MEDICAL MARIJUANA: CONVERTS AND CRITICS

Gallatin County has the second-highest number of registered medical
marijuana patients in Montana. Who are they, where do they get it,
and how will changes at the state and local levels affect them?

Every night, Boyd Nelson is jarred awake by the sound of his wife
Bonita's scream.

Her cry of pain, usually occurring around midnight or 1 a.m., alerts
him it's time to get up and fix Bonita's medicine, a tea made from
ground marijuana. After boiling water and the marijuana together in a
pan, he strains it and adds a bit of milk and honey to cut the bitterness.

Since the 87-year-old Bonita suffered a debilitating stroke that
caused severe nerve damage to her left side three years ago, Boyd has
become her caretaker. In addition to preparing her tea, which she
needs to drink every five to eight hours, he has assumed most of the
household responsibilities, with help from their son, John. A former
farmer, Boyd, also 87, still hays his Manhattan fields every summer,
a job that requires about a week of 12-hour days outside.

Although she is now basically homebound and has limited mobility on
her left side, Bonita and Boyd said that before she started using
marijuana in April, her health was much worse. Even morphine wouldn't
break the grip of her pain, which is still audible in her faint,
wavering voice.

"It really helped her," Boyd said. "It's just been a godsend."

Bonita Nelson is one of thousands of Montanans - almost 20,000,
according to the Montana Department of Public Health and Human
Services - who has legally registered to use marijuana. In 2004,
Montana voters easily passed an initiative allowing "certain patients
with specific medical conditions" to use marijuana to alleviate their symptoms.

In the year after the law took effect, 112 people registered with the
state and obtained "green cards," allowing them to purchase, possess
and use a limited amount of marijuana at any given time.

But since fall 2009, when the Obama administration announced it would
not actively investigate or prosecute people using medical marijuana
in states where it was legal, the number of people allowed to use pot
in Montana has exploded. From the start of 2009 to July 1 of this
year, about 14,000 patients were added to the state's registry.

The effects of the federal decision have been especially pronounced
in Gallatin County.

Although it is the third-largest county in the state, with a
population of about 89,000, Gallatin County has the second-highest
number of medical marijuana patients at 2,729. That's just below
Missoula County, which has 2,924 patients out of 107,000 residents.

With about 3 percent of the population holding green cards, Gallatin
County far outpaces Yellowstone County, the largest county in the
state, which has 1,942 registered users out of 142,000 people, about
1.4 percent.

Towns and cities within the county have been grappling with how to
address the influx of growers, storefronts and the accompanying
questions of abuse that these numbers have produced. In Helena, a
special legislative committee is discussing potential changes to the
law, including a licensing system for caregivers and more specific
recommendation standards for doctors.

The city of Bozeman recently drafted an ordinance to cap the number
of medical marijuana providers within the city limits to 32. Two
weeks ago, the Belgrade City Council voted to ban the businesses
altogether, as did the Manhattan Town Council.

Whatever new rules the Legislature passes at its next session in
2011, the changes are likely to have a profound effect in Gallatin
County, on the patients, caregivers and medical providers who
recommend medical marijuana, and on local governments working to
address the issue.

WHO'S USING IT

For most of her life, Jehnet Carlson's exertion-induced asthma was
manageable, albeit with careful monitoring and an oral steroid
regimen. But in 2007, a bad case of the flu landed Carlson in the
hospital, where she would return several times a year over the next
three years.

"After that, my lungs just never recovered," she said.

The 58-year-old, who is also a diabetic, said she developed severe
anxiety about suffering an asthma attack while working on her Dry
Creek ranch, away from her husband or other help. Combined with the
chronic pain associated with the neuropathy she developed after so
many years of taking steroids, "I became a couch potato," she said.

But medical marijuana changed that. Though her doctors were unsure
how she would react to the drug, Carlson went to a registration
clinic at a local hotel last fall. She uses a both a tincture - an
acidized, liquid version of the drug - and a vaporizer to take her marijuana.

"You don't get high," she said. "You don't get the head rush."

Carlson said she experiences no side effects from the drug, and has
lost about 40 pounds that she gained while using the steroids.

She said her doctors approve of her choice of medicine, as long as
it's working.

Carlson hasn't been hospitalized for nearly a year. In addition, her
anxiety is now controlled without the use of anti-depressants, and
she has returned to a limited level of strenuous work around the ranch.

"Was it coincidence?" she said on a recent sunny day, referring to
the improvement in her symptoms since she started using marijuana. "I
don't think so."

Several local caregivers say the bulk of their patients are people
like Carlson: middle-age, with chronic illnesses and little or no
prior use of marijuana.

"A majority of my patients are 50-plus," said Valerie Sigler, owner
of Big Sky Patient Care in Four Corners.

She cited cancer, Parkinson's disease and multiple sclerosis as
common diagnoses. Her employees, all licensed caregivers, also see
quite a few people with chronic pain complaints.

Sigler said her business is largely set up around the premise of
providing quality care to these types of patients, who may be
uncomfortable or scared about obtaining marijuana. She operates out
of a former veterinary clinic, which has "a medical feel" with its
private rooms and separate lab area.

"Patients tell us there's a lot of anxiety about trying to find their
medicine," she said. "This kind of setup makes them feel more comfortable."

The most recent data available shows the average age of Montana's
medical pot user is 41, according to DPHHS. Those ages 51 to 60 years
old make up the second-largest share of the total, with 4,300 people,
or 22 percent.

However, the largest group of patients, 25 percent of the total, are
between 21 and 30; 5,000 people in this age group use medical marijuana.

The state said it doesn't track demographics of users by county, but
Buck Taylor, director of Community Health Partners Bozeman, said the
21-to-30 figure makes sense, given the makeup of Gallatin County's
population and what many criticize as overly lax guidelines for
getting a green card.

"Demographically, Gallatin County is a very young population. I think
the word has gotten out like wildfire that it's pretty easy to get
your card. If they were maybe using marijuana recreationally and
maybe worried about the implications about the legality ..." Taylor
said, his voice trailing off.

Then he continued, "It certainly seems like people can get their card
for any number of medical complaints."

In a request for participation in this article, several people in
their 20s responded, but did not wish to be named to avoid judgment
by peers or employers or, in one case, possible legal repercussions.

WHO'S RECOMMENDING IT

The most high-profile group working to register new patients is the
Missoula-based Montana Caregivers Network, headed by Jason Christ.

Just last month, the organization, known for registering hundreds of
patients at its traveling clinics, decided to discontinue its
"cannabis caravan" practice. MCN has been criticized by many,
including the Montana Board of Medical Examiners, for bringing in
out-of-state doctors who spend only a limited amount of time with
potential patients before recommending medical marijuana.

Chris Arneson, MCN's public information officer, said the group set
out to fill a void created by the unwillingness of Montana doctors to
write recommendations.

With the end of the clinics, MCN plans to set up permanent locations
in several communities, including Bozeman. It also holds
teleconferencing clinics, where patients use the Internet to speak
with a doctor based in another state.

"The business model has changed," he said. "We can serve our patients
better if we have a true clinic type setting."

Arneson said there were "no doctors in Bozeman that we know of" who
write recommendations for medical marijuana. "Most hospitals have a
policy against primary care physicians or pain management specialists
who are allowed to prescribe medical marijuana. Essentially, DPHHS
has figures that 95 percent of doctors in Montana won't prescribe
medical marijuana."

The Bozeman Clinic has a policy of not recommending medical
marijuana, but not Bozeman Deaconess Hospital, said Connie Martin,
the hospital's director of marketing and communications.

"There is no written policy for or against medical marijuana," she
said. "Our doctors are allowed to practice within the limits of state
and federal laws to provide the best quality care for patients."

Dr. Kathryn Borgenicht, who practices internal and palliative
medicine at BDH, is one doctor who will recommend medical marijuana
"in very specific situations," she said.

"I do a complete evaluation of a patient, then they have a follow-up
with either myself or someone in my office," she said.

She has found that some of her patients undergoing chemotherapy
experience fewer side effects if they use marijuana. She will also
consider recommending it for patients undergoing end-of-life care who
have "persistent" pain.

"For some of these people, medical marijuana has fewer side effects
than opiate options," she said.

But it is overused, she said, and a lack of solid scientific research
on the medicinal properties probably makes other physicians
uncomfortable with it. The industry also needs more regulation.

"I think it would be helpful if there were some good guidelines to
follow for physicians," she said.

Bonita Nelson's primary care doctor wrote her a recommendation, but
she declined to name him.

Some doctors in private or group practices are afraid of becoming
known as "the pot doctor," said Charles "Stonewall" Thomas, who
operates Honest John's Farmacy in Belgrade, the only storefront
dispensary in the city.

Thomas said he prescreens people before helping them set up
appointments with physicians. He also refers patients to Premier
Networking in Four Corners, which uses Skype, an Internet
video-networking site, to facilitate appointments between patients
and out-of-state doctors.

Thomas said he has turned people away for not having medical records,
including some "young people with back pain," he said.

"There's people out there who want the medicine for the wrong
reasons," he said. "They were not the type of client we wanted."

WHAT THE GOVERNMENTS ARE DOING

The issue of how to regulate medical marijuana within municipal
boundaries has been heavily discussed in recent months by the
governments of Bozeman, Belgrade, Manhattan, Three Forks and West Yellowstone.

Citing a reluctance to have a "Main Street full of marijuana,"
Belgrade officials passed one of the more restrictive ordinances.
Growing, selling or distributing marijuana is banned within city
limits, but caregivers with a valid city business license may still
deliver to their patients with a valid city business license, said
Mayor Russ Nelson. Patients are still allowed to grow their own
plants in their homes.

Manhattan also recently passed a ban on commercial medical marijuana
operations within city limits. Three Forks and West Yellowstone are
still working on their regulations, but Three Forks Mayor Gene
Townsend and West Yellowstone Town Manager Jamie Greene said they are
studying Bozeman's recent effort to cap the number of businesses
within city limits, as well as require facility inspections and
prohibit smoking in public.

Townsend said that while public meetings on the matter have drawn
proponents of a ban like Belgrade's, he doesn't think it's a good
idea to "zone them out of business." There are currently no
dispensaries or grow operations licensed in Three Forks.

"Instead of pushing it out in the county, or pushing it underground,
do you at least try to come up with an ordinance where you can
inspect them, have police inspect them and regulate them?" he said.
"The legitimate people will step up to the plate and make it right,
and hopefully the people who aren't will get out of the business or
get out of town."

Townsend, like the other government officials interviewed, said he
wished the state had done a better job of clarifying the law before
it reached the local level.

"It's really throwing the cities and towns into a loop," he said.

The Gallatin County Commission has no plans to address the issue,
said Commissioner Steve White.

"It's really important to understand that quite a bit of the county
is already zoned," he said.

For instance, Four Corners - where some grow operations have set up
shop to avoid Bozeman's new regulations - already has zoning in
place, and medical marijuana is an allowed use.

And no Four Corners' residents have asked to change that, White said.

"The solution really is in Helena," he said. "This was something the
people voted for. We can only do the things the Legislature gives us
power to do.

"You still have to provide the opportunity for legal businesses to
operate. You've got to allow it, you've just got to figure out where."

For their part, both Sigler and Thomas said they support some of the
changes to the law being batted around in Helena, like establishing a
licensing process for caregivers.

"Everyone just wants to know what to do," Sigler said.

But the most fundamental change, she said, must come with doctors
being more willing to recommend marijuana for their patients.

"Some of the alternatives have gotten out of hand, like those
traveling clinics," she said. "(But) there's a bottleneck because
there are not enough doctors to write recommendations. In a perfect
world, their doctors will do it for them. We need to educate doctors
so they're not afraid to write them."

Sigler said she is encouraging Big Sky Patient Care's patients-she
has about 200-to register to vote and get involved in the political discussion.

"Patients need to understand that this is a fragile system for them," she said.

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By the numbers

19,635 registered medical marijuana patients in Montana 12,381 new
in 2010 2,729 registered users in Gallatin County, second only to
Missoula County 3,940 registered caregivers in Montana 538
registered caregivers in Gallatin County, third behind Flathead and
Missoula counties

- - Compiled by Jack Sorensen

Sources include the Montana Department of Public Health and Human
Service and the Montana Medical Marijuana Program.