Voters’ approval of medical use of marijuana on Tuesday is already prompting questions about the readiness of beleaguered state health regulators, local communities, and police to oversee the retail outlets where the drug will be sold.
The law, which won majorities in all but two Massachusetts communities, takes effect Jan. 1. But some groups, including the Massachusetts Municipal Association, are calling on the Legislature to delay it. Town officials must draft zoning rules stipulating where the distribution centers may be located — or whether to allow them at all — and police departments are grappling with how to deal with a law that is in direct conflict with federal drug policy and their own training.
“There’s no attempt to stop the ballot question in any way,” said Geoff Beckwith, executive director of the municipal group, who would like to see a “transition period” until about mid-2013. “It’s just a real-world challenge of suddenly having something that’s been illegal now being legal, and communities need to have time to update their ordinances.”
The ballot measure charged the Department of Public Health with writing the rules for the program, including those determining just how much drug each patient can possess at a given time and the required operating procedures for distribution centers. The department’s budget has been cut in recent years, and the past two months have brought two major public crises.
A chemist at the Jamaica Plain drug lab formerly run by the department was arrested in September, accused of tampering with drug samples and throwing into question thousands of convictions. Commissioner John Auerbach, a respected public health leader, resigned under pressure soon after the case came to light.
Then news broke in late September that an injectable steroid produced at a Framingham pharmacy had been linked to a growing number of fungal meningitis cases, including at least 31 deaths. Questions have been raised about the adequacy of the state board of pharmacy’s oversight of New England Compounding Center — concerns heightened Wednesday when the department’s interim commissioner, Dr. Lauren Smith, announced she had fired the board’s director for allegedly mishandling a complaint against the compounder.
“Right now, we know that DPH has had unprecedented pressure,” and creating a medical marijuana program will cost “valuable state resources,” Representative Jeffrey Sánchez, a Boston Democrat, said last week when asked about the ballot question.
Sánchez is House chairman of the Joint Committee on Public Health and has joined other lawmakers in calling hearings starting Nov. 14 on the department’s ability to protect public health, given the recent crises.
Sánchez said Wednesday that lawmakers are just beginning what will probably be a long process of investigating the stability of the Department of Public Health, but regulators will begin grappling with medical marijuana now. “The dialogue and debate have just begun on this issue,” he said.
Both recent scandals were disturbing but not entirely surprising to Dr. Barry Zuckerman, an outgoing member of the state Public Health Council, an appointed panel of doctors, professors, and consumer advocates that oversees the public health agency. He said the department’s budget has been dramatically cut in recent years, and it was “only a matter of time and in what area” that those cuts would have real public health repercussions.
In fiscal 2009, the budget was about $589 million. In the latest state budget, it is $519 million.
Community-based programs have seen the most cuts, said Maddie Ribble, policy director for the Massachusetts Public Health Association. And those came even as the department was given new responsibilities, including school nutrition programs, concussion monitoring in youth sports, and duties related to the medical cost containment bill passed this summer.
In July 2011, members of the Public Health Council sent a letter to lawmakers expressing concern about the department’s finances and asking them to be as generous as possible in the final budget negotiations for the year.
Ribble said he hopes the Legislature will add to the department’s budget to fund proper oversight of the medical marijuana program and sustain other important programs, such as regulating food safety.
The Department of Public Health has about four months to write rules for the program, based on the ballot measure’s basic framework: Patients who are certified by a doctor as having a “debilitating” medical condition can receive a card from the state allowing them to purchase drugs from a nonprofit distribution center and possess up to a 60-day supply, though the language does not specify how much drug that is.
Some opponents are pushing for more narrow definitions of who could have access to the drug, specifying the qualifying medical conditions.
The health department must register at least one center in every county, with no more than 35 total in 2013. It also is tasked with overseeing the program and revoking cards from anyone who abuses it.
State health officials did not respond to requests for comment on the department’s capacity for managing the new program. Smith said in an e-mail that the department will work “to develop smart and balanced policies and procedures over the coming months.”
“We will work carefully, learn from other states’ experiences and put a system in place that is right for Massachusetts,” she said.
The Massachusetts Patient Advocacy Alliance, a group that pushed for the law, is ready to work with the state to make the program “the safest and most secure medical treatment program in the country,” said director Matt Allen.
Many police chiefs in the state are anxious about how the law will affect public health and recreational use of marijuana, particularly among teens. The Massachusetts Major City Police Chiefs Association met Thursday to discuss how to have a voice in the implementation process.
Chelsea Police Chief Brian Kyes, the association’s vice president, said rules about where the distribution centers may be located will be important. Imposing a stay on the law until that and other issues are worked out may be necessary, Kyes said.
“It’s kind of a complicated issue,” he said.