D.C. looks to state programs for answers on medical marijuana

March 23, 2010

Ann E. Marimow, Washington Post

Los Angeles imposed strict limits on medical marijuana shops this year after hundreds of them popped up with little government oversight. Colorado is still wrestling with how to ensure legitimate doctor-patient relationships after the number of people applying to use medical marijuana surged dramatically in a six-month period. And in the District, elected officials are trying to learn from what they consider cautionary tales from other jurisdictions as they try to create a program that strikes a delicate balance: allowing safe access to the drug for those who need it, while avoiding the kind of abuse by recreational users that would attract a backlash from Congress. Adding to the pressure, the D.C. Council has been inundated with calls -- from a Netherlands company offering indoor-growing technology to a California dispensary proposing a new franchise to the Drug Enforcement Administration asking for the latest legislative language -- reminding members of the need to get this right. 'We are not an island unto ourselves,' said council member David A. Catania (I-At Large), the leading sponsor of the legislation that is a starting point for debate this month. 'We have to be careful that we don't have a system that creates more mischief than benefit.' More than a decade has passed since District voters approved a ballot initiative to legalize marijuana for medical treatment. But it was not until December, with Democrats controlling Congress and the White House, that city lawmakers considered converting voter intent into reality. It helped that the Obama administration had urged federal prosecutors last fall not to interfere with local medical-marijuana laws. Catania's bill, backed by most of his council colleagues, proposes five retail-style dispensaries throughout the city and prevents the shops from locating near schools or youth centers. If the measure is approved, District residents with a doctor's recommendation could legally purchase the drug as early as the fall. However, District officials must decide whether five is the right number of dispensaries for a city of 600,000 residents, where the seeds would be planted, what requirements to set for doctors who recommend medical marijuana, and which conditions would qualify for the treatment beyond illnesses such as AIDS, cancer and multiple sclerosis. Search for answers Council members are looking to the 14 states where the use of medical marijuana is legal for answers. Steph Sherer, executive director of Americans for Safe Access, which supports legalizing pot for medical reasons, said that once policymakers become more familiar with regulating marijuana dispensaries, it becomes a routine part of governing. 'It's a boring clinic. It just maybe smells different than anything you've been in before,' said Sherer, a D.C. resident who uses a marijuana spray four times a day for neck spasms. In California, home of the nation's first program, medical marijuana was initially so loosely regulated -- without limits on the number of dispensaries -- that nearly 1,000 shops sprang up in Los Angeles, creating a booming business and leading elected officials to quip that there were more pot shops than Starbucks stores. The Los Angeles City Council responded in January, capping the number of dispensaries at 70 and placing limits on locations and employee compensation. The landscape in Colorado was transformed last summer when a state health board scrapped the patient limit for caregivers. The decision essentially remade the system from one in which patients grew their own marijuana or were supplied by caregivers into a dispensary model with scores of shops. Now, public health officials say they can't keep up with the 500 patient applications that arrive by mail each day. The number of people on the state registry has exploded from 8,900 last June, according to a health department spokesman, to an estimated 63,000 last month, and perhaps as many as 100,000, according to advocates. 'We're looking at the label of pot capital of the world, competing with California,' said Colorado Attorney General John Suthers, who is pressing the legislature to restore the patient-caregiver limit. 'It's totally out of control.' Ned Calonge, the state's chief medical officer, said he is troubled by reports of doctors signing off on hundreds of forms on the fly and by the small number treating the majority of patients. As of December, his office reported that 820 physicians had authorized medical marijuana for 15,800 patients and that of those doctors, just 15 were responsible for 73 percent of patients. Calonge also is concerned that the most common condition under which patients qualify is 'severe pain,' a category that he said has 'no objective measurement.' 'Because of the vagueness of the wording and the lack of specificity in oversight, we're facing a program that has clearly expanded beyond what was envisioned,' Calonge said. Importance of rules Matthew Brown, executive director of the pro-dispensary Coloradans for Medical Marijuana Regulation, said the physician numbers are outdated and reflect the previously small pool of doctors who were comfortable even discussing the possibility of marijuana use for medical treatment. Brown cautioned that defining the relationship too narrowly would harm low-income patients, for instance, who may not have a primary-care physician. Access would also be limited, advocates said, by creating an arbitrary, limited list of qualifying medical conditions. 'The first year or two will probably not be perfect,' Brown said of the District's plans, but 'if the law and regulations are written to encourage responsible patients and responsible providers, then a lot of the issues will be taken care of.' The District's program is likely to resemble the highly regulated model in Oakland, Calif., which serves about 400,000 residents. After a rocky start that included armed robberies and resale troubles, Oakland officials in 2004 limited the number of dispensaries to four and created a rigorous permit and annual renewal system. The process assigns points for security, financing and criminal background checks, tests an applicant's knowledge of medical marijuana laws and interviews for finalists. After the first year of stricter standards, city officials shut down two of the four dispensaries. Since then, the city has not received complaints from neighbors or other merchants, according to Barbara Killey, the recently retired assistant to the city administrator who oversaw the program. Under the District's ballot initiative, nonprofit operators would be exempt from local taxes, as are other nonprofit corporations, a plan that Killey said, 'seems kind of crazy.' In addition to an annual $30,000-a-year permitting fee, Oakland dispensaries pay a business tax rate that is 15 times as high as the typical rate for retailers. Oakland City Council member Rebecca Kaplan, who is considering an increase in the number of dispensaries, recommended that the District start small, though not so small that there are huge crowds. 'There could be such a thing as too many,' Kaplan said. 'But the content of the rules probably matters more than the number.'

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