GROWING PAINS: COLORADO'S MEDICAL MARIJUANA INDUSTRY IGNITES

Colorado Scrambles To Manage An Industry Some Say Is Rife With
Abuse

Steamboat Springs -- Kara Rosen is among the more than 100,000 Colorado
residents who have become legal users of marijuana since 2009.

The 32-year-old Hayden resident and cancer survivor has used medical
marijuana every day for about a year. It's the only remedy she's found
to treat pain, digestion problems, nausea, loss of appetite and insomnia.

"I had lung cancer," said Rosen, who owns Air-tech Heat-ing & Sheet
Metal with her husband, Shelby. "I had it surgically removed. I have
to deal with the pain just like other people deal with pain. I just do
it in a different way. And it's not a bad way."

Medical marijuana became legal in Colorado, for patients with certain
conditions and a doctor's recommendation, after nearly 54 percent of
voters approved Amendment 20 in 2000.

Nearly a decade later, Rosen is happy she had that option when
confronting her post-cancer pain.

But Rosen's story isn't typical. The vast majority of Coloradans who
use medical marijuana do so to treat severe pain, not the effects of
cancer, glaucoma, HIV/AIDS and the other preapproved conditions.

For every Rosen, there are many more like Kip Strean.

Although Strean said he uses medical marijuana to relieve chronic back
and shoulder pain, as well as insomnia, the 59-year-old also said he's
been smoking marijuana for about 40 years.

Strean, a musician who has lived in Steamboat Springs since 2000, was
a child of the 1960s. He said marijuana is part of his culture. After
a spring 2009 visit to Amsterdam, known in part for its legalization
of marijuana, he applied for a state-issued medical marijuana registry
card.

"I decided to get the card because I was tired of feeling like I was
doing anything illegal anymore," he said. "I mean, come on, the
acceptance of it today is so much different than it was in the '60s."

In the nine years after it was added to the state constitution,
medical marijuana mostly flew under the radar in Colorado. But a
sequence of events starting in 2009 triggered what has become an
emerging industry, changing the business and social landscape in
Colorado while creating a model for the rest of the country.

Taking root

Some lawmakers, law enforcement officers, state officials and medical
professionals said a surge is taking place in the industry, which was
largely unregulated and rife with abuse before legislation took effect
July 1.

The biggest problem, they say, is approved medical marijuana users
defrauding the system to smoke pot recreationally.

"Anybody who doesn't think there's abuse going on has to be pretty
naive. We don't have 108,000 people with debilitating medical
conditions," Colorado Attorney General John Suthers said in August,
referring to an earlier estimate of the number of approved medical
marijuana cardholders.

Some Routt County dispensary owners acknowledge the willingness of
some to take advantage of the system.

"I would say over 50 percent of cardholders use recreationally -- a lot
for pain management or as a stress reducer," said Chris Ward, whose
Milner medical marijuana center has a Hawaiian theme to reflect his
upbringing on the island of Kauai.

A 'perfect storm'

Colorado is one of 14 states with legislation making the use of
medical marijuana legal. California came first in 1996. Earlier this
year, Washington, D.C., approved it.

After Colorado voters approved Amendment 20, the state's constitution
was amended to allow the use of medical marijuana for eight
debilitating conditions: cancer, glaucoma, HIV/AIDS, cachexia
(physical wasting away though weight loss and muscle atrophy), severe
pain, severe nausea, seizures and persistent muscle spasms.

Several events last year created what Ned Calonge, the state's chief
medical officer, called a "perfect storm" for medical marijuana in
Colorado.

First, U.S. Attorney General Eric Holder said in March 2009 that
federal raids of medical marijuana dispensaries would stop. Then, the
Colorado Board of Health chose not to impose a limit on the number of
patients a medical marijuana provider, called a caregiver, could have.
And finally, the U.S. Justice De--part-ment sent a memo to prosecutors
in October 2009 instructing them to not use federal resources against
people in compliance with state medical marijuana laws.

The industry quickly took off. There were 4,720 Colorado cardholders
by the end of 2008. As of Aug. 31, that number had swelled to an
estimated 113,000, according to the Colorado Department of Public
Health and Environment. The agency is charged with overseeing the
state's Med--ical Mari---juana Reg--istry. The estimate is based on
the volume of applications the registry receives.

Coinciding with the exploding number of approved marijuana users,
state officials once estimated that 1,100 medical marijuana centers
operated in the state. A stretch of South Broadway Street in Denver,
for example, is referred to as "The Green Mile" or "Broadsterdam" for
the many medical marijuana centers there, some next door to or across
the street from each other.

"We never imagined that the surge would be so high or would be
sustained for so many months," Calonge said in a telephone interview.
"All these elements came together and gave birth to this industry."

Routt County, with a population of 23,500, has five medical marijuana
centers -- a sixth in Yampa has closed. Steamboat, with more than
12,000 residents, is home to three of them. The number of pharmacies
in the county outnumbers medical marijuana centers by one.

Registry overwhelmed

In a Colorado Department of Public Health and Environ-ment office
building in Denver, U.S. Postal Service boxes sit stacked on shelves
in the new mailroom of the Office of Vital Statistics Medical
Marijuana Registry.

Ron Hyman, the Colorado registrar and director of the Medical
Marijuana Registry office in Denver, estimated in August that more
than 30,000 medical marijuana card applications sat unopened in those
boxes. Another batch of applications -- an additional 30,000 or more --
had just been sent for data entry to Integrated Doc-ument Solutions in
Pueblo, part of Colo-rado's Depart-ment of Person-nel and
Admin-istration.

Hyman said those applications were opened and each $90 application fee
was deposited. But because the applications haven't been processed,
medical marijuana registry cards haven't been issued.

"I believe today we are mailing out cards for applications we received
in early January," he said Aug. 20.

The lack of cards doesn't prevent users from being able to possess and
smoke marijuana or use marijuana products. Patients use copies of the
notarized application, physician authorization, photo identification
and registered mail receipt as their temporary medical marijuana
cards. The permanent cards -- pieces of white paper outlined in red
that resemble a sales tax license -- take as long as nine months to
process. Cardholders must renew their licenses every year.

The Office of Vital Statistics receives about 1,000 pieces of
medical-marijuana-related mail daily, of which about 500 applications
are approved, about 250 are incomplete and returned and about 250 are
information changes for people already on the registry. Hyman said the
volume of mail overwhelmed the office's mailroom. So the Medical
Marijuana Registry got its own.

The office also processes birth and death certificates and marriage
licenses. Hyman estimated that "well over 80 percent" of his job was
dedicated solely to the Medical Marijuana Registry during the past
year.

Thousands of other pieces of unopened mail from patients on the
registry wanting to update information won't be processed until after
Hyman's staff catches up on the application backlog. He's been given
the go-ahead to triple his staff, to 33 employees, after a
supplemental budget request he made in June was approved.

"In 2008, the entire year, I had 5,000 patients," Hyman said. "Now I
get that in a week. One person could easily handle the registry on
their own from start to finish" in 2008.

A chronic debate

Dr. Brian Harrington, a physician with Yampa Valley Medical Associates
in Steamboat, says the abuse and misuse of medical marijuana
undermines the legitimacy and reasons for it.

Because of the medical marijuana registry backlog, only 41,039
patients -- 292 in Routt County -- are listed as being approved for
medical marijuana as of Dec. 31, 2009, in the statistics section of
the registry website. Of those patients, 92 percent cite severe pain
for at least one qualifying debilitating condition. Patients can list
more than one.

Muscle spasms, cited on 29 percent of applications, are the second
most frequently reported condition. Cancer accounts for 2 percent, and
glaucoma and HIV/AIDS were cited on 1 percent of applications.

Harrington said he has never recommended the use of medical marijuana
but has discussed it with patients because he recognizes that it could
have medical value for the right person. He also said the severe pain
condition has opened the door for recreational users.

"Heroin takes care of pain," he said while sitting in an exam room at
his office. "Just to say marijuana takes care of pain is not a good
argument."

Brian Vicente, executive director of Sensible Colorado, an advocate
for the state's medical marijuana patients, disagrees that a majority
of patients are citing severe pain simply as an excuse to use
marijuana recreationally.

"There's a lot of people in an active state like Colorado that suffer
from chronic pain related to biking injuries, skiing injuries," he
said in August at his Denver office. "If they and their doctor feel
it's better to use marijuana than hydrocodone or OxyContin as a better
treatment regimen, I think we have to respect that."

Registered nurse Shannon Winegarner, the director of hospice and
palliative care for the Northwest Colorado Visiting Nurse Association,
said her organization supports the use of medical marijuana for its
end-of-life patients because it is a legal medication defined by the
state constitution.

"In my experience working with terminally ill patients, I have
definitely seen people using marijuana to effectively manage symptoms
that were not managed by other treatments," she said about patients
suffering from nausea, anxiety and weight loss.

"Our primary goal in hospice is to manage comfort -- quality of life
versus quantity of life. We don't discriminate on the choice of
medications."

Determining legitimacy

Hyman, who runs the Medical Marijuana Registry, doesn't think all
patients approved for medical marijuana have legitimate medical needs.
But in the decade he's run the program -- and especially during the
past year -- Hyman said he's spoken with many patients who have said
medical marijuana has had a tremendous impact on their lives.

"For these individuals, it's imperative we maintain the integrity of
the program and reduce abuses," he said. "If the public loses
confidence, it hurts the integrity of the program. I think it's
imperative we have this avenue available for patients who need it."

That so many have been approved to use medical marijuana indicates the
industry is growing, Attorney General Suthers said, but he added that
there's not much integrity to the process of determining debilitating
medical conditions.

"About 75 percent of the patients are males," he said. "The average
age (currently 40) is dropping precipitously. I would predict to you
in a couple years the average age of a patient will be 24, 25,
something like that."

Charish Adams, 30, tried medical marijuana after injuring her back in
May while trying to move furniture at her Hayden home. The medications
doctors prescribed were ineffective. It's not that they didn't work;
Adams couldn't keep them down.

She was diagnosed in 2009 with gastroesophageal reflux disease, or
chronic acid reflux disease, after vomiting nearly every morning for
10 years. Adams, the mother of a 10-year-old boy, joked that during
that time, she constantly thought she was pregnant.

Knowing she couldn't take pills -- she couldn't even keep Advil down --
Adams first visited a chiropractor and acupuncturist to relieve her
back pain.

Nothing worked, she said. Having used marijuana in the past, Adams
thought she would give it a try. In June, she went to Mary's, a
medical marijuana center in Oak Creek.

Through her visits to Mary's, she discovered tinctures -- an alcohol-
or glycerin-based liquid extract typically made from dried marijuana --
and started taking an eyedropper full about once a week for her acid
reflux. She hasn't vomited since June.

"What it does is it stops the acid, it settles my stomach and doesn't
allow it to come back up," Adams said. "I'd recommend it to anybody
with nausea problems, headaches, usually anything that goes with being
sick."

Medicine vs. drug

Harrington, the Steamboat physician, struggles with the idea of
marijuana as medicine. It's listed as a Schedule 1 controlled
substance by the federal government.

Under the Controlled Sub-stances Act, marijuana is categorized with
drugs including heroin and LSD. The Act states that Schedule 1
controlled substances have a high potential for abuse and have no
"currently accepted medical use" in treatments in the United States.

Harrington said there's a conflict between the medicinal value of
marijuana and its health risks if it's smoked, which the U.S. Food and
Drug Administration has never approved as a medical delivery method.

He says marijuana is habit-forming, has been linked to respiratory
problems if smoked and can cause a decline in cognitive function and
increase anxiety.

"I do think the health benefits of marijuana are well-overplayed," he
said.

But Harrington acknowledged that ingesting marijuana, if used as a
medicine, makes more sense than smoking it. He mentioned Marinol, an
FDA-approved pill form of synthetic delta-9-tetrahydrocannabinol, or
THC, thought to be the active ingredient in marijuana.

After surgery for her lung cancer, Kara Rosen experienced pain from
the muscles doctors sliced through and ribs they fractured to get to
her lung. The medications her doctors prescribed contributed to or
exacerbated her digestion problems, nausea, loss of appetite and insomnia.

She got a recommendation from a Denver doctor and was approved for a
medical marijuana card. She found that medical marijuana was the only
thing that worked for her pain and other post-cancer ailments. But she
rarely smokes it. Instead, she drinks teas or eats cookies infused
with marijuana.

Infused products, a burgeoning portion of the state's medical
marijuana industry, are becoming more common and popular among
patients, center owners said.

At 61, Jacob Wise, who owns Mary's in Oak Creek, calls himself an old
hippie. He is a civil engineer by trade, lost millions as a real
estate developer when the industry went south and has counseled
cocaine addicts as a minister certified in three religions. Owning a
medical marijuana center was another venture.

When he opened his business, Wise said, he thought the industry was a
scam, a way for recreational users to smoke legally. But the 42-year
recreational and medical marijuana user said he's seen improvement in
his patients.

Wise is pushing tinctures, which he makes, for patients like Charish
Adams. He also treats seven cancer patients with them.

"I'm going after the tincture business because I see it more as a
medical application," he said. "The other business is bigger right
now, but eventually tinctures will be more popular. Tinctures don't
give the euphoric feeling. People smoke pot for the rose glass
syndrome -- 'I feel good. Everything's purty.'"

Regulating the medicine

Calonge, the state's chief medical officer, said the rapid growth of
medical marijuana in Colorado led to fraudulent, substandard care from
doctors who charged fees to sign medical marijuana recommendations for
patients they saw via webcam or met at a medical marijuana center.

He called those evaluations and that care "recreational use
masquerading as a medical program."

In the spring, Colorado lawmakers began discussing two pieces of
legislation aimed at governing the industry for the first time. Senate
Bill 109 was created to regulate the medical side of the industry and,
among other provisions, precludes doctors from having any financial
relationships with medical marijuana centers.

House Bill 1284 was created to regulate the business side of the
medical marijuana industry. Among its many provisions, it forces
medical marijuana center owners to undergo criminal background checks
and forbids their ownership if they've been convicted of a
drug-related felony.

Colorado Gov. Bill Ritter signed both pieces of legislation into law
in June. They took effect July 1.

Calonge said Senate Bill 109 was intended to reduce some of the
fraudulent actions by doctors that had become commonplace.

"I believe if we're going to call it medical marijuana, we have to
hold it to the same standards as all medical care," he said.

"We believe (Senate Bill 109) is the first step to really put it back
in the medical realm from the recreational-use realm and, we believe,
more in line with what people voted when they voted for Amendment 20."

House Bill 1284 has been called a significant piece of legislation
that could become a model for the rest of the country.

Vicente, executive director of Sensible Colorado, who is not a medical
marijuana cardholder ("I don't have a qualifying condition," he said.)
called House Bill 1284 a landmark piece of legislation. He said it was
a major step forward in legitimizing centers as safe access facilities
for medical marijuana. But Vicente said the legislation has issues
that he hopes to work through with legislators this session.

Despite the concerns, he said Colorado's medical marijuana has become
a legitimate business in the past year.

"We do have a constitutional amendment and a state law in the Colorado
Revised Statutes that regulate this industry," Vicente said. "I think
it is legitimate, and I think it's going to continue being one of the
few growing areas of our economy, at least for the immediate future."