It's fairly settled science that pot has analgesic and anti-nausea properties, which is why it can be so soothing for people undergoing chemotherapy or suffering from pain. But does that mean it's harmless, or are there more-compelling reasons to steer clear of the stuff?

Smoking joints does not seem to pose as many pulmonary risks as smoking cigarettes, in part because people simply smoke fewer of them. One large study in 2006 found no increased risk of lung cancer. But a French study last year found an "independent role of cannabis in the development of lung cancers." A 2009 study in the U.K. concluded that acetaldehyde, which is present in both marijuana and tobacco smoke, can cause DNA damage "with the possibility to initiate cancer development."

The science, however, remains unsettled, and other research has reached opposite conclusions. Another U.K. study showed that the anti-inflammatory properties of cannabis may have an anticancer effect. And a 2009 study in Spain found that tetrahydrocannabinol (THC), the main intoxicating component of pot, can lead human brain-cancer cells to self-destruct—though the study involved introducing the cells into mice and treating them with THC. That's a long way from treating cancer in a human brain.

The timeless question of whether pot makes you stupid seems easy to answer just by watching a stoner movie. Do those guys look smart to you? The science, though, is subtler than that, and the answer depends at least in part on the chemical makeup of what's in your stash. A recent British study looked at how users are affected by different ratios of THC and cannabidinol (CBD), pot's other principal intoxicant.

It's THC that's behind a pot high's otherworldly edge—and also behind the paranoia and hallucinations it can cause. It's CBD that gives the drug its sedating power. The lower the concentration of CBD relative to THC, the worse the subjects in the British study performed on word-recall tests; the higher the concentration, the better they did. Graded on the generous curve required when all the subjects were wasted, the people with the mellower buzz were generally smarter. While there is some conflicting data, most studies do not find lasting effects on cognition.

Although pot's rep for diminishing short-term memory is deserved, it surprisingly may have therapeutic value in treating Alzheimer's disease. A 2008 study in rats showed that the anti-inflammatory effect of a THC-like compound might slow the progression of the degenerative illness. The compound may also promote the growth of new cells in aging brains.

And what about addiction? Can you get hooked on pot? The answer is yes—depending on how addiction is defined. There are substance addictions and process addictions—heroin vs. sex or gambling, say—and they all target similar reward pathways in the brain. Heroin, alcohol and other substances, however, trigger violent withdrawal symptoms if the chemical is cut off, and that clearly doesn't happen with pot—to say nothing of sex and gambling. Even among experts, the existence of withdrawal symptoms used to be the key criterion defining addiction. 

But that thinking has changed, and nearly everyone now goes by the broader definition of addiction in the Diagnostic and Statistical Manual—psychology's field guide to mental illness. The DSM describes addiction as compulsive use of a substance or repetition of a behavior despite repeated negative consequences. About 10% of pot users are addicts by that definition—lower than the roughly 15% to 30% of alcohol, tobacco, cocaine and heroin users who are addicts, but in the vicinity.

There may never be a final word on the health effects of pot, but if there were, it would not lie at the extremes. Somewhere between Reefer Madness and Alice's Restaurant is the truth.

I've always been passionate about food," says Jenelise Robinson. "And I've always been passionate about marijuana and the things it can do for the world."

The Denver woman is 35 but looks 20, with heavy loop earrings distending her lobes and an enormous bracelet to match. From her clavicles southward, her body is a riot of tattoos—the usual skulls and anchors as well as a large circle with a squiggle inside it on her right arm. (When a visitor points quizzically to the squiggle, she replies politely, "It's a baby in a brain," though the tone of her voice says, "Like, duh.") We shouldn't be misled by the biker look or the faux-'60s talk of changing the world. Robinson is all business—a consummate tradeswoman. In the past 16 months she has found a way to combine her passions for food and pot and make the combination pay, as founder, owner and head baker of Nancy B's Edible Medicine, one of the most successful start-ups in Colorado's newest "industry": medical marijuana. 

Robinson's muffins and Rice Krispies squares are getting raves. "I have a very high tolerance," said one food critic in the Denver Chronicle, a medical-marijuana blog, "and a 2-dose lemon bar will put me on my ass." "I loved the buzz, which lasted 8 hours," wrote another. "Very functional and social." The growth of Robinson's business has come with the explosion in the number of Colorado's medical-marijuana dispensaries, or centers. Coloradans who are recommended by a doctor and approved by the state go to the centers to buy their pot, either in traditional bud form or as an "infused product" like Robinson's lemon bars, which are 100% organic and laced with a marijuana concentrate. Her success is reflected in the Mile High Macaroons and Cannabis Cups stacked in the new commissary-style kitchen she's rented in the gentrifying neighborhood of City Park West in Denver.

Even with a decent supply of high-grade pot in her walk-in freezer, Robinson can scarcely keep up with demand. She and her two employees (a third is soon to be hired) work six days a week to refine her menu, revise recipes, taste-test hash oil and manage inventory—and still squeeze in time every day to medicate.

"For my ADD," she says. "And some shoulder pain."

Medicate? The medical-marijuana industry relies heavily on such genteel euphemisms. To medicate is to smoke pot, and no one in the industry calls pot pot anymore; it's medicine now. Dealers are called caregivers, and the people who buy their dope—medicine, medicine—are patients. There's no irony here, no winks or nudges to signal that someone's leg is being pulled. "After work," says a counter clerk, or budtender, at Briargate Wellness Center, an upscale dispensary serving the tony north side of Colorado Springs, "I'll just go home, kick back, take out the bong and medicate."

The euphemisms are an important element in the larger movement to bring marijuana use out from the shadows, as advocates say, so it can take its place innocently on Americans' nearly infinite menu of lifestyle preferences, from yachting to survivalism to macrobiotic cooking. So far, the strategy is working. Colorado and 13 other states, along with the District of Columbia, have legalized medical marijuana in the past 14 years. More than a dozen other states are considering the idea. Overnight, dispensaries have sprung up in hundreds of towns and cities; billboards touting one outlet's pot over its rivals' are plastered all over Los Angeles. In some parts of California—where marijuana is the biggest cash crop, with total sales of $14 billion annually—medical pot has become such an established part of the commercial base that cities are moving toward taxing it.

It's not clear that even political setbacks discourage, much less stop, the mainstreaming of marijuana. Anti-pot forces cheered on Nov. 2 when voters in four states apparently rejected pro-pot ballot initiatives—including California's Prop 19, which would have legalized possession of an ounce (28 g) of pot or less. But by Election Day, Governor Arnold Schwarzenegger and the state legislature had already rendered Prop 19 moot. A month earlier, he signed a bill that reduced possession of up to an ounce from a misdemeanor to a civil infraction. By Jan. 1, 2011, jaywalkers may have more to fear from California cops than potheads do.

Medical marijuana has helped make all this possible. In a short time, pot has gone from being a prohibited substance to one that is, in many places, widely available if you have an ache or a pain and the patience to fuss with a few forms. This did not take place by accident. In fact, medical marijuana's emergence has many of the attributes of a product rollout. As with any hot commodity, dope is now accorded the same awed regard in some Colorado retail establishments as fine wine, dark chocolate and artisanal cheese. Only now it takes place under the cover of medical care, wellness and pain management. And so what is emerging in many places is a strange, bipolar set of rules: dope is forbidden for everyone but totally O.K. for anyone who is willing to claim a chronic muscle spasm. Does anyone take such farcical distinctions seriously? And can a backlash be far behind?

Legalization via the Clinic Door
George Soros, the jillionaire currency trader and patron of countless liberal organizations, began funding pro-legalization groups in the early 1990s, with instructions that they redirect their energies toward "winnable" issues like medical marijuana. It was a savvy tactic. Even when polls showed strong resistance to making pot legal, large majorities of Americans supported making it available to patients for pain relief. "If we get medical access, we're going to get legalization eventually," activist Richard Cowan said in 1993. "The cat will be out of the bag." Colorado is a good test of whether that seemingly inexorable trajectory will remain plausible or prove a pipe dream.

Along the regulatory spectrum that stretches from distinctly mellow L.A. to schoolmarmish New Mexico, Colorado sits somewhere near the middle. In 2000, Colorado voters approved an amendment to the state constitution to legalize the possession of marijuana for patients suffering from "debilitating medical conditions": cancer, glaucoma, HIV/AIDS and multiple sclerosis, along with more nebulous symptoms like "severe nausea" and "severe pain." Voters supported Amendment 20, 54% to 46%.

The implementation was based on what is called a caregiver model. Each patient, on the recommendation of a doctor, could designate a friend or neighbor to grow up to six plants for the patient's use, and each of these caregivers could provide for no more than five patients. Both patient and caregiver would register with the state. The idea was to prevent profiteering, and from 2000 to 2007, roughly 2,000 patients signed up. "The system worked pretty well," says Don Quick, state district attorney for two counties in central Colorado. "Nobody really had a problem with it."

But in 2007, a pro-pot group called Sensible Colorado sued the state health department, and a state court ruled the five-patient limit unconstitutional. "That opened the floodgates," says Brian Vicente, the group's executive director. "A caregiver could have 50 patients if they wanted. And if you had 50 patients, why not open a shop?" Over the next two years, more than 1,000 dispensaries sprang up to serve the more than 100,000 Coloradans who had suddenly discovered their need for medicinal marijuana and applied for a patient card. As Jon Stewart noted, what had been considered the healthiest state in the country rapidly became one of the sickest.

And the economics changed overnight. Patients might spend $500 a year growing six plants on their own. By contrast, dispensaries routinely charge $350 to $500 for 1 oz. of pot. With patients limited by law to possession of no more than 2 oz., they could easily drop $5,000 a year on treatment. "A good-size dispensary will have a few hundred regular customers," Quick says. "You can do the math."

One who did the math was Joe DiFabio, who fits the mold of the hardy American entrepreneur—if the hardy American entrepreneur sold pot for a living. Now in his late 20s, DiFabio ran a construction company and worked in sales before a friend suggested he open a dispensary. He is also a patient, for back pain—nearly everyone who works in the industry medicates—and he had become disenchanted with the dispensaries he'd seen: stoned budtenders, sloppy service, subpar medicine. "They just weren't well kept up," he says. "Kind of dirty."

His business plan was to offer an alternative for the well-heeled professionals in northern Colorado Springs. "I wanted to have the very best medicine at the lowest prices in town," he says, in "a safe, discreet, professional environment." Briargate Wellness Center opened earlier this year, and the plan seems to be working. On a recent weekday afternoon, the three cars in Briargate's parking lot were a Jaguar, a Mercedes and a BMW. DiFabio greets customers in a pressed oxford shirt, trim khakis and polished loafers. The place is painted in pale pastels, and back issues of Golf Digest are fanned out on a slate table. The flat-screen TV plays the A&E channel.

"It's way more work than I expected," he says. "Everyone thinks you get rich on the first day. I'm $45,000 in debt." Beyond the waiting room, the medicine sits carefully displayed on a shelf in little vials labeled with venerable names from a distant, less businesslike era: Mowie Wowie, Couchlock, Atomic Haze—more than 20 varieties in all. There are boxes of rolling papers and massed ranks of bongs and vaporizers, a recent innovation that theoretically allows the patient to inhale pot fumes without burning the weed. Pipes made of colorful blown glass have replaced the old metal pipes familiar to an earlier generation of dopers. Marijuana-infused salsa and chips—"they work phenomenally," DiFabio says—are waiting to be washed down with a bottle of Dixie Elixir medicated soda, in your choice of grape, strawberry or orange. Lollipops are in high demand, and gummy bears fly off the shelves. DiFabio's biggest complaints nowadays would warm the heart of a U.S. Chamber of Commerce lobbyist. "The regulations," he says, "are just over the top." His application for a dispensary license ran to 1,400 pages, with attachments.

Modern liberalism has always maintained a tension between its libertine and bureaucratic impulses, and in medical marijuana the contradictions collide: the government will let you get as high as you want, but only if you fill out a form first. Would-be patients must obtain a recommendation from a doctor and mail a notarized application and a check for $90 to the state department of health. If they can prove to a budtender that they've applied for a card, they're eligible to buy medicine after 35 days. The card arrives in the mail eventually; the backlog at the health department is nine months and getting longer. For dispensary owners and their suppliers—growers and infused-product makers like Robinson—the regulations seem to never end. Alarmed by the sudden efflorescence of dispensaries and customers, the Colorado legislature this summer placed the industry under the regulatory oversight of an official of the state revenue department. Though he's a former cop who busted pot smokers in the 1980s, Matt Cook says he approaches his work with pristine disinterestedness. "The way I see it," he says, "I regulate widgets. Whatever there is to regulate, that's fine with me." 

Cook has prepared 92 pages of proposed regulations modeled on the rules that govern casinos. Dispensary-license fees now run as high as $18,000. Budtenders and owners face strict residency requirements, and anyone with a felony drug conviction is barred from the industry for life. Owners will soon be required to place video cameras throughout their cultivation sites and dispensaries so regulators can log on to the Internet and trace the movement of every marijuana bud from the moment its seeds are planted to the point of sale. The video will be transmitted to a website accessible to regulators round the clock. The regulators dictate where the cameras must be placed and at what angle. DiFabio is particularly irked by a proposal to monitor his marijuana scales by linking them to the Web. "We've paid our fees," he says. "Why do they have to watch us every second?"

Only in a state where marijuana is almost legal can you find so many Obama voters complaining about Big Government.

High? What High?
A few facts in particular drove the legislature to tighten the regs this summer. Even Inspector Clouseau might have begun to suspect there was more to the industry than medicating the terminally ill. No one doubts that medical marijuana has brought relief to the state's cancer patients, AIDS sufferers and MS victims. But these aren't the customers the industry is really serving. At the beginning of this year, Colorado health department records show that only 2% of registered patients had cancer; 1% had HIV/AIDS. There were 94% who suffered "severe pain"—a catchall condition that can be entirely subjective and difficult for a doctor to measure or verify. Statewide, more than 70% of doctor recommendations were written by fewer than 15 physicians. Three out of four patients are men under 40. This patient profile—young males complaining of chronic pain—has been roughly the same in other medical-marijuana states like Montana and California.

A couple of weekday afternoons spent at several Colorado dispensaries confirms the picture the numbers paint. Nearly all the patients were male, a large majority in their 20s and 30s. Figures from other states, though less comprehensive, match Colorado's. Brian Vicente shrugs off the numbers. Young men are more likely to work the kind of jobs that result in chronic pain, he says. "All this really shows is that pain is more prevalent in society than AIDS and cancer."

Pot affects different people differently—"We're all our own walking chemistry experiments," Robinson likes to say—and for many patients, smoking it or eating it will quickly relieve pain, nausea and muscle spasms associated with chemotherapy and MS. Studies have demonstrated beyond quibble that marijuana has some effectiveness in mitigating severe pain. Unfortunately, only clinical tests can show which of marijuana's 108 active compounds cause which of its many effects, and because the balance of compounds shifts from plant to plant, dosage is nearly impossible to control when the medicine is consumed in its botanical state.

Even activists now concede that marijuana is addictive for 10% of regular users—making it less addictive than alcohol (15%) and much less addictive than cigarettes (32%), which are, they point out, perfectly legal. Marijuana unquestionably causes cognitive impairment; nobody would smoke it for fun otherwise. Loss of memory and a decline in decisionmaking ability are the most pronounced effects, data confirmed anecdotally and by Cheech and Chong movies. How long the impairment lasts—whether a month or a lifetime—and to what degree are open questions. Use of marijuana has been linked clinically to the onset of depression, anxiety and schizophrenia; the link is especially strong in younger users and stronger still in young men with a predisposition to mental illness.

At the same time, budtenders and dispensary owners alike extol pot's bounteous ability to heal in language that is part Diagnostic and Statistical Manual, part Whole Earth Catalog. Forget migraines and insomnia, back pain and lack of appetite: pot is routinely sold as a cure for irritable-bowel syndrome, Tourette's, muscular dystrophy, herpes, diabetes, gonorrhea, bulimia, eczema and—oddly enough—both obesity and weight loss. Andrew Weil, the alternative-medicine doctor and holistic-healing guru, suggests marijuana might cure cancer.

And what, a layperson might impolitely ask, about the buzz? Hearing tales of pot's medicinal powers, you would think it was the last thing on anybody's mind. Budtenders will even use air quotes when they speak the word high to nonpatients, as though the stoner effects were an elaborate urban myth. Yet among patients, it's often hard to disentangle the curative and palliative functions of marijuana from the desire to get, if you'll forgive the expression, high. Typical are these patient testimonials from a website run by Montana Caregivers Network: the RomSpice variety, says one satisfied customer, "is the strongest body high I've ever felt. It literally makes my whole body feel numb and tingly. I give it a 12 out of 10 for pain." About AK-47, another testifies, "A more 'active' high, pretty decent munchie factor after a few minutes and a very pleasant mental haze. Pain relief is definitely also a good plus with this one." Here the recreational and medicinal are so balled up that one begins to look like an excuse for the other. Nobody would dare talk this way about Percocet.

That's what worries Christian Thurstone, a psychiatrist for adolescents who runs a drug-treatment program in Denver. He cites the confluence of two trends among the city's young. "There's an increase in the availability of marijuana," he says, "at the same time that we're seeing a decrease in the perceived harmfulness of marijuana." His program has seen a marked increase in patient referrals for marijuana use at his clinic, where all patients are under 18.

"We've started hearing things we hadn't heard before," he says. "They're telling us that marijuana isn't a drug, that it's a medicine. They even call it medicine."

To register as a medical-marijuana patient, a minor must submit the notarized signatures of both parents to the Colorado board of health. Even so, Thurstone says, when he collected data on 55 juvenile marijuana patients, he found that 60% of them had gotten their pot from a patient with a medical-marijuana card. "This age is a crucial developmental window for these teenagers, particularly young males," he says. He cites studies that suggest marijuana use in adolescence doubles the risk of schizophrenia in later life. "The human costs are potentially huge." Meanwhile, a national survey on drug use and health reports that the percentage of kids under 17 using marijuana has been rising—from 6.7% in 2008 to 7.3% last year.

The Backlash Cometh
For all its success, there are signs that the advance of the medical-marijuana movement is not inevitable. The narrow losses for initiatives in South Dakota and, apparently, Arizona, despite lavish funding on their behalf, were discouraging to advocates, who are ordinarily quite cheerful—no surprise there—and upbeat about the prospects for their cause. The Los Angeles city council recently moved to reduce the number of local dispensaries from an estimated 1,000 to roughly 200. The New Jersey legislature passed a medical-dope law in January far more stringent than the one activists hoped for. Only terminally ill patients or those with cancer or ALS will be permitted to buy marijuana from a handful of state-sponsored clinics. New Mexico's law, passed in 2007, will prohibit the private cultivation of marijuana, which will be available only through the state government's own "cannabis-production facilities."

Meanwhile, at the federal level, it's still 1985. Marijuana retains its status as a Schedule 1 controlled substance, the legal equivalent of heroin and LSD, with "a high potential for abuse" and "no currently accepted medical use." That designation sharply limits the medical research that can be done with marijuana, setting up a flawless bureaucratic catch-22: pot is listed as Schedule 1 because science hasn't found an accepted medical use for it, but science can't find a medical use for it because it's listed as Schedule 1. Either Congress or the Drug Enforcement Administration could change the designation, but the DEA shows no signs of budging, and when Representative Barney Frank introduced a bill two years ago to reclassify marijuana for medical research, he gathered all of four original co-sponsors.

The high hopes that advocates once had for the Obama Administration have faded too. During the presidential campaign, Barack Obama promised to de-emphasize federal prosecution of medical-marijuana violations, and Attorney General Eric Holder formalized the policy with a memo to U.S. Attorneys in September 2009.

But it was a short honeymoon. Last January, Obama stunned the movement by reappointing George W. Bush's DEA acting administrator, Michele Leonhardt, who has an uncompromising approach to marijuana. This year, the DEA has made a series of raids on medical-marijuana facilities in Nevada, Michigan and California, claiming the operations were simply fronts for conventional drug dealing. When a federal survey last month showed a surge in pot smoking among young people, Obama's drug czar, R. Gil Kerlikowske, was quick to finger medical-marijuana laws as the culprit. "I think all of the attention and the focus of calling marijuana medicine has sent the absolute wrong message to young people," Kerlikowske said. For the marijuana movement, the Obama era has been all hope and no change. 

If nothing else, technology may make medical marijuana obsolete. Mark A.R. Kleiman, a specialist in drug policy at UCLA, says it's inevitable that some form of measurable, dosable medical marijuana will be made available in the next few years, a medicine that comes not in plant form but in a spray or an inhaler. "And that will do away with the argument for medical marijuana as we know it," he says. Already Canada and the U.K. have approved the use of Sativex, a cannibis-based spray for the nose and mouth that was developed by GW Pharmaceuticals, and it's in late-stage testing in the U.S. Sativex has been effective for pain from MS spasms and cancer treatment without causing the marijuana high. The moment Sativex goes on the market, the need for medical dispensaries, caregivers and growers—and all the confusions and prevarications that attend them—disappears.

There's a rough justice here: the disingenuousness of the push for medical marijuana—billed as a compassionate reform and used as a tactic toward full legalization—was always its Achilles' heel. Up to now, most states have approached medical marijuana with a series of evasions. Doctors rely on a patient's report of pain to recommend it, dispensaries rely on the word of doctors to sell it, regulators rely on legislators to determine who can provide it, and legislators fall back on public opinion, which is ill suited to making careful and informed decisions about pharmacology. And no one takes direct responsibility. None dare call it legalization.

There is another way to go about it.
"If we want to legalize marijuana," said Thurstone, "then let's legalize marijuana and call it a day. Let's not sneak it in the back door, dragging the medical system into it."

Here, at least, Thurstone finds an unexpected ally in Jenelise Robinson. Going through boxes of her new Puff Potion medicated soda ($6 a bottle wholesale), she reflects on the oddity of the culture that medical marijuana has created in her state. "It seems silly, doesn't it?" she says. "If there's someone who's been smoking for a long time, medicating, and this is what they like to do and this is what works for them, then why can't they just do it? Why make them go to the doctor and register? Why force them to lie about it?"

But Chairwoman Gloria Molina was having none of that. Molina said she supports the ban because anti-pot zealot District Attorney Steve Cooley's office had supposedly "done a poor job" cracking down on out-of-compliance pot shops.

Supervisor Michael Antonovich first proposed the ban in July, claiming to be concerned that as Los Angeles and other cities crack down on dispensaries, more of the pot shops would open in unincorporated areas of the county, reports the Pasadena Star-News.

Antonovich, clearly a lover of the spotlight much more than a stickler for the facts, claimed that more dispensaries would bring "more crime" to the area, despite studies showing no such effect.

Cannabis advocates argued for safe access to medically necessary marijuana for patients throughout the county.

L.A. County Sheriff Lee Baca, who along with hot-dogging D.A. Cooley is one of the loudest and most obnoxious voices against safe access in the county, is undoubtedly happy with this turn of events.

"The medicinal marijuana program that voters authorized years ago has been hijacked by underground drug-dealing criminals who are resorting to violence in order to control their piece of the action," Baca said, seemingly describing his own Sheriff's Department in a Freudian slip.