After waiting in line for hours at a booth during a medical marijuana convention in San Francisco, Jeff Harrington needed only a two-minute consultation and a written recommendation to become a medical marijuana patient in California. He now can legally purchase and possess marijuana from any one of thousands of marijuana businesses in the state.
Across the country in Connecticut, an established physician-patient relationship is required before patients are deemed qualified for medical marijuana, and only licensed pharmacists can own and operate dispensaries.
Between these two extremes, a News21 investigation has found there are as many ways to deal with medical marijuana as there are states that have legalized it.
As the federal government continues its prohibition of marijuana, the District of Columbia and the 23 states that have legalized marijuana for medical use have been left to write the rules and regulations on their own.
The experimentation has produced wide variances and contradictions in their approaches to everything from possession limits and lab testing to how people qualify as medical marijuana patients.
For example, in Vermont, a medical marijuana patient is allowed only two mature plants and 2 ounces of marijuana. By contrast, in Washington state, a patient can have 15 plants and 24 ounces of prepared marijuana.
In some states, like New Mexico, there is no fee for a medical marijuana card, while others, such as Minnesota, charge up to $200. Some states do not tax medicinal marijuana, but others charge a sales tax or a specific tax on marijuana products of as much as 37 percent in Washington state.
Because marijuana remains a federally controlled, Schedule 1 drug, federal agencies do not offer states any guidance or medical protocol for state medical marijuana programs.
"Based on the research to date, the U.S. Food and Drug Administration has not recognized or approved the marijuana plant as medicine," Mario Moreno Zepeda, spokesperson for the White House Office of National Drug Control Policy, said. "However, research on marijuana extracts, called cannabinoids, has led to FDA-approved medications."
FDA approval of marijuana would require "carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication," according to the National Institute on Drug Abuse.
The News21 analysis of medical marijuana programs across the country also showed states diverge on what health conditions qualify a patient for medical marijuana, and little or no research has been done to determine whether marijuana or its derivatives effectively treat those conditions. AIDS, cancer and chronic pain qualify as conditions for medical marijuana treatment in more than 20 states. But traumatic brain injury qualifies only in New Hampshire and Tourette syndrome qualifies only in New Mexico.
To be considered qualified for medical marijuana, patients in all 24 programs must be diagnosed with an approved condition by a physician. Yet the standards for physician evaluations vary. The California doctor that Harrington saw in San Francisco legally certified him for medical marijuana in a consultation that took less than five minutes. He was one of hundreds seen on the same day.
A single physician in New Jersey has approved over 1,000 of that state's more than 4,000 medical marijuana patients. In Washington state, at least 12 doctors have faced penalties for operating so-called marijuana mills at which they recommended medical marijuana for large numbers of people, according to Donn Moyer, a spokesman from Washington state's Department of Social and Heath Services.
Dr. Anthony Anzalone, the New Jersey doctor who has paved the way for at least 1,000 of the state's medical marijuana patients, is a former gynecologist who left his former practice to evaluate patients for medical marijuana. He said that he wants to see patients have access to medical marijuana, even if he has to dig for a reason.
"Patients say, 'Oh, I have post-traumatic stress.' I say, 'Unfortunately, the state will not allow it at this point in time. However, tell me more. Do you have any kind of GI (gastrointestinal) problem - irritable bowel (syndrome)?'" Anzalone said. "They don't think about that."
He said the idea is to make people feel better—not high.
"If you are not getting approved for medical marijuana in New Jersey, you are going to the wrong doctor," said Anzalone's patient counselor, Kevin Long.
Connecticut is the only state that treats medical marijuana like any other pharmaceutical drug.
Jonathan Harris, commissioner of the Connecticut Department of Consumer Protection, said that state is "the only state in the nation that has a true medical marijuana program."
Once patients are approved by a doctor and registered through Harris' department, they must obtain their medical marijuana from one of six licensed dispensaries, which are owned and operated by licensed pharmacists.
When Laurie Zrenda, a pharmacist of 27 years, opened her dispensary in Uncasville, Connecticut, patients handed her hundreds of dollars in cash to pay for their medical marijuana.
"And then, I realized they were paying their drug dealers all of this money before," she said. "They were used to it."
Her dispensary, Thames Valley Alternative Relief, serves 515 patients. "I didn't realize how widely used it was for so many other conditions," she said. "It's pretty amazing that one plant can do all these things. ... I know the evidence is anecdotal, but it's there. It's hard to deny it."
Eight states—Connecticut, Delaware, Illinois, Maryland, Minnesota, New Hampshire, New Jersey, New York—and Washington, D.C. require patients to use dispensaries rather than allowing home cultivation.
Of those, seven states require their dispensaries to submit product for testing.
New Jersey's Public Health and Environmental Laboratories, however, is the only state-run lab in the United States to test product from the medical marijuana dispensaries, said Megan Latshaw, the director of environmental health programs for the Association of Public Health Laboratories.
According to Dave Hodges, a dispensary inspection monitor in New Jersey, these tests are only conducted when requested by the dispensary.
This is from a continuing series from America's Weed Rush, an investigation of marijuana legalization in America, a 2015 project of the Carnegie-Knight News21 program produced by the nation's top journalism students and graduates.