September 08, 2008
Healing With Herb:
A Comprehensive Report
on Medical Marijuana in Montana
In November 2004, 62 percent of Montana voters passed a proposal to legalize the use of marijuana for medicinal purposes in the state. Of 11 other states that have voted to legalize “medical marijuana,” none have approved legalization by such a margin. There are now 1,080 registered users of medical marijuana in Montana and many users–some of whom are terminally ill–report success with the drug.
However, some details of the current law regulating the use, growth, and proliferation of marijuana have caused difficulties among both users and law enforcement. Legislators and law officials agree the decision Montana voters made should be upheld, and have begun working with advocates of medical marijuana to clarify and improve the current law.
Marijuana is popularly used as an illegal “recreational drug,” but many recent scientific studies have found the plant to be of medicinal value. Marijuana has a long history as medicine, and was used by the Chinese as early as 2700 B.C. to treat conditions including pain, gout, malaria, and rheumatism. Other conditions traditionally traditionally treated by marijuana included seizure, nausea, insomnia, asthma, poor appetite, and depression. Current medical uses of marijuana address many of the same conditions, and physicians have also discovered new uses for the drug. Laws regulating use vary among the states in which medical marijuana is legal, and Montana law allows use by patients who suffer from a “debilitating medical condition.”
Debilitating medical conditions include cancer, HIV, glaucoma, and acquired immune deficiency syndrome. The law also identifies any medical condition causing severe or chronic pain, nausea, seizures, muscle spasms, or wasting syndrome as debilitating. A physician can recommend the use of marijuana on grounds that its use will be more beneficial than it is harmful, but he may not legally prescribe it.
Belgrade physician Dr. Kurtz says marijuana is most useful for controlling things that no other medication controls, such as persistent nausea and the symptoms of multiple sclerosis, but he adds that most recommendations are for chronic pain. Physicians say they rarely recommend marijuana before a patient inquires about it. Patients often inquire about marijuana as a possible homeopathic or natural alternative to pharmaceuticals, and nation-wide interest in alternative medicine continues to grow: a recent study showed more than a third of Americans use some form of “complementary and alternative medicine.”
Under the current Montana law, a qualifying patient may grow and possess up to six marijuana plants and one dried smokable ounce of marijuana. A patient is also entitled to the services of a “caregiver” who may possess another six plants and one smokable ounce on behalf of the patient.
The law allows caregivers to receive “reasonable compensation” for assisting qualifying patients, and caregivers may assist multiple patients. Registered caregivers have begun businesses growing and distributing medical marijuana, among whom are Park County residents Dave Minnick, of “Caregivers of Montana” and Robert Carpenter, of “A Kinder Caregiver.” Caregivers of Montana is a conglomeration of three registered caregivers working out of an office on Park Street, while Carpenter works independently from an office on Callender Street; each serve separate client pools. Both caregivers are open about their operations and have clients state-wide: Caregivers of Montana currently serves 101 clients, while A Kinder Caregiver serves 44.
Caregiver Minnick says nine of his clients are terminally ill, and Carpenter reports six terminal patients. Both work to accommodate special needs of patients according to their conditions and incomes, as many patients are living on government stipends. Carpenter has a policy of providing his product free of charge to terminal patients. There is some debate among critics of medical marijuana concerning what conditions the drug should be recommended to treat, but caregivers say they are more concerned with following the law than inquiring about the particulars of patient claims. “It’s not our right to question legitimacy–it’s physician recommended,” says Minnick. As of July 31, 2008 there were 324 registered caregivers in Montana; 260 serving one patient each, and 64 serving multiple patients.
State law also restricts business interactions between physicians and caregivers. Physicians cannot recommend particular caregivers, nor can caregivers recommend physicians. The current law leaves registered patients to pursue legal means of obtaining marijuana on their own.
The federal government recognizes no medicinal value of marijuana, nor does it condone medical use of the drug. The Federal Drug Enforecemnt Agency (DEA) currently identifies marijuana as a Schedule I drug, or a dangerous addictive narcotic with no recognized medical uses, and their position is stated on their website www.usdoj.gov/dea. Billings special agent Dan Dunlap did not return calls regarding medical marijuana by press time.
History of Marijuana
“Marijuana” is a relatively recent term of Spanish-Mexican origin for the plant *Cannabis Sativa, which has been used as medicine for thousands of years. The first documented use of cannabis for medicinal purposes is found in the ancient Chinese pharmacopoeia Pen-ts’ao, which appeared around the first century AD.
The drug was thought to have been discovered by the legendary Shen Neng, a mystical Chinese emperor who, according to legend, tested hundreds of herbs by ingesting them and gazing inside his belly to identify their effects. Ingestion was the primary means of use, and cannabis was often mixed with wine. The Chinese used the drug primarily for its pain-relieving properties, but named it ma, a word for “chaotic.” Physicians recognized some of the medicinal properties of the drug but advised against large doses, which might cause a user to see “devils” or communicate with spirits.
In India, people sought the psychoactive properties avoided by the Chinese. Cannabis is referred to in the ancient “Science of Charms” as one of the “five kingdoms of herbs…which release us from anxiety.” It was thought to have been brought from the Himalayas by the Hindu deity Shiva, who purportedly enjoyed the drug. Devotees offered cannabis to Shiva during religious ceremonies, and the herb continues to have a religious association in India.
Cannabis eventually moved west, where Assyrians used marijuana as medicine as early as 600 B.C. The Greeks and Romans recognized pain-killing and psychoactive properties of the drug, but its use was not widespread. The second-century physician Galen noted a custom sometimes practiced among wealthy Romans of serving a marijuana-garnished dessert with “warming” effects which, “when taken too generously affects the head, emitting a warm vapor and acting as a drug.”
The medical and psychoactive properties of marijuana were not well known in Europe until the eighteenth century when Napolean’s soldiers returned from Egypt with stories of the exotic “hashish.” In the mid-nineteenth century the French author Pierre Gautier formed the “Hashish Club” with literary notables such as Baudelaire, Balzac, Dumas, Flaubert, Hugo, and others. The reactions of these men to the drug were mixed, and they mentioned intense periods of both euphoria and dysphoria as well as synaesthesia, a confusion of one sense for another. Under the influence of marijuana Baudelaire wrote, “Sounds have odor and colors are musical.”
Americans also experimented with medical and psychoactive uses of cannabis during the mid-nineteenth century, but use did not become widespread until later. Cannabis reached Latin America and the Caribbean around the first half of the fifteenth century, and did not become popular in North America until a wave of refugees fleeing the Mexican Revolution of 1910 entered the Southern United States, bringing “marijuana” with them. By 1937 at least 28 pharmaceutical preparations had been developed from the cannabis plant, but the Marijuana Tax Act was passed the same year, placing a prohibitive tax on all uses of cannabis and effectively halting medical, commercial, and recreational uses of the plant.
Cultural Perspective
Harry Anslinger, founder and head of the Federal Bureau of Narcotics, led the social movement against marijuana that resulted in its prohibition in 1937. Anslinger was assigned to the post by Hoover in 1930 and held it until 1962. He is considered the first “drug czar” and a progenitor of what is now termed the “war on drugs.”
Recreational marijuana use in the early twentieth century was associated with minorities. Prejudice against Mexican immigrants led officials in Texas and California to criticize the use of “killer weed” among members of the growing minority. Officials sometimes claimed the substance aroused a “lust for blood” in immigrants and generated superhuman strength. In the Deep South, marijuana use often became associated with African-Americans, jazz musicians, prostitutes and others.
In “Legalizing Marijuana: Drug Policy Reform and Prohibition Politics”, Rudolph Gerber writes that the prohibition of alcohol led to an increase in the use of marijuana, and “tea pads” sprung up where “weed” and opium could be bought and used. In the twenties there were as many as 500 tea pads in New York City. When alcohol prohibition was repealed some government agents turned their efforts toward marijuana, which they claimed could cause “reefer madness” in users.
Conclusive medical studies were unavailable at the time, though an 1894 study by Britain’s Indian Hemp Commision had found cannabis to be of some medicinal value and “almost without exception harmless in moderation.” Anslinger’s campaign, however, did not seem founded upon scientific studies, but rather upon his own drastic and often racist determinations of the effects of marijuana. “Much of the irrational juvenile violence and killing that has written a new chapter of shame and tragedy is traceable directly to hemp intoxication,” he said.
One of Anslinger’s favored devices was the Indian legend of the “Old Man of the Mountains” and his band of assassins. Marco Polo first recorded the legend, telling of an old man who recruited members to the band by administering doses of hashish large enough to put the novices to sleep. The old man had them transported to a garden where, awaking under the influence of the drug, they were tended to by ladies and made to believe they had entered paradise. The old man then promised the assassins they would return to the paradise upon completion of the murderous tasks he assigned them. There is no evidence the legend holds any truth, but it was often used as propaganda by critics of marijuana.
During the court hearings of the Marijuana Tax Act of 1937, Anslinger’s colorful claims outweighed the testimony of a qualified physician. Anslinger asserted, “Most marijuana smokers are Negroes, Hispanics, Filipinos and entertainers. Their satanic music, jazz and swing result from marijuana usage.”
Dr. William Woodward of the American Medical Association defended medical use of marijuana as useful and relatively harmless, but members of Congress criticized him for attempting to impede the progress of the federal government. The Marijuana Tax Act was passed, and later–in 1970–marijuana was classified as a Schedule I drug, further restricting use.
Contradicting Claims
The federal government maintains a strict anti-marijuana policy. Nonetheless, federally supported studies have identified some medicinal value of marijuana. The federal identification of the drug’s medicinal value is evidenced by the Compassionate Investigational Drug Program, begun in 1978. Under this Federal Drug Administration-supported program, people with serious medical conditions could petition the government for legal supplies of marijuana. About three dozen applicants were accepted in the program before legal complications prevented further applications.
As of 2007, seven of the CIDP participants remained alive. Every month the federal government mails 300 joints, or about 10.75 ounces of marijuana, to pharmacies where the patients pick them up and use them legally. This program directly contradicts the official stance of the federal government.
The movement of states to legalize the medical use of marijuana has largely been a voter-powered movement. Legislators and officials have nearly always opposed medical marijuana measures. In Arizona, one of the first states to approve medical marijuana legislature, legislators even repealed the voter-approved measure. Voters reinstated the measure by means of a petition, and instituted a clause to prevent further such legislative repeals.
California passed the first state medical marijuana law in 1996. Before passage of the law, buyers’ clubs had dealt marijuana illegally to patients suffering from the side effects of chemotherapy and from chronic pain, AIDS, and glaucoma. With the passage of Proposition 215, medical use was extended to symptoms such as anxiety and depression. The federal government does not honor any state marijuana laws, and sometimes raids grow houses and buyers’ clubs in California cities. Clubs have developed low-profile images in attempts to escape DEA notice. They are often marked by dark windows and sparse signage, and do not advertise in public sources like newspapers or phone books.
The Montana medical marijuana law does not currently allow the recommendation of marijuana for symptoms of anxiety or depression. California is the only state to currently support such liberal use of medical marijuana. Belgrade physician Dr. Kurtz says he thinks medical use of marijuana in Montana could be expanded to include treatment of anxiety and depression. He says the common prescription drugs used to treat these conditions–including Xanax, Clanopin, and Valium–have significantly more dangerous side effects than marijuana.
Marijuana as Medicine
Many studies conclude the medical benefits of marijuana outweigh harmful side effects. The Institute of Medicine report of 1999 concluded, “Marijuana...is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications.” Further, a Police Foundation review in 2000 concluded “By any of the major criteria of harm–mortality, morbidity, toxicity, addictiveness, and relationship with crime–cannabis is less harmful than any of the other major illicit drugs, or than alcohol or tobacco.”
A common consideration among critics and concerned parties is the “gateway” phenomena attributed to marijuana. This theory holds that marijuana is often a stepping stone or a gateway to harder drugs. Studies by the Institute of Medicine and others show marijuana has no inherent chemical properties that cause a gateway effect. The IOM study does point out that many of the factors associated with a willingness to use marijuana may also be factors of a willingness to try harder drugs, but the study found no causal connection between marijuana use and the use of harder drugs. Other studies report the same conclusion.
Marijuana’s long history of use as medicine has no bearing on a decision concerning its validity as a modern medicine. Modern medical standards by which the efficacy of medications are judged are more rigorous than at any time in the past. Some physicians hail marijuana as something of a wonder drug, while others are more conservative in their estimations of its use.
When prescribing any treatment, the physician usually heeds the principle, “First, do no harm,” meaning the first qualification of a medication is the degree of harm associated with its use. The use of marijuana in treating symptoms such as pain, nausea, seizures, lack of appetite, and other symptoms is generally accepted. One of the difficulties in determining the harmful effects of the drug is the variety of experiences had by different users. The psychoactive effects of marijuana are considered pleasant by some and unpleasant by others, depending upon personality, mood, setting of use, and other factors.
Euphoria and stress reduction are common side effects of marijuana use, but some users report adverse reactions including anxiety, paranoia, depression, and dysphoria. Among regular users of marijuana 17 percent report that they experienced negative effects, often early in their use. This figure is especially significant when considering medical marijuana patients who might be using the drug for the first time, many of whom are elderly.
Patients using medical marijuana to treat glaucoma, an eye disorder that can cause blindness, often praise the effects of the drug. The most significant symptom of glaucoma is pressure inside the eye caused by restricted blood vessels. Marijuana releases pressure on the vessels, and when smoked provides rapid relief from the intense pain caused by glaucoma. Marijuana use can prolong or prevent blindness in some glaucoma patients.
Park County resident and medical marijuana user Bill Dobrowski reports that the pain caused by glaucoma feels “like a nail in the eye.” He says other treatments are available in pills or eye drops, but they take a long time to act, whereas smoked marijuana provides instant relief.
Many patients prefer marijuana to prescribed pharmaceuticals because they say the side effects are less severe. Local card-holder Steve Stoelb used morphine to treat the pain associated with the degenerative tissue disease he suffers from, and says of the opiate, “It will steal your soul.” After a difficult recovery process from morphine use Stoelb began using medical marijuana, which eases his pain without the drastic side effects.
Some patients find marijuana helps treat damaging side effects of other heavy-duty medications. Park County resident Jay Zuhlke suffers from terminal end-stage liver failure. He uses marijuana to relieve chronic pain, loss of appetite, muscle spasms, and other symptoms. He says marijuana use prevents him from having to use the prescription drug Oxycodone, which harms the liver. Zuhlke says marijuana helps relieve the side effects of some of the 13 medications he takes two or three times a day, including nausea, vomiting, and loss of weight. He smokes marijuana before going to bed, and says it replaces the need for anti-convulsants and anti-hystamines.
Many patients prefer marijuana to prescription drugs because it is often cheaper. Lewistown card-holder Eric Billings suffers from neuropathy and other symptoms of AIDS, and says he used to take four to six different pain pills every day to treat the symptoms. Now he says marijuana limits his need for pain pills to 50 or 60 pills per year, rather than approximately 120 per month. He claims using medical marijuana saves him $30,000 dollars per year in prescription medications and says, “It has given me my life back.”
One difficulty associated with medical marijuana use is providing patients with consistent doses of the drug. Quantities of tetrahydrocannabinol (THC) and other active components of marijuana vary depending upon plant varieties and the methods used to grow and harvest marijuana crops. Marijuana use is recommended, like some other prescription drugs, according to “patient required need,” or PRN. This means that the patient may use the drug in the quantity and manner he or she desires to treat the symptoms of an ailment.
The current marijuana law is sometimes criticized for allowing marijuana to be smoked, and studies have linked smoking marijuana to increased risks of bronchitis and other respiratory ailments. But smoked marijuana is particularly effective in providing rapid relief, as in the case of glaucoma, and studies also show that experienced marijuana smokers can control the amount of THC they inhale by varying the amount of oxygen they intake with each puff. Thus users can attain the desired “effect” regardless of the specific THC content of the marijuana they smoke. Ingestible forms of marijuana are slower to act and dosages are more difficult to control.
Medical Legalization in Montana
As in other states that have voted to legalize medical marijuana, Montana voters showed a surprising amount of support for the proposition in 2004. The 62 percent margin by which it was passed is a greater margin than any issue or candidate has received in Montana in more than 25 years. The proposition had more support in Montana than did Representative Denny Rehberg, Governor Brian Schweitzer, or Senator Jon Tester.
In early 2004 the Montana Medical Marijuana Policy Project sought to push medical marijuana legislation in the state. The group hired political communications consultant Tom Daubert to spearhead the campaign, and it was a success. Daubert says the process of working on the campaign was enlightening, and he felt compelled to help the many people he met suffering from terrible medical conditions.
Daubert helped write Proposition 148, the Montana medical marijuana legislation. He says the main concern at the time of writing was to create something that would establish the legality of marijuana as a medicine for people suffering from the most severe conditions, for whom marijuana was best established as effective treatment. He says the initiative committee wanted to make the law as workable as possible for suffering patients without making it overly problematic for people who might be innately skeptical of the idea. The committee used the medical marijuana laws of other states as models for Montana’s law.
Since passage of the law, Daubert says he has become aware of situations in Montana which pose unique difficulties for the function of the current law. For example, many rural Montanans see a nurse or a physician’s assistant rather than a practicing physician as their primary doctor. While nurses and physician’s assistants can legally prescribe opiates and other prescriptions, they cannot currently recommend marijuana. Other difficulties are the possession limit and the logistics of transportation of medical marijuana. Daubert describes one patient in remote Eastern Montana who needs about one ounce of marijuana per week to treat her condition. Due to the one-ounce possession limit she has to restock every week, and the nearest grower is 100 miles away. Because the patient’s condition prevents her from operating a motor vehicle her elderly mother makes the trip every week, breaking medical marijuana transportation laws.
After the campaign Daubert formed the group Patients and Families United, a support and public education group for registered users of medical marijuana and for any patients who suffer from pain whether they use medical marijuana or not.
Economy of Grow Houses
Medical marijuana sales are untaxed in Montana, and many proponents of medical marijuana say the state would greatly benefit from taxing sales. Medical marijuana dispensaries in California pay an 8.25 percent sales tax to the state on marijuana sales, totaling about $100 million annually. The medical marijuana business is relatively young in Montana, and local caregivers report they are just beginning to break even as they establish growing patterns and clients. If the demand for medical marijuana in the state continues to increase, a tax on sales could benefit many state programs, while patients would be largely unaffected.
Of the 1,080 registered medical marijuana users in Montana, 323 have no registered caregiver. Some of these patients may be in the process of getting a caregiver, but many are likely growing their own plants. Park County caregiver Dave Minnick says he encourages patients to grow their own plants if they can, because it costs less than the standard $300 per ounce charged by growers. The commercial grow operation is expensive and time consuming, and Caregivers of Montana pays as much as $1,000 per month in energy bills to support high-powered lights. Light is carefully controlled in the grow houses, as the plants are kept on a strict regimental cycle of absolute darkness and bright fluorescent light.
Some patients prefer the product they can buy from a commercial caregiver because the commercial product is often more potent than the product they can grow themselves, and caregivers offer a variety of strains. There are two primary types of marijuana, called “Indica” and “Sativa,” which produce different types of “highs.” Indica is reported to induce a sleepy and lethargic feeling, and works as a good pain-reliever. Sativa is reported to induce a more energetic and creative high. Within these two categories there are many hybrids and strains, with titles such as “White Widow,” “Mauwie Wauwie,” “Kush,” and “Purple Haze.” All produce different types of high, and users can sometimes sample varieties before a purchase.
Nearly every step in planting, cultivating, and harvesting a crop influences the character and potency of the final product. It is often difficult for patients to begin to grow crops at home and they must start by purchasing seeds, which is illegal.
Federal Consequences
Federal law assigns a mandatory prison sentence of five years to the possession of more than 99 marijuana plants, whereas the federal penalty under the 99 plant ceiling is less severe. The only plant limit imposed on caregivers by the state is the per-patient limit of six plants. Growers who serve enough patients to exceed 99 plants by state law usually stay below the federal plant limit to decrease the risk of severe penalty. So far there have been no major medical marijuana busts in Montana. Growth and use seem to be tolerated to some extent, if growers and users heed the established rules. Caregiver Minnick says agents of the Missouri River Task Force, the local branch of the Drug Enforcement Agency, have inspected his growing operation four times and left on good terms each time.
The legal status of marijuana affects several aspects of its growth, use, and perception. Prohibition ensures high prices for users, and creates an atmosphere of secrecy around many state-sanctioned medical interactions. Caregivers operate out of unmarked buildings, physicians hesitate to take public stances on marijuana use, and some patients report disapproval of family members or friends.
One concern expressed by the federal government and shared by Livingston Police Chief Darren Raney is that allowing medical use of marijuana sends a mixed message to youth. It is thought youth will be more likely to abuse or try marijuana if they are told it has some value. Several studies, including the Institute of Medicine study of 1999, present data contradicting this concern. During the 1990s marijuana use increased at the same rate in the Netherlands–where possession of marijuana is legal–as use in Norway and America, where use is strictly forbidden. Further, approximately equal percentages of American and Dutch 18-year-olds used marijuana. Another study showed no increase of marijuana use among youth during the California medical marijuana legalization debates of 1996-1997, when the subject of marijuana was all over the news.
California’s medical marijuana laws have changed and developed since the state passed marijuana legislation in 1997. Dispensaries and growers in the state have undergone major DEA busts, and some counties have responded by changing possession limits and regulations on sales, and some cities have recently instated moratoriums on dispensaries. Responses among city, county, and state law enforcement officials in California have ranged from passivity toward DEA activity to opposition to the agency. Police Chief Raney says he believes law enforcement should enforce and uphold laws passed by voters, and the medical marijuana law is no exception. He expresses concern over aspects of the current law but says it should be improved rather than making any attempt to discard it.
Propaganda vs. reality
As of 2004, federal, state, and local governments now spend a total of about $60 million, or $380 per average American adult each year on the “war on drugs.” A large portion of this war is waged on marijuana users. In the year 2000, 734,497 people were arrested on marijuana charges. As of 2003, it cost $1.2 billion per year to keep 60,000 people imprisoned for marijuana misconduct.
Some critics of medical marijuana claim it is a step toward legalization of the drug. The future of marijuana law will determine whether or not this claim is true, but Montanans made a firm decision concerning medical use of marijuana. Nearly four years in effect have highlighted successes and shortcomings of the law, and voters now have a chance to examine some of the effects of their choice.
State Representative Bob Ebinger is organizing a meeting of law enforcement officials, attorneys, and medical marijuana advocate Tom Daubert on August 20 to discuss the current medical marijuana law. “I feel that the people spoke pretty emphatically that they wanted medical marijuana; whether they realized there weren’t the necessary checks and balances, I don’t know,” says Ebinger. Park County legislators and law officials have demonstrated respect for the decision of the people, and seem to be taking a more clear-headed approach to the medical marijuana issue than officials elsewhere in the country.
Scientific studies continue to report medicinal value of marijuana, and states continue to legalize medical use despite federal prohibition of the drug. Some advocates express hope that a quorum of 25 supportive states will force the federal government to reconsider its draconian marijuana policy. Among other things, the medical marijuana movement has demonstrated the influence voters can exert on pressing and controversial matters of law.
—Wes Venteicher
Source = http://livweekly.typepad.com/livings...g-with-he.html
Healing With Herb:
A Comprehensive Report
on Medical Marijuana in Montana
In November 2004, 62 percent of Montana voters passed a proposal to legalize the use of marijuana for medicinal purposes in the state. Of 11 other states that have voted to legalize “medical marijuana,” none have approved legalization by such a margin. There are now 1,080 registered users of medical marijuana in Montana and many users–some of whom are terminally ill–report success with the drug.
However, some details of the current law regulating the use, growth, and proliferation of marijuana have caused difficulties among both users and law enforcement. Legislators and law officials agree the decision Montana voters made should be upheld, and have begun working with advocates of medical marijuana to clarify and improve the current law.
Marijuana is popularly used as an illegal “recreational drug,” but many recent scientific studies have found the plant to be of medicinal value. Marijuana has a long history as medicine, and was used by the Chinese as early as 2700 B.C. to treat conditions including pain, gout, malaria, and rheumatism. Other conditions traditionally traditionally treated by marijuana included seizure, nausea, insomnia, asthma, poor appetite, and depression. Current medical uses of marijuana address many of the same conditions, and physicians have also discovered new uses for the drug. Laws regulating use vary among the states in which medical marijuana is legal, and Montana law allows use by patients who suffer from a “debilitating medical condition.”
Debilitating medical conditions include cancer, HIV, glaucoma, and acquired immune deficiency syndrome. The law also identifies any medical condition causing severe or chronic pain, nausea, seizures, muscle spasms, or wasting syndrome as debilitating. A physician can recommend the use of marijuana on grounds that its use will be more beneficial than it is harmful, but he may not legally prescribe it.
Belgrade physician Dr. Kurtz says marijuana is most useful for controlling things that no other medication controls, such as persistent nausea and the symptoms of multiple sclerosis, but he adds that most recommendations are for chronic pain. Physicians say they rarely recommend marijuana before a patient inquires about it. Patients often inquire about marijuana as a possible homeopathic or natural alternative to pharmaceuticals, and nation-wide interest in alternative medicine continues to grow: a recent study showed more than a third of Americans use some form of “complementary and alternative medicine.”
Under the current Montana law, a qualifying patient may grow and possess up to six marijuana plants and one dried smokable ounce of marijuana. A patient is also entitled to the services of a “caregiver” who may possess another six plants and one smokable ounce on behalf of the patient.
The law allows caregivers to receive “reasonable compensation” for assisting qualifying patients, and caregivers may assist multiple patients. Registered caregivers have begun businesses growing and distributing medical marijuana, among whom are Park County residents Dave Minnick, of “Caregivers of Montana” and Robert Carpenter, of “A Kinder Caregiver.” Caregivers of Montana is a conglomeration of three registered caregivers working out of an office on Park Street, while Carpenter works independently from an office on Callender Street; each serve separate client pools. Both caregivers are open about their operations and have clients state-wide: Caregivers of Montana currently serves 101 clients, while A Kinder Caregiver serves 44.
Caregiver Minnick says nine of his clients are terminally ill, and Carpenter reports six terminal patients. Both work to accommodate special needs of patients according to their conditions and incomes, as many patients are living on government stipends. Carpenter has a policy of providing his product free of charge to terminal patients. There is some debate among critics of medical marijuana concerning what conditions the drug should be recommended to treat, but caregivers say they are more concerned with following the law than inquiring about the particulars of patient claims. “It’s not our right to question legitimacy–it’s physician recommended,” says Minnick. As of July 31, 2008 there were 324 registered caregivers in Montana; 260 serving one patient each, and 64 serving multiple patients.
State law also restricts business interactions between physicians and caregivers. Physicians cannot recommend particular caregivers, nor can caregivers recommend physicians. The current law leaves registered patients to pursue legal means of obtaining marijuana on their own.
The federal government recognizes no medicinal value of marijuana, nor does it condone medical use of the drug. The Federal Drug Enforecemnt Agency (DEA) currently identifies marijuana as a Schedule I drug, or a dangerous addictive narcotic with no recognized medical uses, and their position is stated on their website www.usdoj.gov/dea. Billings special agent Dan Dunlap did not return calls regarding medical marijuana by press time.
History of Marijuana
“Marijuana” is a relatively recent term of Spanish-Mexican origin for the plant *Cannabis Sativa, which has been used as medicine for thousands of years. The first documented use of cannabis for medicinal purposes is found in the ancient Chinese pharmacopoeia Pen-ts’ao, which appeared around the first century AD.
The drug was thought to have been discovered by the legendary Shen Neng, a mystical Chinese emperor who, according to legend, tested hundreds of herbs by ingesting them and gazing inside his belly to identify their effects. Ingestion was the primary means of use, and cannabis was often mixed with wine. The Chinese used the drug primarily for its pain-relieving properties, but named it ma, a word for “chaotic.” Physicians recognized some of the medicinal properties of the drug but advised against large doses, which might cause a user to see “devils” or communicate with spirits.
In India, people sought the psychoactive properties avoided by the Chinese. Cannabis is referred to in the ancient “Science of Charms” as one of the “five kingdoms of herbs…which release us from anxiety.” It was thought to have been brought from the Himalayas by the Hindu deity Shiva, who purportedly enjoyed the drug. Devotees offered cannabis to Shiva during religious ceremonies, and the herb continues to have a religious association in India.
Cannabis eventually moved west, where Assyrians used marijuana as medicine as early as 600 B.C. The Greeks and Romans recognized pain-killing and psychoactive properties of the drug, but its use was not widespread. The second-century physician Galen noted a custom sometimes practiced among wealthy Romans of serving a marijuana-garnished dessert with “warming” effects which, “when taken too generously affects the head, emitting a warm vapor and acting as a drug.”
The medical and psychoactive properties of marijuana were not well known in Europe until the eighteenth century when Napolean’s soldiers returned from Egypt with stories of the exotic “hashish.” In the mid-nineteenth century the French author Pierre Gautier formed the “Hashish Club” with literary notables such as Baudelaire, Balzac, Dumas, Flaubert, Hugo, and others. The reactions of these men to the drug were mixed, and they mentioned intense periods of both euphoria and dysphoria as well as synaesthesia, a confusion of one sense for another. Under the influence of marijuana Baudelaire wrote, “Sounds have odor and colors are musical.”
Americans also experimented with medical and psychoactive uses of cannabis during the mid-nineteenth century, but use did not become widespread until later. Cannabis reached Latin America and the Caribbean around the first half of the fifteenth century, and did not become popular in North America until a wave of refugees fleeing the Mexican Revolution of 1910 entered the Southern United States, bringing “marijuana” with them. By 1937 at least 28 pharmaceutical preparations had been developed from the cannabis plant, but the Marijuana Tax Act was passed the same year, placing a prohibitive tax on all uses of cannabis and effectively halting medical, commercial, and recreational uses of the plant.
Cultural Perspective
Harry Anslinger, founder and head of the Federal Bureau of Narcotics, led the social movement against marijuana that resulted in its prohibition in 1937. Anslinger was assigned to the post by Hoover in 1930 and held it until 1962. He is considered the first “drug czar” and a progenitor of what is now termed the “war on drugs.”
Recreational marijuana use in the early twentieth century was associated with minorities. Prejudice against Mexican immigrants led officials in Texas and California to criticize the use of “killer weed” among members of the growing minority. Officials sometimes claimed the substance aroused a “lust for blood” in immigrants and generated superhuman strength. In the Deep South, marijuana use often became associated with African-Americans, jazz musicians, prostitutes and others.
In “Legalizing Marijuana: Drug Policy Reform and Prohibition Politics”, Rudolph Gerber writes that the prohibition of alcohol led to an increase in the use of marijuana, and “tea pads” sprung up where “weed” and opium could be bought and used. In the twenties there were as many as 500 tea pads in New York City. When alcohol prohibition was repealed some government agents turned their efforts toward marijuana, which they claimed could cause “reefer madness” in users.
Conclusive medical studies were unavailable at the time, though an 1894 study by Britain’s Indian Hemp Commision had found cannabis to be of some medicinal value and “almost without exception harmless in moderation.” Anslinger’s campaign, however, did not seem founded upon scientific studies, but rather upon his own drastic and often racist determinations of the effects of marijuana. “Much of the irrational juvenile violence and killing that has written a new chapter of shame and tragedy is traceable directly to hemp intoxication,” he said.
One of Anslinger’s favored devices was the Indian legend of the “Old Man of the Mountains” and his band of assassins. Marco Polo first recorded the legend, telling of an old man who recruited members to the band by administering doses of hashish large enough to put the novices to sleep. The old man had them transported to a garden where, awaking under the influence of the drug, they were tended to by ladies and made to believe they had entered paradise. The old man then promised the assassins they would return to the paradise upon completion of the murderous tasks he assigned them. There is no evidence the legend holds any truth, but it was often used as propaganda by critics of marijuana.
During the court hearings of the Marijuana Tax Act of 1937, Anslinger’s colorful claims outweighed the testimony of a qualified physician. Anslinger asserted, “Most marijuana smokers are Negroes, Hispanics, Filipinos and entertainers. Their satanic music, jazz and swing result from marijuana usage.”
Dr. William Woodward of the American Medical Association defended medical use of marijuana as useful and relatively harmless, but members of Congress criticized him for attempting to impede the progress of the federal government. The Marijuana Tax Act was passed, and later–in 1970–marijuana was classified as a Schedule I drug, further restricting use.
Contradicting Claims
The federal government maintains a strict anti-marijuana policy. Nonetheless, federally supported studies have identified some medicinal value of marijuana. The federal identification of the drug’s medicinal value is evidenced by the Compassionate Investigational Drug Program, begun in 1978. Under this Federal Drug Administration-supported program, people with serious medical conditions could petition the government for legal supplies of marijuana. About three dozen applicants were accepted in the program before legal complications prevented further applications.
As of 2007, seven of the CIDP participants remained alive. Every month the federal government mails 300 joints, or about 10.75 ounces of marijuana, to pharmacies where the patients pick them up and use them legally. This program directly contradicts the official stance of the federal government.
The movement of states to legalize the medical use of marijuana has largely been a voter-powered movement. Legislators and officials have nearly always opposed medical marijuana measures. In Arizona, one of the first states to approve medical marijuana legislature, legislators even repealed the voter-approved measure. Voters reinstated the measure by means of a petition, and instituted a clause to prevent further such legislative repeals.
California passed the first state medical marijuana law in 1996. Before passage of the law, buyers’ clubs had dealt marijuana illegally to patients suffering from the side effects of chemotherapy and from chronic pain, AIDS, and glaucoma. With the passage of Proposition 215, medical use was extended to symptoms such as anxiety and depression. The federal government does not honor any state marijuana laws, and sometimes raids grow houses and buyers’ clubs in California cities. Clubs have developed low-profile images in attempts to escape DEA notice. They are often marked by dark windows and sparse signage, and do not advertise in public sources like newspapers or phone books.
The Montana medical marijuana law does not currently allow the recommendation of marijuana for symptoms of anxiety or depression. California is the only state to currently support such liberal use of medical marijuana. Belgrade physician Dr. Kurtz says he thinks medical use of marijuana in Montana could be expanded to include treatment of anxiety and depression. He says the common prescription drugs used to treat these conditions–including Xanax, Clanopin, and Valium–have significantly more dangerous side effects than marijuana.
Marijuana as Medicine
Many studies conclude the medical benefits of marijuana outweigh harmful side effects. The Institute of Medicine report of 1999 concluded, “Marijuana...is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications.” Further, a Police Foundation review in 2000 concluded “By any of the major criteria of harm–mortality, morbidity, toxicity, addictiveness, and relationship with crime–cannabis is less harmful than any of the other major illicit drugs, or than alcohol or tobacco.”
A common consideration among critics and concerned parties is the “gateway” phenomena attributed to marijuana. This theory holds that marijuana is often a stepping stone or a gateway to harder drugs. Studies by the Institute of Medicine and others show marijuana has no inherent chemical properties that cause a gateway effect. The IOM study does point out that many of the factors associated with a willingness to use marijuana may also be factors of a willingness to try harder drugs, but the study found no causal connection between marijuana use and the use of harder drugs. Other studies report the same conclusion.
Marijuana’s long history of use as medicine has no bearing on a decision concerning its validity as a modern medicine. Modern medical standards by which the efficacy of medications are judged are more rigorous than at any time in the past. Some physicians hail marijuana as something of a wonder drug, while others are more conservative in their estimations of its use.
When prescribing any treatment, the physician usually heeds the principle, “First, do no harm,” meaning the first qualification of a medication is the degree of harm associated with its use. The use of marijuana in treating symptoms such as pain, nausea, seizures, lack of appetite, and other symptoms is generally accepted. One of the difficulties in determining the harmful effects of the drug is the variety of experiences had by different users. The psychoactive effects of marijuana are considered pleasant by some and unpleasant by others, depending upon personality, mood, setting of use, and other factors.
Euphoria and stress reduction are common side effects of marijuana use, but some users report adverse reactions including anxiety, paranoia, depression, and dysphoria. Among regular users of marijuana 17 percent report that they experienced negative effects, often early in their use. This figure is especially significant when considering medical marijuana patients who might be using the drug for the first time, many of whom are elderly.
Patients using medical marijuana to treat glaucoma, an eye disorder that can cause blindness, often praise the effects of the drug. The most significant symptom of glaucoma is pressure inside the eye caused by restricted blood vessels. Marijuana releases pressure on the vessels, and when smoked provides rapid relief from the intense pain caused by glaucoma. Marijuana use can prolong or prevent blindness in some glaucoma patients.
Park County resident and medical marijuana user Bill Dobrowski reports that the pain caused by glaucoma feels “like a nail in the eye.” He says other treatments are available in pills or eye drops, but they take a long time to act, whereas smoked marijuana provides instant relief.
Many patients prefer marijuana to prescribed pharmaceuticals because they say the side effects are less severe. Local card-holder Steve Stoelb used morphine to treat the pain associated with the degenerative tissue disease he suffers from, and says of the opiate, “It will steal your soul.” After a difficult recovery process from morphine use Stoelb began using medical marijuana, which eases his pain without the drastic side effects.
Some patients find marijuana helps treat damaging side effects of other heavy-duty medications. Park County resident Jay Zuhlke suffers from terminal end-stage liver failure. He uses marijuana to relieve chronic pain, loss of appetite, muscle spasms, and other symptoms. He says marijuana use prevents him from having to use the prescription drug Oxycodone, which harms the liver. Zuhlke says marijuana helps relieve the side effects of some of the 13 medications he takes two or three times a day, including nausea, vomiting, and loss of weight. He smokes marijuana before going to bed, and says it replaces the need for anti-convulsants and anti-hystamines.
Many patients prefer marijuana to prescription drugs because it is often cheaper. Lewistown card-holder Eric Billings suffers from neuropathy and other symptoms of AIDS, and says he used to take four to six different pain pills every day to treat the symptoms. Now he says marijuana limits his need for pain pills to 50 or 60 pills per year, rather than approximately 120 per month. He claims using medical marijuana saves him $30,000 dollars per year in prescription medications and says, “It has given me my life back.”
One difficulty associated with medical marijuana use is providing patients with consistent doses of the drug. Quantities of tetrahydrocannabinol (THC) and other active components of marijuana vary depending upon plant varieties and the methods used to grow and harvest marijuana crops. Marijuana use is recommended, like some other prescription drugs, according to “patient required need,” or PRN. This means that the patient may use the drug in the quantity and manner he or she desires to treat the symptoms of an ailment.
The current marijuana law is sometimes criticized for allowing marijuana to be smoked, and studies have linked smoking marijuana to increased risks of bronchitis and other respiratory ailments. But smoked marijuana is particularly effective in providing rapid relief, as in the case of glaucoma, and studies also show that experienced marijuana smokers can control the amount of THC they inhale by varying the amount of oxygen they intake with each puff. Thus users can attain the desired “effect” regardless of the specific THC content of the marijuana they smoke. Ingestible forms of marijuana are slower to act and dosages are more difficult to control.
Medical Legalization in Montana
As in other states that have voted to legalize medical marijuana, Montana voters showed a surprising amount of support for the proposition in 2004. The 62 percent margin by which it was passed is a greater margin than any issue or candidate has received in Montana in more than 25 years. The proposition had more support in Montana than did Representative Denny Rehberg, Governor Brian Schweitzer, or Senator Jon Tester.
In early 2004 the Montana Medical Marijuana Policy Project sought to push medical marijuana legislation in the state. The group hired political communications consultant Tom Daubert to spearhead the campaign, and it was a success. Daubert says the process of working on the campaign was enlightening, and he felt compelled to help the many people he met suffering from terrible medical conditions.
Daubert helped write Proposition 148, the Montana medical marijuana legislation. He says the main concern at the time of writing was to create something that would establish the legality of marijuana as a medicine for people suffering from the most severe conditions, for whom marijuana was best established as effective treatment. He says the initiative committee wanted to make the law as workable as possible for suffering patients without making it overly problematic for people who might be innately skeptical of the idea. The committee used the medical marijuana laws of other states as models for Montana’s law.
Since passage of the law, Daubert says he has become aware of situations in Montana which pose unique difficulties for the function of the current law. For example, many rural Montanans see a nurse or a physician’s assistant rather than a practicing physician as their primary doctor. While nurses and physician’s assistants can legally prescribe opiates and other prescriptions, they cannot currently recommend marijuana. Other difficulties are the possession limit and the logistics of transportation of medical marijuana. Daubert describes one patient in remote Eastern Montana who needs about one ounce of marijuana per week to treat her condition. Due to the one-ounce possession limit she has to restock every week, and the nearest grower is 100 miles away. Because the patient’s condition prevents her from operating a motor vehicle her elderly mother makes the trip every week, breaking medical marijuana transportation laws.
After the campaign Daubert formed the group Patients and Families United, a support and public education group for registered users of medical marijuana and for any patients who suffer from pain whether they use medical marijuana or not.
Economy of Grow Houses
Medical marijuana sales are untaxed in Montana, and many proponents of medical marijuana say the state would greatly benefit from taxing sales. Medical marijuana dispensaries in California pay an 8.25 percent sales tax to the state on marijuana sales, totaling about $100 million annually. The medical marijuana business is relatively young in Montana, and local caregivers report they are just beginning to break even as they establish growing patterns and clients. If the demand for medical marijuana in the state continues to increase, a tax on sales could benefit many state programs, while patients would be largely unaffected.
Of the 1,080 registered medical marijuana users in Montana, 323 have no registered caregiver. Some of these patients may be in the process of getting a caregiver, but many are likely growing their own plants. Park County caregiver Dave Minnick says he encourages patients to grow their own plants if they can, because it costs less than the standard $300 per ounce charged by growers. The commercial grow operation is expensive and time consuming, and Caregivers of Montana pays as much as $1,000 per month in energy bills to support high-powered lights. Light is carefully controlled in the grow houses, as the plants are kept on a strict regimental cycle of absolute darkness and bright fluorescent light.
Some patients prefer the product they can buy from a commercial caregiver because the commercial product is often more potent than the product they can grow themselves, and caregivers offer a variety of strains. There are two primary types of marijuana, called “Indica” and “Sativa,” which produce different types of “highs.” Indica is reported to induce a sleepy and lethargic feeling, and works as a good pain-reliever. Sativa is reported to induce a more energetic and creative high. Within these two categories there are many hybrids and strains, with titles such as “White Widow,” “Mauwie Wauwie,” “Kush,” and “Purple Haze.” All produce different types of high, and users can sometimes sample varieties before a purchase.
Nearly every step in planting, cultivating, and harvesting a crop influences the character and potency of the final product. It is often difficult for patients to begin to grow crops at home and they must start by purchasing seeds, which is illegal.
Federal Consequences
Federal law assigns a mandatory prison sentence of five years to the possession of more than 99 marijuana plants, whereas the federal penalty under the 99 plant ceiling is less severe. The only plant limit imposed on caregivers by the state is the per-patient limit of six plants. Growers who serve enough patients to exceed 99 plants by state law usually stay below the federal plant limit to decrease the risk of severe penalty. So far there have been no major medical marijuana busts in Montana. Growth and use seem to be tolerated to some extent, if growers and users heed the established rules. Caregiver Minnick says agents of the Missouri River Task Force, the local branch of the Drug Enforcement Agency, have inspected his growing operation four times and left on good terms each time.
The legal status of marijuana affects several aspects of its growth, use, and perception. Prohibition ensures high prices for users, and creates an atmosphere of secrecy around many state-sanctioned medical interactions. Caregivers operate out of unmarked buildings, physicians hesitate to take public stances on marijuana use, and some patients report disapproval of family members or friends.
One concern expressed by the federal government and shared by Livingston Police Chief Darren Raney is that allowing medical use of marijuana sends a mixed message to youth. It is thought youth will be more likely to abuse or try marijuana if they are told it has some value. Several studies, including the Institute of Medicine study of 1999, present data contradicting this concern. During the 1990s marijuana use increased at the same rate in the Netherlands–where possession of marijuana is legal–as use in Norway and America, where use is strictly forbidden. Further, approximately equal percentages of American and Dutch 18-year-olds used marijuana. Another study showed no increase of marijuana use among youth during the California medical marijuana legalization debates of 1996-1997, when the subject of marijuana was all over the news.
California’s medical marijuana laws have changed and developed since the state passed marijuana legislation in 1997. Dispensaries and growers in the state have undergone major DEA busts, and some counties have responded by changing possession limits and regulations on sales, and some cities have recently instated moratoriums on dispensaries. Responses among city, county, and state law enforcement officials in California have ranged from passivity toward DEA activity to opposition to the agency. Police Chief Raney says he believes law enforcement should enforce and uphold laws passed by voters, and the medical marijuana law is no exception. He expresses concern over aspects of the current law but says it should be improved rather than making any attempt to discard it.
Propaganda vs. reality
As of 2004, federal, state, and local governments now spend a total of about $60 million, or $380 per average American adult each year on the “war on drugs.” A large portion of this war is waged on marijuana users. In the year 2000, 734,497 people were arrested on marijuana charges. As of 2003, it cost $1.2 billion per year to keep 60,000 people imprisoned for marijuana misconduct.
Some critics of medical marijuana claim it is a step toward legalization of the drug. The future of marijuana law will determine whether or not this claim is true, but Montanans made a firm decision concerning medical use of marijuana. Nearly four years in effect have highlighted successes and shortcomings of the law, and voters now have a chance to examine some of the effects of their choice.
State Representative Bob Ebinger is organizing a meeting of law enforcement officials, attorneys, and medical marijuana advocate Tom Daubert on August 20 to discuss the current medical marijuana law. “I feel that the people spoke pretty emphatically that they wanted medical marijuana; whether they realized there weren’t the necessary checks and balances, I don’t know,” says Ebinger. Park County legislators and law officials have demonstrated respect for the decision of the people, and seem to be taking a more clear-headed approach to the medical marijuana issue than officials elsewhere in the country.
Scientific studies continue to report medicinal value of marijuana, and states continue to legalize medical use despite federal prohibition of the drug. Some advocates express hope that a quorum of 25 supportive states will force the federal government to reconsider its draconian marijuana policy. Among other things, the medical marijuana movement has demonstrated the influence voters can exert on pressing and controversial matters of law.
—Wes Venteicher
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