Second in a series.
After waiting for hours at a booth during a medical marijuana convention in San Francisco, Jeff Harrington needed only a two-minute consultation and a written recommendation to become a medical marijuana patient. He now can legally purchase and possess marijuana from any one of thousands of businesses in California.
Across the country in Connecticut, an established physician-patient relationship is required before patients are qualified for medical marijuana, and only licensed pharmacists operate dispensaries.
Between these extremes, a News21 investigation has found there are as many ways to deal with medical marijuana as there are states that have legalized it.
As the federal government continues its prohibition of marijuana, the District of Columbia and the 23 states that have legalized marijuana for medical use have been left to write the rules and regulations on their own. The experimentation has produced wide variances and contradictions on everything from possession limits and lab testing to how people qualify as medical marijuana patients.
In Vermont, a medical marijuana patient is allowed only two mature plants and 2 ounces of marijuana. By contrast, a Washington state patient can have 15 plants and 24 ounces of prepared marijuana.
States such as New Mexico have no fee for a medical marijuana card, while others, such as Minnesota, charge as much as $200. Some do not tax medicinal marijuana, but others charge a sales tax or a specific tax on marijuana products - as much as 37 percent in Washington state.
New Jersey legalized medical marijuana in 2010. Three dispensaries have opened so far, and three others are planned. Delaware followed in 2011. In Pennsylvania, a bill to legalize medical marijuana has support from the Senate and Gov. Wolf, but has become stalled in the House.
Federal agencies offer no guidance or medical protocol for state medical marijuana programs. "Based on the research to date, the U.S. Food and Drug Administration has not recognized or approved the marijuana plant as medicine," said Mario Moreno Zepeda, spokesman for the White House Office of National Drug Control Policy. But research on marijuana extracts, called cannabinoids, has led to FDA-approved medications.
FDA approval of marijuana would require "carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication," according to the National Institute on Drug Abuse.
The News21 analysis of medical marijuana programs also showed that states diverge on what health conditions qualify a patient for medical marijuana, and little or no research has been conducted to determine whether marijuana or its derivatives effectively treat those conditions. AIDS, cancer, and chronic pain qualify as conditions for medical marijuana treatment in more than 20 states. Traumatic brain injury qualifies only in New Hampshire, Tourette syndrome only in New Mexico.
To be considered eligible, patients under all 24 programs must be diagnosed with an approved condition. Yet the standards for physician evaluations vary. The doctor who Harrington saw in San Francisco legally certified him for medical marijuana even though the consultation took less than five minutes and he was one of hundreds seen on the same day. That's all that's required in California.
A single physician in East Rutherford, N.J., has approved more than 1,000 of that state's more than 4,000 medical marijuana patients. Anthony Anzalone, a former gynecologist whose website is drmarijuananj.com, said he wants patients to have access to medical marijuana, even if he has to dig for a reason.
"Patients say, 'Oh, I have post-traumatic stress.' I say, 'Unfortunately, the state will not allow it at this point in time. However, tell me more. Do you have any kind of GI [gastrointestinal] problem - irritable bowel [syndrome]?' " Anzalone said.
He said the idea is to make people feel better - not high. "If you are not getting approved for medical marijuana in New Jersey, you are going to the wrong doctor," said Anzalone's patient counselor, Kevin Long.
Connecticut is the only state that treats marijuana like any other pharmaceutical drug. Jonathan Harris, commissioner of the state Department of Consumer Protection, calls Connecticut the only state with "a true medical marijuana program."
Patients are approved by a doctor and registered with the state, and must obtain marijuana from one of six dispensaries owned and operated by licensed pharmacists. When pharmacist Laurie Zrenda opened her dispensary in Uncasville, Conn., patients routinely paid her in cash.
"I realized they were paying their drug dealers all of this money before," she said. "They were used to it."
Her dispensary serves 515 patients with a range of conditions. "It's pretty amazing that one plant can do all these things. . . . I know the evidence is anecdotal, but it's there. It's hard to deny it."
Connecticut, Delaware, Illinois, Maryland, Minnesota, New Hampshire, New Jersey, New York, and Washington, D.C., require patients to use dispensaries rather than allowing home cultivation. Nearly all require dispensaries' products to be tested.
But New Jersey's Public Health and Environmental Laboratories is the only state-run lab to test product from the dispensaries, according to Megan Latshaw, director of environmental health programs for the Association of Public Health Laboratories. According to Dave Hodges, an inspection monitor in New Jersey, these tests occur only when requested by the dispensary.
Sixteen states and the District of Columbia, though, have no testing requirements, according to a News21 analysis of laws.
For example, private testing for pesticides or other harmful chemicals is available in Maine, but neither home cultivators nor dispensaries are required to submit samples to labs. Tests also are not required in Maine to determine cannabidiol (CBD) or tetrahydrocannabinol (THC) levels.
CBD is the non-psychoactive component of the marijuana plant. It has yet to be proven scientifically as a successful treatment, though anecdotal evidence suggests it helps some patients who use it. THC is the part of the plant that produces a high and is used to treat pain, nausea, and insomnia, among other symptoms.
Without testing, the potency of a strain is difficult to measure. In states with limits on THC levels, determining potency is key to creating a product within the law.
Seventeen states have passed legislation allowing only for cannabis extracts, such as oils. The states determine a mandatory ratio of CBD to THC, usually limiting the amount of THC, and in this way, the psychoactive effect. There isn't a consensus on that ratio.
Though these 17 states have limited patients to using extracts, others give medical marijuana patients the option of using their medical marijuana by smoking, vaporizing, or eating edibles, such as cookies and butters.
About this Series
This report is part of the project titled "America's Weed Rush," an investigation into the legalization of marijuana.
It was produced by the Carnegie-Knight News21 initiative, a national investigative reporting project involving top college journalism students across the country and headquartered at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University. For the complete project, including additional stories, videos and interactive elements, go to weedrush.news21.com.
Anne M. Shearer is an Ethics and Excellence in Journalism Foundation Fellow. Rilwan Balogun is a John and Patty Williams Fellow.