Ten years ago this month, Rhode Island legalized medical marijuana. Today, nearly 13,000 patients are enrolled, not to mention more than 2000 caregivers. And 100 new applications arrive every week. Is it sustainable?
Ellen Lenox Smith taught seventh grade social studies for years. She was nearing retirement when the pain got so intense she couldn’t bear it. A bone was slipping into her throat, she couldn’t breathe, and her body seemed to be falling apart. After months of tests, doctors finally discovered what ailed her: Ehlers Danlos.
“I was diagnosed with Ehlers Danlos, which is a connective tissue disorder, which means all of the ligaments and tendons in my body are like overstretched elastic bands.”
In other words, Smith isn’t held together very well. She wears a neck brace that almost overwhelms her petite frame. Her service dog, Maggie, naps at her feet. "I’ve just completed my 23rd surgery to hold me together," she says.
No surprise, then, that Smith hurts.
“I went to my doctor and said if this surgery doesn’t work, I’m going to need help. I’m living with pain, I knew I couldn’t go on like that.”
Smith couldn’t tolerate the usual painkillers. So her doctor suggested medical marijuana. This was before Rhode Island’s medical marijuana dispensaries, or compassion centers, had opened. She was nervous about where to find the drug, and what it might do to her. But she figured she had to try something.
“So I took a half a teaspoon that night, told my husband, ‘I just want you to know I just took it, you better keep an eye on me,’ thinking I would be a basket case. Went to bed. And the next thing I knew it was morning. I literally had slept the entire night for the first time in months.”
Some patients who take medical marijuana say it’s the only thing that works. People with chronic pain, debilitating nausea, undergoing chemotherapy or in the late stages of AIDS.
“That teaspoon of oil has given me my life back," says Smith. "No one would want my body on a good day but what it does is it takes the raw edge off.”
In January 2006, the General Assembly created the state’s medical marijuana program. Governor-at-the-time Donald Carcieri vetoed the bill, but lawmakers overrode it.
Rhode Island became the 11th state to allow some kind of medical marijuana. But there was nowhere to buy it. Rhode Island Patient Advocacy Coalition head Joanne Leppanen remembers.
“And so when the program first started, you had to grow it yourself or you had to find someone to grow it for you," says Leppanen. "That was not an easy task at the time.”
Her organization operated as a clearinghouse of information for patients wanting to get started. Meanwhile, in western states, retail dispensaries just started popping up. So Rhode Island decided to allow dispensaries, but only three, and they would be regulated. Today, three so-called compassion centers are open for business, like Greenleaf Compassionate Care Center in Portsmouth, Rhode Island. Meet Greenleaf CEO Seth Bock.
“We offer somewhere in the ball park of about 30 to 35 different strains of marijuana."
Bock is an acupuncturist by training and now the tall, casually dressed business man overseeing a thriving retail marijuana dispensary. It’s a strange business to be in, if you look from the outside: the center is nondescript, along kind of a strip mall, and you have to flash your medical marijuana card at the gated entrance to come in. But once inside, the walls are a soothing avocado-green, a fountain burbles in the center, and comfy couches line the wall.
Bock says his business has grown to about $3 million in sales, and he employs 28 people for lots of tasks, “Everything from growing the marijuana to trimming it, packaging it, security, retail sales, the edibles kitchen.”
"I’m Christine Reed. I am the chef at Greenleaf Compassionate Care Center.”
You heard that right. They hired a chef. Reed makes the so-called edibles that patients can eat as an alternative to smoking marijuana or sipping teaspoons of medicinal oil. Reed shows off a glass case full of brownies, cookies, lollipops, all dosed with different amounts of the medical components of marijuana.
“These are our fruit chews. They’re two to a package. Each one has 15 mg of THC. Very little CBD...." THC, CBD – these are acronyms for the different medicinal compounds, canabinoids, in marijuana. Reed’s not a doctor or a pharmacist, but she does her own research and recipe testing. She believes THC is generally for mental health, CBD for physical, like pain. As medicines, she says, they have very little psychoactive effect. To be sure, she measures each medicinal dose like a scientist.
“We do an extraction with either coconut oil or clarified butter. So each time we do an extraction, we have our medicine tested. And when the results come back we know exactly how much medicine is in each gram….”
So which edible should a patient choose? How much THC or CBD will help? That’s still a matter of experimentation. Everyone is different, says Reed. Plus, doctors can’t exactly prescribe this stuff. They complete the paperwork needed to enroll a patient in Rhode Island’s medical marijuana program. But it’s not a prescription. It’s simply a form that says yes, this patient has a diagnosis qualifying them for the program. Most physicians aren’t exactly broadcasting their willingness to fill out this kind of paperwork because of the stigma that surrounds medical marijuana. But that hasn’t stopped the program from growing.
Mike Simoli administers medical marijuana patient and caregiver licensing for the Department of Health. He says a hundred new applications arrive every week.
“Because these are professional licensing staff, and we do have 90 other professions we license," says Simoli, "so there’s always competing for time between all of the other professional licenses and medical marijuana.”
Which means there’s a backlog of about 200 applications at any given time, he says.
The growing number of medical marijuana cardholders has posed a challenge for State police, who’ve said in the past that it’s tough to enforce a law that prohibits growing marijuana when some Rhode Islanders have permission to grow it.
But local governments and law enforcement may be stuck with the dilemma, unless the federal government legalizes marijuana. Massachusetts just launched its own program, and more states are expected to do the same. For patient advocate Joanne Leppanen, it’s great that more patients will have access to medical marijuana. But the next challenge is making it more affordable for low-income patients.
“We have a significant percentage of this population who’s living on SSI, SSDI; many of them, their incomes are less than $1000 a month. There’s no subsidy for this, there’s no reimbursement.”
No insurance coverage, in other words, for a tab that can run $400 to $800 dollars a month for some patients, says Leppanen. Plus, there’s not much official guidance about using medical marijuana. For people like Ellen Lenox Smith, the patient with a rare disorder we heard from earlier, it’s a bit like living in medical limbo.
“If I had had cancer, hands would have been reached out, I would have been given a plan," said Smith. "I would have been given hope, I would have had a medical team on my side, but with this condition you’re just pretty much on your own.”
There are signs more states will develop their own medical marijuana programs, or consider legalizing marijuana for recreational use this year.