© iStockphoto/Nicholas Belton

Fourteen years have passed since California’s Proposition 215 forged the path for medical marijuana legislation in the United States. That ballot initiative, which passed with 56 percent of the vote, legalized the possession of marijuana in California for medical use. Since that time, an estimated 200,000 patients statewide have been approved to receive the substance for physical conditions ranging from HIV/AIDS to chronic pain. The legislation has fostered cannabis-centered collectives, holistic health care facilities and pharmacy-like dispensaries in more than 100 cities across the state. Opponents of medical marijuana legalization have said, in fact, that the proposition was written so broadly that almost anyone can be given approval to use cannabis.

On Tuesday, the new nationally watched California marijuana initiative, Proposition 19, asks voters to decide whether cultivating and using marijuana should require permission from anyone at all. The initiative would allow anyone over 21 to grow and possess cannabis for personal use, and would allow for state, county and city cannabis taxation.

But Prop. 19 is only one of many marijuana initiatives facing voters next week. Coupled with the new proposition are city-level measures appearing on ballots across the state. Several deal with taxation and regulation of dispensaries. Measure Q in Albany would add a new business license category to allow a $25 per-square-foot tax for nonprofits; for-profit ventures would be taxed on 2.5 percent of gross receipts. If Proposition 19 passes, La Puente’s Measure N would impose an annual 10 percent tax per $1,000 on non-medicinal cannabis distributers. In San Jose, Measure U would allow the City Council to establish up to a 10 percent business tax on local marijuana distributers.

The issue is on three state ballots outside California, too. A total of 14 states and Washington D.C. already have medical marijuana regulation laws in place. Each state followed after California’s action in 1996. On Tuesday, voters in Arizona, Oregon and South Dakota will also determine the future direction of medical marijuana legislation. Yet not all advocates are looking to follow the Golden State’s lead.

Proposition 203: Arizona makes a second attempt after 14 years

Arizona voters approved a medical marijuana proposition similar to California’s in 1996, the same year Proposition 215 was passed. But the law was thwarted before it went into effect. Legislators challenged the proposition, introducing a House bill in the spring of 1997 that took the voter-approved initiative down. As a result, a referendum on the proposition went on the Nov. 3, 1998 ballot. This time voters rejected it by a vote of 57 to 43 percent. According to Andrew Myers, campaign manager for Yes on Prop. 203, the repeal was a good thing. “Had it happened,” Myers said in an interview recently, “we may have had a very Californian-esque system with all the drawbacks.”

In Arizona, leaders on opposing ends of Proposition 203 say the California tale is more cautionary than an example to follow. “I think the most visible aspect is the proliferation of for-profit dispensaries like those in Los Angeles County,” Myers said. “Particularly in California, there’s no qualifying conditions list.” Because of this, Myers says, writers of the new proposition have taken care to ensure that an efficient system would operate in the state if the initiative were to pass. Arizona’s dispensary system, unlike California’s, would be fully regulated by the state, Myers said.

Arizona’s Proposition 203 would allow state residents with specific medical conditions to be treated with marijuana for personal use. Debilitating and chronic conditions listed in the language of the legislation include multiple sclerosis, cancer, HIV/AIDS, Hepatitis C, seizures and severe and chronic pain. The Arizona Department of Health Services would be handed the task of regulating the sale and usage of medical marijuana.

Carolyn Short, chairwoman of the Keep Arizona Drug Free campaign, agrees that watching California for the past 14 years has helped educate people in her home state on the social issues surrounding medical marijuana. “I think that people are waking up big time and seeing that it’s a sham,” Short said. She also does not believe Proposition 203 is written well enough to avoid the same regulation disparities. “In Arizona we have a particular problem,” Short said. “If it passes, it’s voter-protected. We would be stuck with a poorly or craftily written initiative.”

Short, who said she believes public safety will be compromised if the proposition is passed, cited a National Highway Traffic Safety Association study that focused on California. The study found that the greatest increases in fatal crashes in which the driver tested positive for marijuana occurred over the five years following the legalization of medical marijuana in January 2004. “There were 1240 fatalities in fatal crashes where the driver tested positive for marijuana for the following five years, compared to the 631 fatalities for the five years before, for an increase of almost 100 percent,” the study found. California’s Department of Motor Vehicles reported a decrease in alcohol-involved traffic fatalities, from 1,462 to 1,355 per year, within the same time period.

Although Short said she is confident that Proposition 203 will not pass, she added that she is alarmed about the consequences if it does. “We will have chaos if this thing passes,” she said.

Measure 74: A tighter medical marijuana system in Oregon

An Oregon ballot measure legalized marijuana in the state in 1998. The law now permits the possession and cultivation of marijuana by patients with a physician’s signed recommendation. But the problem, said Bob Wolfe, media liaison for Yes on Measure 74, is the fact that patient access to marijuana is limited.

Patients currently get their medical marijuana from illegal for-profit dispensaries, through cultivation of the plant by themselves, through a caregiver or on the black market, he said. “I think we’d like to see the patients get safe, reliable access to medicine,” Wolfe said.

Oregon’s Measure 74, on the state’s November ballot, would allow medical marijuana cardholders to buy their marijuana from state-licensed and regulated dispensaries. Those businesses would have to pay 10 percent of their income to the state, and pay a licensing fee — $1,000 for producers and $2,000 for dispensaries. There would be no restrictions on the number of dispensaries allowed to operate in the state.

Unlike California, the Yes On 74 website points out, Oregon would require its cannabis providers to be nonprofits. Wolfe said he has heard about problems with Los Angeles County’s for-profit dispensaries. Anyone who has been to Venice Beach has seen the “carnival calls” from people trying to get passersby into the dispensaries there, Wolfe said. “That’s not a medical marijuana program,” he said.

But Wolfe also said there are also good examples to be found in California. “From what I know, I do admire dispensaries like those in North Berkeley, and Harborside [Health Center], where they test the product,” he said. In addition to providing medical marijuana, Oakland-based Harborside offers hypnotherapy and yoga courses, as well as groups that focus on substance misuse. Wolfe said those types of facilities are better models for what he hopes to see in Oregon. “It makes the whole community look better,” he said.

Measure 13: South Dakota, a second attempt at a medical marijuana program

Medical marijuana legislation has been on the South Dakota ballot once before, in 2006, when it was rejected by just over half the state’s voters. Now the South Dakota Coalition for Compassion’s Yes on Measure 13 campaign is aiming to “bring medical marijuana to South Dakota.” If passed, South Dakota’s program might look very similar to the one currently in Oregon. Approved cardholders would be able to grow their own marijuana or have a caregiver cultivate it for them. Like Arizona’s Proposition 203, patients would need to have a serious condition such as HIV/AIDS or cancer to be approved. But provisions concerning pain are much more strict than those in other states with similar ballot initiatives this year. The legislation states that the pain must be “debilitating pain that did not respond to other reasonable medical efforts for at least six months, including in cases where other treatment options produced serious side effects.”

South Dakota’s No on 13 campaign website raises objections that pharmacies would have no involvement in the proposed state cannabis program, and that there is no regulation on how the cannabis is produced.

Emmett Reisetroffer, spokesman for the South Dakota Coalition for Compassion, said there is no provision for dispensaries to operate in the state. Patients would have to grow their own product or have a caregiver do it for them. Without distribution facilities, Reisetroffer said, South Dakota would not have the same problems other states do. He also said he believes the conservative atmosphere of South Dakota will keep things under control. ”We’re the only state on record that has rejected this type of measure,” Reisetroffer said. “I don’t see South Dakota moving toward a California-like situation.”

Back home in California: county by county and city by city

Within California, the rules affecting marijuana production, sale and regulation for both medical and recreational use vary considerably. Oakland, for example, has approved a medical marijuana farms ordinance, and will allow four industrial indoor growing facilities to begin operation in January 2011. The general standard for cultivation in counties across the state is that cardholders can have up to six mature plants and up to 12 immature plants. Access in Los Angeles County is abundant, with more than 1,000 dispensaries. But there are fewer than 50 medical marijuana establishments in both Riverside County and neighboring San Bernardino County combined. Palm Springs is Riverside County’s only city with an active medical marijuana ordinance.

Proposition 19  would allow individuals over 21 years old to “cultivate marijuana on private property in an area up to 25 square feet per private residence or parcel.” Those who operate licensed marijuana establishments would have to pay all “applicable federal, state, and local taxes and fees currently imposed on other similar businesses.”

In the event it does pass, U.S. Attorney General Eric Holder stated clearly in a letter sent out in mid-October that the U.S. Department of Justice will “vigorously enforce” federal laws against marijuana.

Yet even after all the anticipation from one end of the state to the other about how things may turn out, California’s marijuana policy may in many ways wind up back where it started. A recent Los Angeles Times/USC poll found 51 percent of voters against Proposition 19. Tom Angell, spokesman for the Yes on Prop 19 campaign, said if Prop. 19 loses, the state will continue to indirectly fund gangs and drug cartels that sell marijuana on the black market.

If the initiative does pass, he argued, it will be a logical move for the state. “Proposition 215 did lead up to this,” he said. “It created a situation for people to see what controlled sales of marijuana looks like, and they’ve realized it’s not that scary.”