Medical Marijuana 2.0: The Next Steps for Vermont

Cannabis plants on a rainy spring afternoon in Vermont.
Cannabis plants on a rainy spring afternoon in Vermont.
benignflotsam 5 Jun 2016
Cannabis plants on a rainy spring afternoon in Vermont.
Young cannabis seedlings on a rainy spring afternoon in Vermont. © Heady Vermont

BURLINGTON, Vt. — Vermont’s cannabis community reeled last month when the House finally sounded the death knell on measures to regulate recreational cannabis and home growing. Out of the chaos, however, emerged a quiet victory for medical pot users. S.14, expected to be signed by Governor Shumlin on Monday, includes (among other items) the expansion of qualifying conditions to include chronic pain and glaucoma, and reduces physician-patient wait time from six to three months.

As of April this year, there were 2,542 patients on Vermont’s medical marijuana registry. The addition of chronic pain, in particular, is an enormous step for the state and has the potential to expand the patient registry by leaps and bounds. Chronic pain, unlike severe pain, is a much broader designation and by far the most commonly diagnosed condition for which doctors recommend medical cannabis throughout the country. A recent analysis of data from the 2012 National Health Interview Survey (NHIS) found that around 25.3 million adults, or 11.2 percent of the population, experience chronic pain.

“I think it’s taken way too long for the politicians and the powers that be to be all right with the idea,” said Vermont patient Mark Tucci. “You can knock your pain level down 15, 25, 30 percent. You don’t know what a benefit that is when you’re straight up dying. It takes the pain from chronic to just kind of persistent. The question of course, now, is how do patients present themselves to doctors.” Tucci, the seventh medical marijuana patient in Vermont, was an instrumental voice in the passage of the state’s first medical law in 2004.

“The question of course, now, is how do patients present themselves to doctors.”

However, as many Vermonters know, change happens slowly here. The medical community  — meaning physicians in a position to recommend cannabis to their patients — will need to catch up to the new rules. For many doctors, there is a learning curve when it comes to medical cannabis. Executive Director Shayne Lynn of Champlain Valley Dispensary says that a significant part of what they do is educating doctors. “The health care community is getting more comfortable with us,” he said. “[Doctors] say, I have a patient thinking about using cannabis. Can you tell me what that means? What would they be doing, would they be smoking it?”

Many doctors are still uncomfortable recommending cannabis for fear of legal reprisal. “As a doctor you’re afraid of losing your license,” said Tucci. In Conant v. Walters, the Ninth Circuit Court of Appeals held that the federal government could neither punish nor threaten a doctor merely for recommending the use of cannabis to a patient. Physicians are allowed to discuss the pros and cons of medical cannabis with any patient and recommend its use where appropriate, including putting that in writing or otherwise participating in state medical cannabis programs without fear of legal reprisal. They may not, however, provide cannabis or tell patients where or how to obtain it.

A 2013 poll conducted by the New England Journal of Medicine found that three out of four clinicians would recommend the use of medical cannabis for a hypothetical cancer patient. However, doctors from six physicians organizations, including the Vermont Medical Society, the Vermont Academy of Family Physicians and the Vermont Psychiatric Association, testified against legalization at the Statehouse early this year. They argued that not enough research has been done into the subject, citing concerns about youth usage and risk of mental problems.

Lynn says that many doctors are unaware of vaporizing, tinctures and edibles as options for their patients. As a part of their educational outreach, the dispensary visits doctor’s offices weekly. “We’re hoping more Vermonters will start to choose cannabis as an alternative to the traditional pharmaceuticals,” said Lynn. With opioid painkiller prescriptions falling under scrutiny and a rampant heroin epidemic in several areas of the country, advocates argue that the availability of medical cannabis is more important than ever. In April, health officials in that Maine started considering whether to make opiate addiction a qualifying condition for the use of medical marijuana, and studies have shown a decrease in opioid overdose deaths in states where medical pot has been legalized.

“We’re hoping more Vermonters will start to choose cannabis as an alternative to the traditional pharmaceuticals.”

In stark contrast, at hearings across the state this past spring, legalization opponents seized on the opiate crisis as an even more compelling reason not to legalize. Some argued that the state shouldn’t legalize one drug while fighting an epidemic; Others insisted that marijuana could even lead to opiate abuse. D.A.R.E., in the meanwhile, has quietly removed cannabis from its official list of gateway drugs.

It’s worth noting that, despite paving the road to an expanded patient registry, the new bill did not include additional dispensary licenses to address increased demand. Currently, says Director Jeffrey Wallin of the Vermont Crime Information Center, 81 percent of all registered patients have a dispensary. Patients may choose a dispensary, assign a caregiver or grow their own. Transferring between any of these options requires paperwork, a processing fee, and several weeks or months of waiting. Generally speaking though, says Wallin, “We have seen a steady increase in patient numbers since the dispensaries opened.”

Out of the roughly 2,059 who opt for a dispensary, 1,400, or 68 percent of dispensary patients, are registered with either Champlain Valley Dispensary, which enters its third year of operation June 26, or its sister store Southern Vermont Wellness. Asked about their experience trying to meet demand, Lynn said, “The limitation for us is the cost of production ahead of more customers. We have to be ahead of the curve by six to eight months. If I could call someone and say, ‘I need to purchase cannabis,’ that would change the dynamic, but we don’t have that right now.”

However, parts of that will soon change. Previously, dispensaries could only ‘barter’ with each other for products. One of the additional stipulations of S.14 is that dispensaries can now sell each other, where previously the language had a barter-only clause for dispensaries. “[We didn’t always] have something to barter,” said Lynn. “Now if we have this product or they have that product or tincture … we can purchase that and fill it up. That’s a really helpful thing for us.”

It’s worth noting that, despite paving the road to an expanded patient registry, the new bill did not include additional dispensary licenses to address increased demand.

It’s not just doctors seeking education on the new medical cannabis frontier. Many patients coming into the fold are looking for guidance and information. To that effect, Champlain Valley Dispensary is opening a shop adjacent to their flagship retail store on the Burlington waterfront next month. Lynn says that many people want to come to the dispensary for basic education, but are not yet medical patients and so are not allowed entry. CVD Shop will serve to answer questions for the general community and visitors, and will also sell non-cannabis medicinal items that are available to the public, including CBD products.

CBD, a nonpsychoactive cannabinoid, has been hailed for the treatment of conditions like inflammation, pain, anxiety, psychosis, seizures, spasms and more, without the disconcerting feelings of lethargy or dysphoria associated with its psychoactive cousin THC. According to data collected by market research firm SPINS and shared by the Hemp Industries Association, there were more than $30 million in CBD sales in 2015, and that number is widely expected to increase in 2016. A survey conducted last month by VPR reporter Jon Kalish, estimates that around 60 acres of industrial hemp are being planted this year, with a significant portion dedicated to CBD production.

Green State Gardener, which is opening its Pine Street retail store on June 20, is also looking at how to incorporate CBD into its retail inventory. The company briefly offered CBD products on its website, but was forced to remove them after being dropped by Paypal. They’re certainly not the first to struggle with the banking industry: Due to the still-illegal federal status of cannabis, most traditional banks and major financial institutions refuse any transaction involving cannabis products. “We all have to be very conscious and respectful of the regulation surrounding CBD and cannabinoids,” said Retail Marketing Manager Kelsy Raap of Green State Gardener. “There’s a lot of complication around banking. The plan is that [retail] will be slightly more flexible than Paypal.”

The store, says Raap, will primarily provide growing equipment and education, including classes on growing hemp. “When we open, our primary focus is going to be helping people grow and process that includes anything from cannabis to echinacea to turmeric,” she said. “As far as we can help people understand how to grow and process hemp in order to receive the benefit so of CBD and endocannabinoids, we will do that.”

It’s apparent that, in spite of missing the ball on legalization and regulation, the first small wave of cannabiz has taken hold in Vermont, and it’s in the form of a largely medicinal product. Still, medical pot patients looking for traditional THC-imbued medicine face limited options. One Burlington medical patient, who asked to remain anonymous, lamented high prices at his assigned dispensary. “I’m starting to grow my own,” he said. “But I have space limitations … and I really have no idea what I’m doing when it comes to growing.” Dispensaries are required to have a sliding scale fee that takes into account a patient’s ability to pay.

Patients also cite fear of theft as a major concern of growing at home, buying firearms and instituting other security measures.

Patients also cite fear of theft as a major concern of growing at home, buying firearms and instituting other security measures. Several years ago Tucci, while away at a drug policy reform conference in New Orleans, was robbed by local teenagers of equipment and plants, including strains he’d spent years developing. Though he now uses a dispensary, he recalled the healing nature of having your own grow room. “There’s nothing better than sitting in your grow room and  lights are going to come on and just breathing the air and smelling the plants,” Tucci said. ” It’s just symbolic looking at flower just swaying in the breeze … and taking it all in. If you had stage four cancer and all you can do is sit taking a little sips of water and you just felt like shit and you’re taking your meds and taking more pills, wouldn’t your rather have something that would take your mind out of your state and just take you away for 10, 15 minutes?”

Tucci said that an increase in dispensaries would lead to greater choices for patients. “There should be more dispensaries. We’re about the point now where there’s enough patients.” he said. “I think it’ll be cheaper. But we’ll have a wider variety of strains. We’ll have a greater variety of tinctures and edibles.”

Some of the new medical cannabis measures go into play immediately upon the governor’s signing tomorrow, while the rest take effect July 1. Vermont Cannabis: Heady Vermont Watermark

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