Massachusetts allows voters to implement state laws by initiative without approval of the legislature or governor, and it appears likely to adopt medical marijuana on the November 2012 ballot.  A 2008 initiative approved a state law decriminalizing adult possession of an ounce of cannabis (substituting a fine for any threat of arrest or other penalty) with a 65% vote, 2% ahead of Barak Obama’s total.  Recent polling on the medical initiative is 80% favorable.

In January 2012 the state elections agency certified 70,000  signatures, enabling the initiative “A Law for the Humanitarian Medical Use of Marijuana” to appear on this year’s ballot, after two easily-achieved preconditions:  The legislature must fail to implement the initiative before May (a cochair of the committee, to which the initiative is assigned, already has killed less beneficial medical bills); and, the same amply-funded organization that collected signatures must collect another 11,000.  On a majority vote, the initiative becomes effective January 2013; its text cannot be changed before 2013.

The initiative requires the state public health agency (DPH) to license 35 dispensaries (“medical marijuana treatment centers”), at least one in each of the state’s 14 counties, and no more than five in one county.  More can be licensed after 2013 if the DPH deems 35 outlets inadequate for patient needs.  Dispensaries must be Massachusetts nonprofits.

Rules for selecting among license applicants are to be adopted by May 2013, although DPH staff limitations may delay license-competition rule-making.  Application fees are to offset the cost of administering the medical law.  All dispensary board members and employees must be licensed by the DPH, 21 years old, and cannot have drug felony records.

Unlike other states that enable nurses and other clinicians to permit patient access, this initiative allows only physicians to grant access to medicine, for patients with whom a “bona-fide doctor-patient relationship” exists.  To qualify, patients must have certain illnesses (cancer, glaucoma, HIV or AIDS, hepatitis-C, Crohn’s disease, Parkinson’s disease, ALS, multiple sclerosis), or other conditions deemed “debilitating” by their physician’s written recommendation.

The initiative allows qualifying patients to designate caregivers (including hospice, nursing and medical facility employees) to assist obtaining or using marijuana, and to keep a 60-day supply of medicine.  Doctors, and healthcare professionals operating under their direction, are protected from state penalty for complying with the initiative.  Physicians, health insurers and employers are not required, however, to approve, fund or accommodate medical use.

DPH-issued cards, requiring written doctor-recommendations and retained on a confidential DPH patient-caregiver registry, are required for patient or caregiver dispensary access.  Until dispensaries open, however, a physician’s written certification will protect qualified patients’ possession or cultivation of a sixty-day supply of medicine from state law enforcement.  Once dispensaries open, only patients eligible for hardship permits (based on distance, cost or debilitation) may cultivate.

Identifying doctors, willing to record their support for medical use, will be critical to patient access.  Patients can report their history of successful self-medication to their primary care physician or specialist, in support of becoming qualified patients entitled to protection under the initiative.

Will 2012 be the last year that Dutch coffeeshops can welcome foreign customers? The rules officially changed on the first of January, but it remains unclear whether policies of the right-wing government will prevail.

In typical Dutch fashion, the new scheme is extremely complicated and hard to explain. The goal is to turn all coffeeshops into private clubs, with memberships limited to 2,000 each. Only residents of the Netherlands can obtain a membership. The physical ‘weed pass’ that Minister of Justice and Security Opstelten had announced is no longer mandatory, a ministry spokes­person declared recently.

To implement the new rules, two criteria have been added to the so-called AHOJ-G policy that coffeeshops now have to follow. These new criteria will not be enforced immediately, however. In the three Southern provinces of the Netherlands, enforcement begins May 5, 2012. In the rest of the country enforcement is to start on Jan. 1, 2013. This means that Amsterdam coffeeshops can cater to tourists for the rest of this year. Opposition to the new rules is growing steadily, not only among shop owners and their visitors, but also from local governments and ordinary citizens, who anticipate that widespread,  large-scale street dealing will emerge if the new rules are enforced.

Two judicial verdicts already handed down leave considerable room for further court battles. Thus there is a real risk for local governments, who may eventually  have to pay compensation to the coffeeshops. The mayor and city council of Amsterdam rejected the plans of mister Opstelten from the start. A fierce tug-of-war is expected between the city of Amsterdam and the national government — if the government itself doesn’t collapse beforehand, which is not unlikely.

Meanwhile, the Dutch parliament still hasn’t debated the issue. The national government’s debate on drug policy has been tabled since March 2008, leaving the Ministry to dictate policies — and activists to stew in skepticism and anger. Two events are planned in Amsterdam to protest the ongoing wave of repression. A ‘420 Weed Pass Smoke Out’ has been organized by coffeeshopnews.nl moderator Peter Lunk for April 20, and VOC (Society for the Abolition of Cannabis Prohibition) will hold its annual free Cannabis Liberationday festival June 17.

* voc-nederland.org / www.coffeeshopnews.nl

Exposure to moderate levels of cannabis smoke — even over the long-term — is not associated with adverse effects on pulmonary function, according to clinical trial data published in the January 2012 Journal of the American Medical Assn.

Investigators at UC San Francisco analyzed the association between marijuana exposure and pulmonary function over a 20-year period in a cohort of 5,115 men and women in four US cities.

The data “confirmed the expected reductions in FEV1 (forced expiratory volume in the first second of expiration) and FVC (forced vital capacity)” in tobacco smokers. By contrast, “Marijuana use was associated with higher FEV1 and FVC at the low levels of exposure typical for most marijuana users. With up to 7 joint-years of lifetime exposure (e.g., 1 joint/d for 7 years or 1 joint/week for 49 years), we found no evidence that increasing exposure to marijuana adversely affects pulmonary function.”

They conclude, “Our findings suggest that occasional use of marijuana … may not be associated with adverse consequences on pulmonary function.”

The results are consistent with other reports finding no significant decrease in pulmonary function associated with moderate cannabis smoke exposure. A 2007 literature review conducted by researchers at the Yale University School of Medicine and published in the Archives of Internal Medicine found that cannabis smoke exposure is not associated with airflow obstruction (emphysema), as measured by airway hyperreactivity, forced expiratory volume, or other measures.

The largest case-controlled study ever to investigate the respiratory effects of marijuana smoking reported in 2006 that cannabis use was not associated with lung-related cancers, even among subjects who reported smoking more than 22,000 joints over their lifetime. “We hypothesized that there would be a positive association between marijuana use and lung cancer, and that the association would be more positive with heavier use,” stated its lead researcher, Dr. Donald Tashkin of California’s UCLA. “What we found instead was no association at all, and even a suggestion of some protective effect,” in that marijuana smokers had lower incidences of lung cancer than non-users.

Separate studies of cannabis smoke and pulmonary function indicate that chronic use may be associated with an increased risk of certain respiratory complications, such as cough, bronchitis and phlegm. However, alternative ingestion methods such as edibles, liquid tinctures, sprays or vaporizers virtually eliminate consumers’ exposure to such unwanted risk factors and have been determined to be ‘safe and effective’ methods of ingestion in clinical trial settings.

* “Association between marijuana exposure and pulmonary function over 20 years,” JAMA, January 2012.