Sunday, July 5, 2015

Sunday Globe Special: Drug War Defeat

When they start waving children in your face.... 

"Hospitals adapt as opioid epidemic hits infant victims; Infants born exposed to drugs" by Felice J. Freyer Globe Staff  June 28, 2015

At one time, babies withdrawing from drugs were a rarity, except in the inner city. But now from Boston to Springfield, from Plymouth to Worcester, they are a regular presence at birthing hospitals large and small, as the state’s opioid epidemic cascades down to the next generation.

Nationwide, the number of newborns treated for drug withdrawal increased nearly fivefold between 2000 and 2012, according to a study this year in the Journal of Perinatology. The study estimated the annual cost of their care — days to weeks in the hospital — at $1.5 billion, more than 80 percent paid by Medicaid. 

So not only is the CIA drug smuggling supplying black profits for black budgets while bolstering the bottom lines of banks, it costing taxpayers plenty on the other end. too.

In Massachusetts, where the opioid-abuse epidemic has hit particularly hard, hospital data suggest that the rate of drug-dependent newborns is two to three times the national average.

Charlie’s illness was a consequence not of neglect, but of diligence. Years before his birth, Michelle Frigon had been addicted to painkillers. In recovery, maintenance drugs successfully controlled her addiction. She followed her doctor’s advice to keep taking a steady dose during her pregnancy, even though the baby, inevitably, would take the drug along with her.

You ask me what to do, I don't know. Just say no?

Some 20 to 40 percent of babies exposed to drugs in the womb are born without any symptoms. But the rest go into withdrawal, experiencing what doctors call neonatal abstinence syndrome, or NAS: irritability, tight muscles, excessive crying, low-grade fevers, difficulty feeding, tremors, watery stools, sweating, and sneezing.

Hey, I feel sorry for the kids. Terrible way to come into this world.

Charlie would need medication — small doses of morphine — and then he would need to wean off morphine. But, doctors say, what he most needed is what Frigon provided day in and day out: cuddling, breast milk, love.

!!!!!!!!

“A lot of these moms are trying really hard to do what’s right,” said Dr. Munish Gupta, a newborn medicine specialist at Beth Israel Deaconess Medical Center in Boston. “They’re in recovery from a terrible illness.” For many, that illness is best treated with medications such as methadone and buprenorphine. That’s why, Gupta said, “We’re not going to get rid of NAS for a long time.”

**********

The road to addiction, Frigon said, started with a prescription: Percocet to relieve pain from wisdom-teeth removal. She was 16, and for the first time she felt confident and calm. She now believes that without knowing it, she was medicating an anxiety disorder.

The 21st-century gateway drugs.

At a gathering of high school friends in suburban Millbury, someone took out one tiny OxyContin pill, crushed it and passed it around to sniff. Frigon’s life would never be the same.

“By two years later, I needed two 80-milligram Oxy just to go to work,” she said. For the next few years, she lived in pursuit of pills, at one point sleeping in her car.

When Frigon became pregnant with her first child eight years ago, her mother went to court to have her committed to a drug treatment facility, where she started on methadone. The day she gave birth to William at UMass Memorial, she felt transformed, filled with a sense of purpose — and she says she has not misused drugs since. William, she says, “saved my life.”

It was 2007, and in those days, drug-exposed babies were given a diluted tincture of opium — which Frigon said left William “conked out,” so she never witnessed any withdrawal symptoms.

William’s doctors had been winging it. With limited experience caring for these babies, every hospital had its own way of doing things, said Dr. Alan P. Picarillo, chief of newborn medicine at UMass Memorial. Some hospitals didn’t even have written policies or procedures.

The opium treatment approach was abandoned a year or two after William left the hospital. Further changes occurred after 10 Massachusetts hospitals that treat the highest-risk newborns launched a joint effort, in 2013, to improve the care of drug-exposed babies, ultimately drawing 42 hospitals into the project. The hospitals are working on setting policies and standards and better engaging the parents.

But they have few hard facts to guide them, said Dr. Jonathan M. Davis, chief of newborn medicine at the Floating Hospital for Children at Tufts Medical Center. “People aren’t sure about the best treatments in the mothers. They’re not sure about the best treatment in the baby. And everybody does something different,” he said. Davis is leading a nationwide study comparing treatments, but answers are years away.

Meanwhile, the hospital collaborative has reduced the length of hospital stays and increased breast-feeding. (Doctors believe the benefits of breast-feeding outweigh any hazards from the traces of maintenance drugs that may get into breast milk.) But the biggest improvement, Gupta said, has been changing attitudes by teaching the staff that addiction is a chronic illness....

Unless it's money.

William, her 7-year-old, just finished first grade with high marks in reading and math, Frigon said. And Charlie is a cuddly 4-month-old who looks the picture of health. She remains close to his father, and they plan to marry. Her parents have provided shelter and support for years. In treatment, she met women who had been through detox multiple times, whose veins were destroyed from injecting drugs, who had nowhere to turn for support.

*************

Abigail Haskins has that disease. It started with prescribed painkillers in her teens and progressed to heroin.

But two years ago, she went on methadone and hasn’t looked back. Two months after starting treatment, she became pregnant.

Haskins, who lives in Clinton, north of Worcester, recalls standing in line at a methadone clinic while pregnant. Someone behind her muttered, “That’s so selfish. If I was pregnant, I wouldn’t be here.”

“People judge you all the time,” she said. “People said, ‘Get off,’ like it’s that easy. . . . I would have stopped, but I talked to doctors and they said that was a horrible idea.”

The American College of Obstetricians and Gynecologists advises against withdrawing from drugs during pregnancy.

“Withdrawal is very physically taxing on the mom,” said Dr. Jessica L. Young, an obstetrician-gynecologist who runs a clinic for drug-dependent pregnant women at Vanderbilt University Medical Center in Tennessee. Withdrawal, she said, can lead to uterine cramping, high blood pressure, rapid heartbeat, and increased blood flow to the placenta, conditions that can result in miscarriage or preterm labor.

And stopping methadone, even gradually, is also considered too risky, because the woman could relapse into illicit drug use, which is far worse for the baby.

Dr. Kelley A. Saia, director of Boston Medical Center’s Project RESPECT, a treatment program for pregnant women struggling with addiction, said most mothers want to get off medication because they don’t want their babies to go into withdrawal, but she works hard to persuade them to continue. Among those who stop their medication, “99 percent of them relapse before delivery,” she said. Then, they’re more likely to be taking more than one drug and exposing babies to ever-changing doses.

Haskins stayed with her methadone treatment. When her baby was born in April 2013, he went into withdrawal. She visited him every day at UMass Memorial for several weeks. She hated seeing him go through that, hated not being able to take him home.

Today, Ayden is a lively 2-year-old, who, his mother said, came out with flying colors on a recent developmental evaluation.

Haskins said she never thinks about using heroin and does not crave it. Besides, she said, she’d never do anything to jeopardize Ayden: “He is my life. He just makes me smile every day.”

Such an uplifting ending!

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Continuing on with the treatment:

"Opioid task force says more beds, treatment options needed; Group’s work was commissioned by Governor Charlie Baker" by Felice J. Freyer Globe Staff  June 22, 2015

Governor Charlie Baker pledged Monday to establish 100 new addiction-treatment beds within a year, to provide education on addiction to professionals who care for pregnant women and new mothers, and to make an overdose antidote more widely available.

The recommendations, among 65 steps from Baker’s Opioid Working Group, represent the governor’s first major response to an epidemic that claimed 1,000 lives from overdoses last year.

The group called for improved access to all types of treatment, including medications that quiet addicts’ cravings, as well as public education to end the stigma that prevents many from seeking help.

Which is all fine and good, but I would like you to keep this caring and compassionate response in mind as we move forward.

Some recommendations, such as a plan to lower the cost of the overdose antidote by purchasing it in bulk, will require legislative action, while others will involve partnerships with private industry and the federal government.

Related: Narcan Carries Its Own Addiction

I will give you one gue$$ what.

And one is already underway: public service advertisements alerting parents to the hazards of prescription painkillers.

Wasted money. People tune that out now, but at least certain well-connected interests will get paid.

“I didn’t originally run for governor to fight opioid addiction, but simply put, it was everywhere I went,” Baker said. “I can’t remember the last time I was in a room of more than 20 people where someone didn’t have a story that directly connected them to this crisis.”

Baker revealed that he, too, was personally connected: “I have family that almost lost somebody to this,” he said at the end of a State House press conference releasing the report.

Look, this guy was left an absolute disaster by Patrick. He's got loads of slack with me right now.

Marylou Sudders, secretary of health and human services and the group’s co-chair, said she will create a new position — assistant secretary of behavioral health — to oversee implementation of the recommendations.

More bureaucracy?

“There are too many barriers to treatment,” she said. “We will open new pathways.” That will include a pilot program placing trained counselors in outpatient settings and increasing the use of medication-assisted treatment. The Department of Public Health also will develop a database of available treatments open to anyone.

The state will also tap into data about overdose deaths to identify community “hot spots” that will be targeted for extra help.

Sudders also pledged to make the prescription monitoring program, a database of opioid prescriptions, a more useful tool for those checking to see whether a patient is seeing multiple physicians to obtain large amounts of drugs. Currently, it takes 11 clicks for a physician or other prescriber to reach the needed information, and even then, the information they get is often outdated. Sudders said the number of clicks would be reduced and the program will be updated daily.

Attorney General Maura Healey, who co-chaired the working group, said that while opioid addiction involves law enforcement, it also requires a public health approach.

“We are not going to arrest or incarcerate our way out of this,” she said. “Addiction must be treated like any other chronic illness.”

She said she would enforce the state law requiring insurers to cover behavioral health in the same way they cover physical health. She also plans to make the overdose antidote naloxone — widely known by its commercial name, Narcan — more widely available to emergency workers. And she said she would publicize the state’s Good Samaritan law, which protects people from arrest if they call 911 to report an overdose.

Healey pledged to step up enforcement of medical professionals who overprescribe and treatment centers that unlawfully charge for care.

The report was well-received in the treatment community, but....

That a word of defeatism.

--more--"

"23 arrested on heroin charges in Lawrence" by Aneri Pattani Globe Correspondent  June 19, 2015

Nearly two dozen people were arrested Thursday in a Lawrence police operation focused on street-level heroin sales, officials said.

The sweep saw 23 men and women, ranging from 17 to 59 years old, taken into custody, said Lawrence Police Chief James X. Fitzpatrick.

“This will have a significant impact on the retail level of heroin sales in the city,” he said.

Most of the people arrested face charges of distribution or possession of a Class A drug. A 35-year-old Lawrence man was discovered to be a fugitive from Texas, Fitzpatrick said.

The operation, which was conducted after weeks of investigation involving Methuen and New Hampshire law enforcement officers, focused on buyers from New Hampshire and other areas outside the city, Fitzpatrick said. Massachusetts and New Hampshire residents were arrested, the chief said.

“We have a market that is supported by drug users from outside our jurisdiction,” he said.

The arrests were made in the neighborhoods of Prospect Hill, Lower Tower Hill, Broadway, and Arlington.

Fitzpatrick said the operation was part of the department’s ongoing effort to combat heroin sales. “We’re out there every day fighting the opiate problem,” he said.

It's a never-ending war.

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"Quincy police seize $150,000 in heroin" by Aneri Pattani Globe Correspondent  June 26, 2015

Quincy police seized $150,000 worth of heroin and arrested four people Thursday in a joint operation with regional authorities aimed at dismantling a heroin delivery system, officials said.

The distribution network has been operating for several months in Quincy, Braintree, Randolph, and Brockton, Quincy police said in a statement. Customers would call a telephone number, and heroin would be delivered to them in bulk for individual sales....

Police arrested Jordan Martinez, 25, of Dorchester; Alexa Geracie, 21, of Plymouth; Luis Guerrero, 22, of Chelsea; and Brian Stuart, 34, of Quincy. Martinez, Geracie, and Guerrero face charges of trafficking more than 200 grams of heroin and conspiracy to violate drug laws, while Stuart faces the conspiracy charge.

Just a day earlier, two Lawrence men were indicted by an Essex County grand jury for allegedly packaging and distributing more than $1 million worth of heroin and fentanyl, a synthetic opioid, Attorney General Maura Healey said in a statement.

RelatedGuns, $2 million in drugs seized in Lawrence raid

“Fentanyl is an extremely potent opioid that authorities believe has contributed to many heroin-related deaths in Massachusetts,” Healey said in the statement.

“This deadly epidemic of opioid abuse is devastating our families and communities across the state. Our office will hold accountable those who make these lethal drugs available with no regard for the consequences, including the overdoses and deaths of users and the heartbreaking effects on their loved ones.”

Wilkins Diaz, 39, and Luis Hernandez, 32, were indicted on charges of trafficking more than 200 grams of heroin, conspiracy to traffic heroin, possession with intent to distribute fentanyl, falsification of a license, and possession of a firearm without a valid license.

The men were arrested in May while trying to flee a Lawrence residence during a raid by police....

--more--"

Related: Drug Gang Busted in Boston

All Jade Helm sweeps?

At least no one was killed and everything has been cleaned up.

Of course, when the subject turns to marijuana:

Mass. opioid battle is lost when marijuana is legalized

I'm waving the white flag then.

"Salem medical marijuana dispensary to open Wednesday" by Kay Lazar Globe Staff  June 23, 2015

Nearly three years after Massachusetts voters overwhelmingly approved marijuana for medicinal use, the state’s first dispensary is poised to open Wednesday in Salem.

But in striking contrast to the hoopla that has surrounded the state’s dispensary selection process, Alternative Therapies Group plans a decidedly low-key debut — with patients accepted by appointment only.

State regulators signed off on the final paperwork Tuesday allowing the dispensary to open.

Access to the dispensary, which is in a converted factory building that houses other businesses, will be restricted to patients with a state-issued marijuana registration card, according to the company. Even then, patients will not see any products on display, but will make their choices via a computer screen, according to Salem’s police chief, Mary Butler .

People may have a perception, Butler said, “that there is all this marijuana sitting out and around, and that’s not the case.”

No marijuana is grown or processed at the Salem site; the company’s cultivation center is in Amesbury.

Alternative Therapies’ chief executive, Christopher Edwards, did not return calls from the Globe. But Baker and Salem’s mayor, Kim Driscoll, said company leaders have been forthright in communicating their plans to the city.

“They went out of their way to meet with neighbors, officials, and others in Salem, to introduce themselves and explain what they will be doing,” Driscoll said in a statement.

“Salem has long been a progressive, forward-thinking, and open-minded community, and we look forward to [Alternative Therapies] starting operation this week and providing yet another critical medical choice to patients for the entire North Shore,” the mayor said.

Under an agreement signed between Salem and Alternative Therapies, the city will receive 1.25 percent of the company’s annual sales for the first two years. That climbs to 2 percent in subsequent years.

It has been a long haul for Alternative Therapies and for thousands of patients waiting for the first dispensary to open.

Alternative Therapies initially announced an April opening, only to push it back two months. A lab testing the company’s marijuana detected lead levels that exceeded the state’s strict rules. State regulators and chemists at two labs that will be testing dispensary products are at odds over testing rules.

Last week, the state granted Alternative Therapies a temporary waiver that will allow it to sell cannabis that has not been fully tested for pesticides and other contaminants.

--more--"

"At Salem medical marijuana dispensary, a sense of relief" by Kay Lazar and Virgie Hoban Globe Staff and Globe Correspondent  June 24, 2015

SALEM — It was 40 minutes past 10 a.m., and already roughly two dozen patients waited in line. They had come for the start of business Wednesday at Alternative Therapies Group, the first dispensary to sell marijuana for medical use in Massachusetts. Patient number one was a gray-haired man with a walker.

Access to the dispensary is by appointment only. A police officer stood by the entrance to the old brick factory building, and a private security guard checked off patients’ names from a clipboard as they waited under crystal blue skies.

Voters in November 2012 overwhelmingly approved medical marijuana in a statewide ballot initiative. But the awarding of dispensary licenses quickly became mired in controversy under the administration of Governor Deval Patrick, with questions about conflicts of interest and political favoritism. The system, stalled for months as patients grew increasingly frustrated, was recently revamped and streamlined by Governor Charlie Baker’s administration.

Do I even have to type it?

Now, nearly three years after the vote, medical marijuana is legally available to the 18,000 people who, according to state records, have the required physician certifications.

“We fought a long time for this,” said Peter Hayashi, a 59-year-old former neuropsychologist who was among the first to enter the dispensary.

Hayashi said he has a painful neurological condition — at times, cold air can make his skin hurt — and he has been getting medical marijuana from a Maine dispensary to ease his symptoms. Without the marijuana, he said, he has often spent hours in bed, his skin under covers to protect it against temperature changes.

“Marijuana has helped me be up and around more normally,” he said.

Wendy Atwood was waiting in line, too. The 53-year-old said she has used marijuana to ease knee and back pain from arthritis, depression, and anxiety. She also said she has long used the drug recreationally.

“I am a law-abiding citizen, a mom with two kids, and a day-care provider,” Atwood said. “It’s going to be very exciting” to walk into the dispensary, she added. “I’m happy that it’s not under wraps anymore.”

I'd rather she suffer at the hands of state officials. They didn't like us voting that way, and it's the vote I most regret casting.

But the process was hardly speedy. Waves of patients waited up to an hour in line, and then, in small groups, were ushered inside.

They said they were shown a 10-minute video about marijuana and the types of strains the dispensary would be selling, although on Wednesday just two varieties were available.

Patients said they were not allowed to see or smell the products, and were instead shown pictures on a computer screen, using a system that staffers told patients they had learned to operate just the night before.

Patients said they placed their orders and then went to another area in the dispensary to pick them up.

Many said that the prices were higher than they had anticipated, and that the dispensary took only cash, but had an ATM for those who ran short.

Barry Levine, a 62-year-old self-employed lawyer from Marblehead, said he paid $372 for 1 ounce. Levine said marijuana helps ease his nausea from chronic gastritis.

Seems like a lot.

Access to medical marijuana “is a panacea for everyone who uses it,” he said. “This for me is an old hippy’s fantasy land.” 

:-(

About 120 patients had signed up for appointments Wednesday, according to the company’s security guard. Alternative Therapies executive director Christopher Edwards briefly stepped outside to speak with the guard, but declined a request for an interview.

Fourteen other dispensaries from Northampton to Boston have received preliminary state approval and are finalizing plans to open. At least two are expected to open this fall.

The executive director of a trade association for the dispensaries issued a statement saying the industry welcomes the opening of the first facility, but raised concerns the state’s testing standards for medical marijuana are too stringent.

Why does that not surprise me?

“Massachusetts has the most conservative testing limits in the country,” Kevin Gilnack, executive director of the Commonwealth Dispensary Association, said in the statement.

Hey, Massachusetts, yer number one!

Alternative Therapies was able to open after receiving a temporary waiver last week from the state that allows it to sell cannabis that has not been fully tested for pesticides and other contaminants.

Good idea; however, no big deal on the food(!) and remember the meningitis murders? State regulators fell down on the job? Gotta sift through the pot companies chaff though.

The one-time waiver was granted because laboratories in Massachusetts are not yet able to complete the quality testing required under state health department rules, Baker’s office said last week.

But chemists at two labs poised to test dispensary products said the problem isn’t operations at the labs. The problem, they said, resides with the state’s guidelines, issued just six weeks ago, which set standards that are too stringent for lead.

Seriously, they are not citing the work of state drug labs?

The trade association said in its statement that the state made an errant assumption about how much marijuana patients might consume.

“A survey of available data showed that the heaviest users consume about 2 to 3 grams of cannabis per day,” Gilnack stated. “Connecticut assumed a patient might consume 2.33 grams per day while Nevada assumed a patient might consume 5 grams in a day,” he said, yet the Massachusetts Department of Public Health “based our testing limits on the assumption a patient could consume 28 grams — about six to 12 times more than what we’re seeing in other states.”

Those numbers don't mean anything to me. Is that a lot?

--more--"

I get the feeling I'm coughing on the first hit.

Related:

“Patients have waited to access marijuana for medical purposes for far too long,” Governor Charlie Baker said in a statement. “This waiver will allow industry laboratories a little more time to reach full operation while providing safe amounts of medical marijuana for qualifying patients who need it.” But chemists at two labs poised to test dispensary products said the problem isn’t operations at the labs. The problem, they said, resides with the state’s guidelines, issued just six weeks ago, that set standards that are too stringent for lead."

I think the guy does mean well. He's of the elite of Bo$ton; however, he didn't need to take the job. Would have been better off without it. 

"Lots of interest shown for new batch of marijuana licenses" by Kay Lazar Globe Staff  July 01, 2015

No, I'll pass.

More than 50 applications from companies eager to open medical marijuana dispensaries flooded the offices of state regulators this week, two years after Massachusetts launched its ill-fated licensing process.

I've already blown enough smoke about making suffering people wait.

Should have gotten addicted to prescription pharmaceuticals or heroin; then there would be sympathy pouring out state ears.

The submission of so many applications indicated robust interest in the state’s emerging medical marijuana industry. The state had previously licensed 15 dispensaries, with the first opening last week in Salem.

For marijuana executives who lost hundreds of thousands of dollars vying for licenses during former governor Deval Patrick’s administration, the opportunity to apply again couldn’t come soon enough.

Concerns about political favoritism, conflicts of interest, companies with questionable financial structures, and executives with questionable pasts mired the process last time around. As a result, more than two dozen lawsuits were filed, and patients were left without any dispensaries until last week.

I think it was all on purpose. A way to drag their heals on something they didn't really want.

Regulators from the administration of Governor Charlie Baker recently revamped the system for awarding licenses, promising the new process will strip away the subjectivity and secrecy that had tainted it under Patrick’s tenure. The latest applications will be considered in the order received, the state Department of Public Health said Tuesday.

The health department has not released the names of the applicants, but the leaders of several marijuana companies confirmed Tuesday they had reapplied.

“I have learned to meter my expectations based on the rough road we had,” said Jeffrey Roos, chief executive of Mass Medi-Spa, which has reapplied for dispensary licenses in Norwell and Nantucket.

Roos said he believes his company was unfairly knocked out of the selection process last time, based on a faulty review by health department contractors. Now, he said, he has more confidence after hearing the Baker administration’s plan to license dispensaries in a format similar to other health care facilities, such as pharmacies.

Each application will be judged on its merits, using guidelines posted by the department on its website, and will move forward when the company meets the overhauled standards, officials have said. The old system involved scoring, essentially pitting applications against each other.

Roos said his new applications closely resemble his earlier ones, but he has beefed up his board of trustees, including the addition of Dr. Bob Arnot — a physician, author, and former news correspondent for CBS and NBC — to advise the company on medical issues.

“Dr. Bob is a longtime Nantucket summer resident,” Roos said. “He has a passion for cannabis science and the opportunities that lie ahead of us.”

Arnot’s agent, Alan Morell, confirmed that his client has agreed to be a medical adviser on Medi-Spa’s board.

One name that has left the lineup of applicants is William Delahunt, the former US representative from the South Shore.

Delahunt’s former company, Medical Marijuana of Massachusetts, resubmitted just one application, for a dispensary in Plymouth County, according to its new chief executive, Jonathan Herlihy.

Under the Patrick administration, the company had been tapped for three dispensary licenses, in Mashpee, Plymouth, and Taunton. But regulators later rejected the company after questions were raised about its financial structure and potential conflicts of interest between Delahunt and the Patrick administration’s health commissioner, Cheryl Bartlett. Delahunt has since left the company. 

I'm sure I could find all the links if I remembered where they were.

A judge in April ruled that regulators acted improperly when they dropped Medical Marijuana. The judge ordered that the company be allowed to move ahead with its plans in Mashpee and Plymouth, and Herlihy said he is now working with state regulators on those applications.

Amid the legal morass, Herlihy said his company continued to pay rent on a vacant, 46,000-square-foot cultivation center for the past 18 months.

“We raised $3 million and spent quite a bit of that on rent and lawyers,” Herlihy said. “We now have to raise another $3 million or more to go forward. We have to go back to those investors and see if they are willing to contribute more.”

Rina Cametti, president of Beacon Compassion Center, is also huddling with her investors. The company this week submitted three applications, two in Norfolk County and one in Middlesex County. Cametti’s company was one of five that received among the highest marks during licensing evaluation by the Patrick administration, only to be left hanging.

At the time, regulators would say only that one of Beacon’s executives didn’t pass a background check, but that if the executive were removed, the company could continue in the licensing process.

Beacon Compassion and the other four companies removed executives deemed questionable by regulators, but the companies were then all rejected without comment.

“I think this process makes so much more sense this time around,” Cametti said. “I have my fingers crossed that the Baker administration will work in a much more timely manner.”

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I sure hope they didn't base it on Minnesota:

"Minn. marijuana patients face hurdles" Associated Press  June 29, 2015

ST. PAUL — There will be no baggies of pot awaiting patients next week when Minnesota joins 21 other states in offering medical marijuana. No glass pipes, no plants to tend at home. Instead, the nation’s latest medical marijuana program is a world of pill bottles and vials of marijuana-infused oil.

For the qualifying patients seeking relief from pain, medical marijuana advocates, and some lawmakers, Wednesday isn’t the finish line, but the first step. The state’s restrictive approach, unseen in the industry, is likely to mean high costs, long drives, and reluctant doctors.

‘‘The door is opening,’’ said Bob Cappechi of the Marijuana Policy Project, a national outfit that pushes to loosen marijuana laws. ‘‘This will start helping people out. That’s really what this is all about.’’

Minnesota’s medical marijuana advocates snatched an unlikely victory from the Legislature last year after years of failed efforts, but there was little celebration. What emerged to assuage skeptical law enforcement lobbyists and a wary governor was one of the strictest programs in the nation.

Smoking the plant is forbidden.

They took all the fun out of it.

Pills, oils, and vapors are only available to patients suffering from severe conditions, such as cancer, epilepsy, HIV, and AIDS.

Ah, who cares about their pain and suffering, and in an all too familiar drill, that is where the print I'm reading ended.  

And the medicine can only be sold in eight locations, hundreds of miles away from some in Minnesota’s rural expanses.

The two companies growing, cultivating and selling marijuana for the state say Minnesota stands out for its medical approach to a nearly 20-year-old industry that uses terms like ‘‘budtender’’ (salesmen) and ‘‘California Kush’’ (a strain of marijuana).

‘‘The industry doesn’t do it this way,’’ Dr. Kyle Kingsley said just days before opening Minnesota Medical Solutions’ first dispensing clinic in Minneapolis. ‘‘It’s all new.’’

Kathy Schroeder’s difficult path shows how the medical polishes on Minnesota’s program look more like hurdles to some patients. On paper, her multiple sclerosis and glaucoma — two of the nine conditions that qualify — made her a perfect fit. But like many residents, the 63-year-old struggled to get a doctor’s signature to sign up for the program.

Prodding a second doctor paid off for her, but Schroeder isn’t sure whether she can even afford a month’s worth of medicine, which Kinglsey said may sell for up to $600. Still, she'll make the 180-mile round trip Wednesday from her home near Rochester to MinnMed’s Minneapolis facility.

‘‘I knew it was going to be bad, I had no idea it was going to be this bad,’’ her daughter, Maren Schroeder, said. 

Hey, they don't want you using, period.

Representative Carly Melin sympathizes. The Democrat faced criticism for watering down her medical marijuana bill to get police and Governor Mark Dayton on board.

‘‘We weren’t going to get anything done if we didn’t pass this law,’’ Melin said.

Kinglsey said he’s confident doctors and hospital systems will eventually approve, but it’s made for a slow start to a program that’s supposed to sign up 5,000 people. As of Friday morning, just 65 patients were completely registered and another 74 were being processed.

Cappechi and other advocates already have ideas for how to improve it: allow more than eight dispensaries, add more manufacturers and patients who suffer from chronic pain, and perhaps lift the ban on smoking the drug.

But before expanding, Dr. Andrew Bachman, co-founder of the state’s other medical marijuana manufacturer, LeafLine Labs, said they need time to show lawmakers and doctors alike that the new industry works.

That starts Wednesday, he said.

‘‘Ideology does not change overnight. It’s important to start somewhere,’’ he said.

For some it never changes at all.

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I'm thinking legalization won't work or lead to jobs:

"Workers can be fired for using pot off-duty, Colo. court rules" by Kristen Wyatt Associated Press  June 15, 2015

DENVER — Pot may be legal in Colorado, but you can still be fired for using it.

You should have gotten addicted to, you know. 

So when do they start testing for booze?

The state Supreme Court ruled 6 to 0 Monday that a medical marijuana patient who was fired after failing a drug test cannot get his job back. The case was being watched closely by employers and pot smokers in states that have legalized medical or recreational marijuana.

Gee, that's not even a recreational.

Colorado became at least the fourth state in which courts have ruled against medical marijuana patients fired for pot use. Supreme courts in California, Montana, and Washington have made similar rulings, and federal courts in Colorado and Michigan also have rejected such claims.

The Colorado worker, Brandon Coats, a quadriplegic, was fired by Dish Network after failing a 2010 drug test. The company agreed Coats wasn’t high on the job but said it has a zero-tolerance drug policy.

Coats argued his pot smoking was allowed under a state law intended to protect employees from being fired for legal activities off the clock. Coats didn’t use marijuana at work, but it’s intoxicating chemical, THC, can stay in the system for weeks.

The Colorado justices ruled that because marijuana is illegal under federal law, Coats’s use of the drug couldn’t be considered legal off-duty activity.

And you wonder why I scream state's rights and cite the Constitution?

‘‘There is no exception for marijuana use for medicinal purposes, or for marijuana use conducted in accordance with state law,’’ the court wrote.

That settles that.

Coats and his lawyers said the decision at least clarified the matter for workers.

‘‘Although I’m very disappointed today, I hope that my case has brought the issue of use of medical marijuana and employment to light,’’ Coats said in a statement. 

I'm sure a joint will lift your spirits.

Dish Network and other business groups applauded the ruling.

‘‘As a national employer, Dish remains committed to a drug-free workplace and compliance with federal law,’’ company spokesman John Hall said in a statement.

Twenty-three states and Washington, D.C., allow people to use medical marijuana. Alaska, Colorado, Oregon, Washington state, and Washington, D.C., have legalized recreational marijuana.

The Colorado Constitution specifically states that employers don’t have to amend their policies to accommodate employees’ marijuana use.

Coats was paralyzed in a car crash as a teenager. He was a telephone operator with Dish for three years.

--more--"

Should have had a different addiction.

Turns out they despise all things herbal:

"The International Herbal Symposium is typically a celebration of the ancient practice of using medicinal plants to heal the body, where herbalists from around the world exchange recipes as freely as hugs, meditate, and catch presentations including “How Mushrooms Can Help Save the World.” But the harmonic gathering of 900 herbalists at Wheaton College last weekend was rattled by a dissonant intrusion from the business world: Shire City complained to the e-commerce site Etsy about versions bearing the trademarked name being available on the marketplace. Herbalists counter that trademark disputes such as this are common." 

Just killed my buzz, man!