John Stewart sleeps in the greenhouse behind his Washington home, where he grows marijuana for himself and two others who use it for medical purposes.

“People are afraid of getting robbed,” said Stewart. In addition to sleeping with the marijuana he grows, he has installed security lights and video cameras on his property. Several dogs patrol the area, barking loudly when a newcomer arrives, and a loud-voiced tropical bird lives in a large cage, under the fig and papaya trees at the entrance to the greenhouse.

Stewart said it could be nerve-wracking, thinking about the possibility of being robbed.

“Security is a good idea,” said Jake McClure, another of approximately 460 Maine caregivers growing for patients whose doctors have certified them to use marijuana for one or more of a list of approved conditions. Marijuana can be used in tinctures, salves and prepared foods, and smoked.

Stewart, McClure and patient Chris Watson of Chelsea stood around a counter in Stewart’s warm, fragrant greenhouse on a December afternoon, discussing the merits of a drug that they say offers medical and financial benefit to members of their community. They described advances in propagation, hybridization and delivery methods that make the marijuana they use a very different product from that long thought of as a merely recreational substance. While underground marijuana emphasizes psychoactivity — the ability to get a person high — medical strains are less psychoactive and have more therapeutic properties.

While registration with the Department of Health and Human Services is not mandatory, more than 2,000 patients are registered with the state. Medical marijuana patients have a choice of growing their own, purchasing the remedy through one of the state’s eight dispensaries, or contracting with a caregiver who may grow the plant for up to six patients. One of those patients can be the caregiver, as is the case for Stewart and McClure.

McClure said that, with home invasions on the rise and elderly people being robbed for their prescriptions, precautions such as those taken by Stewart are worthwhile, even though marijuana doesn’t have the black market value of pharmaceuticals such as oxycodone.

Watson is a fisherman. He began using marijuana about a year ago as a treatment for genetic spondylosis, a degenerative condition of the spine, that in Watson’s case has resulted in fused vertebrae. He said tetrahydrocannabinol, or THC, one of the active agents in marijuana, “gets into the bone” and helps him move with greater comfort. Before using it he lived with a lot of pain.

Watson said the medications he previously used caused cramps, nausea and constipation.

“You get all these side effects that the doctor doesn’t tell you about,” he said. “He’s wearing a lab coat that looks like NASCAR with all the pharma logos.”

“When I work, I smoke,” he said. “When I’m in pain, I smoke.”

Stewart said the drug mitigates severe pain, rather than giving a patient the sense of euphoria that is generally associated with its use. He said stacking firewood is easier after experiencing the pain relief that comes from using the drug.

“It doesn’t mean you’re baked all the time,” said Stewart. He said patients should understand how the drug affects them before operating heavy machinery under its influence.

“I wake up stiff and sore, have breakfast and a joint, and feel motivated,” he said.

Watson rents space to grow his plants in Stewart’s 48-foot greenhouse, heated with a combination of wood and biodiesel he makes from used frying oil received from area restaurants.

McClure is one of the founders of Medical Marijuana Caregivers of Maine, a statewide trade association of approximately 200 members that connects qualified patients with caregivers, provides resources and information and advocates in the Legislature to protect and further the rights of medical marijuana caregivers.

He said his association saw a demand for quality marijuana and the possibility of economic development. While many members grow for one or two patients, for some it is a full-time job. He said patients experiencing a great deal of pain consume large quantities, especially if they are cooking with it. Patients who grow their own medicine may be able to do so in a space as small as a 4-foot by 4-foot closet, he said.

Maine law allows each patient a maximum of six flowering plants and the seedlings that will grow to replace them as they are harvested. McClure said amateur growers have a large margin of error and that, while six plants may seem like a lot, the cloning process by which the plant is propagated is subject to failure. He has helped more than 30 patients learn to grow for themselves. Some can afford the fans and lights that help Stewart produce medicine for himself and others, but many patients grow outside, with their marijuana sharing garden space with tomatoes and flowers. The limited number of flowering plants allowed at a given time makes it a challenge for a patient to grow what is needed in Maine’s short season, said McClure.

Stewart said the state is trying to limit the number of small, non-flowering plants that can be grown.

Age-old drug used to treat pain and nausea

Patient Hershyl Warren of Sullivan has been under treatment for HIV for 22 years. The 45-year-old tractor-trailer operator has been a recreational marijuana smoker since he was 8 years old but stopped smoking when he began taking pharmaceuticals for his illness. He has used medical marijuana for about a year.

“I’ve been on just about every type of HIV medicine that there is,” he said in a telephone interview. “Now they’ve got me on just one — Atripla — once a day, and the marijuana twice a day.” Warren smokes and takes Marinol, the only FDA-approved synthetic cannabinoid. While he cannot smoke while working, use of Marinol is allowed.

“I feel 100 percent better,” said Warren. “Before, I was so sick I had to go on disability. I tried to work and I’d get sick. I was just miserable.”

“Before it was like a total of nine pills, three times a day,” said Warren. He said the change in treatment has made it possible for him to return to work, and that he expected to be taken off disability payments within a year.

Warren said both Marinol and smokable marijuana help him find the appetite to eat after undergoing chemical treatment for HIV.

“I went from 240 pounds to 160, because I couldn’t eat,” he said.

He keeps all of his medications locked up.

Although he expected marijuana to make him sleepy, Warren said the Indica strain he smokes does not have that effect.

In order to qualify for medical marijuana treatment, a patient must be certified by a medical doctor or doctor of osteopathy, licensed to practice in Maine. While the services of integrative practioner Dr. John Woytowicz of Maine-Dartmouth Family Medicine Residency in Augusta are those of a consulting physician and are covered by most health insurance policies, Dr. Dustin Sulak of Maine Integrated Healthcare in Hallowell only certifies his own patients and does not accept insurance payments for medical marijuana services.

“We bill them,” said Woytowicz. “I work for a big institution. Social services sees if they are eligible for other services. The Maine General system has a sliding scale that’s very liberal.”

While there is no fee for a patient to register with the Department of Health and Human Services’ Maine Medical Use of Marijuana Program, caregivers who grow the plant must pay $300 a year for each patient. In addition, caregivers pay $31 for an annual background check.

Once qualified, a caregiver may grow for up to five patients, and may also grow his or her own medicine.

Dispensaries pay a $15,000 annual registration fee and cover the cost of background checks and a $25 annual certification for each employee. There are no limits to the number of patients a dispensary may serve.

Patients pay caregivers between $150 and $300 for an ounce of marijuana, depending on the quality. Many caregivers offer a sliding fee scale and some patients, like Watson, work out arrangements whereby they help grow their own medicine and pay a reduced fee.

Warren said an ounce of marijuana lasts him two to three weeks and McClure lets him pay for his medicine in installments.

In addition to providing medicine, Stewart said marijuana cultivation offers opportunities to farmers. McClure said a caregiver growing for six patients could recoup the costs of setting up his operation within a year or two of starting.

“You can’t do that with tomatoes,” he said.

McClure said farmers who are turning to this recently legitimized crop are getting off welfare and subsidies and creating a market for a new range of growers’ supply stores.

“Our money stays in the county,” he said.

The VillageSoup Gazette reporter Shlomit Auciello can be reached at 236-8511 or by email at auciello@villagesoup.com.

 

The law says…

Maine residents who wish to use marijuana as part of their medical treatment must submit an application to the Department of Health and Human Services. John Thiele, program manager for DHHS’s Maine Medical Use of Marijuana Program, said his job is to create an atmosphere where the patient has access to medical marijuana.

In a phone interview, he described the process that regulates that access.

In addition to a written certification from a Maine-licensed medical doctor or doctor of osteopathy, the patient must fill out a two-page application and provide a copy of his or her Maine driver’s license or Maine-issued photo identification card. No photo identification card is required for a hospice patient or a nursing home resident.

Patients who choose not to register with DHHS must be prepared at all times to present law enforcement personnel with a copy of their physician’s certification.

Any certified patient can grow his or her own medicine or purchase marijuana and marijuana products from one of 460 caregivers or eight dispensaries licensed to operate in Maine. Thiele said unregistered patients should ask their physician to issue a tamper-proof certification form.

There is no fee to patients for registering with the state program.

Thiele said approximately 300 physicians, seven in Knox County, have certified Maine patients to use medical marijuana.

Under federal law, marijuana is considered a Schedule 1 drug. Thiele said that means, “It has no medical use whatsoever.”

The Drug Enforcement Agency’s website at justice.gov/dea says that tetrahydrocannabinol, or THC, has been found to relieve nausea and vomiting associated with chemotherapy and assists AIDS patients with loss of appetite.

“Medical marijuana already exists,” the DEA website states. “It’s called Marinol.” Marinol is a pharmaceutical product, available through prescription in pill form, made by Solvay, a subsidiary of Abbot Laboratories in Abbott Park, Ill.

“Marinol is synthetic THC that is legal,” said Thiele. “People can go to a drug store and buy it and MaineCare will reimburse.” He said Marinol was not made from the plant.

Thiele said the state was responding to a referendum decision by 60 percent of Maine voters who wanted to legalize medical marijuana.

“They were thinking about relatives in pain and distress,” he said. “They wanted them to have choices.” While that referendum took place more than a decade ago, it was only in 2009 that the state began to create a mechanism to provide patients with access to the drug.

“We do occasionally get letters from the U.S. Attorney’s Office, saying we are engaging in an activity considered criminal,” said Thiele. “The Obama administration has issued a statement to the Department of Justice saying, if the state has a medical marijuana law DOJ should honor that as it exists in that state.”

While federal agents have been closing dispensaries in California, Thiele said he was unaware of dispensaries or caregivers enrolled in Maine’s medical marijuana program being visited by federal officials.

According to a Nov. 23 story in The New York Times, a recent rise in federal enforcement in California is the result of an increase in the proliferation of large, commercial enterprises and skepticism, on the part of prosecutors, as to the veracity of some patients’ claims of medical need. The Times said California’s medical marijuana laws are inadequate and leave it to local officials to set the rules.

State Sen. Mark Leno, D-San Francisco, is now working with California’s attorney general on a state law to establish more uniform and stringent rules for medical marijuana.

“For the most part they’re leaving us alone,” said DHHS’s Thiele. “We must be doing something right.” He said Vermont, one of two other states in New England to legalize marijuana for medical purposes, is using Maine’s law as a template for its own program. Across the U.S., 16 states and the District of Columbia have medical marijuana programs.

Maine law allows a patient to be certified for medical marijuana if he or she has one or more of the following conditions: cancer, glaucoma, positive status for human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), hepatitis C, amyotrophic lateral sclerosis (Lou Gehrig’s disease), Crohn’s disease, agitation of Alzheimer’s disease or nail-patella syndrome.

Marijuana may also be used to treat intractable pain, cachexia or wasting syndrome, severe nausea, seizures including but not limited to those characteristic of epilepsy, severe and persistent muscle spasms including but not limited to those characteristic of multiple sclerosis or any other medical condition or its treatment that is approved by the commissioner of DHHS.

It is illegal for anyone who does not have a debilitating medical condition to use marijuana. Caregivers who are found to have committed a Class A or B felony within the previous 10 years are disqualified from the program.

Different smokes for different folks

Maine marijuana caregiver Jake McClure said Dec. 7 that different varieties, with names such as Chernobyl, White Widow, Blueberry and Diesel, are designed to meet different medical needs.

Dr. Dustin Sulak of Maine Integrative Healthcare in Hallowell said that each strain contains different ratios of cannabinoids, each producing a different medicinal quality.

Those differences result in more or less psychoactivity, producing a plant that can be more sedating or energizing, better for treating pain, nausea and other gastro-intestinal symptoms or have greater or lesser anti-inflammatory effects.

Sulak said he conducts a risk/benefit analysis for each patient, comparing treatment options such as osteopathic manipulation, Reiki and homeopathy, pharmaceutical medications, herbs, supplements, diet and exercise, counseling, and hypnotherapy. He also considers a patient’s preference for natural versus synthetic treatments.

While strain selection usually takes place between the patient and his cannabis provider, Sulak often suggests trying several strains until a patient finds two or three that work, “usually one for day and one for night.”

“For certain conditions I recommend strains high in a non-psychoactive cannabinoid … [that] has strong anti-inflammatory and anti-anxiety effects,” he said.

Osteopathic physician John Woytowicz of Maine-Dartmouth Family Medicine Residency in Augusta said the two main constituents in medical marijuana are tetrahydrocannabinol, or THC, and cannabidiol. In addition, there are probably more than 30 lesser constituents, he said.

He said THC gives a euphoric effect while cannabidiol offers more pain relief. Those experiencing nausea and lack of appetite benefit from both.

Sulak said the most common symptom that led to certifying a patient for the Maine Medical Use of Marijuana Program was chronic pain, often caused by musculoskeletal conditions like degenerative disc disease, and inflammatory conditions like rheumatoid arthritis. Other conditions that benefit from the plant-based drug are multiple schlerosis, cancer, Crohn’s disease, hepatitis C, spasticity from spinal cord injury and cerebral palsy and seizure disorders.

“Many of my patients report it also helps with PTSD, anxiety, depression, insomnia, and ADD/ADHD,” he said. None of the last conditions are indications for medical marijuana under current state law.

The DEA helped facilitate research on Marinol and has registered seven research initiatives on the effects of smoked marijuana as medicine.

Sulak said an average of two scientific studies are published each day, mostly funded by the pharmaceutical industry.

“Synthetic cannabinoids are going to be the future of chemotherapy, acute brain injury and stroke treatment, and much more,” he said.

“Marijuana use has been documented for 6,000 years,” said John Thiele, program manager for the Maine Medical Use of Marijuana Program of the Department of Health and Human Services. “Although it’s been difficult doing the scientific methods within the studies, there are certain things that you know.”

“Nobody has ever been diagnosed for overdosing or dying from overuse of marijuana,” he said.

Thiele said there were approximately 80 psychoactive cannabanoids, and that it was possible to grow strains where the THC content is so low that the user would not become intoxicated.

“Other cannabanoids are so high that it really is an analgesic answer for people who suffer spasms or headaches, such as multiple sclerosis patients,” he said. “I’m a bureaucrat. I do what people tell me. I do believe there are benefits to using medical marijuana.”

Woytowicz said he screens out patients who have active substance abuse problems. Some return after getting those issues under control.

“Drug interactions are pretty limited,” he said. Woytowicz said patients who use marijuana and oxycodone find they need to use less of the latter medication, due to a reduced escalation of tolerance to the opioid. “Compared to pharmaceuticals, patients are not constipated, the mind is clearer and they get better sleep.”

He said the greatest hazard he saw from marijuana use was the risk of cognitive impairment — whether people can function, drive a car or perform their job.

Woytowicz said physicians were basically conservative but that there was plenty of evidence to support the use of medical marijuana. He encouraged doctors and hospitals to have “rational discussions” about the treatment.

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