Not too long ago any talk of a "green" business had something to do with the environment or climate change. But a bumper crop of new medical marijuana businesses in Missoula—and across the state—forces a new definition of the phrase. Montanans are now coming to grips with a different kind of green business, and an emerging "green rush."
Much like the West's gold rush, the noticeable rise in cannabusinesses elicits a mix of heart-warming success stories, rampant opportunism and chaotic legal wrangling. More than anything, the current green rush speaks to just how fast the industry has grown since federal enforcement was relaxed late last year.
The numbers tell much of the story. At the end of 2008, Montana's Department of Public Health and Human Services (DPHHS) reported 1,557 registered medical marijuana patients in the state. One year later, there were 7,339. Based on current trends and estimates from those in the industry, the state likely added another 3,000-plus patients to the rolls in January.
In Missoula County, where 935 patients were registered at the end of 2009, storefront businesses are sprouting up throughout downtown. The city counted four licensed medical marijuana businesses last November. Now, just three months later, there are 12, according to Bill Bonetati, accounting supervisor at the city's licensing department.
That number doesn't include the many more registered caregivers operating without storefronts. According to DPHHS, 260 caregivers call Missoula County home, and they range from those growing marijuana in a spare bedroom for one patient to those with more than 500 patients growing thousands of plants in local warehouses. These operations may challenge the community's capacity to enforce the vague state law that governs them, but are still gaining legitimacy. To wit, one local business, Zoo Mountain Natural Care, joined the Missoula Chamber of Commerce last month, the first such business to join any of the chambers in the state.
The "green rush" took five years to take root in the Treasure State (see timeline below). In 2004, 62 percent of voters supported Initiative 148, making Montana the 10th state to pass a medical marijuana program. (There are now 14.) At the infancy of the Medical Marijuana Act, patients and caregivers still feared federal prosecution. For instance, Missoula activist Robin Prosser, the poster child for medical marijuana rights, fought a constant battle against federal authorities to gain access to her medicine until she killed herself in 2007. Just last year, the Independent interviewed four different caregivers who, despite adhering to state laws, operated largely secret grow houses and delivery services in order to help registered patients who also felt as if they could be arrested at any moment.
But the landscape abruptly changed last October after the Obama administration announced that federal authorities would defer to state marijuana laws, essentially meaning the days of feds raiding patients' homes and pot dispensaries around the country were over. The move opened the floodgates in Montana, bringing the industry out of the grow rooms and onto main street. Patients and marijuana advocates rejoiced, and law enforcement appeared to look the other way. Today, advocates and law enforcement alike wonder if it's grown too fast (see sidebar on page 16). Specifically, concerned patients question whether some caregivers operate in deference to the "spirit of the law" and keep a patient's best interests in mind. Authorities suspect the law now serves to "cloak" illegal drug dealing. Either way, the industry has changed dramatically, causing a ripple effect through the local job market, medical community, court system and police force.
The Independent spoke with more than 50 sources to try to cut through the haze of the state's medical marijuana industry. What we found might be best explained by walking through the three steps to becoming a medical marijuana patient: finding a doctor, choosing a caregiver, and growing medicine on your own.
Finding a doctor
In order to legally use marijuana in Montana, a licensed doctor must verify that a patient has a qualifying medical condition and find that the potential benefits of medical marijuana will likely outweigh the risks. According to the state, a total of 247 doctors have approved the paperwork for the state's more than 7,000 patients. A single doctor estimates he's signed off on nearly a quarter of them.
Chris Christensen, a family practitioner at Big Creek Family Medicine in Victor, has come to specialize in medical marijuana. He says he's registered more than 1,500 patients from a small, cash-only clinic that caters to the uninsured.
"I've just happened to have developed both a willingness and a knowledge base to allow me to feel like I can venture into an area that a lot of doctors won't touch," says Christensen, a primary care physician for 35 years. "It began with people coming to see me who had pain problems, and that started me looking back at what was in the literature about marijuana for pain. I think the first half-dozen patients that I certified were people I already had in the practice and they came to me and said, 'This is how I'm managing my chronic pain.' And as a result of that I got informed about the law and said, 'Okay, I don't have a problem certifying you to do this.'"
Five years after opening Big Creek Family Medicine, Christensen says he now spends about 50 percent of his time working with patients who come from all over the state seeking medical marijuana cards. Many of these patients, he says, are people whose primary doctors rejected their requests for one. He and his staff devote two or three days a week to these patients, seeing about 30 each day. Patients pay, on average, $150 and must watch a 30-minute video of Christensen explaining the legal nuances of the Medical Marijuana Act before visiting with the doctor one-on-one. Patients report that Christensen conducts complete evaluations and fosters a genuine doctor/patient relationship. One patient says Christensen spent three hours evaluating him.
The sheer number of patients Christensen has registered raises the eyebrows of others in his field. But being at the center of controversy is nothing new for him. About a decade ago, while practicing in Idaho, Christensen says authorities charged him with multiple felony counts of prescribing controlled substances outside the scope of a professional practice.
"In other words, dealing drugs," he says.
He was practicing in Idaho's Silver Valley, where he found high instances of chronic pain a function of the timber and mining industries "that leave a lot of damaged bodies behind." His prescribing habits—most of his 400 patients, he says, were on some opioid—raised eyebrows, and the state filed charges. The accusations of abuse also led to a dispute with the state's Board of Medicine, which resulted in Christensen relinquishing his license for two years. He says he also relinquished his ability to prescribe opioids for the rest of his career.
Christensen acknowledges what he calls "the double-edged sword of trying to practice compassionate care." But the key to providing compassionate care, he says, is believing the patient. He explains that many doctors, holding a handful of negative test results, will tell a patient that they must not hurt, instead of figuring out a way to fix it or to make life more tolerable.
"You either believe the patient or you believe the study," he says.
Christensen's point cuts to a major criticism of Montana's Medical Marijuana Act: that individuals can exaggerate, or outright lie about, their symptoms and easily obtain a medical marijuana card.
Christensen addresses the concern directly: "One of the most common things I say to the patient—not that I'm going to be able to observe it—is if the point of you being here today is so that you can go sit in the corner and drool on yourself, I'd rather not be doing this. I'd rather that we talk about some other options. But the vast majority of the people I'm seeing have self-selected by having to get their medical records and wait for an appointment. And they have a one-on-one encounter with me in which they know they have to look into my eyes and be judged. And that, I'm telling you, is a very powerful force."
He says it's impossible, though, to always identify disingenuous patients.
"I wouldn't tell you," Christensen says, "that I haven't had a patient come into my office, give me a song and dance about a past injury and still having pain, go out the door, slap their buddy on the back and say, 'I got what I wanted.' But I think that's, in a percentage, less 5 five percent of the total, and if that's how well I'm doing I think that's probably pretty good."
Christensen's practice stands out, but a number of other clinics specialize in medical marijuana, too. In Missoula, for example, River City Family Health recently expanded its clinic by creating Montana Medical Cannabis Certification Inc., or M2C2. The new branch charges patients $200 for an appointment, offered, typically, twice a month.
"It's quite a remarkable opportunity for health care providers to interface with people who have never had health care, or who have been out of the system for years, sometimes 20 or 30 years," says Deni Llovet, the clinic's owner and a family nurse practitioner.
Llovet estimates her clinic has approved about 300 patients since last April, many of whom have a distrust for western medicine and self-medicate with marijuana. Patients who already have a primary doctor come to M2C2, Llovet says, because their regular doctor refuses to sign the medical marijuana certification, or because the patient is afraid to even mention it.
"One of the things that we ask our patients is, 'Is it okay with you if we notify your primary care physician that we've certified this for you?' And the majority of the patients don't want us to do that, and we're not going to if they don't want us to," Llovet says.
Practitioners like Christensen and Llovet take specific steps to honor the "bona-fide physician/patient relationship" as required by the Medical Marijuana Act, and operate like a traditional doctor's office. But others, most notably the Montana Caregivers Network (MCN), take a different approach.
The group, led by director Jason Christ, drives RVs all over the state and operates "Cannabis Conventions" where, for $150, patients can see a roving doctor, sign up with a caregiver, and even get legal advice. Some critics call this one-stop-shop approach "docs in a box" or an assembly line of medicine. Christ says he's revolutionizing modern health care.
"What we're doing, the community that is arising out of this, is changing the face of medicine," Christ declares. "It's working. We've registered over 7,000 or 8,000 people in six months through our program."
MCN's recent run through Kalispell, Great Falls, Billings, Bozeman and Missoula drew, according to Christ, a total of 4,500 people, 3,850 of whom received recommendations for medical marijuana cards. Christ says the majority of those who didn't left not because the doctor rejected them, but because the wait was too long.
Christ says about 800 people—most appearing to be in their 20s and 30s; some dreadlocked, some in shirt and tie—showed up at the Cannabis Convention at Missoula's Hilton Garden Inn Jan. 26. Attendees registered with MCN staffers, then waited as long as three hours to see one of three doctors in small rooms down the hall. A fourth doctor saw patients through a video feed, part of MCN's trademarked "TeleClinic" program. (Christ declined to provide the names of the doctors because of past attempts to report them to the Montana Board of Medical Examiners.)
In the meantime, prospective patients could meet the few dozen caregivers sitting at booths circling the room, each displaying different strains of medicine in hopes of signing up new patients. Or, prospective patients could go to the next room and listen to Great Falls attorney Carl Jensen lecture on the limits of the medical marijuana law. Occasionally, a woman would read names into a microphone, and patients would head toward their appointment. Five patients said their visits with a doctor lasted between five and 20 minutes.
"Our doctors want to publish what we're doing in the New York State Journal of Medicine and they want to talk to Cambridge about it," says Christ. "These doctors are very well connected. They're going to the state's Medical Board of Examiners and explaining what they do and how they do it, because they believe in it."
Christ is proud of MCN's work, and also not shy about the group's financial status. He says MCN grossed about $1 million in sales its first year.
"God, I'm going to be a millionaire in a year," he says. "But I don't care. It's not about the money at all. Period. My goal is to help end suffering. And if I can do it en masse, great."
Choosing a caregiver
The Medical Marijuana Act allows patients to grow six plants and possess one dried ounce of marijuana. Patients may also purchase medicine from a registered caregiver who is allowed to cultivate six plants per patient, as well as hold an ounce of smokable marijuana for each. Patients can only buy from their registered caregiver. There's no limit to the number of patients to whom a caregiver can provide medicine.
The caregivers courting patients at last week's Cannabis Convention provide a sense of the variety.
Montana Pain Management (MPM), owned by Rick Rosio, stood out in the exhibit hall. The corner booth featured a large flat-screen TV displaying close-up images of its strains, as well as physical examples. Rosio's operation, which is located on Third Street, is perhaps Missoula's largest "dispensary" by volume. Rosio estimates that he's the caregiver for more than 500 people, meaning he can legally grow more than 3,000 marijuana plants. (A person has to be listed as the caregiver, not a business or nonprofit.) He says ounces typically sell for between $300 and $350, but often less based on an income-based sliding scale.
A few booths down from MPM, Zoo Mountain Natural Care displayed its strains in glass boxes and gave passersby a lighted magnifying glass with which to examine the tetrahydrocannabinol (THC) crystals coating its products. Run by 20-year-old Logan Head and his two business partners, Zoo Mountain would have a fruitful day: Head said afterward that about 30 patients signed up, giving the clinic, which has a storefront on the corner of Orange and Front streets, about 160 patients between its three caregivers. Head says Zoo Mountain's success has to do with its prices—all strains are $225 an ounce—and he claims to donate 10 to 20 percent of profits back into the community.
Farther down the row sat Terry Lucke, dubbed in his advertisements as "The Fat Hippie." He and his two business partners have fewer than 50 patients, he said, but they're still in the process of finding a storefront and obtaining a business license from the city. Lucke sells ounces for between $275 and $325.
Across the room, another caregiver sat with small jars of marijuana on his table, the names of the strains written in Sharpie on strips of duct tape—"Blueberry" and "Train Wreck," among others. The older man said he was among the 417 workers let go by Smurfit-Stone Containerboard Corp. earlier this year when it shut down its Frenchtown linerboard plant, where he worked for 30 years. The man, who wished to remain anonymous, said it's too late to go back to school for retraining. He came to the Cannabis Convention, his first, in hopes of adding another patient or two to the six he currently supplies.
"I'm 51 years old and this is my best shot," he said.
With so many caregivers flooding the market, prices are getting pushed down, patients and caregivers say. Barry George, a caregiver with Helping Hands, reports dropping the price for an ounce by $50 to stay competitive. John Masterson, the director of the Montana chapter of the National Organization for the Reform of Marijuana Laws (NORML), says competition has become so fierce that some resort to aggressive tactics to sign up new patients. He tells of one instance in which a grower cornered a disabled person in a bar offering to be their caregiver.
Shaneca Adams, a caregiver with Grizzly Organics, says there's "definitely some scandalous stuff" happening in the industry.
"Caregivers are basically guiding potential patients into the process of signing up so they can end up as their caregiver," he says. "It's kind of like a preying market—people are like sharks looking for the old ladies who don't know any better."
And if growers can't persuade patients to designate them their caregiver, they often, according to some observers, sell to them anyway.
"A lot of these places around here, if you have a card, you can get smoke, you can get marijuana," says George. "That ain't right...A couple places in town are just treating it like California [where card holders don't have to get medicine from just one caregiver]."
While it would appear caregivers are cashing in, most claim that's not the case. They tell of failed crops and $600 electric bills from their high-wattage grow lights, or more significant investments in storefronts and legal teams to make sure they stay on the right side of the law.
"In the current environment," Adams says, "you're working with a few select people. It's almost like a coffee shop but you have a very limited clientele. So I think there's a limit to the profit that can be made off of it. A lot of caregivers that I talk to are seeing that it's not as profitable as they thought it would be. And especially right now, because there are so many people getting set up."
Growing at home
The Medical Marijuana Act allows for patients to designate a caregiver, as well as grow as many as six plants themselves. Evidently many are trying, because indoor gardening stores are sprouting up right alongside Missoula's medical marijuana clinics. The owner of one store, who wished to remain anonymous because she doesn't want to associate herself too closely with the industry, acknowledged that her business probably wouldn't have opened last October if not for Montana's medical marijuana program.
"It wasn't so much the law passing," she says. "It was more when the federal government said that they wouldn't be prosecuting people as much, and everybody in Montana started getting their cards and doing these bigger indoor operations."
The Green Light in downtown Missoula, a store that sells organic and ethically produced products, has dramatically expanded its offerings of grow supplies in recent months to meet demand, says co-owner Steve Luedecke. He devotes almost a quarter of the store's space to it now. As he walks through the inventory pointing out everything an individual needs for indoor gardening—ballasts, bulbs, reflectors, ventilation systems and various soils—Luedecke says a basic system with a 400-watt bulb can be had for as little as $275.
"There's been a lot of activity, as far as people growing," Luedecke says.
But customers tell him that the learning curve is steep, beset with trials and errors—and expensive ones. After all, caregivers are caregivers for a reason.
"I don't think this is something that you can go buy a book, some grow lights and some water pumps, and come out with a medical grade product without some background," says Lucke from "The Fat Hippy."
The plethora of rookie growers has also sparked another occupation within the medical marijuana industry: grow coaches.
David Drake doesn't necessarily call himself one, but he fits the job description. The 27-year-old Missoulian started the website Smokereports.com—"Home of the largest cannabis (marijuana) database ever created!"—and consults patients and caregivers across the state.
"When people have problems they know to get a hold of me," he says. "I help people get set up. Or if there's a caregiver with a few hundred plants that are about to die, then sometimes they'll call me and I'll help make sure that doesn't happen."
Drake's expertise serves as an example of the breadth of marijuana knowledge quietly cultivated over the years suddenly seeing the light of day. And it's just another example of how much the medical marijuana program has impacted the local economy.
"We're in a time when more traditional businesses have cut back and more people are hurting financially, and people see opportunity in the medical marijuana business," says Tom Daubert, founder of Patients and Families United, a group that lobbies for marijuana patients' rights in Helena. "But I don't think the opportunity is as real as they expect...And I think the trend is potentially unfortunate for patients, and certainly laden with political risks that I am deeply concerned about. I think we all agree that this is moving very fast."
Ever since voters approved Montana's Medical Marijuana Act in 2004, the measure has been criticized as too vague. But with the medical marijuana industry's recent growth, and interpretations of the law increasingly stretched, those criticisms have become more widespread.
Perhaps the best evidence of this prevailing concern is that those who helped craft the law count themselves among those most worried.
"I was imagining that this program would evolve primarily under the influence of Montanans who understand Montana culture and Montana ethics," says Tom Daubert, founder of Patients and Families United, the main group lobbying for medical marijuana rights in Helena. "I think some of the, shall we say, 'ganja-preneurial' behavior that's inciting backlash is coming from people who have only recently moved to Montana. In some cases, it's people who moved here solely to make money from medical marijuana."
Daubert never thought the tenor of the debate would reach this pitch. He puts himself alongside the law enforcement officials, legislators, doctors and lawyers who wonder if the intent of the original law has been lost amid the industry's sudden growth.
"I really do fear for the future of patient rights, and the possibility that certain kinds of medical conditions could be eliminated from our law as a result of some types of clinics," he says.
Daubert is just one person who's raised concerns. Deputy Missoula County Attorney Andrew Paul describes what he sees as "rampant abuse" of the medical marijuana law.
"It seems to me like there's a lot of gray area in the medical marijuana law, and I think that public officials are really having a difficult time trying to figure out how to address it, and how to address all of these dispensaries popping up everywhere," Paul says. "And it's not just in Missoula. Local government officials are struggling with this all through Montana."
Specifically, Paul suspects the medical marijuana movement is trickling into the black market.
"We're seeing a lot of people cloaking themselves with medical marijuana who are basically just drug dealers," he says. "We know that that's going on frequently. It seems like every person that we've busted who has been a caregiver has been selling to people who are not their patients, and have been either growing or buying large quantities of marijuana that are not going to legitimate patients, but is being sold, basically, on the black market."
The problem, Paul adds, is that it makes it difficult for law enforcement to differentiate between illegal users and patients who are trying to access their medicine legitimately.
The medical profession expresses its own concerns. Dudley Dana, a Missoula-based clinical psychologist and licensed addiction counselor, says he and colleagues have noticed a dangerous rise in the number of patients receiving marijuana recommendations.
"I know of no other medication that has bypassed rigorous research before it is allowed to be prescribed," he says. "The focus is generally on efficacy, safety and side effects. It is hard to imagine given the side effects of THC that it would be approved."
More than that, Dana worries about the minimization of marijuana's addictive potential. He explains that the vast majority of addiction therapists and researchers think that medical marijuana can precipitate "a spiral into addiction," similar to alcohol, especially for those genetically predisposed. He tells of one young patient for whom "everything went to hell" after receiving a medical marijuana card for a dubious health issue. Once the patient used marijuana daily, Dana says it led to "the deterioration of his life."
"If we're going to legalize marijuana, let's have that debate," Dana says. "Let's not make an end run around the whole issue by medicalizing it."
The issue has already been brought to the attention of the Montana Board of Medical Examiners. In particular, roving clinics run by Montana Caregivers Network (MCN), which can include doctor visits via video conferencing, have been the source of informational meetings with the board. Jean Branscum, the board's executive director, says the board doesn't have jurisdiction over the clinics themselves, but it does over all licensed doctors in the state. Confidentiality rules forbid her from saying whether or not doctors associated with MCN or other clinics are under investigation.
"We've heard from physicians that there's a question of clarification that's needed for physicians participating in these clinics," she says. "And the board is working on a position paper [to address that]."
All investigations, Branscum says, look at whether or not a physician upholds a standard level of care. Asked if it's possible for physicians who visit with patients via video conference to uphold that standard, she says, if they're under investigation, they'd have to prove it.
Branscum stresses that complaints trigger any board investigation, and that a review can end with a physician's license suspended or revoked.
While there's no consensus about how to immediately address the concerns, Daubert at least offers some common ground. He says law enforcement and patients ultimately desire the same end result.
"Patients merely want access to the medicine without fearing arrest or prosecution, and they want it to work, to be good, and to be safe," he says. "Law enforcement, primarily, just wants to know that all the medicine going to patients is legal Montana medicine, and that none of the medicine produced is going to anyone but legal patients. There's no area of that with which patients would disagree. The question then becomes: How do we rework a solution that makes it all possible?"
Following the sudden rise in new patients, storefront businesses and bold interpretations of the state law, we look ahead at the next big things in Montana's medical marijuana movement.
Looming legislative fight
Little can be done to change Montana's current Medical Marijuana Act until the 2011 Legislature takes up the issue. And all indications are the fight in Helena will be intense.
"There is a lot of improvement needed in the Medical Marijuana Act. Have we as a city gotten together a complete list of our concerns? No. We're working on it," says Keithi Worthington, deputy city attorney in Missoula. "And I've been in discussion with one of the county attorneys to talk about ways that we can gather our concerns and put them together both as a county and as a city to get those concerns to the Legislature."
Tom Daubert, the founder of Patients and Families United, a lobbying group that organized "Cannabis at the Capitol Day" during the last legislative session, says he sees areas of common concern between patients and law enforcement. But he also acknowledges that certain caregivers and entrepreneurs have undone a lot of the headway his group made in Helena.
"I've been told by law enforcement officials that we're further behind today than we were at the beginning of the last legislative session, politically," he says, "and my own read of the situation confirms that."
The main fight may be waged in Helena next year, but some Montana cities are already using zoning to chip away at medical marijuana businesses.
Whitefish City Council passed an "urgency ordinance" in early December banning medical marijuana businesses for three months so the Whitefish Planning and Building Department could investigate ways to appropriately zone them. In the decision, the council determined that such establishments "could be immediately detrimental to, harmful to, and a threat to the peace, property, health, safety, and welfare of the city and its inhabitants." Billings tabled a similar ordinance in November. Just this week, Great Falls passed a zoning ordinance that prohibits medical marijuana businesses from opening within city limits for three months.
Allen St. Pierre, director of the National Organization for the Reform of Marijuana Laws (NORML), says that land use and zoning is "the great frontier" in marijuana law reform. He says hundreds of communities, most notably in California and Colorado, have moved to ban medical marijuana. Most recently, the Los Angeles City Council passed a new ordinance in January that puts strict controls on where dispensaries can operate, and will force hundreds to close.
One of the main concerns about the rising number of patients and increased competition among caregivers is the quality of the actual medicine. Montana Botanical Analysis (MBA), based in Bozeman, calls itself the first state laboratory "dedicated to the study and analysis of medical cannabis." Founded by Dr. Michael Geci last year, the lab purports to, among other things, measure the tetrahydrocannabinol (THC) in strains of medical cannabis, as well as test for mold, pesticides, heavy metals and other potentially harmful contaminants.
A similar operation in Missoula, CannabAnalysis Labs, expects to open in the next month or two. Rose Habib, a chemist and founder of the lab, says she'll test product for its cannabinoid profile, with a special focus on working with extracts for edibles. "We will make your extract, and test it," she says.
With more and more caregivers cropping up, quality control labs could serve as an important step for concerned caregivers and patients as they try to bring legitimacy to their medicine.
Decriminalization or legalization
The pro-marijuana movement has never had as much political momentum, media exposure and general support as it does today. A huge portion of that swing is due to 14 states legalizing the use of medical marijuana and generations of Drug War rhetoric being stripped away.
St. Pierre recently told OC Weekly the movement's "almost at a zeitgeist," meaning enough favorable forces have come together to help make reform possible.
"I definitely think the tide of public opinion is moving rapidly toward favoring legalization for adults with regulation and taxation," says Daubert of Patients and Families United. "I think probably the biggest driving factor in that is budget considerations."
Harvard economist Jeffrey A. Miron says legalizing marijuana would benefit taxpayers nationwide by roughly $25 billion per year in both generating new tax income and eliminating the cost of enforcement. John Gettman, a former NORML president who now works for DrugScience.org, claims legalizing marijuana would benefit taxpayers by $42 billion per year.
"The solution to many of the current medical marijuana program's woes and complexities and gray areas," says John Masterson of Montana NORML, "is to just drop the 'medical' and have a regulated system for all adults."Skylar Browning contributed additional reporting to the story