Lily Fisher sits on the edge of her bed in the front room of her duplex, her prosthetic foot with the red-painted nails propped against a footrest.
Her face creases with worry as she ponders her precarious housing situation. Fisher, 55, is caught in a conundrum that confronts anyone in Montana who relies on medical marijuana for pain relief but seeks federal Section 8 housing assistance.
She can have one or the other, but not both.
While marijuana is legal in Montana for anyone with a state-issued medical marijuana card, the federal Drug Enforcement Agency still classifies it as an illegal Schedule 1 drug. Drugs in that category are defined as “substances with a very high potential for abuse and no accepted medical use.”
That means even people with medical marijuana cards are ineligible for the federally funded Section 8 housing assistance program.
Fisher got a wake-up call as she was filling out a screening questionnaire for the Montana Department of Commerce’s Section 8 program, which helps low-income residents pay for privately owned rental property. In Billings the program is coordinated by the local Housing Authority.
Two years before, Fisher had filled out a preliminary application and was placed on a waiting list. On July 5, she received a letter that she was nearing the top of the list and was asked to return for a mandatory eligibility briefing.
One of the questions on the screening form asked if the she or any member of her family had a medical marijuana card. She checked the “yes” box.
The employee doing the screening told Fisher that answer would disqualify her from housing assistance, she said.
“It never even crossed my mind in a million years that that would be an issue,” Fisher said. “I started getting shook up and nervous because I’m about to be homeless.”
She grabbed the paperwork and walked out of the office, unsure where to turn for help.
The Billings woman was diagnosed with breast cancer in 2005. During the treatment, she developed blood clots in her foot, which led to the amputation of the lower part of her leg.
To cope with the pain, her physician prescribed two types of narcotics, hydromorphone and oxycodone. The potentially addictive drugs left Fisher in a constant fog, and she quit them cold turkey before looking to medical marijuana to deal with the pain.
Eventually she got a job at a local grocery store a couple of miles from her rented duplex.
“I felt good about being able to do something again,” Fisher said. “I worked all my life. I was a very active person.”
But two miles is a long way to walk in the winter. She eventually got fired for having too many tardy notices.
“That devastated me,” Fisher said.
Living on a disability payment didn’t leave much money after she paid rent, so Fisher applied for Section 8 housing. In the meantime, she received an eviction notice that will soon force her to move out.
“I can’t pay the rent, and it takes money to move,” she said. “I don’t know what I’m going to do.”
Where it all started
The Montana Medical Marijuana Act was initially approved by the Montana Legislature in 2004, though it has gone through a number of revisions since then. According to the state, as many as 26,549 Montanans have medical marijuana cards, with 3,396 of them in Yellowstone County.
Patients secure the cards through doctor recommendations. The card, issued through the Department of Public Health and Human Services, is good for 365 days and then must be renewed.
In the United States, according to the National Conference of State Legislatures, 31 states allow public medical marijuana and cannabis programs.
In 2011, with the increase in the number of states passing medical marijuana laws, the U.S. Department of Housing and Urban Development issued a memorandum concerning the drug’s use at HUD-assisted properties.
Essentially, HUD said anyone found to be illegally using a controlled substance would be denied admission into its federal public and assisted housing programs.
As for people already living in federally-subsidized housing and using medical marijuana, it would be up to individual public housing authorities and owners whether to evict tenants, the memo said.
The Housing Authority of Billings operates a number of programs that provide either low-cost housing or rental assistance, including Section 8.
Patti Webster, executive director of the Housing Authority of Billings, explained that reasonable accommodation is something for which a person with a disability can request a waiver of policy. That may include a ramp or grab bars to accommodate a renter with physical limitations.
“We cannot grant reasonable accommodation for medical marijuana,” Webster said.
As for people already in the program with marijuana cards, Webster said if they are found using medical marijuana regularly, they would be evicted or terminated from the program.
On the other hand, Webster said, “we’re not going and knocking on doors.”
The housing authority’s screening questionnaire doesn’t specifically ask if an applicant has a medical marijuana card, but whether they use any drug considered illegal by the federal government, which includes medical marijuana.
The Montana Department of Commerce is in the process of standardizing the pre-screening process used by the 11 housing authorities in the state, said Emilie Ritter Saunders, communications director for the MDOC.
The pre-screening questionnaire used in Billings specifically asks if the applicant or a family member has a medical marijuana card. That jives with the 2011 HUD memorandum, which spelled out what is and isn't allowed.
“The state has interpreted this to mean that medical marijuana card holders are not allowed on the program unless they relinquish the card prior to being admitted to the program,” Saunders wrote in an email response.
“Also, the FDA has approved drugs for medical uses which are comprised of marijuana synthetics, such as Marinol and Cesamet,” Saunders said. “HUD says these drugs are not medical marijuana and are legal.”
Those drugs have limited uses, said Dr. Michael Uphues, a board-certified family physician in Billings who is also certified in cannabinoid medicine. Both are used by cancer patients for nausea and vomiting during chemotherapy, and Marinol also helps treat loss of appetite in some AIDS patients.
There are no marijuana synthetics that deal specifically with pain, Uphues said. Medical marijuana, in its many different forms, can provide that relief.
“Modes of delivery range from topical preparations, which you apply locally such as creams and salves,” he said.
One of the most popular are tinctures, which involves half a drop or more under the tongue. Dissolving strips also are available, as are a variety of edible preparations that range from hard candies to cookies, brownies and muffins.
The patients Uphues tends to see are age 40 or older. They typically choose topical or oral cannabis products over smoking it.
“People have these visions in Section 8 housing of having cannabis smoke billowing out of windows,” he said.
In most cases, he said, no one living near a resident using medical marijuana would even notice.
The issue isn't unique to Montana. In June, Congresswoman Eleanor Holmes Norton, D-D.C., introduced a bill that would permit the use of marijuana in states where it is legal, for medical or recreational use, in federally assisted housing. But there's no knowing if such a bill will make it into law.
Fisher, whose card will expire in September, received a letter on Aug. 16 from the Section 8 Rental Assistance program telling her the agency "recently received information from our field office that (she had) engaged in illegal use of a drug." Because of that, her name would be removed from the MDOC Section 8 wait list, and she would have to reapply.
The letter also invited her to request an informal review if she believed the information was incorrect. She has 20 days to submit the request in writing.
Nowhere in the letter did it say that if she gave up her medical marijuana card, she would be eligible for Section 8.
Fisher planned to visit another physician soon to see what her pain-management options are. Pain pills are out, she said, so she’s going to see what else may be available, besides medical marijuana.
“I’ve got to do something," she said. “I can’t be on the street.”