by Kim Krisberg

For years, Peter Rosenfeld was looking for an effective way to treat what doctors had diagnosed as severe and intractable migraines. He’d heard of medical marijuana, but thought it was a joke — that it was just a way for people to justify their marijuana use.

Then in 2000, the New Jersey resident enrolled in a California program studying the effects of medical marijuana. It was a blind study, so Rosenfeld didn’t know whether he was one of the participants being given marijuana or not. It turns out he was. And it worked.

“Marijuana was the first effective treatment that I had tried,” he told me. “I seriously didn’t think it would work because I had been on pretty heavy [prescription] drugs. I was just shocked that it worked.”

The experience contributed to Rosenfeld, who is now 57, becoming a passionate advocate for medical marijuana, eventually joining the board of directors of the Coalition for Medical Marijuana – New Jersey. Today, he and fellow New Jersey residents living with conditions that could benefit from marijuana should be celebrating: In early August, the state opened its patient registry for medicinal marijuana patients and will begin issuing IDs to eligible patients in accordance with the state’s Compassionate Use Medical Marijuana Act, which was signed into law in 2010. But what was signed into law and what’s come to fruition in New Jersey isn’t what patients and advocates had hoped for.

“We really do not expect any kind of meaningful program during [Gov. Chris] Christie’s administration,” said Ken Wolski, the New Jersey coalition’s executive director. “There are tens of thousands of patients who thought they’d be protected by this law…but not a single one of them, as far as we know, has gotten to enjoy its protections.”

Wolski said the regulations crafted to implement the law “establish bureaucratic hurdles for just about every aspect,” even going beyond what the law called for, such as requiring physicians who want to prescribe medicinal marijuana to register with the state and complete education in addiction medicine and pain management. (Not even physicians who prescribe morphine have to document such education, Wolski noted.) To date, only about 150 of New Jersey’s 30,000 licensed physicians have registered. The law authorizes the opening of six nonprofit dispensaries; however, only one is ready to open. The disappointing numbers mean most patients who could benefit from marijuana’s therapeutic effects will still go without access, Wolski said.

Rosenfeld said he’s not even sure his condition — what doctors now believe to be cervical myelopathy, or a squeezing of the spinal cord — will qualify him for New Jersey’s medical marijuana program. Plus, he said traveling a long distance to find a participating doctor would be too difficult for him anyhow. He’s hoping more doctors will begin joining the registry.

“It’s one barrier after another,” said Wolski, who’s a registered nurse and a founding member of the American Cannabis Nurses Association. “There’s nothing patient-friendly about it.”

Here come the feds

While New Jersey’s medical marijuana program struggles to get up and running, other states with medical marijuana programs are facing a different problem: a renewed federal crackdown. (Wolski noted that Gov. Christie did cite federal actions in delaying implementation of New Jersey’s medical marijuana law.)

The disappointment among advocates is compounded by the fact that the crackdown comes under the watch of President Obama, who during his 2008 campaign said he wouldn’t use federal resources to circumvent state medical marijuana laws. In 2009, a Justice Department memo echoed Obama’s statement, stating that federal resources shouldn’t be focused on users and dispensaries in compliance with state law. But that doesn’t seem to be the case anymore. Today, hundreds of dispensaries in states where medical marijuana is legal have closed up shop under federal threat of criminal prosecution and property forfeiture.

“What we’ve seen from Obama, despite repeated statements to the contrary, are attacks that have escalated far beyond what [President] Bush ever did, both in breadth and intensity,” said Kris Hermes, spokesperson for Americans for Safe Access. “Does it make political sense to be doing what he’s doing? Not really. Especially when the vast majority of the American public supports medical marijuana…what is clear is that it’s indiscriminate and it’s harming hundreds of thousands of patients.”

Some results of the recent crackdown, according to Hermes: Raids and the threat of raids have contributed to shutting down the majority of medical marijuana dispensaries in Montana and Washington; at least 400 California dispensaries have shut their doors (though more than 1,000 dispensaries are still operating); and in Colorado, dozens of dispensaries have been shuttered. Seventeen states and Washington, D.C., have enacted medical marijuana laws.

Hermes said his organization isn’t waiting around for federal agencies to come to their senses: Americans for Safe Access has filed suit against the Drug Enforcement Administration, challenging the government’s classification of marijuana as a dangerous drug with no medical value. In October, Hermes said, Americans for Safe Access will present oral arguments that “politics is trumping scientific integrity…that the federal government is ignoring the scientific evidence on this issue.”

“The Obama administration stance on this issue is unprecedented in its aggressive attacks on the medical marijuana community,” he said. “These are the last dying gasps of an outdated policy on medical marijuana that is likely to change very soon.”

‘Spend one day in my shoes’

Damien LaGoy beat hepatitis C. Unfortunately, the disease left him with liver cancer. He tells me that he doesn’t think he has much time left, that he’s getting worse by the day.

LaGoy, whose also been living with HIV for nearly 30 years, has had a doctor’s recommendation for medicinal marijuana since 2006. He uses marijuana to help manage his pain and HIV symptoms as well as deal with the nausea from chemotherapy treatments. He said marijuana also helps him maintain a semblance of an appetite — the 52-year-old Denver resident is down to just 95 pounds. Usually, he uses marijuana once in the morning and once at night before taking his meds. Doctors have prescribed him morphine, but he says marijuana works better and allows him to go about his daily life. Morphine, he says, just knocks you out.

“So many times, I’ve just given up…but (marijuana) helps my mood too. I don’t feel so desperate and despaired,” he said. “To those who are against it, just spend one day in my shoes. Just one day. That’s all it would take.”

Recently, the medical marijuana dispensary LaGoy used shut down after a U.S. attorney said it was operating too close to a school. Fortunately, LaGoy found another dispensary close enough to his home. The shuttered Denver dispensary was one of more than 50 medical marijuana dispensaries in Colorado to receive a U.S. attorney letter claiming it was operating too close to a school and threatening criminal prosecution or property seizure, according to Brian Vicente, executive director of Sensible Colorado, a drug policy reform organization. Under Colorado’s medicinal marijuana law, which voters passed in 2000, dispensaries must be more than 1,000 feet from a school, unless the local community decides differently, Vicente said. But the feds, he said, have decided to “draw a line in the sand.” To date, 54 dispensaries have either shut down or moved.

“It feels kind of like a broken promise,” Vicente said of the recent federal crackdown. “I can only think [Obama is] trying to pander to law enforcement and have this tough-on-drugs posture to help get re-elected. But the American public and certainly the voters support medical marijuana and don’t want to see those patients going to street corners.”

According to the Colorado Medical Marijuana Registry, which is administered by the Colorado Department of Public Health and Environment, more than 98,900 residents currently have IDs allowing them access to medicinal marijuana. The average age of medicinal marijuana patients is 42 and the majority use marijuana to treat severe pain. Any licensed Colorado physician can prescribe it. Mark Salley, a spokesperson for the state health department, said registration really began to grow in 2009 after a lawsuit threw out health department rules that limited the number of patients a medicinal marijuana caregiver could have. The lawsuit also made it financially viable for dispensaries to open.

“The big picture is that we have the most strictly regulated medical marijuana system in the world,” Vicente told me, noting that cameras track Colorado’s medicinal marijuana industry from seed to sale, with footage accessible by law enforcement and state revenue officials. “It’s good for patients — prices have gone down under regulation…And it’s been positive for business owners because they have a rulebook. It’s just a more understandable and workable business field.”

Chris Lindsey thinks if his state’s medicinal marijuana program had a regulatory framework more similar to Colorado’s, it wouldn’t have become such an easy target. Lindsey is president of the Montana Cannabis Industry Association, though through a combination of federal raids and state actions, “there’s not really an industry left,” he said.

“The state law was very vague and created an atmosphere where anybody could jump in and they did,” Lindsey told me. “Without regulations, you’ll create problems because those that get the most attention are those that are abusive (of the system).”

Montana residents voted in favor of a medical marijuana program in 2004, though the number of patients and caregivers really skyrocketed in 2009. What happened in 2009? Obama happened, Lindsey said — with his promises on the campaign trail, “we thought as long as we’re following state law, we can do this.” By the end of 2010, Montana was home to more than 27,000 medical marijuana patients and more than 4,800 providers, according to the state health department. In 2011, Montana lawmakers replaced the original law with a new law so restrictive that Lindsey says it’s no longer financially viable to be a medical marijuana provider in Montana. Montana’s provider numbers are down to less than 400, he said.

“The problem for patients is there’s no providers anymore,” he said. “Providers are few…so if you sign up today as a patient, there’s no way to find a provider except through word of mouth. The storefronts are pretty much gone. We’re back to the way it was in 2008, which was people growing in their basements and providing it to patients. That’s what we thought we were going to fix.”

Daryl Jones, a 57-year-old resident of Kila, Mont., tells me he looks like a POW. Jones suffers from severe neurological damage in his neck as well as wasting disease — at 6 foot, 8 inches, he says he’s down to just 165 pounds from 234 pounds in 2006. Jones, who’s been a medical marijuana patient for four years, uses the plant to help with muscle spasms, chronic pain and to increase his appetite — “one thing I can’t afford to do is to not eat,” he says. But with the new state restrictions, he hasn’t been able to access medicinal marijuana for about five months now.

“It sucks,” he said. “I can hardly do anything. I can’t write well, I can’t sit for very long…my pain level is just too high. With [marijuana], I can get to a place where I can push through it. But now I don’t have too many options; everyone’s in hiding now. I wish they would just leave us alone.”

To learn more about the current challenges to medical marijuana, visit Americans for Safe Access. For more on the science of marijuana’s therapeutic effects, visit the organization’s research page.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for a decade.