls show people want legalized medical use, but they also “want a tightly regulated system.”

Downing argues that no matter what the polls have shown, legislators refused to work on the bills because the word “marijuana” was in the titles.

“It’s more important to [them] to not touch the marijuana issue than do what [they] were elected to do,” he says.

If the bill passes in November legislators would have some authority to make changes (or even ignore it), though Rosenberg said those are difficult maneuvers especially because “the people” wrote and drafted the law.

And that’s another part of the issue – who’s in charge. While the MassCann membership voted to support the ballot question, there’s still some behind-thescenes criticism of a bill that many in the legalize community have quibbles with. For one, the restrictions on personal cultivation; and two, clear distinctions between two groups of people: long time statewide reform activists and the professional organizers who drafted and fundraise.

Mike Cann, a former MassCann president who now advocates independently via his “Two Hotheads” show on UNregular Radio, says he “really tried to bring two groups of people together.”

Some of these issues stem back from the 2008 decriminalization push, where some felt concessions were made allowing home-rule petitions that could recriminalize marijuana possession through increasing the fine.

Still, Cann, who’s been advocating for legalization for the past decade, says these skirmishes haven’t taken away from the end goal. No one in the movement wants to see patients denied access, he says. “It’s going to pass and it’s going to pass big.”

That’s the MO of the Committee for Compassionate Medicine, the group pushing the ballot question that, according to its 2011 campaign finance reports, has a $526,000 campaign chest. $525,000 of that money has come from Progressive Insurance CEO Peter Lewis, an amputee who treats his pain with marijuana. Lewis has personally spent $40 million to $60 million backing medical marijuana initiatives across the country since the 1980s, according to Forbes Magazine.

“The people who have the money write the legislation,” Downing says. “He has goals beyond Massachusetts in mind. [These ballot questions] are written in a way they want to pass, and they want to get big numbers. They want to have slam dunks.”

The proof is in the campaign spending; hundreds of thousands of the campaign’s dollars have gone to some of the state’s top signature gathering and consulting firms.

Still, that doesn’t matter much to most legalize activists, many who say Massachusetts is about four years behind the marijuana legalization movement. Some of the initial quarrels, like the difficulty in growing one’s own marijuana for medicinal use, might also disappear, Downing says, as zoning laws and NIMBY-ism keep dispensaries from appearing.

“We have both sides covered,” says Cann. “We’ve got so many activists, people on the street…This keeps getting bigger and bigger.”

DESPITE ASSURANCES…

While Maine’s medical marijuana program has had about a year and a half to gain its footing, Massachusetts’ neighbor to the south, Rhode Island, has struggled. Though legalized through the state legislature in 2006, no dispensaries have been licensed, and plans to do so were set back after Governor Lincoln Chafee received a strongly worded letter from the state’s U.S. Attorney’s Office warning that grow operations and investors will still be susceptible to prosecution (though individual users wouldn’t be targeted).

Thiele says Maine received a similar letter when its program began, but timing makes all the difference.

“We had already established our program. Our dispensaries were up and running at the time,” he remembers. Since then, there hasn’t been federal involvement.

The small number of operators, and strict laws, he and Smale add, also help keep the government’s focus on busting facilities in other states with older, and perhaps looser, laws.

“The fear is we’ll repeat the mistakes of California and other states,” Rosenberg says, or these dispensaries will allow a “backdoor approach to recreational use.”

Federal government involvement, rather than popular opinion, seems to be the last hurdle proponents need to tackle.

“The Massachusetts initiative will be the safest medical marijuana law in the country, based on the best practices of 17 other states and the District of Columbia,” reads a statement from the Committee for Compassionate Medicine. “The hallmark of the initiative is state regulation. It requires that doctors writing recommendations have a bona fide relationship with their patients and that the state verifies all recommendations.”

Downing says fears about government involvement are overblown in this case.

“This is a game the federal government can only play for so long,” he says. “They don’t have the resources to police medical marijuana states across the nation,” especially now that over one-third of the states have some kind of program. “Government is not targeting caregivers … with whom a patient is acquainted.”

On July 9, employees at Harborside Health Center, one of the largest dispensaries in the country, found seizure notices on its two buildings courtesy of California’s U.S. attorney, Melinda Haag, who wrote that her office would target large dispensaries, a sentiment U.S. Attorney General Eric Holder agreed with.

Contrary to their fears, Tim Smale says legalized medical marijuana has made Maine safer. The Remedy Compassion Center has brought a security guard and cameras to the Auburn Plaza and the drugs have to be produced cleanly since they’re going into the bodies of people with already compromised immune systems.

“We’re taking pot sales off the street and putting it into the hands of patients who need it,” he says. “We want to show the nation we can safely provide medicinal cannabis products.”

PUTTING DOCTORS IN THE MIDDLE

Pat (whose last name is being withheld) was diagnosed with Crohn’s disease during his senior year of college. After surgery that removed six inches of his large intestine and a year of recuperation, he went back to school with bouts of internal swelling, pain, nausea and a loss of appetite.

Now in graduate school in Worcester, Pat still fights his symptoms. He takes 14 pills a day and he’s prescribed Percocet for the pain when the Crohn’s flairs up.

Percocet, however, can add to the nausea, and doesn’t do much for appetites. In the past month, he’s dropped 25 pounds.

“What’s nice about using marijuana for it is the nausea,” he says. “It dulls the pain; it really slows your system down. It gives you your appetite back. It kinda calms down your intestines.”

He uses it irregularly, mostly because the disease flairs up every few weeks and because of concerns that potential employers would make a drug test a condition of employment. During one of his latest fits of pain he wrote a letter to Senator Scott Brown asking him to support legalizing medical marijuana.

“In that instance it would’ve been really nice to smoke some herb,” he says of his last bout.

At this point, it’s not shocking to hear that some patients respond to marijuana as a salve for pain or nausea, but what does the medical community think about a legal way to prescribe it?

Locally, prominent doctors and medical groups have come out against the ballot question.

Earlier this year the Worcester District Medical Society adopted the resolutions passed at the Massachusetts Medical Society meeting in May that laid out a nuanced position against this iteration of legalized marijuana for medicinal use.

Before resolving to oppose the ballot question, the group essentially asked that marijuana be reclassified by the U.S. Drug Enforcement Administration “so that it’s potential medicinal use by humans may be further studied and potentially regulated” and that the society supports “the development of nonsmoked, reliable delivery systems for cannabis-derived and cannabinoid medications.”

Until that time, however, they added the Massachusetts Medical Society should “educate the residents of the Commonwealth that there is insufficient scientific information about the safety of marijuana when used for ‘medicinal’ purposes.”

(PHOTO: Worcester District Medical Society Chair Jay Broadhurst. Steven King/Worcester Mag)

“We’re hoping that cooler heads will prevail,” says Jay Broadhurst, chair of the Worcester District Medical Society public health committee and assistant professor of the Department of Family Medicine and Community Health at the University of Massachusetts Medical School, about Massachusetts voters’ trends with marijuana ballot questions.

Broadhurst’s main complaints come from the medical community’s lack of study of the drug. For example, there’s nothing to stop him, in confidentiality, from talking to a patient of his about using marijuana as a pain reliever or appetite enhancer, but he says he can’t in good faith recommend it because he doesn’t have information on it like he does with Food and Drug Administration approved drugs.

“I cannot give you information about its safety or scientific information about its effectiveness,” he says. “How are you, as a physician, to make any responsible decision about dosing?”

Though Tim Smale insists that having nonprofit medical centers would provide the best patient care when it comes to medical marijuana (a term Broadhurst calls a “gross misrepresentation”), Broadhurst disagrees.

“If this stuff is medicine, we’ve already got entities that create medicine. They’re called pharmaceutical companies. We’ve already got entities that dispense medicine. They’re called pharmacies.”

As for the bill itself, he’s not thrilled with the language, because he says it fails to adequately restrict the amount of marijuana that can be prescribed and for what reasons.

“Medically, this makes no sense at all,” he says. “There is no reason to put physicians in the middle of this thing” until it’s treated as an FDA approved (or rejected) drug.

Recently, calls from the scientific community have taken the government to task for limiting experiments on validating or refuting the medicinal impacts of marijuana.

A University of California – San Diego study, notably partially funded by the US Department of Health and Human Services and published in the Open Neurology Journal this summer, takes the government to task for harshly classifying marijuana as a Schedule I drug, which makes it hard to obtain it for medical tests.

“As these therapeutic potentials are confirmed, it will be useful if marijuana and its constituents can be prescribed, dispensed, and regulated in a manner similar to other medications that have psychotropic effects and some abuse potential,” the study reports. “The continuing conflict between scientific evidence and political ideology will hopefully be reconciled in a judicious manner.”

Dr. Michael Hirsh, Worcester’s commissioner of public health, and president of the Worcester District Medical Society, agrees.

“We really did take some direction from the Worcester District Medical Society,” he says, in formulating a city Department of Public Health position. “As physicians it just did not seem it was practical to prescribe this” because of a lack of FDA involvement.

Hirsh instead would ask patients suffering from pain and nausea to try outlets already available to them, from prescription drugs to working with hospice and other pain-management programs.

“I would prefer grappling with problems related to prescription opioids than take on the new problem of marijuana prescription,” he says, when asked if it’s a suitable replacement for highly addictive pain medication.

“That’s the reason kids think pills are safe and heroin’s dangerous,” Broadhurst says when asked if more patients will be comfortable broaching the subject of marijuana with him if legalized, “because a doctor prescribes them.”

At the policy level, Hirsh says the new law would “force public health departments to be more aggressive and monitor whether medical marijuana laws increase the use of marijuana” and if it leads to an increase in fatalities or “an extra burden on the police department.”

For Broadhurst, it’s just an end around to a bigger question: legalization.

“That’s a very different discussion,” he says. He cites preliminary data about the drug’s effects on the development of the adolescent brain but adds, “I’m from Worcester. People in Worcester tend to have something of a libertarian streak. If we want to have a debate about legalizing marijuana, let’s have it but let’s not do it through the backdoor and put me, as a physician, in the middle of it.”

Still, Tim Smale believes Maine has gone about the legalization in the right way: keeping control in the hands of a nonprofit, requiring doctor-patient relationships and offering smoke-free and high-free alternatives. (For many, it’s not all about smoking. Pat says he’d like to come across marijuana in pill form.)

In a lot of ways, with the mixture of state and federal laws the way they are, no one wins. Those against legalizing marijuana in any form are slowly losing as popular opinion chips away at prohibition. Care providers lose because there’s no guarantee that their facility won’t be raided by the feds. Doctors lose because the federal government still refuses to take the exploration of the drug’s medicinal properties seriously, and patients still face stigmatization and access issues.

Voting yes or no in November on the ballot question won’t change much of this, but it’ll be another reminder to politicians that this is one uncomfortable topic that they can’t avoid forever.

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