Buying medical marijuana: behind the green curtain

Editor’s Note: Proposition 215, also called the Compassionate Use Act, was passed in 1996. Since then, there seems to be a lot of confusion from people on all sides of the issue about exactly what is and isn’t legal concerning medical marijuana.
This is the first in a two-part series on medical marijuana in San Diego County and attempts to clear up some of the misconceptions regarding buying medical marijuana. The second part of the series, which will run next week, will focus on medical marijuana dispensaries and feature some prominent local legal battles addressing the issue.

Luke is 10 pounds heavier than he was several months ago, and he couldn’t be happier.
For the last decade, Luke, who asked that his real name not be published, has suffered from a debilitating genetic back disorder. In order to relieve the pain, he takes a daily dose of pain relievers, including the powerful narcotic Oxycontin. While the pharmaceutical medication helps with his pain, it also causes him severe nausea.
“I lost a lot of weight and wasn’t feeling good,” the 66-year-old Encinitas resident said.
In June 2010, Luke decided to explore medical marijuana to help with his nausea and weight loss. But despite Proposition 215 being passed 14 years ago, he still had anxiety about getting his recommendation due to an uncertainty about the legality of possessing medicinal marijuana as well as the legitimacy of seeing a physician who advertises in the back of a free weekly magazine.
Under Proposition 215 and Senate Bill 420, which was enacted in 2003 as a compromise between advocates and law enforcement, state guidelines were established relating to how much marijuana a qualified patient could legally grow and possess.
According to the guidelines established by Attorney General Edmund G. Brown Jr. in 2008, patients and primary caregivers may possess 8 ounces of dried marijuana, and cultivate six mature or 12 immature plants per patient, if they hold a state-issued identification card. But if needed, a patient or primary caregiver can receive an additional doctor’s recommendation stating that the aforementioned quantity does not meet their medical needs, and that the patient or primary caregiver may possess a larger amount of marijuana.
The confusion
Since the county began issuing the state of California Medical Marijuana Identification Card, or MMIC, in July 2009, the Department of Health and Human Services has issued 790 cards; however, that number is not indicative of the actual number of patients recommended under Proposition 215/SB 420 in the county. The number is actually much higher because the state card is not mandatory to legally possess marijuana in San Diego, and California for that matter. A patient only needs a recommendation from a physician, which must be renewed yearly.
“The doctor issued cards are not connected with the state MMIC programs,” said Adrienne Yancey, an assistant deputy director with the county’s Health and Human Services Agency. “The state MMIC has a unique identifier for each valid card holder that is listed in the state MMIC registry.”
While the program is voluntary, those are the only identification cards that offer the patient protection from arrest, according to the attorney general’s guidelines. Alternately, if a physician’s identification card or recommendation is presented, the officer is supposed to review the document and then use his own judgment to determine whether the person is within the local or state possession guidelines.
Since adopting the program, Yancey said the county has received 819 applications; the majority — 573 — coming from persons aged 31 and up. The application fee for the state card is $166 or $83 for Medi-Cal beneficiaries, which is in addition to the doctor’s fee charged to obtain the recommendation. And just like the physician’s recommendation, the card needs to be renewed yearly.
Curt Moore, who operates Canna Care Consultants, a medical marijuana referral service in Oceanside, said first-time patients pay $89, while renewals cost $80. If the physician approves the patient for medical marijuana, they are then given a paper recommendation, which he advises patients to keep in their glove compartment, as well as a wallet-sized medical marijuana card. Additionally, Moore said his office also uses a third-party verification company that is available 24 hours a day for medical marijuana providers, such as collectives, or law enforcement to utilize so they can check the validity of the patient’s recommendation.
However, Moore said the state card is the only card that law enforcement agencies have to recognize on the spot. “Basically, the card that all doctors give out are fluff; they hold no legal value,” he said. “We shrink down the original recommendation to card size with the hope that law enforcement will see it and call the number.”
Despite the cost of the state card, Moore, who has operated his referral service on South Coast Highway for more than six months, recommended that patients who travel with their medication or cultivate their own marijuana under Proposition 215/SB Bill 420 get the state card.
Kris Hermes, a spokesman for Americans for Safe Access, also agreed that if a patient can afford the state card it is a good idea to apply for it. Often, Hermes said, patients shy away from the state card or medical marijuana as whole because they believe that their information is going to end up in the hands of local or federal law enforcement.
Though Yancey said when asked, state law requires the county’s records and information regarding medicinal marijuana patients to be kept confidential; however, if the records are subpoenaed then it’s handled on a case-by-case basis relating to the facts and circumstances of each particular case and subpoena.
Throughout the state, Hermes said his organization has seen better compliance from law enforcement agencies as key court cases are won regarding Proposition 215/SB Bill 420, including the 2009 ruling in which the California Supreme Court ruled that San Diego and San Bernardino County could not use federal law as an excuse to avoid implementing the state MMIC program. However, he said there are still instances where local authorities want to ignore state law even though the courts have “flatly” ruled that federal law does not pre-empt state law.
A quick trip to the doctor’s office
When Luke decided to get his evaluation for medicinal marijuana, his two friends, who also suffer from their own set of ailments — arthritis, a rotator cuff injury, back pain — decided they would also get evaluated.
One of Luke’s friends, Ken — a North County business owner who also asked to remain anonymous — said the trio drove to downtown San Diego for their doctor’s visit. Inside the waiting room, the three men — all in their 60s — were handed paperwork to fill out about their medical history, ailments and experience with marijuana.
Ken said the waiting room looked just like any other physician’s office. Besides his group, he said there were four other people, who appeared to range in age from 30 to 60, waiting to be seen by the doctor.
“We totally didn’t feel nervous because it was a friendly place,” Ken said. “It’s not dark or seedy or anything, but we were still a little apprehensive.”
Because the three men were together, their evaluation was performed at the same time. After taking their blood pressure, the physician then conducted her evaluation by talking to the men about their ailments and medical history; 20 minutes later the trio left the referral office each with a recommendation to legally use, possess and cultivate marijuana.
“It didn’t seem like a slimy atmosphere,” Luke said. “I felt pretty at ease.”
At Canna Care Consultants, Moore said his office gets a lot of cancer patients with nausea and joint pain. Recently, he said he had an 83-year-old patient who had never used marijuana before come in for a recommendation.
“Every year they keep proving the medicinal benefits are great,” Moore said. “Of course it’s not snake venom though; it’s not a miracle cure, but it does have a lot of benefits for a lot of patients.”
Unfortunately, for North County residents who would like to get an evaluation close to home, Canna Care Consultants is only one of three in the area; the other two are in Vista and Carlsbad.
“The North County has a real need for more services,” Moore said.
City officials in Oceanside, Vista and Carlsbad have said that medical marijuana referral offices are legal to open; it’s just dispensaries — collectives that operate nonprofit storefronts to sell medicinal marijuana products to patients — that are currently barred in those cities.
“We would treat that as a kind of like medical office,” Carlsbad City Attorney Paul Edmundson. “If there was a doctor who gave a referral for medical marijuana that would be under the ethical practices as opposed to a dispensary.”
Moore said doctors who are conducting evaluations just for the money are a large reason why referral services have gotten a bad name. “Without denials, it’s not a real doctor’s office, because not everybody coming through the door is legitimate,” he said.
Since opening in April, Moore said his office has rejected a lot of people, some of whom he said looked to be only 15 or 16 years old. One safeguard Moore and his doctor have established is to only issue one-month recommendations for patients who don’t have their medical records or prescription bottles with them during the evaluation to justify their medical condition; the patient would then be required to bring in their records after the month is up.
“It’s a little inconvenient for the patient, but it helps protect the office and the doctor,” Moore said.
In addition to physician evaluations, Moore said his office is focused on providing each patient with the information they need to fully benefit from the use of medicinal marijuana. For instance, he said his elderly patients — his oldest is 90 — often do not like to smoke it, so his office informs them about other ways marijuana can be ingested and still be effective. Further, Moore said his office also instructs patients on how to cultivate their own marijuana, which is highly beneficial for users on a fixed income.
“We try to be full-service and help them in anyway we can,” Moore said.