Philly420: Pennsylvania's medical cannabis conundrum

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The inside of the Columbia Care medical marijuana dispensary is seen in New York on Jan. 7, 2016.

Chris Goldstein is a marijuana activist living in New Jersey.

Cheers erupted through the Capitol building when the Pa House passed the medical cannabis bill two weeks ago. It was a wide margin, 149-43, and accompanied by impassioned speeches on the House floor by lawmakers in favor of the move.

Rep. Jeff Pyle (R. Armstrong) said, “4,056 days ago I was diagnosed with renal carcinoma.” Pyle continued, choking up: “I was literally given the ten-day warning.”  He was referring to fears he might become terminal.

Pyle explained how a friend offered him cannabis oil but he refused to take it. He did not want to break the law. Pyle then urged his colleagues to vote yes on the bill.

Rep. Mike Regan (R. Delaware) said, “I think of those who are illegally healing every day. Wondering if they will get arrested or incarcerated helping themselves or a loved one trying to get medical marijuana.”

“We have a moral obligation to do what’s right here,” added Regan.

Rep Brian Sims (D. Philadelphia) said that medical marijuana “opponents offer a parade of horribles by passing this bill, those of us with common sense know they are not true.”

“There is no metric to measure the smile on a child’s face when they can go a day without a seizure,” Sims added.

Sims and other House members referred to members of the group Campaign for Compassion who have spent the last two years lobbying for the bill to pass on behalf of their severely ill children.

But even as the elation of the hurdle being cleared echoed in the chamber, a more cautious reality began to sink in.

The bill is not actually, completely through the legislative process. In fact it may have reached the stickiest phase of any bill, concurrence.

The House passed language that is quite different than what was passed by the Senate last May.

Both chambers must approve exactly the same language in order to send a bill to Governor Wolf's desk.

Right now there are some changes that could further dilute a program already stripped down to the very limits.

Both bills prohibit smoking and would only allow allow extracted, processed cannabis oils that could eaten or used in an e-cigarette. Tinctures and capsules would also be allowed. Yet no whole plant material and no pre-made edibles, like cookies or candy, could be sold to patients. There is no home cultivation either.

While the news has been that some Senators are examining the technicalities, a "may" here and a "shall" there, some of the concepts are more fundamental.

The House bill would require doctors who wish to register patients in the medical cannabis program to themselves register with the Department of Health. Physicians would need to take an as-yet-determined course on cannabis therapy to complete their status as a "practitioner" in the program.

It is an odd system. One that has seriously hampered patient access in both New Jersey and New York.

Doctors in both of those states must follow similar, overly-strict protocols. There are tens of thousands of physicians in NJ and NY but because of this registry requirement fewer than 1,000 doctors have signed up. This is a a big problem if you want to become a patient.

Potentially qualifying patients find that their regular doctor or specialist isn't part of the cannabis program and isn't quite willing to join the registry. Patients then call up all the doctors who are registered, but many say they aren't taking new patients. When patients do find an appointment they often have to pay, out of pocket and without insurance, for several visits.

Oh, and then pay the patient registration fee on top of it all.

The bottleneck has been significant. New Jersey was projected to have 100,000 medical marijuana patients. The physician registry requirement has kept that to just 6,000 after almost 5 years. New York is following the same path.

The low patient numbers then translate into expensive products from the licensed medical cannabis operators who had planned for greater volume. It's an ugly cycle. From $530 to $1200 per month, in cash is the cost for medical cannabis in NJ and NY. Patients simply opt to access the less expensive, readily available underground marijuana market instead.

Michigan does not have a doctor registry and allows home cultivation. There are almost 100,000 patients. In other states like Maine or even Maryland, any state licensed doctor in good standing can recommend cannabis therapy. Where patient numbers are higher, costs are lower.

Another bizarre approach in the House bill is on the issue of some adding qualifying medical conditions or allowing whole plant cannabis to be dispensed later on.

These, and a long list of other variables, is supposed to be the subject of study by an Advisory Board made up of - seriously - political appointees from the Majority and Minority offices of the state Senate and House. There are even representatives of several organizations including - no kidding - the state Police Chiefs Association, who have been among the only groups to have testified against medical marijuana. Sigh.

The House bill also carefully outlines that whole plant medical cannabis, really just the dried flowers, can only be dispensed after the Advisory Board meets three years after the program is operational...which is (somewhat optimistically) put at 18 months after the law is signed and enacted.

So, if the Senate just accepts this version of the House medical marijuana bill that means that possibly, maybe, perhaps a group of politicians and police will decide to give seriously ill patients some raw cannabis sometime in the year 2021. For real.

In the next five years Pennsylvania would take the best of the worst aspects of the ineffective programs in New Jersey and New York and attempt a mash up of bizarrely restrictive and completely arbitrary rules.

We've gone from a core of attempting simple relief to a million complexities. From zero to politics in the blink of an eye.

While this concurrence phase could certainly see the final language get even worse it is also the last chance for any improvement.

Medical marijuana represents a major learning moment for state government. Here is a chance to do good, using common sense and helping to regulate an emerging domestic health care option. The temptation is to over-regulate, treating this plant as undeservedly dangerous in ways that stretch the imagination. But there is a better balance.

Patients and advocates in both New Jersey and New York tried legislative changes and even court actions after their restrictive bills were passed into law. Nothing has really worked.

Concurrence between the Pa House and Senate is a common part of the legislative process. In both chambers there was a lot of talk about compassion and even morality. That weighing the issue by those factors legalizing medical cannabis is something they can support.

That certainly seems to be true sentiment of the public. They are thinking of their friends, neighbors and family members - maybe even themselves - who have already used cannabis, often simply smoked it, to find relief. Astounding majorities of the voters in Pennsylvania, some polls say up to 90 percent, actually support medical marijuana.

So here is a final opportunity for the state government to do right by the people on this issue.

The point of passing a medical marijuana bill is to bring patients into the program, and soon, not keep them out.

Three things that might make the bills reach the broader patient population:

- Allow any licensed doctor or nurse practitioner in Pennsylvania the ability to recommend medical marijuana without becoming part of a special registry at DOH.

- Allow whole plant cannabis to be supplied directly to patients immediately as the lowest cost option.

- Allow immediate patient registry and legal protections for those patients.

Pennsylvania has a chance to do better. We can truly stop making refugees of our families and criminals of our neighbors over medical marijuana.

The House and Senate need to fix some fundamentals as well as technical problems with these bills. The patients they are standing up for, and the voters, deserve something that truly operates in the real world.