MEDICAL

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MEDICAL MARIJUANA
THE TRUTH ABOUT MEDICAL MARIJUANA AND ITS ABUSE
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November 2000 Colorado voters approved Amendment
20, allowing the medical use of marijuana for
people suffering from debilitating medical
conditions. The Amendment allows a physician to
write a recommendation for a patient authorizing
her or him to possess six plants and 2 ounces of
marijuana (or more if medically needed).
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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Physicians Statement

• The above-named patient has been diagnosed with
  and is currently undergoing treatment for the
  following chronic debilitating medical condition
• 1. Cancer
• 2. Glaucoma
• 3. HIV or AIDS positive
• A medical condition or treatment that produces,
  for this patient, one or more of the following
  and which, in the physicians professional
  opinion, may be alleviated by the medical use of
  marijuana.
• 4. Cachexia
• 5. Severe pain
• 6. Severe nausea
• 7. Seizures (including those characteristic of
  epilepsy)
• 8. Persistent muscle spasms (including those
  characteristic of multiple sclerosis)

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Physicians Statement

• I hereby certify that I am a physician duly
  licensed in good standing to practice medicine in
  Colorado, and that I have a bonafide
  physician-patient relationship with the
  above-named patient. I have assessed this
  patients medical history and current medical
  condition, and I conclude that this patient may
  benefit from the medical use of marijuana. This
  assessment is not a prescription for the use of
  marijuana.

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The Amendment also allows the patient to
designate a Primary Care-giver to provide the
marijuana. Primary Care-giver means a person
other than the patient and the patients
physician, who is 18 years of age or older and
has significant responsibility for managing the
well-being of a patient who has a debilitating
medical condition.
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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June 2001 The Colorado Department of Public
Health and Environment began accepting
applications for the Medical Marijuana Registry.
The applicant is required to send the doctors
recommendation, an application and 90 to the
Health Department and then receives a certificate
that is valid for one year.
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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Medical Marijuana Certificate
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November 2004 The Health Department created a
guideline that a primary care-giver could only
provide marijuana for up to five patients after
concerns arose about care-givers claiming to
provide for hundreds of patients. At that time
there were 512 patients listed on the Registry.
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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• November 2006
• Colorado voters rejected Amendment 44 by a 61-38
  percent margin, which would have allowed adults
  to legally possess one ounce of marijuana.

20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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July 2007 A Denver District Judge overruled the
five patient per care-giver guideline because it
had not been made using the proper public
process. There were 1350 patients on the
Registry at that time.
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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February 2008 The first medical marijuana
dispensary was issued a Sales and Use Tax License
in Fort Collins.
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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March 2009 The Obama administration stated that
federal resources should not be used to prosecute
people who were in clear and unambiguous
compliance with existing state laws providing for
the medical use of marijuana. There were about
5000 patients on the Registry at that time. 3
dispensaries in Fort Collins
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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Federal Law

• Marijuana remains a Schedule I drug under federal
  law.
• A drug is included in schedule I, the most
  restrictive schedule, if it "has a high potential
  for abuse," "has no currently accepted medical
  use in treatment in the United States," and has
  "a lack of accepted safety for use under medical
  supervision." 21 U.S.C. 812(b)(1)(A)-(C)

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July 2009 The Board of Health held a hearing to
establish rules regarding the Medical Marijuana
Program. The Board decided not to re-establish
the proposed five patient rule and defined
significant responsibility for managing the
well-being of a patient to include simply
providing marijuana. 10,000 patients on the
Registry. 10 dispensaries in Fort Collins
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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Role of the Care-giver

• Significant responsibility for managing the
  well-being of a patient means assisting a
  patient with daily activities, including but not
  limited to transportation or housekeeping or meal
  preparation or shopping or making any necessary
  arrangement for access to medical care or
  services or provision of medical marijuana.

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October 2009 The Colorado Court of Appeals ruled
that to qualify as a Primary Care-giver a
person must do more to manage the well being of a
patient who has a debilitating condition than
merely supply marijuana. 20 dispensaries in Fort
Collins
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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November 2009 The Board of Health held an
emergency meeting and changed their definition of
significant responsibility for managing the
well-being of a patient in reaction to the
Courts ruling. The change was again overruled
by the Denver District Judge. 29 Dispensaries
in Fort Collins
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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November 2009 The Medical Marijuana Registry
surpassed 21,000 patients, and 600 applications
are received per day. About 10 of the
registered patients live in Larimer County.
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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December 11, 2009 A moratorium passed by the
Fort Collins City Council took effect. By that
time there were 108 sales tax licenses issued to
dispensaries in Fort Collins. The moratorium will
remain in effect until March 31, 2010.
20,000
15,000
10,000
5000
Patients on the Registry
2001 2002 2003 2004
2005 2006 2007 2008 2009
2010
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Amendment 20

• No patient shall Engage in the medical use of
  marijuana in a way that endangers the health or
  well-being of any person or engage in the
  medical use of marijuana in plain view of, or in
  a place open to, the general public.

CO Amendment 0-4-287 Article XVIII
Miscellaneous Art. Section 14(5a) I, II
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Amendment 20

• No governmental, private, or any other health
  insurance provider shall be required to be liable
  for any claim for reimbursement for the medical
  use of marijuana.
•      
• Nothing in this section shall require any
  employer to accommodate the medical use of
  marijuana in any work place.

CO Amendment 0-4-287 Article XVIII
Miscellaneous Art. Section 14(10a, 10b)
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Medical Marijuana Abuses

• Some physicians are making recommendations for
  people who do not have legitimate debilitating
  medical conditions.
• Large retail dispensaries do not meet the
  intended meaning of Primary Care-giver.
• Large quantities of marijuana are being produced
  and there is no control over where it is
  distributed.
• Marijuana produced under the protection of
  Amendment 20 is being sold illegally on the
  street.
• There is a huge profit potential in growing and
  selling marijuana.

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Marijuana Dispensaries

• The Colorado Medical Marijuana amendment,
  statutes and regulations are silent on the issue
  of dispensaries. While the Registry is aware that
  a number of such businesses have been established
  across the state, we do not have a formal
  relationship with them.
• www.cdphe.state.co.us/hs/medicalmarijuana/

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Marijuana Dispensaries

• The Registry does not license dispensaries.
• The Registry does not have a list of
  dispensaries.
• There are no regulations regarding dispensaries.
• The Registry is unable to assist with complaints
  regarding dispensaries.
• The Registry has no information on how to
  establish/operate a dispensary.
• There may be local ordinances that might impact
  the operation of a dispensary.
• www.cdphe.state.co.us/hs/medicalmarijuana/

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Marijuana Dispensaries
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Marijuana Dispensaries

• Dispensaries must meet the requirements of a
  Primary Care-giver. Growers and wholesalers are
  not defined or protected.
• There are no regulations pertaining to
  Dispensaries
• No required qualifications or background checks
  for operators
• No requirement to disclose that marijuana is
  being sold
• No location restrictions under state law
• No restrictions on hours of operation
• No restrictions on marijuana use on site
• No restrictions on signage or advertising
• No controls on marijuana food products

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Indoor Process

• You control the environment
• You can harvest all year long in cycles
• You can grow in hidden areas
• You can create a high Delta 9 THC
• You can make
• high profits

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Hydroponics
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Outdoor Marijuana Grow
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Outdoor Marijuana Grow
Larger, more plentiful plants, typically with
higher THC levels than most indoor grows with
artificial light.
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• Enforcement
• Challenges

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Confidentiality

• No person shall be permitted to gain access to
  any information about patients in the state
  health agency's confidential registry, or any
  information otherwise maintained by the state
  health agency about physicians and primary
  care-givers, except for authorized employees of
  the state health agency in the course of their
  official duties and authorized employees of state
  or local law enforcement agencies which have
  stopped or arrested a person who claims to be
  engaged in the medical use of marijuana and in
  possession of a registry identification card or
  its functional equivalent, pursuant to paragraph
  (e) of this subsection (3).

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Confidentiality

• Authorized employees of state or local law
  enforcement agencies shall be granted access to
  the information contained within the state health
  agency's confidential registry only for the
  purpose of verifying that an individual who has
  presented a registry identification card to a
  state or local law enforcement official is
  lawfully in possession of such card.

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Return of Seized Evidence

• Any property interest that is possessed, owned,
  or used in connection with the medical use of
  marijuana or acts incidental to such use, shall
  not be harmed, neglected, injured, or destroyed
  while in the possession of state or local law
  enforcement officials where such property has
  been seized in connection with the claimed
  medical use of marijuana. Any such property
  interest shall not be forfeited under any
  provision of state law providing for the
  forfeiture of property other than as a sentence
  imposed after conviction of a criminal offense or
  entry of a plea of guilty to such offense.

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Return of Seized Evidence

• Marijuana and paraphernalia seized by state or
  local law enforcement officials from a patient or
  primary care-giver in connection with the claimed
  medical use of marijuana shall be returned
  immediately upon the determination of the
  district attorney or his or her designee that the
  patient or primary care-giver is entitled to the
  protection contained in this section as may be
  evidenced, for example, by a decision not to
  prosecute, the dismissal of charges, or
  acquittal.

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Penalty for Information Release

• 18-18-406.3. Medical use of marijuana by persons
  diagnosed with debilitating medical conditions -
  unlawful acts
• (5) Any person including, but not limited to, any
  officer, employee, or agent of the department, or
  any officer, employee, or agent of any state or
  local law enforcement agency, who releases or
  makes public any confidential record or any
  confidential information contained in any such
  record that is provided to or by the marijuana
  registry of the department without the written
  authorization of the marijuana registry patient
  commits a class 1 misdemeanor.

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Application as Certificate

• Except for patients applying pursuant to
  subsection (6) of this section, where the state
  health agency, within thirty-five days of receipt
  of an application, fails to issue a registry
  identification card or fails to issue verbal or
  written notice of denial of such application, the
  patient's application for such card will be
  deemed to have been approved. Receipt shall be
  deemed to have occurred upon delivery to the
  state health agency, or deposit in the United
  States mails.

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Application as Certificate

• A patient who is questioned by any state or
  local law enforcement official about his or her
  medical use of marijuana shall provide a copy of
  the application submitted to the state health
  agency, including the written documentation and
  proof of the date of mailing or other
  transmission of the written documentation for
  delivery to the state health agency, which shall
  be accorded the same legal effect as a registry
  identification card, until such time as the
  patient receives notice that the application has
  been denied.

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Safety Issues(for police and property managers)

• Environment in MJ Grows
• Air Quality
• Mold and Fungus
• Electrical Hazards
• Confined Spaces
• Booby Traps and Weapons
• Robberies and burglaries

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Carbon Dioxide (CO2)

• Plants need to carry out the process of
  Photosynthesis.
• For this to occur the plant must have CO2.
• The plant discharges a waste product, that it
  cannot use, that being Oxygen (O2)
• CO2 must be pumped into the grow
• The normal amount of CO2 in the air is around 300
  parts per million. Cultivators will want to pump
  that up to around 1600 parts per million.

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One way to accomplish this is to use a CO2
cylinder with a flow valve.
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or by burning Propane gas inside the grow area.
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Electrical Hazards
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Electrical Hazards
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HAZARDS
MOLD
MOLD
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Safety

• Water
• Electricity
• Toxic Molds

Can be exposed to mold through skin contact,
inhalation or ingestion.
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Aspergilliosis

• August 2008, Information from the Denver Police
  Department on an Officer that suffered
  complications from a possible indoor marijuana
  grow.
• After seizing 1000 plants, the officer developed
  severe back pain.
• Through exploratory surgery, Doctors noticed a
  white fungus and crusty bacteria growth on the
  vertebra.
• From Ron Hollingshead with NDIC

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Aspergillus Fungus cont.

• Sources of increased risk include
• Dirty air conditioning units
• Compost heaps
• Damp or flood-damaged homes
• The Aspergillus Website
• Indoor marijuana grows!

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Fertilizers and Pesticides
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Safety Issues

• Utilize the Fire Department for air monitoring
• Open the windows for venting
• Recommend long sleeve shirts, Nitrile gloves and
  APRs and Tyvex suits.

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Safety Issues
They will protect their grows any way they can.
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HAZARDS
Source Marijuana Horticulture, The
Indoor/Outdoor Medical Growers
Bible Author-Jorge Cervantes
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The Profit Motive

• The current retail price for medical marijuana is
  about 120 per ¼ ounce (about 14 marijuana
  cigarettes).
• 480 per ounce
• 7,680 per pound
• It costs about 400 per pound to grow

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The average THC content of marijuana nearly
doubled between 1996 and 2006.
                                                  
                                               
                                                  
                                  Source The
University of Mississippi Potency Monitoring
Project.
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Questions???