The ski communities of Summit County, San Miguel County  and Pitkin County are some of the youngest, fittest and healthiest counties in Colorado.

So it would stand to reason that those counties would have the lowest rates of registered medical marijuana users. After all, use of medical marijuana, approved by voters in 2000, is limited to patients with debilitating medical conditions, including cancer, HIV and glaucoma.

And yet medical marijuana use in these mountain communities is twice the state average, as measured by per capita number of medical marijuana cardholders in each county.

When it comes to medical marijuana in Colorado, topography has more influence than health.
People seeking medical marijuana have to get a referral from a doctor and register with the Colorado Department of Public Health and Environment to legally use the drug.

An analysis of the state’s registry shows the highest rates of registered medical marijuana users lie in a swath of high country dominated by ski resorts like Aspen (Pitkin County), Breckenridge (Summit County) and Telluride (San Miguel County.) Those counties, meanwhile, have some of the state’s lowest rates of cancer and HIV.

Call it the green belt.

In contrast, flat, rural communities of the eastern plains and San Luis Valley barely touch the stuff. Some counties on the plains have no patients registered to use medical marijuana at all.

The urban counties of the Front Range fall in between, ranked roughly in order of wealth: Boulder, Denver, Colorado Springs, Pueblo.

Marijuana is not only pervasive in ski towns, it’s flaunted and even vaunted. Aspen held a two-day festival this spring to crown the best cannabis in the state. Breckenridge residents voted three to one in 2009 to legalize possession of small amounts of marijuana, and the town now boasts a club where members can toke up, whether they are registered patients or not.

“It seems to be a function of lifestyle,” said John Harner, a geography professor at the University of Colorado at Colorado Springs, when he saw the numbers. “The mountains are dominated by a recreational culture. They are there to have a good time. And perhaps that includes recreational use of medical marijuana. If that is true, it confirms suspicions that people are gaming the system.”

The health department’s registry seems to back up this hunch. Though many backers of medical marijuana focused on how it would help cancer and AIDS patients, only 3 percent of people on the registry have either, while 92 percent cited “severe pain” — a condition as hard to prove as it is to disprove, but which also is allowed.

As much as they encourage it, cultural values also can discourage use of medical marijuana.

In the windswept prairie of Kiowa County, snug against the Kansas border, where the economy is dominated by wheat farming and cattle ranching, dispensaries were outlawed before one even arrived.

As of the beginning of 2010, the most recent data available from the state, the county had no registered medical marijuana users.

“People around here are not much for modernization. A dispensary would be a big change, and folks here are not that into change,” said Jan Richards, economic development coordinator for Kiowa County’s largest town, Eads (pop. 747).

It’s not that patients couldn’t get marijuana if they wanted it, said Dr. Jeffery Waggoner, one of the few physicians in the county. Some doctors are willing to refer patients, he said, but, “Kiowa is terribly conservative, and marijuana is not the drug of choice, medically or otherwise. Booze is widespread, and causes a lot of damage, but when it comes to marijuana, there is a tremendous stigma attached. I think some people would be afraid to try it.”

Tradition has the same power in counties where rates of medical marijuana use are high.

Gilpin County, wedged in the mountains between I-70 and Boulder, has the highest rate of marijuana cardholders in the state. In this former mining community now dominated by the gambling towns of Central City and Black Hawk, 32 of every 1,000 people are registered.

Residents say it has less to do with health than with the region’s long tradition of growing weed.

For decades, the secluded hills stretching from Rollinsville in Gilpin County north to Ward in Boulder County acted as the Humboldt County of Colorado, where growers secretly tended crops of top-shelf bud to sell on the Front Range. Nederland, in the center of the region, is so tolerant of pot that people often call it Nedsterdam — a play on the Dutch city of Amsterdam, where pot is legal.

“People here have been growing for a long time and they are very good at it. It’s just part of the culture. I’d say five of my customers today are known to be in the business,” said a clerk who answered the phone at the Rollinsville Country Store, but declined to give his name because he felt uncomfortable talking about something that is widely known but rarely said.

David Forsyth, director of the Gilpin Historical Society, said the pattern might be explained by the fact that mountain communities have always been more tolerant of vice.

“It’s a very old attitude,” he said. “A lot of people moved up to get away from society, get away from rules of the big city. For generations, gambling, prostitution, and bootlegging were quietly accepted, as long as you kept your place and did not make it too obvious. I don’t see marijuana being any different.”

Gilpin does have the highest rate of cancer in the state, according to the The National Cancer Institute, but looking at all 64 Colorado counties, factors besides disease rate seem to have more influence on who registers to use pot and who doesn’t.

Where median income is highest, so is medical marijuana use. Same with college degrees. Same with voting for Barack Obama.

One of the few areas where there does not seem to be a correlation with is health.

“I would be wary to say it is totally people scamming the system,” said Harner, looking over the map. “Perhaps because these communities where we see high numbers are more liberal and progressive, they are more open to new, alternative medicines. But I’m not sure that could account for all of it.”