MEDICAL MARIJUANA WINS OVER VOTERS - WHAT NOW?

Would-be patients hoping to get some medical marijuana now that
voters have approved the law should not hold their breath.

State Health Director Will Humble said Monday Proposition 203 gives
his agency 120 days from the time the election results are certified
- -- now set for Nov. 29 -- to come up with the rules and regulations
of how the system will operate.

Theoretically, he said, that should allow doctors to begin writing
the legally required recommendations for patients in early April. But
Humble said they may not have any place to purchase their drugs, at
least not legally.

At the end of that 120 days, Humble said his agency has to start
reviewing what he expects to be hundreds of applications by groups
that want to operate one or more of the marijuana dispensaries around
the state. And, by law, he's currently allowed to give permits to
only 125 of them.

Humble said he probably will screen each of the applications to check
their plans for operations and security and award the licenses to
only the most qualified. The alternative, he said, is a simple
lottery process -- something he does not favor.

Even that, however, doesn't get the process started: He said each
dispensary needs time to get up and running.

"And remember, they've got to get their cultivation facility up and
running so they have an inventory that's legitimate," he said.

"I don't want this to be inventory that comes off the street or from
Mexico or something," Humble said. "This has got to be from
cultivation facilities inside the state."

He figures it could be sometime next summer, if not the fall of 2011,
before the plants are legally grown, harvested and ready for sale.

But Andrew Myers, the campaign manager for Prop. 203, said patients
may not have to wait that long. He said the measure allows those who
are at least 25 miles from a state-regulated dispensary to do their
own cultivation.

"Patients will be given I.D. cards before dispensaries will be
licensed," he said. "So, at the outset, the first batch of patients
are all going to be able to grow, for a year, until their renewal comes up."

Humble, though, said he's still researching that question.

More complex, he said, will be everything else to make the system
work. Humble said there needs to be a secure computer system to track
the drugs and the users.

On the front end, he said there needs to be an inventory system to
ensure that everything that starts out as seeds in a legal
cultivation facility winds up being sold through a legal dispensary,
and only to a legitimate cardholder.

"That's not as simple as it might sound on the surface," he said.

"When they grow the plants, they weight different amounts at
different times," Humble said.

"And there's a drying period," he continued. "So part of that weight
was water weight."

He said dispensaries need round-the-clock access to the database of
patients who have state-issued cards to verify that person is
entitled to purchase marijuana. More to the point, the system will
keep cardholders from buying more than 2 1/2 ounces every two weeks,
the limit in the new law.

Finally, law enforcement needs the same access to determine whether
the person they stopped is entitled to have that bag of marijuana.

Of greater concern, Humble said, is keeping some doctors from
becoming the kind of "recommendation mills" he said have popped up in
Colorado. The health director said he wants to spell out what sort of
doctor-patient relationship has to exist before a physician can write
such a recommendation.

"If we have a loose interpretation of what a doctor-patient
relationship is ... then you could end up with situations like they
have in Colorado where folks are walking into a doctor's office for a
15-minute appointment and $150 bucks on the barrel head, they're
walking away with a recommendation," Humble said.

At the very least, Humble said, he wants some assurance that doctors
have discussed alternative to marijuana for their patients,
particularly those who say they need the drug for "severe and chronic
pain," one of the conditions that lets a doctor write a
recommendation. He said that should include biofeedback and
acupuncture, where there is peer-reviewed evidence both actually work.

"Chronic pain is very difficult to measure," Humble said, which is
one reason he opposed the initiative in the first place. And that, he
said, provides an opportunity for abuse.

In Colorado, he said, more than 90 percent of cardholders get them
for chronic pain.

"The majority of those cardholders are guys in their 20s and 30s," Humble said.

"I'm not saying none of them are in chronic pain," he continued. But
Humble said that condition becomes a "gateway" into Colorado's system.

"I want to make sure we have some checks and balances in the system
to make sure they are in a true doctor relationship, that they've
truly evaluated that patient, that they truly think marijuana is the
mechanism that they want to use for managing that patient, and
they've talked with that patient about the various alternative
treatments that they may have access to," he said.