Ken Alltucker

The Republic | azcentral.com

When JP Holyoke learned that a Maricopa County judge allowed a young East Valley boy to take marijuana extracts to help control his seizures, he shared the news with his 5-year-old daughter, Reese.

"I told her it was a really good day," Holyoke said. "She smiled and clapped at me."

Reese clapped because she cannot talk. She could barely move before she began ingesting an oil-based form of marijuana extract to tame prolific seizures caused by a rare genetic disorder. Used in tandem with an experimental drug, the frequency of the girl's seizures plummeted from 25 to 30 a day to just three to five a week.

The court ruling in late March involved another Valley family. But it described nearly identical facts and circumstances that Holyoke and his daughter face.

"She has started to develop, to advance, to interact with the world around her," Holyoke said of his daughter since she began taking the extract. "She is learning and gaining strength and confidence every day."

While Arizona's program appears to be popular among patients and caregivers, tension remains pitting growers, sellers and patients against law enforcement and some politicians who worry about efforts to loosen restrictions or to push for overall legalization of the drug.olyoke is one of 71 dispensary operators under Arizona's medical-marijuana program, and he said the only reason he became one is because of his daughter's illness.

Although 20 states and the District of Columbia have medical-marijuana programs and Colorado and Washington have legalized marijuana for recreational purposes, the federal government classifies marijuana as a Schedule I controlled substance along with street drugs such as heroin and LSD. Schedule I substances are illegal to sell or possess.

And some prosecutors in Arizona have waged ongoing legal and bully-pulpit challenges against the state's medical-marijuana law.

Holyoke began studying medical options for his daughter's rare condition when drug after drug failed to control her seizures. He read that parents of children with comparable conditions had luck using cannabidiol, an oil derived from marijuana, as a calming agent, relaxing the brain and minimizing the life-disrupting seizures.

That's what he wanted for Reese, so he became one of 486 individuals or businesses who entered a lottery to win a state-issued license for the right to operate a medical-marijuana dispensary, where qualified patients could purchase cannabis for approved purposes.

Holyoke secured his license for his Peoria dispensary, called Arizona Natural Selections, and he now runs a robust business in a state that has sprouted a multimillion-dollar industry since voters passed the Medical Marijuana Act in 2010.

Patients with a qualifying medical condition, such as cancer, glaucoma or chronic pain, can obtain written certification from a doctor and get a state-issued card that allows them to purchase 2.5 ounces of marijuana every two weeks from a dispensary.

Last year, nearly 41,000 cardholders purchased 2.7 tons of marijuana at the state-licensed dispensaries. The average patient purchased medical marijuana 10 times last year, and there were more than 422,000 transactions statewide. Severe and chronic pain — alone or with one or more additional health conditions — was the diagnosis for nearly nine out of every 10 cardholders last year.

A dozen county prosecutors asked Arizona Attorney General Tom Horne to clarify whether federal law trumped the state's voter-approved initiative. In December 2012, a Maricopa County judge rejected arguments from Horne and Maricopa County Attorney Bill Montgomery that the state law should be struck down, giving dispensaries the green light to open and serve patients. Two days after the ruling, Arizona Organix in Glendale became the first dispensary to open.

But Montgomery planted the seed that public employees and some patients could be prosecuted. He said county employees could face federal prosecution if they processed required paperwork, such as zoning permits, for dispensaries. He also warned that patients who use marijuana extracts could be prosecuted because, he contended, the state's law did not allow such alternative forms of medical marijuana.

That prompted an east Valley family to file a Maricopa County Superior Court lawsuit last October on behalf of their 5-year-old son, Zander Welton. With legal help from the American Civil Liberties Union, they sought clarification on whether the state law allowed them to give the boy extracts to treat his seizures.

A Maricopa County judge ruled on behalf of the family, noting that the law allowed them to use ingredients, including oil derived from the marijuana plant, to treat the boy. Montgomery will ask the court to reconsider the ruling, his spokesman said.

"One would hope if there was a rational person reading this decision, it would end the contemplation of prosecution of not only for Zander but someone who is similarly situated," said Dan Pochoda, legal director of the ACLU in Arizona.

Although no medical-marijuana cardholders were prosecuted for using extracts, Pochoda said authorities had opened some investigations. Even though those investigations have been dropped, Pochoda said, the specter of prosecution has had a chilling effect among patients and dispensaries alike.

Before the Welton ruling, Holyoke was reluctant to share details of his daughter's cannabidiol regimen. But he agreed to talk more openly about her treatment because the court ruling appeared to put him on safer legal ground.

He previously soaked the plant in an olive-oil-based solution, which Reese had trouble swallowing. Now, he'll extract the cannabidiol from the plant's natural oils and give her much smaller amounts three times a day.

"It's not like you can give a bong to a 5-year-old," he said.

Even if she could smoke marijuana, it would not be the right strain. The cannabidiol treatment that some believe is an effective anti-seizure medication does not have abundant levels of THC, the psychoactive ingredient in marijuana that gives people the feeling of being high.

Holyoke knows marijuana won't cure Reese. She has Aicardi syndrome, in which a part of the brain, called the corpus callosum, is partially or completely missing. Children often die before they reach adulthood. There are an estimated 800 cases in the United States, according to a study cited by the Aicardi Syndrome Foundation.

He said she was on a "merry-go-round of pharmaceuticals" that either didn't slow the frequent seizures or left her comatose. She made strides when she began taking the anti-seizure drug vigabatrin, which also can cause blindness. And she began making developmental gains when she combined the anti-seizure drug with cannabidiol, he said.

He said he realizes that although there are a growing number of medical studies that have evaluated marijuana as a treatment for seizures, it has not gained widespread acceptance in the medical community.

The Epilepsy Foundation recommends patients consult with their doctor about available treatments, including marijuana, and the group started a petition urging the White House to support research efforts to evaluate marijuana as a potential treatment.

Colorado health officials estimated that 150 families have moved to that state to purchase a form of low-THC, high-cannabidiol marijuana known as Charlotte's Web.

Larry Wolk, executive director of the Colorado Department of Public Health and Environment, said supporters of using marijuana to treat epilepsy neglect to point out that it often doesn't work.

"What you don't hear about are the number of children who don't respond" to the cannabidiol oil, Wolk said. "It is a very well-planned campaign nationally by a number of these folks who try to use these kids and their families for trying to get medical-marijuana programs" adopted or modified in their states.

In Arizona, the state Department of Health Services decides whether to add new health conditions to the program based on public requests that are evaluated twice a year.

Arizona contracts with the University of Arizona College of Public Health to review medical literature for any request, which is forwarded to the health department's own medical-review committee. Department of Health Director Will Humble then decides whether to accept a new condition.

Just this year, Humble rejected requests to add depression, migraines and post-traumatic stress disorder as conditions that would qualify patients for a card.

A key reason: lack of evidence showing the benefits of such treatments.

"Data has to drive the decision, and the data just wasn't there," said Sue Sisley, a UA doctor who backed the petition to add medical marijuana to the state's program.

Sisley hopes to change that. She recently gained the federal Public Health Service's approval to launch what she described as a first-of-its-kind study on the benefits of medical marijuana.

And House Bill 2333 would allow the Arizona Department of Health Services to pay for research with fees collected from patients and dispensary operators participating in the state's medical-marijuana program.

The bill sailed through the Arizona House of Representatives on a 52-5 vote and was assigned to the Senate Education Committee, which is chaired by Sen. Kimberly Yee.

Yee blocked the bill that would fund a study of whether medical marijuana helps veterans overcome symptoms of post-traumatic stress disorder. She said she refused to place the bill on her committee's agenda because of "significant concerns" voiced by members of the Arizona Prosecuting Attorneys Advisory Council.

"The advocates (of House Bill 2333) are those who would like to see recreational use in Arizona and believe this will show it's not dangerous," said Yee, a Phoenix Republican who is advocating her own bill that would fund anti-drug public-service announcements. "It's all about two different bills and two different approaches."

Veterans groups and other advocates, however, said it's a rare opportunity to evaluate how marijuana affects post-traumatic stress disorder patients.

Even if the bill passes, Sisley must get approval from the federal Drug Enforcement Administration before the study is allowed to move forward.

Sisley said state funding is critical because the federal government typically does not pay for studies that seek to evaluate the potential benefits of medical marijuana. Most studies, she said, focus on the potential harm of prescribing marijuana to treat PTSD or other conditions.

She expressed disappointment that a single senator can block a bill that could pave the way for relief for thousands of veterans suffering PTSD. According to the Department of Veterans Affairs, about 30 percent of Iraq and Afghanistan war veterans who were treated at VA hospitals or clinics suffered from the disorder.

"That would be really sad if the veterans suffer because of the schoolyard games that are being played down there (at the Legislature)," Sisley said.

Jason Reis, who operates 10 medical-marijuana clinics in Arizona, said veterans and others often ask whether PTSD and depression are qualifying conditions. The clinics are staffed by medical doctors or naturopaths who triage patients and evaluate whether their conditions can qualify them for a card.

"We get so many calls during the week. People list PTSD or depression," Reis said. "We have to tell them it is not a (qualifying) condition."

By the numbers

Active cardholders: 44,675

Designated caregivers: 554

Average age of patient with card: 43.9

Number of transactions in 2013: 422,495

Ounces sold: 95,263

Severe and chronic pain represented 72.8 percent of diagnosed cases.

Source: Arizona Medical Marijuana Act End of Year Report, 2013, Arizona Department of Health Services

States that allow medical pot

Arizona voters legalized medical marijuana by approving Proposition 203 in 2010. Today, 20 states and the District of Columbia have laws allowing medical-marijuana use. Arizona also allows a patient registry and dispensaries; not all states with medical-marijuana laws do.

Medical marijuana in Arizona

November 2010

Voters pass the Medical Marijuana Act, which requires the Arizona Department of Health Services to create and administer the medical-marijuana program.

April 2011

Patients apply for identification cards that allow them to possess and purchase marijuana for medical use. With no dispensaries in operation, patients with cards are allowed to cultivate their own marijuana.

May 2012

Arizona accepts applications for non-profit medical-marijuana dispensaries.

December 2012

The first dispensary opens in Arizona. Patients with cards are restricted from growing marijuana if they live within a 25-mile radius of a dispensary.

January 2013

Arizona receives several petitions to expand the medical conditions that would allow an individual to qualify for a medical-marijuana card. Among the conditions considered are post-traumatic stress disorder, depression, migraines and anxiety. Hearings are never held on these conditions.

July 2013

Arizona receives nine petitions to add medical conditions, but only three move toward a hearing.

September 2013

A Maricopa County Superior Court judge rules that some of Arizona's regulations, particularly those governing dispensary operations, are unreasonable. This prompts the state health department to review some regulations and create an appeals process for dispensaries.

January 2014

The Arizona Department of Health Service rejects petitions to include post-traumatic stress disorder, migraines and depression as qualifying conditions for medical marijuana.

January 2014

Backers of an effort to legalize marijuana for recreational use concede they won't get enough signatures for a ballot initiative this year. They will push to legalize marijuana in 2016.

Sources: Republic research, University of Arizona, Arizona Department of Health Second Annual Medical Marijuana Report