As the Arizona Department of Health Services approved nearly 100 dispensary application certificates, the battle over whether medical marijuana will be distributed on a large scale in Arizona is far from over.
People in the medical and law enforcement professions, potential patients and dispensary owners, advocates and elected officials are all battling to see their side prevail. While the debate rages on, dispensary owners with certification in hand are preparing to open up shop. And depending on just how prepared they are, dispensaries could open as soon as next month, says Laura Oxley, spokeswoman for the Arizona Department of Health Services.
One of those lucky certification holders is Tucson oncologist Don W. Hill. He strongly believes in the medical science behind marijuana.
And like several other potential dispensary operators, he’s willing to risk prosecution to reap the financial rewards. He says he needs the income because his oncology practice isn’t making money.
Hill will serve as medical director for five Tucson-area dispensaries.
The first dispensary his group is attempting to open will be in Sahuarita near Tucson. Hill’s interest in medical marijuana began after he served as a principal investigator in a medical trial testing the effects of an experimental type of marijuana on cancer patients.
The trial administered marijuana through the mucus membranes in the mouth, Hill says.
After the study ended and the company decided not to pursue FDA clearance for the drug, Hill’s patients urged him to get involved in Arizona’s medical marijuana program. In considering what to do next, he started researching the most effective ways for medical marijuana to be administered. He also polled his patients and found that a third of them were still using marijuana clandestinely.
Hill says he doesn’t smoke marijuana and has only been high once — at a Jethro Tull concert during his high school years. He didn’t like it, but says he understands that the drug can help those suffering from cancer and other ailments.
“Being a libertarian at heart, if my patient is using marijuana, what do I care?” Hill says.
During his research, Hill found that smoking marijuana is not always effective and can actually do more harm to patients than good. He believes that marijuana as a medicine is most effective when it is used in an edible or vaporized form.
“Cannabis is not a powerful analgesic (painkiller), but it augments other pain medications. I really don’t recommend consumption of marijuana in smoke form. There are lots of carcinogens in smoke form,”
The human brain has ten times the number of cannabinoid receptors as opioid (painkiller) receptors, Hill says.
“As biological entities, human must have been exposed millions of years ago and there must have been some biological advantage to having these receptors,” he says.
Marijuana also has a low risk for overdose, Hill says. Yet he does acknowledge that like any drug, it does have the potential to be misused.
“From my research and learning it does have some abuse potential. Some patients abuse it and need it to function,” he says.
Dr. Elaine Burns, medical director for the Southwest Medical Marijuana Evaluation Center, has been studying medical marijuana during the past two years. Although she doesn’t know about the exact number of cannabinoid receptors in the brain, she is aware of the two most- studied receptors. One is present in the brain and the spinal cord, while the other is present in the immune system.
She says that people who don’t respond well to opioids often do much better with marijuana.
“The goal is to get them off the opioid, because there are a lot more side effects than cannabis,” Burns says. “Opioids can cause the heart and breathing to stop, but there isn’t a risk for that in the brain with cannabis.”
The receptors that would cause a cannabis overdose don’t exist, she says. Marijuana still has side effects such as red eye, fatigue and in certain people, anxiety and paranoia.
Burns hasn’t seen studies on whether marijuana is effective in vaporized or edible forms, but says it makes sense as smoking does cause carcinogens to enter the lungs.
“Edibles would be good, but some people don’t get immediate relief and smoking is preferred because it’s quicker,” Burns says.
Even though the dispensary process is starting, Burns will only be satisfied when the facilities are functioning. But there is still a long way to go before people are convinced about the medical benefits of marijuana.
“I think a lot of people are not educated on the subject. There’s what I call the blurred boundary, people looking at Woodstock and hippies and looking at it from a recreational standpoint. We’re talking about the medical benefits,” she says.
While Hill is confident in the medical benefits of marijuana, his motivation to get into the business is far beyond just helping ailing patients. He says he desperately needs the money that would come from working at a dispensary.
“I really need this from a financial standpoint as I can’t make money as an oncologist,” he says.
He says he hasn’t made any money at his oncology practice for two years. Many of his patients are on Medicare and Hill says the reimbursement rate is too low to pay for expenses or his salary. He has had to sell personal stock and use his own money to keep his practice going. Hill has tried to sign on with other clinics such as Sun Life Family Health Center, but has been unable to find a place that will hire him.
Hill estimates that two investment groups have invested $500,000 each, while he personally has invested $150,000. So far, the money has gone to legal fees, educational materials, the application and other expenses, he says.
“It’s not cheap. The state designed it not to be cheap. If you fail they keep most of the money,” he says.
The dispensary may charge up to $350 for an ounce of marijuana. That price is the industry standard, Hill says. “If someone wants it they’re going to pay for and it’s expensive,” he says.
However, even if Hill and his investors get their dispensaries up and running, there are no guarantees that those facilities — and the people who operate them — are in the clear.
Arizona voters approved medical marijuana in 2010 under Prop. 203, but since then there have been several efforts by top officials to undermine the program. Maricopa County Attorney Bill Montgomery says he will prosecute those who operate dispensaries and anyone who facilitates their opening, including state employees. Montgomery called the medical marijuana program a “flawed effort” and says federal law preempts state law.
Arizona Attorney General Tom Horne issued an Aug. 6 opinion stating that Arizona can’t authorize the opening of medical marijuana dispensaries because they would violate federal law. His office’s opinion went on to say that the part of the state law decriminalizing marijuana possession by card holders is, however, not preempted by federal law.
Horne’s opinion is “dead-on correct,” Montgomery says, but he is still waiting on a court ruling on a case brought by the White Mountain Health Center, which applied for a dispensary permit and was denied.
Montgomery says he hopes that the court will directly address the issue of federal preempting state law.
“Just because I say it doesn’t make it so. There’s a particular process we have to follow. We have to wait on a court ruling,” Montgomery says.
Hill isn’t worried about the threat of prosecution. He believes that he’ll be protected from prosecution since he will only be a medical director. “My role as educator and not advocator will insulate me,”
Hill says. He says he will not be recommending marijuana; he will only educate patients and the people running the dispensary.
Hill still won’t be surprised if the dispensaries will be targeted by law enforcement.
“Yeah, Montgomery and Horne may try to steamroll the system, which would be a setback. I’m a pessimist at heart and I have no doubt that someone is going to club us over the head,” he says.
Despite his pessimism, Hill says his plan right now is to continue seeing patients at his oncology office while he hopes for the dispensaries to open. He says he would leave Tucson or even Arizona if he didn’t have to care for his mother, who has dementia and lives with him. Hill is her primary caregiver and promised her he would never put her in a nursing home.
“I’m a good cancer doctor. This is my calling. I’m looking at this economic setback and I will overcome this in some shape or form,” Hill says. “I’ll either sign on with a big firm or I’ll end up leaving the state.”