The Pew Charitable Trusts

The U.S. Supreme Court's first-ever opinion on medical marijuana two months ago hasn't put a dent in state efforts to help seriously ill patients, as critics hoped it would.

Medical marijuana programs in Alaska, Hawaii and Oregon are moving ahead despite the ruling, which said marijuana distributors can still be subjected to federal prosecution. Advocates and state officials aren't surprised though, since they say the court's decision dealt only with federal law enforcement issues.

The court's ruling in favor of the federal government in U.S. v. Oakland Cannabis Buyers' Cooperative last May thrilled medical marijuana critics like U.S. Rep. Bob Barr, R-Ga.

"The unanimous vote in this case reflects the overwhelming evidence that marijuana... should not be legalized for whatever contrived reason," Barr said in a press release.

But the court did not even question the legality of the programs in eight states-- Alaska, California, Colorado, Hawaii, Maine, Nevada, Oregon and Washington --that allow people to use medical marijuana. Instead, the court ruled that medical marijuana distributors, or buyer's clubs as they're known in California, can't hide under a shield of a medical defense to avoid federal penalties.

What does that mean for states? " A big zippo," says Kevin Neely of the Oregon Attorney General's office. "The Supreme Court decision ...hasn't had any effect on the way Oregon operates the program and it has had no effect either on patients or caregivers in their implementing of the law," he says.

Advocates echo Neely's response, and point out that state and local police, not federal agents, make up to 99 percent of all marijuana arrests. , a Washington, D.C.-based nonprofit group that lobbies to increase medical marijuana access.

What's the outlook on state efforts? Kampia currently sees smooth sailing. "Things are going beautifully in the states. Only in Maine (where a panel decided to delay a pilot project) was there really a setback," he says.

Up and running in some states for two years now, medical marijuana programs remain relatively small. In Alaska, nearly 200 patients have signed up since the June 1999 launch. Oregon, meanwhile, has issued around 2,200 registration cards in its two-year-old program and Hawaii has 283 patients signed up after six months.

The major issue states now face is simple growing pains, says Kampia. "The Oregon program has been up since 1999 and after two years, the biggest problem is the staff is under-funded. One doctor's name was made up (on a few registration cards) and that's minor for a state with 3.5 million people. That's certainly less fraudulent than abuse of prescription medicine in society," he says. Having enough money to run the programs hasn't been a big concern, but some state officials say adjustments need to be made. In Hawaii, patients pay an annual fee of $25, which goes into the state's general fund instead of the program. The medical marijuana "law didn't give any money. Right now it's taxing on (our) division. We're borrowing from Peter to pay Paul, using our controlled substance fund registration money, but that's not really fair" to the other program, says administrator Keith Kamita.

Kamita says his department plans to ask the Legislature next year for more money. In the meantime, he remains positive about the medical marijuana program. "The registry is working very well. On the whole this program is still in its infancy, so it's going to have growing pains," he says.

Oregon officials recently audited the state's medical marijuana program to ensure it's on track. "We just went through a management review, which was prompted by the discovery that we'd issued three cards that had forged doctors' signatures. We also discovered four other applications that had forged signatures. (The forged cards) are a very minor number but there's just no room for fraud," says Department of Human Services spokesman Mac Prichard.

Despite the audit, things are going "pretty good," Prichard says. "The only remaining issue is the backlog of applications and we're dealing with that now."