Image: Marijuan Leaf ©Istockphoto.com/Iurii

Several years ago, Eric Friberg’s sister Kirsten was diagnosed with breast cancer. A resident of California, where qualified patients have been allowed to use and cultivate marijuana since 1996, Kirsten hoped to find relief from her nausea in medical marijuana. At the time, however, the state was in the process of establishing wider guidelines for usage of medical marijuana, including the establishment of medical marijuana dispensaries and state I.D. cards for qualified patients.

As Kirsten Friberg waited, the cancer metastasized, eventually eating away at her spine. At home in South Portland, Eric Friberg decided to start growing marijuana in case his sister was able to make it back to Maine, which since 1999 has allowed eligible patients and their caregivers to possess a small amount of marijuana. “I felt like it was my job as her big brother to protect her,” he says.Before Kirsten could make it to Maine, however, cancer killed her. She was thirty-two years old.

Now, Friberg and his fiancée, Elizabeth Thorman, honor Kirsten’s memory via a nonprofit medical marijuana organization called Kirsten’s Compassion. For the last four years, they’ve served as medical marijuana “caregivers” to a handful of individuals suffering from maladies including cerebral palsy, multiple sclerosis, fibromyalgia, and cancer, providing them with marijuana in tincture or edible form as well as ready-to-smoke varieties.

Friberg is also a patient himself, using marijuana to quell the gastrointestinal problems he has from an autoimmune disorder caused by a vaccine reaction. Since Maine voters last year approved a referendum establishing nonprofit dispensaries for medical marijuana, Friberg and Thorman hope to expand the number of people they can serve. “Our goal is to get good-quality, affordable medicine to patients that need it,” says Friberg.

However, the process hasn’t been without bumps — for Friberg and Thorman, and for the state as a whole. Despite Maine’s generally live-and-let-live attitude toward pot, the prospect of medical marijuana dispensaries concerns local law enforcement officials and zoning boards. It also concerns doctors, many of whom will have to juggle potential patients’ requests for medical marijuana with the fact that possession of the drug is still illegal under federal law. Meanwhile, medical marijuana advocates worry that the legislature’s decision to allow the establishment of just eight dispensaries — one for each of the state’s public health zones — means patients still won’t have adequate access to what they insist is an effective medicine, not a recreational drug.

Maine is one of fourteen states that allow individuals to possess marijuana to treat medical conditions — and, as of last November, one of only five states that have established dispensaries to distribute medical marijuana. (The others are California, Colorado, New Mexico, and Rhode Island.) Patients can possess up to two-and-a-half ounces of marijuana, and cultivate no more than six marijuana plants. The referendum also expanded the list of eligible conditions to include hepatitis C, amyotrophic lateral sclerosis (Lou Gehrig’s disease), Crohn’s disease, Alzheimer’s, and several other conditions that were not listed in the 1999 legislation. Barring any additional changes by the legislature, these measures will go into effect in the summer of 2010.

Mainers approved last year’s measure by a sweeping margin, with 59 percent of voters agreeing to expand the state’s medical marijuana law to “allow treatment of more medical conditions and create a regulated system of distribution.” Wendy Chapkis, a professor of sociology at the University of Southern Maine and the author of Dying to Get High: Marijuana as Medicine, attributes voters’ willingness to be on the forefront of medical marijuana legalization at least in part to Mainers’ libertarian tendencies. “Besides the culture of individual liberties here, Maine is also one of the states that has a referendum process,” says Chapkis. “People [in general] are not frightened by the medical use of marijuana, but legislators are.” Indeed, a January 2010 poll by ABC News and the Washington Post found that 81 percent of Americans support legalizing medical marijuana, up from 69 percent in 1997. “I can’t think of any other issue that eight in ten Americans can agree on,” Chapkis says with a laugh. “While it’s true that Maine was early in this effort, it’s not an outlier.”

Following the referendum’s approval last year, Governor John Baldacci appointed a fourteen-member task force to make recommendations on how the state should implement the new law, which called for the establishment of dispensaries to be overseen by the state Department of Health and Human Services (DHHS). In the task force’s meetings as well as hearings in front of the legislature’s Health and Human Services Committee, advocates for various interest groups grappled over several issues. Those included the potential use of medical marijuana by minors and expansion of the list of qualifying conditions to merit medical marijuana usage, as well as privacy concerns. (The bill was sent to the legislature with a requirement that patients and caregivers register with DHHS and carry a state-issued I.D. card, which groups including the Maine Civil Liberties Union said would violate patients’ right to privacy.)

Meanwhile, several municipalities across Maine discussed and, in some cases, instituted moratoriums on medical marijuana dispensaries within their borders. In Topsham, for example, Town Planner Rich Roedner recommended that residents approve a moratorium at town meeting in May, on the grounds that officials need time to develop zoning ordinances and codes for any dispensary that might locate in town. “We’re not taking a position on the use of medical marijuana,” he says. “We’re just saying that we need some breathing room while the state is developing rules for dispensaries.”

Jonathan Leavitt sees the situation differently. The executive director of the Maine Marijuana Policy Initiative, which spearheaded the referendum campaign, Leavitt calls the moratoriums “a waste of time,” since no one can open — or even apply to open — a dispensary yet. “We wrote into the law that towns have the right to zone these appropriately,” he says. “We know we have the support of the citizens of Maine on this issue.”

But zoning isn’t marijuana advocates’ major concern — even though it may present a considerable obstacle. For example, Friberg and Thorman have a location in mind for the dispensary they hope to start, but they decline to discuss details. “Whenever we divulge a piece of information, it’s been used against us,” says Friberg, who adds that in the past he and Thorman have been arrested for possession and had their equipment destroyed. Their bigger concern, however, is access. After lengthy debate over dispensary operations in the Health and Human Services Committee, legislators agreed to limit the number of dispensaries to no more than one per public health zone. The zones vary in size: Cumberland County is its own zone — as is Aroostook County.

Meanwhile, the Midcoast District includes Waldo, Lincoln, Knox, and Sagadahoc counties. “It’s very limiting for the patients,” says Friberg. “How are patients that can’t move around easily going to get their medicine?" Patients already face another significant hurdle: finding a doctor who is willing to put a recommendation for medical marijuana in writing. (Doctors provide patients with a “medical certificate,” rather than a prescription, for medical marijuana.) Even after ten years of state protection for medical marijuana usage, Friberg says there are only “a handful” of doctors in Maine currently recommending it. His assessment is echoed by Gordon Smith, executive vice president of the Maine Medical Association, which represents more than two thousand Maine physicians. “Only a few doctors appear interested in going outside federal law,” says Smith. “Doctors are scientists and rule followers; they’re not used to going outside the process of writing a prescription to give a medical certificate for a product whose strength is unknown ahead of time.”

Like many doctors, law enforcement officials are uneasy about the prospect of medical marijuana distribution. The Maine Chiefs of Police Association opposed the referendum last fall, but now must abide by the state law protecting patients, caregivers, and dispensary operators. “It’s still against federal law,” says Robert Schwartz, executive director of the Maine Chiefs of Police Association — notwithstanding the Obama administration’s announcement last year that it would not prosecute medical marijuana users and caregivers who are in compliance with their state’s law. What’s more, last year Governor John Baldacci signed a bill that decriminalized possession of small amounts of marijuana for any use. If you’re caught with less than two-and-a-half ounces of pot, for example, you’ll face a fine of up to one thousand dollars — and no jail time. Still, Schwartz is uncomfortable with the expansion of the medical marijuana law. “Some of the other states that have this have had some real difficult situations,” he says. “We don’t want to see our state turn into a drug state.”

And therein lies the topic that has hovered in the background the entire discussion: whether advocates are using medical marijuana as the opening salvo in a campaign to legalize marijuana entirely. Wendy Chapkis of USM thinks that supposition springs largely from the fact that far more Americans have used marijuana recreationally than have used it to treat nausea or pain. “So we all assume medical marijuana must just be about getting a foot in the door to legalize it for recreational use,” she says. “But there are a large number of people on the medical side who are very committed to simply rescheduling cannabis for medical use.”

Only time will tell whether a full-scale legalization effort follows the medical marijuana law. In the meantime, says Friberg, “We’re looking forward to putting seeds in the ground.”