Medical marijuana is finally happening—but distributing it may be the least of New Mexico's worries.

Such was the conceit of the International Drug Policy Reform Conference, which began just days after New Mexico's Department of Health approved four new medical marijuana producers to field demand from the state's 755 patients.

The conference, a three-day event held at the Albuquerque Convention Center, featured attendees clad in a broad and fascinating variety of pot-themed T-shirts, as well as workshops and panels galore on subjects ranging from "Marijuana's Cultural Moment" to new developments in psychedelics. There was talk of "the movement" and the future, but the post-Obama cynicism that seems to have hit like a cold front everywhere else was notably absent.

Given the statistics, drug activists' optimism is hardly baseless. An Oct. 19 Gallup Poll finds that 44 percent of Americans support legalizing marijuana, the highest figure ever; in 2003, another poll found that 75 percent support allowing doctors to prescribe medical marijuana. And in Colorado, according to Sensible Colorado Executive Director Brian Vicente, the number of medical marijuana dispensaries jumped from 4,000 to more than 30,000 in 2009 alone.

But the regulations and infrastructure to turn those numbers into reality aren't in place yet, and they vary widely: As New Mexico tiptoes around its 2007 legislation allowing medical marijuana, licensing only a very few producers at a time, states like California are awash in marijuana dispensaries—and not without ideological blowback and a rise in raids by the federal Drug Enforcement Administration.

"If only we had a system as clear as New Mexico [does], I think we'd be in great shape," Alex Kreit, who chairs the San Diego task force charged with developing better regulations for local medical marijuana dispensaries, lamented during a panel discussion that featured Vicente, American Civil Liberties Union staff attorney Allen Hopper, Marijuana Policy Project Director of State Policies Karen O'Keefe and Steve Jenison, the medical director of the New Mexico Department of Health's Infectious Disease Bureau.

"Our process has been deliberate, which you can also read as 'slow,'" Jenison told a room packed with advocates, reporters and medical marijuana patients. "But our process will be a very sustainable one. We build a lot of consensus before we do anything."

Jenison also defended New Mexico's nonprofit production model, which he said grew out of the concern that medical marijuana might end up on the black market.

"A not-for-profit being regulated by the state would be less likely to be a source of diversion to the illicit market," Jenison said.

Hopper emphasized the importance of such step-by-step regulation: Not only does it help states avoid a disordered mass of dispensaries—which, according to some, is the situation in California—but well-defined state regulations also negate the need for federal oversight. And that's exactly the thrust of the US Department of Justice memo released on Oct. 19, Hopper said: to prompt states to impose their own regulations so the federal government won't have to intervene.

"The greater the degree of state involvement, the more the federal government [is] going to leave the state alone," Hopper said.

Meanwhile, in other conference rooms, decriminalization was a major point of focus. New Mexico State Rep. Antonio "Moe" Maestas, D-Bernalillo, plans to champion a "treatment not incarceration" bill in the 30-day legislative session that begins in January.

"In New Mexico, possession of narcotics or illegal drugs is a fourth-degree felony [with an] 18-month penalty," Maestas tells SFR. "This bill made it mandatory for persons with no felony history to get mandatory treatment as opposed to incarceration." Maestas says the bill didn't pass during the 2009 session in part because its critics argued that the necessary treatment facilities and infrastructure don't yet exist. This year, Maestas says he hopes to avoid that "cart-horse argument" because it distracts from the real issue: Incarceration for drug violations is inhumane and, he says, expensive.

"Putting someone in prison for 18 months…is a lot more costly and does nothing to protect the community," Maestas says. "I don't think anyone could argue with a straight face that treatment is more expensive than incarceration." To that end, Maestas says he'll work with Drug Policy Alliance of New Mexico and other supporters—which include Santa Fe-based immigrants' rights group Somos Un Pueblo Unido—to combine government-led incentives for drug treatment infrastructure with a push to get the "treatment not incarceration" bill passed.

"It is ridiculous to spend $60,000 or $100,000 to house a drug addict [in prison]," Maestas says. "Taxpayers should not spend X amount of dollars to babysit a drug addict. It seems mean-spirited but, sadly, those are the arguments that win the day."

As much progress as New Mexico seems to be making in drug policy reform, other areas still present a significant challenge. Since the late 1990s, the state has had one of the highest overdose death rates in the US and, this August, the New Mexico Department of Health released a report that shows a spike in heroin-related and overall overdose death rates between 2007 and 2008.

In a discussion titled "Rural Harm Reduction," panelists focused on the particular obstacles to drug abuse treatment and overdose prevention in remote areas like northern New Mexico, where Jeanne Block, a harm-reduction contract nurse, works to help drug users help themselves. Even though the area has only one methadone clinic and relatively few harm-reduction workers, Block said she's "proud of New Mexico—it's really amazing the services we can provide with not much money."

Still, the logistics of delivering overdose prevention drugs like naloxone (brand name Narcan) to isolated, insular communities can be daunting at best.

"We've worked with grandparents, parents and young adults or young teen children who are all addicted to heroin," Block said. "It's not like the one kid got addicted to heroin and the parents are like, 'How do I help him?' This is generations."

Panelist W Azul La Luz B underscored the need not just for better harm reduction and overdose prevention, but also for mental health treatment. A medical sociologist at the University of New Mexico, La Luz said he reviewed 12 years of accidental drug overdose data and every case, he recalled, involved the use of several different substances—sometimes as many as 37.

"To me, that's not an overdose; that's a suicide," La Luz said. And without mental health treatment in place to help those people, he added, "it's catch and release"—only to reoccur later.

Still, anecdotal evidence seems to support the theory that slow change creates lasting change—and if New Mexico's deliberate medical marijuana program is any indication of the state's future drug policies, there's no need to despair—nor, for that matter, to be complacent.

"We've got to be relentless, always on the offensive," Maestas exhorted conference-goers. "There's a huge crack in the dam, and that dam is gonna burst! We've got to bring the torches to the castle gate!"

The applause was deafening.