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New law for an old drug

Part three of the series examines the process of becoming a medical marijuana patient or caregiver and the regulations involved

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If you believe what you hear on the street, it takes little more to acquire a medical marijuana registration card than to make any purchase of $150 — the going rate for a doctor's evaluation at a Montana Caregivers Network clinic. And if you don't feel like attending a clinic or convention in person, just sign up for a "TeleClinic" on the group's Web site, and a doctor will visit with you via webcam and decide whether to recommend you to the state's medical marijuana program.

While such practices seem to treat the issue flippantly, “in all walks of life, people take advantage of something,” said James Dale, owner of a medical marijuana dispensary based out of the Jette Store near Polson.

As specified in Montana's Medical Marijuana Act, to qualify for a registration card, a patient must have written certification from a physician stating that the patient suffers from a "debilitating medical condition." The list of approved conditions includes cancer, glaucoma, HIV positive status, acquired immune deficiency syndrome, wasting syndrome, severe or chronic pain, severe nausea, seizures and muscle spasms. The catch is that a physician's recommendation that a patient may use medical marijuana is supposed to be made after "a full assessment of the qualifying patient's medical history and current medical condition made in the course of a bona fide physician-patient relationship."

“How do you have a ‘bona fide relationship’ with a doctor if he doesn’t have information on you?” Dale asked, noting that he hasn’t been to any of the large clinics like those put on by the Montana Caregivers Network, but feels that such clinics treat people “like cattle,” herding as many would-be medical marijuana patients through the doors as possible. 

And when it’s time for patients to renew their medical cards, which the state requires annually, finding the doctor that recommended them to the program can be difficult if their only visit took place at a mass clinic. 

In an emerging medical marijuana industry, where the law doesn’t spell out many regulations for caregivers or cardholders, people like Dale who want to provide quality services must hold themselves to high standards. When new would-be customers approach Dale, he refers them to his doctor in Victor, who won’t recommend a patient to the state’s medical marijuana program without a thorough evaluation. Upon a visit to Dale’s doctor, patients undergo a complete physical and have their medical records reviewed by the physician. In addition to filling out “lots of forms,” patients are also required to watch a video that explains the “ins and outs” of the Montana Medical Marijuana Act and how THC and other cannabinoids — chemical compounds in marijuana that produce pleasant effects on the brain — work.

If the doctor approves a patient for medical marijuana use, he’ll write a recommendation — not a prescription, Dale emphasized, since marijuana is still federally classified as a Schedule I drug — for the patient to submit to the Montana Department of Public Health and Human Services along with a completed application and a $25 registration fee. It usually takes about three to five weeks for a patient to receive his or her medical marijuana card in the mail, Dale said, noting that from a law enforcement perspective, people cannot legally use medical marijuana until the card is in their possession.

“You are not in the program until you receive that card,” Dale said.

Patients have the option to assign a caregiver for themselves on the application they submit to the state, or they can declare or change their caregiver at any time free of charge. As defined by law, a caregiver is an individual, 18 or older, “who has agreed to undertake responsibility for managing the wellbeing of a person with respect to the medical use of marijuana.”

Patients are allowed six marijuana plants and an ounce of usable pot, and caregivers can also grow six plants and have an ounce of usable pot for each of their patients. Caregivers aren’t limited on the number of patients they can have, a fact that’s raised concern on many levels, from city councils’ fears that huge growhouses will soon pop up in subdivisions to quality of care issues for patients. But Dale explained that care actually improves if caregivers have more than one patient.

Growers should keep their marijuana plants on a rotating schedule so that only a couple of the six plants allotted per patient bloom at one time, Dale said. Dried, usable pot has a shelf life of only a few weeks, so harvesting six plants at once would be a waste for one person. But a caregiver with multiple patients can ensure that he’s always got enough supply to meet patients’ needs. 

"It allows us to keep up with the demand, which we're still not doing," Dale said. "This is a fledgling industry."

Dale and some other caregivers he knows have even formed an informal growing cooperative where they “help each other out.”

“It’s the only way we’ve found to try to keep up with demand,” Dale said.

Besides growing marijuana, caregivers with many patients and more experience — Dale knows of caregivers in the Bitterroot with as many as 300 patients, while he capped his own group at 42 — are better prepared to advise people on dosage, methods of ingestion and what strains of pot to use for certain ailments, he explained. But caregivers should exercise good judgment and compassion when deciding how many patients to take responsibility for.

“However many you feel you can be responsible for … that’s what you should take,” Dale said.

Caregivers undergo background checks and can’t have any felony drug offenses on their records, but state regulations on caregivers end there. The caregiver/patient relationship is intended to provide patients who may be too ill, don’t have time to cultivate marijuana or can’t afford to set up their own grow operation — a small setup can cost around $2,000 — with an easier way to get high quality medicinal pot. But the law leaves plenty of room for those looking for ways to take advantage of the system — no one’s really watching to prevent caregivers from taking money from patients and failing to provide them with medicine. 

“There is no recourse (for patients),” Dale said. “I don’t know of anything (DPPHS) can really do … There are shady people out there. Don’t assign a caregiver if you don’t know this person.”

Regulations for caregivers is one area Dale hopes to see the state legislature address in the next session, which is sure to produce much debate over details of the Medical Marijuana Act. Nor would he be opposed to the state taxing medical marijuana, something Colorado will consider next January.

While it's almost certain that changes will come to the Medical Marijuana Act when Montana's legislature reconvenes in 2011, Dale believes after studying other states' similar laws, Montana's really doesn't leave much out.

“Our state law is pretty much on point,” Dale said. “It’s not as gray as everybody says it is.”

(Editor's note: This article is part of a series that provides an overview of where medical marijuana use stands and how many questions remain about its use, sale and distribution, particularly within Lake County and the Flathead Indian Reservation. These articles will explore the effects medical marijuana is having in the community, as well as ask some of the questions that remain unanswered.)

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