Until medical marijuana dispensaries open in Massachusetts — which could happen as early as this summer — patients who can legally use pot for medical reasons are supposed to either grow their own or designate someone to grow it for them. Under the law, that person is known as a caregiver.

But there are limits as to what a caregiver can legally do. And right now the system does not appear to be running as intended.

"Though I'm acting as a caregiver at the moment, I'm actually an insurance broker," caregiver Bill Downing says at his home in suburban Boston. "It's much more exciting to be a caregiver than an insurance broker."

Downing works out of his small, cramped basement, just off the garage of his Cape-style home. He calls it his "caregiving operation" and describes it as a "little shop," with all kinds of salves, tinctures, lip balms, edibles, and other cannabis products.

Bill Downing weighs some marijuana before selling it to a patient. Under state regulations, caregivers are supposed to serve just one patient and can’t make a profit. (Lynn Jolicoeur/WBUR)

The room is dimly lit and full of stuff — a large desk, assorted chairs and overflowing metal shelves. Marijuana leaves hang from the rafters and sit in pitchers of water. There are two small rooms with pot plants growing. A back closet-like area holds shelves with acrylic bins and bags of marijuana. This is where Downing shows patients his products. The four strains of marijuana he has on hand right now include one called Elvis.

"Elvis is a hybrid, so it has many of the great properties of both indica and sativa," Downing explains. "So this would be good for somebody who's looking to calm down, keep random thoughts from taking them over. Anxiety, for instance, would be very good for this. And to some degree, pain."

Asked how many patients he has right now, Downing responds, "over 350." Asked about regulations that say he's supposed to serve only one patient, he says, "The regulation violates the statute. The statute allows for caregiving. The regulation does not."

The state Department of Public Health issued regulations governing medical marijuana four months after the law passed by voters went into effect last year.

While Downing admits he's violating the DPH rule saying each caregiver can provide marijuana to only one patient, he says the department is fully aware of what's going on.

"I've been in contact with them ever since the very first day I started this. I've been sending in forms for every patient, and they've never contacted me once, ever, for anything," he explains. "The state Department of Health made this limitation because they wanted to eliminate the caregiver function. And there's probably many, many reasons why they wanted to do that. But I think that probably one of them is that in essence caregivers are competing with their sugar daddies. And their sugar daddies are the guys who are throwing them the tens of thousands of dollars for all those applications, for all those fees that they're going to be charging for dispensaries."

Karen van Unen is the recently hired director of the medical marijuana program for the state Department of Public Health. She won't directly address Downing's allegation that the state simply didn't want caregivers to work out in the first place. She says caregivers were meant to fill in a gap until dispensaries start providing marijuana, and the entire program is based on a "dispensary model."

"In our model in Massachusetts, the caregiver role is about supporting patients who need help with self-administering [marijuana] or accessing it," van Unen explains. "The caregiver role is not set up to function like a dispensary."

Two strains Downing purchased on the black market in order to sell to medical marijuana patients. Downing says he gets all of the marijuana tested at a lab in order to find out the levels of different cannabinoids, but the testing doesn’t yet look for pesticides or contaminants. (Lynn Jolicoeur/WBUR)

Van Unen won't say whether a caregiver having 350 patients shows the system isn't working.

"Our role is about regulating the dispensaries, and not about individuals who are practicing the way this gentleman is," she says.

An organization set up to connect medical marijuana patients with caregivers, called Compassionate Caregivers of Massachusetts, tells us most caregivers went underground after the regulations went into effect last May. It simply isn't sustainable, they say, for a caregiver to grow marijuana for just one person.

Now, a spokesman says, the organization gets 15 to 20 emails a day from patients looking for caregivers, but the group can't help because there aren't enough.

DPH's van Unen says she is hesitant to talk about there being a shortage. "Until our model is fully launched and up and running, we don't really know what the need is and what the demand is going to look like," she says.

At caregiver Bill Downing's house, it's clear demand is high. During our visit, a new patient arrived about every 10 minutes.

Tom Sabin, a 58-year-old from Rockland, is buying marijuana to treat pain from chronic pancreatitis and neuropathy. At this visit, he spends $650 on marijuana and another $90 on chocolate hashish. He explains that his primary care doctor wrote a letter saying he agrees that Sabin might benefit from medical marijuana — but it wasn't an official recommendation. So Sabin took that letter to a specialized clinic where a doctor gave him the necessary certification, which Downing required him to show.

Sabin says he smokes six to 12 joints a day.

Some of the few marijuana plants Downing keeps on hand in order to do a small harvest once a year. (Lynn Jolicoeur/WBUR)

"It beats taking Oxycodone," he says. "If I was taking the pills that the doctors give me, I couldn't stand here and talk to you right now because I'm a drooling idiot on that stuff."

As for the handful of marijuana plants growing in Downing's basement, he says he keeps them on hand in order to grow just one small harvest for patients each fall.

"I'm actually unable to grow nearly enough marijuana to service the patients, as you might imagine," he says. "So the rest of it comes from the black market. People I've known for decades."

Asked how he knows the marijuana is of good quality if he's getting it from street dealers, Downing admits he's been "trading" in marijuana since he was 15-years-old.

"And I know an awful lot about it," he says.

Public health officials point out anyone in the medical marijuana program who gets the drug from the black market is breaking the law. They say DPH will continue to "tweak" the regulations after dispensaries open and won't rule out the possibility that caregivers will be allowed to continue to operate.

Downing expects that dispensaries will mark the end of his operation. But he thinks none of this will matter in a few years. He's hoping medical marijuana will be the first step toward completely legalizing pot in Massachusetts.

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