The Arizona Medical Marijuana Act (AMMA) has been in effect for four years, and the annual report by the Arizona Department of Health Services (ADHS) shows that more and more people are taking part in the program.

The first annual report presented in 2012 revealed that there were 35,641 active cardholders in the state. This year that number has increased by almost 17,000, with the state currently showing a total of 52,374 cardholders, which includes 51,783 qualifying patients and 591 caregivers. In addition, this year there were 904 dispensary agent cards issued.

The number of minors being prescribed marijuana has also increased. There are currently 92 minors (between the ages of eight months and 18) with medical marijuana cards, up from 18 who requested and qualified for one when the law first went into effect. Last year that number stood at 37.

Of the total qualifying patients, about one-third are female, more than a 10 percent increase over the first year.

As far as demographics, Navajo County ranked fifth in the state for the number of qualifying patients per 1,000 residents at 9.47, fourth in the state for caregivers at .17 per 1,000 residents and first in the state for individuals authorized to cultivate their own marijuana at 3.97 per 1,000 residents.

The reasons for being prescribed marijuana have stayed steady, with a majority of the qualifying patients, approximately 80 percent, citing one debilitating medical condition. The report also shows that 71 percent of qualified patients indicated “severe and chronic pain” as their only debilitating medical condition.

Thirty-eight dispensaries became operational this year and 34 cultivation sites were approved. Thirty-seven dispensaries applied for and obtained ADHS authorization to sell or dispense medical marijuana-infused edible food products, and 11 dispensaries applied for and obtained authorization to prepare medical marijuana infused edible food products and supply edibles to dispensaries.

The option to offer marijuana in a liquid tincture or form other than dried plant came about after a court ruling in March 2014, when a Maricopa County Superior Court ruling concluded that all forms of marijuana, including extracts from the plant, are provided the same level of protection for patients and dispensaries as the dried flower of the marijuana plant under AMMA.

Public health impacts under consideration include the relationship of poisonings and the decrease in prescription drug use among qualifying medical marijuana patients prior to and after implementation of AMMA compared to the general population.

Now that the state has allowed marijuana for medicinal use there is an interest by the ADHS in studying the long-term results of that usage both for the patients and others who may be affected. For example, a study of interest in Colorado suggests that the number of children under the age of 12 admitted to emergency rooms for the accidental ingestion of marijuana has increased since the decriminalization of medical marijuana in Colorado.

Other questions for study include whether the use of medical marijuana has an effect on opiate dependency, an impact on motor vehicle traffic injuries, and an impact on pregnancy outcomes or breastfeeding. According to the ADHS, a legislative change or amendment to the AMMA would have to take place in order to conduct studies regarding medical marijuana users that would involve other health and safety data.

There is a strong likelihood that a measure will appear on the 2016 ballot asking voters whether to legalize marijuana for recreational use in Arizona.

One consideration in support of recreational legalization is the taxes that would be generated. Jeremy Gunderson, a fiscal analyst for the Joint Legislative Budget Committee, submitted a memo stating that legalization would bring $48.3 million to state coffers in 2016. Gunderson estimated that the state would have about 543,000 recreational marijuana users in 2016. He arrived at the revenue projection using Washington State Liquor Control Board reports on daily marijuana use estimates. He estimated that Arizona would need more than 90 tons of marijuana annually to meet demand.

The battle between state and federal law enforcement is also showing signs of reaching compromise with the issuance of the Cole Memorandum, which lists eight priorities when enforcing limited investigative and prosecutorial resources in all states. Last week that memo was expanded to include sovereign Indian nations if they should choose to pass laws to use or cultivate marijuana.