COMMUNITIES GRAPPLING WITH MEDICAL MARIJUANA ISSUES

On Nov. 5, 2008, Michigan became the 13th state in the U.S. to
legalize marijuana for medical use, by a statewide vote of 63 percent
to 37 percent on Michigan Proposal 08-1. That may be the last time
there was a clear consensus on medical marijuana use in Michigan, as
municipalities seek to define its use in their borders, law
enforcement officers aren't sure whether it's really legal or not,
doctors debate whether its efficacy is up to snuff, caregivers seek
patients and patients search for caregivers.

Proposal 08-1, known as "a legislative initiative to allow under state
law the medical use of marijuana," also known as the Michigan Medical
Marijuana Act, stated that it would permit physician-approved use of
marijuana by registered patients with debilitating medical conditions,
including cancer, glaucoma, HIV, AIDS, hepatitis C, multiple sclerosis
(MS), and other conditions as may be approved by the Department of
Community Health. The law requires the Michigan Department of
Community Health to establish an identification card system for
patients qualified to use marijuana and individuals qualified to grow
marijuana. The law permits registered and unregistered patients and
primary caregivers to assert medical reasons for using marijuana as a
defense to any prosecution involving marijuana. It also allows
individuals, to become known as caregivers, to grow limited amounts of
marijuana for qualifying patients in an enclosed, locked facility.

By an overwhelming majority, Michigan voters checked the "yes" box
when asked whether to adopt the proposal. In Oakland County, 66
percent of November 2008 general election voters cast ballots
affirmatively for the compassionate use of medical marijuana.

The subsequent permit process for the Michigan Medical Marijuana
Program is a state registry program within the Michigan Department of
Community Health's Bureau of Health Professions. Michigan began
processing applications on April 6, 2009, after developing guidelines,
applications, medical clarifications and qualifications, and an
approval process following the Nov. 2008 statewide vote.

As of July 13, 2010, the Michigan Department of Community Health had
received 37,924 original and renewal applications for medical
marijuana use and dispensation. Of the applications received, 20,548
patient registrations had been issued and 8,905 caregiver
registrations had been issued. Another 5,119 applications had been
denied in that period, primarily for incomplete applications or
documents with missing information.

The department maintains that once it receives a complete application,
it will review an application within 15 days and provide valid
identification cards to qualifying patients and primary caregivers.

Michael Komorn, a Southfield attorney who specializes in medical
marijuana law and helping those in need of it and those providing it,
disputes the amount of time the state is actually taking to process
the applications and issue the cards.

"They're backed up to at least January," he said.

There is a mandatory fee of $100 that must accompany every
application. Individuals receiving Medicaid Health Plan or are in
receipt of current SSD or SSI benefits may be able to have the fee
reduced to $25.

In order to be considered to receive a Michigan medical marijuana
card, the first criteria to meet is to be a resident of Michigan; the
second is to have a recognized debilitating disease. Diseases and
conditions that qualify as debilitating under the Michigan Medical
Marijuana Law are cancer, glaucoma, positive status for human
immunodeficiency virus (HIV), acquired immune deficiency syndrome
(AIDS), hepatitis C, amyotrophic lateral sclerosis (ALS, more commonly
known as Lou Gehrig's Disease), Crohn's disease, agitation of
Alzheimer's disease, or nail patella, a genetic disorder that results
in small, poorly developed nails and kneecaps. Also qualifying are
chronic or debilitating disease or medical condition or its treatment
that produces cachexia or wasting syndrome; severe and chronic pain;
severe nausea; seizures, including but not limited to those caused by
epilepsy; or severe or persistent muscle spasms, including but not
limited to, those which are characteristic of ! multiple sclerosis.

A medical doctor -- which the state recognizes as an MD (medical
doctor) or DO (doctor of osteopathy) -- must review a patient's medical
records to ascertain their status, and determine if marijuana will
provide a medicinal or palliative salve. The state will not look
through a proposed patient's medical records; nor will they recommend
to a patient a physician who is familiar with the program and
predisposed to look at a patient and his/her condition and refer them
to the program. It's up to the patient to find their own licensed and
credentialed doctor -- although it doesn't have to be the doctor who
treats them regularly for their condition.

The physician must state in writing that the patient has a qualifying
debilitating medical condition and that medical marijuana may mitigate
the symptoms or effects of that condition. The Michigan Medical
Marijuana Program contacts each physician during the application
process to verify the patient is under the physician's care. A signed
and dated "Physician Certification" must be current within three
months of the date of a person's new or renewal application. It's a
very thorough process, and one in which the state easily detects
people trying to get marijuana, irrelevant of their need.

Patients do not receive a prescription for medical marijuana -- and
Michigan pharmacies couldn't fill such a prescription. That's because
pharmacies can only dispense medications "prescribed" by licensed
physicians. The federal government classifies marijuana as a Schedule
1 drug, which means that licensed medical practitioners can't
prescribe it. A physician, by providing written certification of a
debilitating medical condition, can only recommend the use of medical
marijuana. The state's Michigan Medical Marijuana card is issued to
qualified patients in lieu of a prescription.

Instead of a neighborhood pharmacy, patients receive their medical
marijuana from designated caregivers. According to state law, a
caregiver can acquire 2.5 ounces of usable marijuana and grow up to 12
marijuana plants for a qualifying patient. One individual caregiver
can assist up to five patients, who can be a relative, friend,
associate, or other known relation -- as long as they've never been
convicted of a felony drug offense. The caregiver must sign a
statement agreeing to provide marijuana only to the qualifying
patients who have named the individual as their caregiver. The
caregiver's name, address, birth date and social security number must
be provided to the state at the time of a patient's registration. They
must be at least 21-years-old.

The department will then issue a registry identification card to the
caregiver who is named by the qualifying patient on his/her
application.

The illnesses which can qualify a patient for medical marijuana use
aren't debatable; but many physicians do question whether marijuana is
a curative drug, rather than merely a recreational drug.

"Marijuana, or the active ingredient, cannibanoid, does have an active
medicinal effect," says Dr. James Honet, a Bloomfield Hills pain
specialist. "There is a medicine with synthetic THC, called Marinol,
that is approved by the FDA (Food and Drug Administration) for people
with nausea and a lack of appetite. It comes in pill form. It's also
been used for glaucoma.

"However, it has no role whatsoever in helping pain," Honet added. "In
no clinical studies has it been proved to help pain. It's really
analogous to drinking a fifth of Jack Daniels. You won't feel any
pain, but it's because you're impaired, not because your pain is gone."

The U.S. Drug Enforcement Administration (DEA) states that Marinol has
been studied and approved by the medical community and the FDA since
the 1980s, and researchers are studying suitability for delivery of
Marinol via an inhaler or a patch, similar to the pain medicine
morphine, which would be beneficial for those suffering severe nausea
and vomiting, especially associated with chemotherapy for cancer
patients and those whose appetite is lost due to AIDS treatments.

Honet and the DEA emphasize that smoking is generally a poor way to
deliver medicine. Unlike monitored dosages in pill, inhaler, or patch
form, they say it's difficult to administer safe and regulated doses
of medicine in smoked form.

"To smoke marijuana is just to put your health at risk," Honet
said.

The DEA notes that morphine has proven to be a medically valuable
drug, yet no one endorses the smoking of opium or heroin. Instead,
scientists and researchers extracted opium's active ingredients, which
are sold as acceptable pharmaceutical products like morphine, codeine,
hydrocodone or oxycodone.

Honet's patients suffer from various forms of chronic pain due to a
variety of conditions, with different levels of tolerance.

"People ask us all of the time for prescriptions for medical
marijuana," he said. "If we find out people are using pot, we will
stop writing any prescriptions for pain medication because we do not
want to further their impairment."

Attorney Komorn, who is on the board of the Michigan Medical Marijuana
Association, a patient advocacy group with approximately 16,000
members, is as passionately opposed to that medical approach as he is
a proponent for medical marijuana use.

"Prescription pills for chronic pain is a facade," he said. "So many
people are never going to get off of them. There's just a growing
number of pills, and it becomes a vicious cycle, with more and more
people becoming addicted to pain pills. You get all of these other
problems from the side effects of them. It affects their whole quality
of life. Eventually, their organs shut down from the use.

"It's hypocritical of our society to be in partnership with the
alcohol and cigarette industries, when there are no medical benefits
from them," he added. "If they came on the market today, they'd be
Schedule 1 drugs, too. After all, people are not overdosing or dying
from marijuana."

Dr. Lawrence Eilander, a West Bloomfield neurologist practicing in
Southfield, said he has found that marijuana can be very beneficial
for some of his patients suffering from multiple sclerosis.

"Chronic pain patients with MS have a lot of muscle and nerve pain,"
he said. "From patients I've seen that have used it, many have been
helped with severe leg pain, cramping, sharp nerve pain, and
discomfort. Most of them smoke it, and that gives them some relief for
four to six hours."

Eilander notes that his MS patients who have used medical marijuana
have ended up "using a lot less narcotics-less morphine, oxycontin and
Vicodin. They get off these drugs and just use the marijuana, which is
much better for them, and it's the only time they get relief. I've
seen it for 15 to 20 years in my practice."

Since the new law came into effect in Michigan a year-and-half ago,
Eilander said he has written out nine or 10 of the medical marijuana
patient forms, all for MS patients.

"I have found that it also works for the leg and back pain cancer
patients get, not just for their nausea," he said.

Dr. Bill Gonte, a Southfield internal medicine/sports medicine
specialist, said he saw a potential opening in the medical field when
the medical marijuana law passed. He said his own patients were
clamoring for it, and after doing his due diligence on the law, he
created Physicians Certification Specialists, a company with 10
doctors which certifies that a qualifying medical condition is present
or not by reviewing patient medical records and documents. The group
has opened clinics, called Michigan Medical Marijuana Certification
Center, in numerous cities (mmmcc.com). The primary clinic is in
Southfield, with others in Grand Rapids, Traverse City, and Port
Huron. Others will be opening soon in other states, as there are
medical marijuana referendums pending in several other states.

Gonte emphasizes that he and his fellow doctors have nothing to do
with determining the efficacy of marijuana use, or dispensing marijuana.

"The state doesn't understand the medical conditions, so the state
wants a medical doctor to certify it," he said. "The state says you
can use marijuana if you have a medical condition, but it has to be
certified by a medical doctor. Yet, some doctors have issues with it,
and some don't want the liability that comes with it. There's a very
low percentage of doctors who will certify for it."

Instead, his clinics are receiving referrals from numerous
oncologists, gastroenterologists, pain medicine specialists,
internists, and family practioners.

"They may recognize a need for their patients, but they wisely don't
write for them, because the issue of the law is still very cloudy,"
Gonte said. "Also, because you have a treatment relationship with a
patient, you have a responsibility to the patient. So we're there to
help walk the qualified patients through the system."

He said his doctors are primarily seeing patients with Hepatitis C,
active AIDS, active HIV, cancer patients and chemotherapy patients,
and chronic pain patients.

"Chronic pain patients are very hard to diagnose because it's
difficult to determine and measure pain," he said.

Each patient pays between $100 and $200 to have their medical records
reviewed.

Michigan Medical Marijuana Certification Centers prescreen all of the
patients who call in, qualifying only about 30 percent.

"We clarify right up front that our standards are very high," Gonte
said. "Therefore, we're not aware of anyone that we've certified that
the state has denied (for a medical marijuana identification card)."

Gonte specifies that he and his fellow physicians don't advocate one
way or another regarding the use of medical marijuana, only certifying
the patients that have the appropriate medical condition and walking
them through the system.

"We always tell them that they must discuss it with their physician.
And after they see us, they should go back and see their physician, so
their physician knows about it," he said.

To find qualified, state-registered caregivers is a much more
difficult endeavor, because the state won't supply a patient with that
information, doctors can't, and the law currently is not clear on
whether caregivers can advertise.

"Finding a caregiver is very difficult," Komorn said.

He advises patients to search the Internet for different organizations
that provide services for medical marijuana users; there is often
information on where and how to find a caregiver, or caregiver message
boards, on some of those sites.

"Compassion club meetings are good places to go, for many reasons," he
said. "They're support groups that are open to the public,
not-for-profit, there's no medicine given out, and they're just for
discussion. Often you may run into a caregiver at a meeting." Many
meet at local libraries.

A bigger issue is one of legality and municipal control.

While medical marijuana is now legal in the state of Michigan, it's
still a violation of federal law; and to many law enforcement
authorities, federal law trumps state law.

"We need some legislation," said state Rep. Chuck Moss (R-Orchard
Lake). They've made it legal, but they don't have the statutory
infrastructure to support it. Ideally, we (state legislators) would
like the local governments to legislate it."

"It hasn't been thought out very well," said Oakland County
Commissioner Shelley Taub (R-West Bloomfield, Orchard Lake). "There
are two schools of thought. One is that we don't want it in our
community at all. The other is looking to put it into an industrial
area and regulating it.

"The problem is, the people in the state of Michigan -- almost 70
percent of them -- believe it should be legal. Many are suffering from
terrible diseases. No one wants a loved one to die in pain, and I
agree. We have to remember, it's now the law."

Some local communities are passing 120-day moratoriums to give them
time to investigate and decide how they want to proceed with medical
marijuana in their communities.

All authorities agree that if an individual patient has a card from
the state's Michigan Medical Marijuana Program, and they are using it
in the privacy of their own home, it's not a problem they will contend
with. The greater issue is distribution by caregivers, and where else
a patient in need of medical marijuana can medicate themselves.

In the lakes area, Commerce Township has developed an ordinance to
outright ban medical marijuana distribution.

Commerce Township Supervisor Tom Zoner said the community has "adopted
federal law" with an ordinance adoption on June 8, and decided that,
within the township's jurisdiction, medical marijuana dispensaries are
prohibited.

"We said, 'Why bother getting involved in federal court cases,'" he
said.

Komorn disagrees. "They do not have a legal right to ban it," he said.
"It violates the precept of the federal law that says it can co-exist
with state law. The cities (who do this) are not acting in a
democratic way because they are removing the people who voted this
initiative into law."

Komorn said he believes many civil and criminal issues will end up
being worked out in the court system.

The Michigan Department of Community Health states that a person with
a medical marijuana card is permitted to medicate on their personal
property. State law, however, doesn't permit someone to undertake any
task under the influence of marijuana, when doing so would constitute
negligence or professional malpractice. They can't possess marijuana,
or use it medically, in a school bus; on the grounds of any preschool
or primary or secondary school; or in any correctional facility; on
any form of public transportation; or in any public place.
Additionally, whether it's for medical use or not, no one can operate,
navigate, or be in actual physical control of any motor vehicle,
aircraft, or motorboat while under the influence of marijuana.

Fraudulent or illegal use of medical marijuana can result in a $500
fine.

Furthermore, employers are not required to accommodate employees' use
of medical marijuana.

Lawmakers failed to incorporate language regarding use, growth, and
dispensation of medical marijuana within 1,000 feet of a school when
enacting laws to carry out the state's medical marijuana program. If
there is a question about this, it's probably best to check with an
attorney.

The city of Walled Lake is the first municipality in the lakes area to
enact an ordinance regulating the operation of medical marijuana
dispensaries.

Walled Lake City Council voted unanimously to adopt the ordinance at
its Tuesday, July 6 meeting.

"As a municipality we are a creature of the state and must abide by
state law," said Mayor William Roberts. "The ordinance gives police,
administration and council the teeth to operate within state law and
provides local protection."

The ordinance requires a local license to operate a medical marijuana
dispensary within the city and sets certain operating standards.

I think it's a good thing," said Walled Lake Acting Police Chief Paul
Shakinas. "State law doesn't put in a lot of local control. This helps
to close doors to civil litigation. While I'm not in favor of
dispensaries on every corner, the vote of the people wanted this. The
whole point from the city's perspective is to regulate it."

According to City Attorney Vahan Vanerian, drafting an ordinance was
challenging due to the lack of existing precedent regarding
interpretation of Michigan's medical marijuana statute, and there are
limited state resources to draw upon in preparing local ordinances.

"It's unprecedented in Michigan," said Vanerian. "All communities
addressing this are venturing into uncharted waters to try and
regulate it at the local level. Currently, there are no court
decisions applied to the statute in specific cases, and there is a
general lack of consensus among municipal attorneys that don't really
know the scope of permissible local regulation until cases make their
way through the judicial process."

The ordinance drew upon local ordinances in other states which have
medical marijuana laws similar to Michigan's.

The ordinance states that a person shall not engage in the business or
occupation of a medical marijuana dispensary within the city without
first obtaining a license from the city. A license will only be issued
if the dispensary is located in a commercial or industrial zoning district.

The city manager is authorized to issue the license as long as the
applicant meets city guidelines.

A security plan must be in place. A dispensary must provide adequate
security and lighting on site to ensure the safety of persons and
protect the premises from theft at all times. Usable marijuana on
site, when not actively dispensed or transported, must be kept or
stored within a secured, locked enclosure accessible only to
caregivers and/or qualifying patients, as permitted under the state
law.

Other communities have issued moratoriums while they determine what
they want to do about the issue. The Waterford Township Board of
Trustees approved a first

reading of an ordinance at its Monday, July 12 meeting, that would
"give us time to get our ducks in a row" regarding the medicinal
marijuana issue, said Township Supervisor Carl Solden.

Solden said that an ordinance prohibiting medical marijuana would be a
"slap in the face" to the 66 percent of Waterford voters who approved
the medical marijuana ballot issue in 2008.

Bob Vallina, Waterford's director of community planning and
development, said that the township was considering "really kind of
looking at the different types of uses we could be faced with, and
what sorts of zones they would be best applied in."

Vallina said the Planning Commission could eventually decide that all
medical marijuana establishments such as dispensaries, caregivers, and
compassion clubs are prohibited in the community.

"We have to be extremely sensitive in terms of how the federal law
deals with this stuff," Vallina said.

On Tuesday, July 6, the White Lake Township Board of Trustees approved
a 90-day moratorium on medical marijuana approvals and facilities
after receiving several inquiries at the township from people
interested in establishing dispensaries in the township.

"This moratorium will give the township and board time to thoroughly
research and draft an ordinance that we feel is appropriate for the
township," Supervisor Mike Kowall said.

The Planning Commission will look at what other communities are doing,
research the law, and form an ordinance.

Orchard Lake Village council unanimously voted to impose a six-month
moratorium on medical marijuana dispensaries in the city at its June
21 meeting.

Mayor Bruce McIntyre spearheaded the discussion after the city
received several inquiries from proprietors seeking a site for a
dispensary, including one in the Orchard Commons Shopping Center.

Planning Commissioners met on July 6, and the consensus was that the
city should regulate dispensaries; however, commissioners are taking
the time to deliberate on all points.

The Wixom City Council voted on May 11 to impose a six-month
moratorium on allowing medical marijuana dispensaries to open up in
Wixom and referred the issue to the Planning Commission.

The moratorium is intended to give township planners and officials
time to study areas within the township where medical marijuana
facilities might be permissible. It's expected that the Planning
Commission will either draft a final zoning ordinance amendment ready
for approval that specifically outlines areas within the township
where medical marijuana can be legally grown and sold, or determine
that the issue falls under the current land use zoning ordinance in
place.

The West Bloomfield Township Board of Trustees, at its May 17 meeting,
voted by a 4-3 margin to direct the township Planning Commission to
draft language regarding the regulation of dispensing of medical
marijuana in the township.

The motion included a 120-day moratorium for the amendment committee
and asked the planning commission to create a proposal. Trustee Howard
Rosenberg said that sales should occur in a well-regulated private
location with no advertisements, and it should be compassionate and
properly regulated. He added that 70 percent of West Bloomfield voters
said marijuana prescribed properly serves as relief for patients.

"It is our responsibility to make sure dispensing is done in a humane
and responsible way," he said. "We cannot have drive-throughs where
people can pick it up the same way you can get a six-pack of pop."

The Milford Township Board of Trustees voted May 19 to implement a
six-month moratorium, and Township Supervisor Don Green previously
said that the township's Planning Commission will look into creating
zoning districts that would allow such activities, including dispensing.

The township's current zoning and land use ordinances don't address
the proper location of land uses involving medical marijuana because
many of the activities previously were illegal and not permitted in
any zoning classification within the township.

Milford Village passed a six-month moratorium back in June, and
forbids land use for growing and distributing medical marijuana or
allowing schools to provide training on the cultivation, processing,
and distribution.

"This is not a criminal concern, but a land-use one, such as signage
and street entrances near a facility," said Village Manager Arthur
Shufflebarger. "The village is not heading into a direction towards
banning medical marijuana. We're reacting to the state law."

Highland Township officials haven't decided whether to allow
dispensaries in the township.

For now, Township Supervisor Triscia Pilchowski said, the township is
operating under, and respecting, federal law.

Under federal law, marijuana use is illegal, even for medical
uses.