Pubdate: Wed, 25 Mar 2015
Source: Gazette, The (Colorado Springs, CO)
Copyright: 2015 The Gazette
Contact: http://www.gazette.com/sections/opinion/submitletter/
Website: http://www.gazette.com/
Details: http://www.mapinc.org/media/165
Authors: Pula Davis, Wayne Laugesen, Christine Tatum
Series: Special report, 'Clearing the Haze:'

MEDICAL MARIJUANA INDUSTRY STILL GROWING IN COLORADO

Colorado made headlines worldwide when recreational marijuana went on 
sale to the public in January 2014.

News organizations descended on the Centennial State to document, and 
hype, the advent of legalized retail pot.

The act of applying for and opening a retail pot business became 
reality-TV drama. MSNBC filmed a six-part documentary titled "Pot 
Barons of Colorado." There was great anticipation, and long lines, as 
pot shops opened for business, and a multimillion-dollar industry was 
born overnight.

By early February 2015, 334 retail shops were selling pot to the 
public, based on state Department of Revenue data.

And amid all the hoopla around legalized recreational pot, its older 
cousin, the medical marijuana (MMJ) industry - with 505 stores 
throughout Colorado - quietly continued to grow, adding patients by 
the thousands who seemingly had no problem finding physicians willing 
to diagnose what critics say are often phantom medical conditions. 
Statewide, the number of people on the Medical Marijuana Registry 
grew 4 percent in 2014 - the first year of legal recreational sales - 
from 111,030 to 115,467 by year's end.

El Paso County was no exception. Although retail pot sales were 
banned in Colorado Springs, that didn't dampen the local demand for 
marijuana - or its availability. The number of El Paso County 
residents on Colorado's Medical marijuana registry grew

17.3 percent - from 15,328 in January to 17,986 in December. And 
those people have plenty of places to shop. City records show there 
are 91 licenses for medical dispensaries in Colorado Springs - one 
for roughly every 4,900 residents. Sales of medical pot in the city 
last year were up 11 percent over 2013 - from $53.7 million to $59.6 
million - according to Gazette calculations based on tax collections.

Shoppers look for bargains

The rise in the MMJ registry roll likely comes down to personal 
finances. Medical marijuana is subject to fewer taxes than its retail 
counterpart. When it comes to pot, Coloradans have proved themselves 
cost-conscious. A pot purchase at El Paso County's lone recreational 
shop in Manitou Springs is subject to 24.03 percent in taxes - and 
that doesn't include a 15 percent excise fee collected by the state. 
The same purchase at a medical marijuana dispensary in Colorado 
Springs would be taxed at 7.63 percent.

The cost disparity may explain why tax collections from recreational 
pot sales statewide haven't produced the windfall originally projected.

In a blog post by the Colorado Fiscal Institute titled "Half a mile 
high: Coloradans not buying as much pot as expected," the institute 
noted: "Coloradans are consuming about half as much retail marijuana 
as state economists predicted before voters approved special taxes on 
recreational pot in 2013, and many state residents have instead stuck 
to using medical marijuana, taxed at a significantly lower rate."

Some MMJ stores even advertise their price advantage over retail 
shops. A sign at a store on West Colorado Avenue, for instance, touts 
"$ave Money! Become a MMJ patient!"

Critics say the data raise questions about pot's role in medicine and 
the legitimacy of the medical marijuana industry. Consider Arizona, 
which tracks daily sales of medical marijuana. Sales are highest on 
Fridays - just in time for the weekend. Wondering which days over the 
past few months were most popular for MMJ sales? New Year's Eve and 
the Friday before the Super Bowl, according to the Arizona Medical 
Marijuana Program.

Twenty-three states have some sort of medical marijuana program, but 
regulations vary widely. Minnesota, for instance, will have just 
eight medical marijuana dispensaries statewide when its program 
launches in July, and patients will receive medical cannabis only in 
a liquid, pill or vaporized form. New York's program also only allows 
nonsmokable marijuana.

Colorado lawmakers intend to address medical marijuana this 
legislative session. Among the issues expected to get attention: the 
oversight of caregivers - those designated by medical marijuana 
patients to grow pot for them  and doctors who approve patients for 
the registry.

Some say the number of patients on the state's Medical Marijuana 
Registry far exceeds the number of people who have legitimate need 
for the plant. Ninety-three percent of medical marijuana patients in 
Colorado cite "severe pain" as their reason for using the drug and 
are smoking "medicine" with names like "Armageddon," "Willie Nelson" 
and "Green Crack."

Dr. Richard Zane, head of the Department of Emergency Medicine at the 
University of Colorado Hospital, summed up the MMJ industry in 
Colorado this way:

"It is not statistically mathematically possible that this one 
substance could possibly be effective for all the things that it has 
been listed for - and for the number of people in Colorado who have 
medical marijuana cards to have an indication for a disease for which 
a singular medicine is indicated and works. It's a medical 
epidemiological statistical impossibility."

Even so, the state seemingly has made getting on the registry more 
attractive; it lowered the application fee to $15, down from $35 in 
2014 and $90 in 2012.

History of Amendment 20

In November 2000, Colorado voters approved Amendment 20, allowing 
doctors to recommend marijuana for people suffering certain 
debilitating conditions. The vote was 53.5 percent to 46.5 percent.

But the industry didn't really take off until after October 2009, 
when U.S. Deputy Attorney General David W. Ogden issued a memorandum 
stating it wasn't prudent to use federal resources to go after MMJ 
patients and caregivers who were in "clear and unambiguous compliance 
with existing state laws."

His memo said, in part: "The prosecution of significant traffickers 
of illegal drugs, including marijuana, and the disruption of illegal 
drug manufacturing and trafficking networks continues to be a core 
priority in the department's efforts against narcotics and dangerous 
drugs. As a general matter, pursuit of these priorities should not 
focus federal resources in your states on individuals whose actions 
are in clear and unambiguous compliance with existing state laws 
providing for the medical use of marijuana."

This was the green light financiers needed to open medical marijuana 
businesses without fear of prosecution - and applications for 
Colorado's medical registry exploded.

In January 2009, for example, just 5,051 Coloradans were on the 
medical marijuana registry - including 568 people from El Paso County 
and 65 from Teller County, according to data from the Colorado 
Department of Public Health and Environment, which was charged with 
implementing and administering the MMJ registry.

The registry numbers in El Paso and Teller counties spiked to 2,947 
and 300, respectively, by the end of 2009.

Today, MMJ shops in Colorado Springs are about as common as 
traditional drugstores. There are 98 pharmacies in the city and 91 
licenses to sell medical marijuana. And dispensaries aren't the 
city's only marijuana businesses. Colorado Springs has issued 242 
medical marijuana business licenses that also include grow operations 
and infused-product manufacturers, some just a stone's throw from 
residential neighborhoods.

Jason Warf, executive director of the Southern Colorado Cannabis 
Council, came to Colorado for marijuana.

"Honestly, I moved out here to be more legitimate as a cannabis 
patient," he said. "People stick with their red cards because they're 
sick and they need it as medicine. Individuals need this as medicine. 
For patients, it's not about recreating. It's about treating what our 
issues are."

Warf said he became a cannabis patient after a failed back surgery 
left him disabled.

"The red card numbers are up slightly, but there are some factors to 
take into account. We still have a huge influx of sick people coming 
to Colorado (for treatment)," he said. "And now since it's legal, it 
opens the door for more people to be comfortable becoming cannabis patients."

Warf worries that bills set to be introduced in the Legislature will 
chip away at the industry.

"In the last three years at the Capitol, what I've seen is really a 
push to essentially do away with medical. This is nothing more than a 
money grab. Obviously patients don't pay nearly the tax on medicine 
that consumers on the recreational side do."

Kevin Sabet, co-founder of Project SAM (Smart Approaches to 
Marijuana), which advocates for public health-based marijuana policy, 
believes there are components of marijuana that may have medicinal 
benefits but they concern only a small fraction of the industry.

"Look, I think the concept of medical marijuana is a political fraud 
and most businesses involved with medical marijuana are a sham," said 
Sabet, who got top billing in Rolling Stone's list of people deemed 
the biggest threats to pot legalization. "However, that does not mean 
there is not medical utility we can derive from the marijuana plant.

"We have early evidence about CBD, which could be helpful with muscle 
spasticity - if you're suffering from MS or epilepsy," Sabet said, 
referring to cannabidiol, a component in marijuana that does not 
produce a high. "These things should be further explored and that 
research should be promoted.

"But medicine should be approved by the FDA and gotten at a pharmacy 
with your doctor's prescription. The way it has panned out in the 
last 20 years is that this has become a political movement designed 
to essentially get anyone stoned who wants to. It's a political sham 
because most people who have medical cards ... the vast majority of 
them are just to serve their own recreational pot interests."

Sabet believes voters were duped by medical marijuana proponents into 
approving Amendment 20. Only 4 percent of cardholders in Colorado 
report using marijuana for HIV/AIDS or cancer, he said.

"But people vote for it and they want it because that's who they 
think it's going to," he said.

"The legalization movement - they wanted to change the face of 
marijuana from the 1970s stoner to the 80-year-old with cancer. They 
did it very effectively. What that has done has unfortunately impeded 
the development of proper marijuana-based medications," Sabet said.

A Colorado Springs physician who specializes in pain medicine and is 
a member of the Colorado Medical Marijuana Scientific Advisory also 
believes marijuana may have a medicinal use but said its sales and 
use are problematic.

"You can theoretically fill your trunk with medical marijuana 
products in one day - there's no system to track that," Dr. Kenneth Finn said.

"You know the definition of a caregiver?" he added. "Anyone who's 
over 18 years of age and has a pulse."

"Patients are free to self-medicate with a 10 percent THC bud or 90 
percent hash oil," Finn said. "They can eat, smoke and vape all day 
without any control.

"To be honest with you, I think that the industry has created a huge 
disservice for the people who might actually benefit from it. ... I 
think it's important that the terminally ill are not part of the 
debate, nor do I have issues with the pediatric population and the 
nonpsychoactive cannabinoids to treat pediatric seizure disorders," Finn said.

"But I think it's very important that cannabis as medicine needs to 
be studied just like any medication should be studied."

Studies about possible medicinal benefits of marijuana are about to 
get underway. The state's Board of Health approved spending

$9 million to research marijuana's impact on several conditions, 
including PTSD, Parkinson's and childhood epilepsy.

Not everyone was thrilled by the news, including pot advocates who 
argued against funding the studies with the registration fees paid by 
those on the registry; the group said such funding is an 
unconstitutional use of the money.

The Journal of the American Medical Association weighed in on the 
importance of marijuana research in its December issue, noting: 
"Patients with some seizure disorders may benefit from the 
cannabidiol component in marijuana, and several clinical trials will 
soon enroll patients." It also noted: "However, it is unlikely that 
marijuana is effective for the wide range of health problems approved 
under Colorado law."

Getting the card

According to the Colorado Department of Health and Environment, more 
than 800 doctors have signed a certification form the state requires 
for a person to apply to the marijuana registry.

Dr. Larry Wolk, executive director and chief medical officer of the 
Colorado Department of Public Health and Environment, said the 
majority of those doctors have each made just a handful of 
recommendations. But some physicians raise red flags - either by the 
sheer number of MMJ recommendations they are making or because they 
are making recommendations out of the scope of their expertise.

"Some things that don't make sense - an OB/GYN who's making hundreds 
of recommendations for male patients," Wolk said as an example, or a 
pediatrician making recommendations to adults.

"Just in the past year alone we've referred 16 physicians for 
investigation," Wolk said.

In December, one physician admitted to writing recommendations to 
more than 7,000 patients - many whom he didn't personally see or 
evaluate. Dr. Lenny Sujdak pre-signed the Medical Marijuana Registry 
application forms and delegated the evaluations to mid-level 
practitioners. Documents from the state's Department of Regulatory 
Agencies show his license to practice was placed on probation for 
five years. He is banned from performing any more marijuana 
evaluations and he was ordered to complete a course titled "The 
Opioid Crisis: Guidelines and Tools for Improving Chronic Pain Management."

It's unclear how many physicians have been sanctioned for similar infractions.

"We don't track discipline by that specificity," said Cory Everett, 
director of strategic and external affairs for the Department of 
Regulatory Agencies, which maintains licensing and disciplinary 
records of physicians. "We track it by the statutory violation."

In order to make a medical marijuana recommendation, physicians are 
required to have a "bona fide" relationship with a patient.

"For us, it's ensuring physicians are acting responsibly," Wolk said. 
"They have to have a bona fide physician-patient relationship, which 
requires an ongoing relationship with a patient - not coming in once 
a year and not receiving all of the necessary components of a doctor 
visit including a history and physical exam and appropriate 
laboratory testing. You would expect to see at least that much if 
it's truly a bona fide physician-patient relationship.

"I believe there are physicians who do have bona fide 
patient-physician relationships who are earnestly and honestly making 
recommendations based on their knowledge of medical marijuana and 
their relationships with patients."

Former Colorado Attorney General John Suthers told The Gazette that 
Colorado's laws "have driven the adolescent perception of risk into 
the ground."

Based on 2012 data from the Rocky Mountain High Intensity Drug 
Trafficking Area, nearly 27 percent of Coloradans ages 18 to 25 
reported using marijuana in the prior month - the third-highest 
percentage in the nation behind Vermont and Rhode Island, which also 
allow medical marijuana.

Although retail sales are banned in Colorado Springs, the city ranked 
No. 2 nationwide for pot use in a Movoto Real Estate Blog, behind 
only Denver. The blog cited dispensaries per capita, number of 
residents with medical marijuana cards and head shops per capita 
among the criteria for its analysis.

If the numbers, anecdotes and experts' opinions are indicators of how 
hard it is to regulate medical marijuana, Colorado certainly has work 
ahead as it attempts to regulate the recreational pot industry.

"What will be the impact of Amendment 64 on Colorado and other 
states? Only time will tell," reads an excerpt from HIDTA's 153-page 
August report titled "The Legalization of Marijuana in Colorado." 
"The five-year experience with medical marijuana in Colorado may be 
indicative of what to expect."

Does marijuana or some of its components have medicinal benefit? 
Early evidence indicates it may, but research is needed.

Suthers said the medical marijuana industry is "pretty much a joke."

"I think there's probably 2 percent of patients who have legitimate 
debilitating medical conditions. The surprise to me - I thought that 
with legalization the vast majority of these young people who are 
lying to their doctor about their chronic back pain would want to go 
legit. But that hasn't happened. Apparently the market is a lot more 
price-sensitive than I thought it was."

[sidebar]

El Paso County Medical Society policy statement on marijuana use

Evidence exists that may indicate the possibility of certain 
medicinal benefits from select components of the cannabis plant. A 
growing body of evidence also indicates negative physiological, 
psychological, developmental, and cognitive health effects associated 
with cannabis use. Until clinical research meeting rigorous 
scientific standards can be performed, EPCMS, in line with the 
policies of the American Medical Association and the Colorado Medical 
Society, believes:

The recreational use of marijuana should be discouraged in adults and 
prohibited in children and adolescents;

The medicinal use of marijuana should take place only within the 
context of an established physician-patient relationship, under 
medical supervision, based upon scientifically valid clinical 
research, and for specified medical conditions;

Additional research meeting the rigorous standards of pharmaceutical 
research should be conducted to determine any risks and benefits.

Day 4: MEDICAL MARIJUANA

Medical marijuana sales in Colorado exploded after October 2009 as 
the result of a federal memorandum stating that resources likely 
would not be used to prosecute people involved in the business, which 
remains illegal under federal law. Gazette research confirmed the 
medical marijuana market continues to grow as the result of porous 
regulation and a favorable price differential versus retail marijuana 
sales. The issue is big and complex and may derail legitimate efforts 
to conduct research on parts of the marijuana plant that could 
produce new, clinically proven medicines.

About the series

The reporting team: editorial board members Pula Davis and Wayne 
Laugesen and local reporter Christine Tatum.

After the first year of recreational pot sales, The Gazette takes a 
comprehensive look at the unintended consequences of legalizing sales 
and use of recreational marijuana.

Day 1: Colorado has a fragile scheme for regulating legal marijuana 
and implementing a state drug prevention strategy.

Day 2: One of the suppositions about legalizing pot was that 
underground sales would be curtailed, but officials say there is 
evidence of a thriving black market.

Day 3: One teen's struggle to overcome his marijuana addiction shows 
how devastating the effects of the drug can be for younger, more 
vulnerable users.

Day 4: Amid the hoopla about recreational marijuana sales, the 
medical marijuana industry is flourishing and has its own set of 
complicated concerns.

Business comparison

The Colorado Springs City Council voted to ban retail marijuana 
stores in the city. However, there are dozens of medical marijuana 
dispensaries in town and other marijuana-related businesses. There 
are dispensaries in every region of the city, with clusters in some 
neighborhoods (see map, facing page).

For a comparison, The Gazette looked up licenses of pharmacies and 
liquor stores within the city:

91 medical marijuana center licenses

98 pharmacies

107 retail liquor stores
- ---
MAP posted-by: Jay Bergstrom