WHAT’S GOING ON with the medical marijuana program? Is it going away?
I THINK SO, and I hope so, and I expect rowdy emails for saying so. After 18 years, the program has run its course. Going forward, I would like to see everything combined into one big casserole, with protections baked in for current medical program patients. That way, we curtail the waste of two big Oregon agencies intensively regulating one little plant.
The Oregon Medical Marijuana Act (OMMA) was enacted in 1998. It has been amended several times, and today, there’s significant overlap with the emerging retail market. Back in the day, the OMMA was drafted to protect patients and their caregivers from criminal liability. Those were commendable goals, but the program never made sense from a business perspective. That would be fine, of course, if the OMMA hadn’t created a sizable market.
Back in the ’90s, the founders of the OMMA contemplated only a few parties: patients and their caregivers. Patients acquired program cards on “recommendation” from doctors, who were barred from prescribing Schedule I substances, like weed. The recommendation language was carefully chosen: US Supreme Court precedent in the abortion context said that doctors could not be stopped from simply discussing health care options with patients. Why not? Free speech.
I revisited the original OMMA recently, and it feels very quaint. For that and other reasons, people kept messing around with it. In 2004, Measure 33 attempted to expand the program by mandating distribution centers. That measure flopped. Thereafter, the legislature created the dispensary program in 2013. That’s when things got weird, in the sense of serious, state-sanctioned commerce.
Under the OMMA, patients have always owned the plants. But, for the past few years, growers have sold “excess medicine” to dispensaries under permitted agreements. Growers are supposed to sell just enough weed to cover costs, but many growers make money. Nowadays, licensed processors make money too. Officially, wholesalers do not exist, but consolidation inevitably happens when markets mature. As you can see, all of this is pretty loose.
The Oregon Health Authority (OHA) has always hustled to deal with OMMA weirdness. However, OHA sits in the hapless position of administering a statute that creates a marketplace while mostly ignoring the market. The agency is also under-gunned when it comes to enforcement: Currently, just seven inspectors deal with 26,943 registered grow sites and 409 dispensaries. OHA is candid about the fact that enforcement is complaint-driven and sporadic.
This spring, the legislature took significant steps to merge the medical and recreational markets. That merger hasn’t entirely happened, I think, because of political constraints. Now, however, the medical program is being carved away piece by piece. It’s almost unrecognizable and will soon be left behind. Might as well get it over with.
Hopefully it just pushes the gray market to get stronger and more flagrant. It was bullshit to make people pay $400/year to get a medical card before, and it’s bullshit to put ridiculous restrictions on what and how much “recreational” customers can buy now. Where are the quotas and limits on “recreational alcohol”? You can walk into any liquor store and buy a bottle of grain alcohol and pour it into your butthole all damn day.
Thankfully cannabis in Oregon has been basically legal for decades, and there is no shortage of medicine to go around if you are in a position to find it. The losers are the poor and sick, as always. The bureaucracy and politics of healthcare in this country make it inevitable that individuals will subvert the $$$-focused industries that try to limit access to well being and drive people back to the black market, overseas, online, etc.
As for “quotas” on “recreational alcohol”: there is a big difference between alcohol and weed: we don’t ALSO consider alcohol “medicinal”. Alcohol does not potentially cure cancer or refractory childhood seizures.
As a medical professional who also makes medicinal cannabis preparations for cardholders, let me pitch to you, Vince, and your readers, exactly why medical cannabis needs to remain a separate and protected category here in Oregon (and, hopefully, eventually nationwide):
Rec cannabis and medicinal cannabis are different animals entirely. Are people buying cannabis at the recreational level and using it to treat their own medical conditions? Absolutely. But from a marketing perspective, it is unethical to market a purely recreational product as having medical benefit. Medical claims sell product, and there is already enough scamming going on of the consumer in both the supplements industries as well as the straight-up pharmaceutical industries regarding claims about what their products can do for people. We should not conflate rec cannabis and medical cannabis for the consumer. The OLCC has no medical expertise and has no business meddling in people’s health care choices. What they would do is flatten medical cannabis entirely, like they did in WA, and disallow any talk of health or health claims, which is of course appropriate for rec cannabis. That would be devastating IMHO for my patients and for the future of cannabis research, which would then be the purview of pharmaceutical companies.
Let rec cannabis excel just like the craft wine and beer excels here: by emphasizing flavor, terroir, aroma, “high”. What is wrong with getting high, for fuckssake?? WHy do we have to pretend getting high is somehow always “healthy?” The sophisticated cannabis consumer can pick and choose for her or himself what they need to get “high”, or self-treat their anxiety or pain. I’m not worried about the sophisticated cannabis user. Go ahead and make your own THC marshmallow treats or buy Cheba-chews, and if it helps your pain, AWESOME!!! But please don’t market these things to the consumer as “medicine”. They are not.
I, however, work with elderly, medically fragile, medically complex, and cannabis-naieve medical cannabis patients. I’m sorry, but these people cannot find what they need at the average rec dispensary, nor should they. They often need high doses (200mg activated THC and up) that should NEVER be available to the public at a rec dispensary. Why? Because NOBODY needs that amount of THC to get “high”, the probability of overdose is extremely high (and YES I know you can’t die from cannabis overdose, but it still sends tons of people to ERs every year with disturbing symptoms, it’s not something to be pooh-poohed away just because YOU have never experienced it).
The fact is, the preparations and doses that many medical cannabis patients need should not and will not ever be allowed at the rec level. THese people need special dosage forms and doses, and they do need to work within their existing health-care frameworks since they are often on pharmaceuticals, as well. If we do away with med cannabis, like they did in WA, it will just go underground. Keeping a protected category for medical cannabis enables us to promote medical cannabis professionalism, conduct research on the medical benefits of cannabis, and protect consumers from companies that make unfounded or excessive claims.
There are plenty of programs to help those who can’t afford cards to get them. We need to keep OHA regulating a protected cardholder class who, due to their medical conditions and cardholder status, deserve to be able to buy cannabis MEDICINE with reduced taxation.
I know to the average non-medical professional and patient, having two categories seems wasteful and unwieldy. But we live in a consumer capitalist environment that values profit over public safety, and we are dealing with a product that has both medicinal and recreational value. Not all cannabis is medicinal, nor should it be. The parallels with alcohol are NOT the same, because alcohol does not have the same healing potential as cannabis.
I hope I have convinced you and your readers of some of the value of keeping and protecting Oregon’s medical cannabis category. What’s more, Oregon has mandated research on cannabis as medicine. How can we conduct this without acknowledging a special category of cannabis that is truly medical?
Thanks for reading,
MK, Pharm.D