Writing for Business of Cannabis, Deborah Tharp, a cannabis-focused political consultant, campaign manager and legal researcher for Nugg and NuggMD, explains why it’s more crucial than ever not to overlook the stark differences between medical and recreational cannabis use. With recreational markets booming, many state governments are erasing these differences, leaving patients without access to the products and care they need. As we stand on the brink of federal rescheduling, she argues we must ensure that patients are not left behind in the rush to legalize.
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Some believe that medical cannabis is merely a stepping stone toward recreational legalization. Many state governments have reinforced this concept by merging recreational and medical markets out of perceived expediency. This is a mistake.
There’s a huge difference between medical and recreational cannabis. It’s a gulf… a chasm the size of the Grand Canyon. In light of upcoming rescheduling/descheduling, we must personally act to preserve our dwindling medical cannabis programs before any more patients are left behind.
By far, the biggest differences between medical and recreational cannabis are the types of products, dosages, and ratios available. Recreational cannabis tends toward high THC, low CBD because it’s more intoxicating in that form. Medical cannabis often offers specific ratios of CBD to THC and is commonly formulated to avoid allergens and irritants. Some patients need high THC, some low, and the ratios are very important for treating specific conditions.
Patients who need higher CBD products, such as 1:1 tinctures, edibles, and vapes, have a difficult time finding them at recreational dispensaries. For example, adult-use shops near patients may have one or two high CBD product options that don’t meet their dietary restrictions, allergy precautions, or physician-advised ratios of CBD to THC.
Furthermore, purely recreational dispensaries lack pharmacists, educated budtenders, or practitioners who can explain drug interactions or how cannabis products fit into treatment plans. The dispensaries couldn’t afford to staff these positions even if they wanted to, as many are hanging on by a thread under the burden of an effective 70% federal tax rate under Schedule 1.
VP Harris just announced a plan for full legalization of cannabis. For purposes of justice and reform, the vast majority of people 100% want this. But we need to remember why we have come this far — because there are patients out there who need cannabis, some for their very survival. With all of these legal and regulatory changes, we are leaving patients behind.
As we lose more and more medical dispensaries in recreational cannabis states, Schedule 3 cannabis is the current hot proposal to fix patient access problems.
But patients in illegal states will literally die waiting for access under a Schedule 3 scheme. It takes years, often a decade or more, to get products approved by the FDA. There are more cannabis-based products closer to the finish line than most know about, but the R&D for new drugs is exorbitantly expensive. The only way to recoup the cost is to charge exorbitant prices.
Exhibit A for what Schedule 3 cannabis would look like: Epidiolex patients are still paying tens of thousands per year for a CBD isolate that hemp producers can make for a couple of bucks, albeit not in such a pure form. Patients have successfully treated their conditions for decades in legal states with dispensary-made high CBD, low THC extracts for just a few hundred to a couple thousand dollars a year, not tens of thousands.
Yet in some states, these non-intoxicating, full-spectrum CBD products are illegal. If children showed any THC in their blood tests, even non-intoxicating levels, their parents would face loss of custody and jail. So they pay Big Pharma tens of thousands of dollars per year where patients in state-legal markets give their children physician-guided treatments for a fraction of that cost.
If this is the current outcome for pharmaceutical CBD years after legalization, why do we think Schedule 3 THC will work out any better?
Worse, what will happen to existing state medical markets if they are subjected to the additional layer of federal regulations being proposed to maintain compliance with international treaties? We are seeing proposals for DEA registration requirements, national track and trace, production quotas, limits on telehealth prescriptions, and crippling marketing restrictions even worse than state restrictions.
This will pump up the prices for federally-approved products to ridiculously silly levels. Consider the exorbitant price vs. production cost of suboxone. As with Epidiolex, the massive cost-of-production to retail price difference isn’t just due to greed, it’s exacerbated by regulatory and compliance overhead.
Will patients really pay those prices for products that literally grow on trees? Or will they just go to the medically unsupervised recreational markets, or worse, back to the black markets?
Yes, we are at the dawn of a new age of acceptance for cannabis. We are winning the war for this vital plant, but we are losing our medical markets at a record pace.
Medical markets are vital for patients who paved the path for legalization. They provide access to medically formulated products, more accessible dispensaries, access to pharmacists or highly trained technicians who can offer appropriate medication guidance, and physicians who follow their care and adjust treatment plans for maximum benefit. Legal benefits like employment protections and transplant equity, often unavailable to recreational consumers (but should be available to all), are key public health benefits of the medical cannabis market.
Sadly, most regulators and politicians don’t pay attention to the need for these vital benefits because medical cannabis consumers are an easily forgotten minority. In all the fuss about state tax windfalls, potential profits, and pharmaceutical startups, the conversation has become more about profit than medical benefit.
In other words, it’s all about the Benjamins.
This isn’t the time to sit back and rest on our laurels. We need to roll up our sleeves and work harder than ever on the upcoming laws and regulations to protect medical cannabis markets, or we’ll lose everything we’ve fought for.
Here’s what we can do to protect our state-legal medical cannabis markets while we work on full federal legalization. If we’re successful, we will improve public health.
As our laws change to meet public demand for reform, we can either have an overly controlled pharmaceutical model that leads to an explosion of black market activity and negative health consequences, or we can have responsible state-controlled recreational and medical markets that focus on equity and healthcare. It’s up to us how this pans out. We aren’t at the end of our journey as activists. Our work has only just begun.
The post The Hidden Costs of Cannabis Legalization: What About the Patients? appeared first on Business of Cannabis.
Continue reading...
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Some believe that medical cannabis is merely a stepping stone toward recreational legalization. Many state governments have reinforced this concept by merging recreational and medical markets out of perceived expediency. This is a mistake.
There’s a huge difference between medical and recreational cannabis. It’s a gulf… a chasm the size of the Grand Canyon. In light of upcoming rescheduling/descheduling, we must personally act to preserve our dwindling medical cannabis programs before any more patients are left behind.
What’s the Difference Between Medical and Recreational Cannabis?
By far, the biggest differences between medical and recreational cannabis are the types of products, dosages, and ratios available. Recreational cannabis tends toward high THC, low CBD because it’s more intoxicating in that form. Medical cannabis often offers specific ratios of CBD to THC and is commonly formulated to avoid allergens and irritants. Some patients need high THC, some low, and the ratios are very important for treating specific conditions.
Patients who need higher CBD products, such as 1:1 tinctures, edibles, and vapes, have a difficult time finding them at recreational dispensaries. For example, adult-use shops near patients may have one or two high CBD product options that don’t meet their dietary restrictions, allergy precautions, or physician-advised ratios of CBD to THC.
Furthermore, purely recreational dispensaries lack pharmacists, educated budtenders, or practitioners who can explain drug interactions or how cannabis products fit into treatment plans. The dispensaries couldn’t afford to staff these positions even if they wanted to, as many are hanging on by a thread under the burden of an effective 70% federal tax rate under Schedule 1.
VP Harris just announced a plan for full legalization of cannabis. For purposes of justice and reform, the vast majority of people 100% want this. But we need to remember why we have come this far — because there are patients out there who need cannabis, some for their very survival. With all of these legal and regulatory changes, we are leaving patients behind.
Why Schedule 3 Won’t Fix It
As we lose more and more medical dispensaries in recreational cannabis states, Schedule 3 cannabis is the current hot proposal to fix patient access problems.
But patients in illegal states will literally die waiting for access under a Schedule 3 scheme. It takes years, often a decade or more, to get products approved by the FDA. There are more cannabis-based products closer to the finish line than most know about, but the R&D for new drugs is exorbitantly expensive. The only way to recoup the cost is to charge exorbitant prices.
Exhibit A for what Schedule 3 cannabis would look like: Epidiolex patients are still paying tens of thousands per year for a CBD isolate that hemp producers can make for a couple of bucks, albeit not in such a pure form. Patients have successfully treated their conditions for decades in legal states with dispensary-made high CBD, low THC extracts for just a few hundred to a couple thousand dollars a year, not tens of thousands.
Yet in some states, these non-intoxicating, full-spectrum CBD products are illegal. If children showed any THC in their blood tests, even non-intoxicating levels, their parents would face loss of custody and jail. So they pay Big Pharma tens of thousands of dollars per year where patients in state-legal markets give their children physician-guided treatments for a fraction of that cost.
If this is the current outcome for pharmaceutical CBD years after legalization, why do we think Schedule 3 THC will work out any better?
Worse, what will happen to existing state medical markets if they are subjected to the additional layer of federal regulations being proposed to maintain compliance with international treaties? We are seeing proposals for DEA registration requirements, national track and trace, production quotas, limits on telehealth prescriptions, and crippling marketing restrictions even worse than state restrictions.
This will pump up the prices for federally-approved products to ridiculously silly levels. Consider the exorbitant price vs. production cost of suboxone. As with Epidiolex, the massive cost-of-production to retail price difference isn’t just due to greed, it’s exacerbated by regulatory and compliance overhead.
Will patients really pay those prices for products that literally grow on trees? Or will they just go to the medically unsupervised recreational markets, or worse, back to the black markets?
We are Winning the War and Losing it at the Same Time
Yes, we are at the dawn of a new age of acceptance for cannabis. We are winning the war for this vital plant, but we are losing our medical markets at a record pace.
Medical markets are vital for patients who paved the path for legalization. They provide access to medically formulated products, more accessible dispensaries, access to pharmacists or highly trained technicians who can offer appropriate medication guidance, and physicians who follow their care and adjust treatment plans for maximum benefit. Legal benefits like employment protections and transplant equity, often unavailable to recreational consumers (but should be available to all), are key public health benefits of the medical cannabis market.
Sadly, most regulators and politicians don’t pay attention to the need for these vital benefits because medical cannabis consumers are an easily forgotten minority. In all the fuss about state tax windfalls, potential profits, and pharmaceutical startups, the conversation has become more about profit than medical benefit.
In other words, it’s all about the Benjamins.
This isn’t the time to sit back and rest on our laurels. We need to roll up our sleeves and work harder than ever on the upcoming laws and regulations to protect medical cannabis markets, or we’ll lose everything we’ve fought for.
How to Protect Our Medical Cannabis Markets
Here’s what we can do to protect our state-legal medical cannabis markets while we work on full federal legalization. If we’re successful, we will improve public health.
- Demand the endocannabinoid system be taught in medical school. Most clinicians are woefully ignorant regarding the endocannabinoid system and cannabis’ effect on physical and mental health. They don’t understand common drug interactions that they need to know about, given that 17% of adults use cannabis.
- Push for dedicated medical dispensaries. We need to maintain dedicated medical dispensaries, separate from recreational outlets, where budtenders are specially trained, pharmacists can check for drug interactions, and medically appropriate, allergen-free products are available.
- Promote a compounding pharmacy model. Compounding pharmacies could preserve specialized medical formulations in the future and create products that aren’t popular in recreational markets. But we would have to make some serious regulatory changes for this to happen.
- Push for patient assistance programs and insurance coverage. Once Schedule 3 or descheduling is official, cannabis will be insurable, but insurance companies will be slow to adopt coverage. State programs can pave the way for acceptance by offering discounts or subsidies for patients with specific chronic illnesses or disabilities such as opiate use disorder and PTSD.
- Push for research that serves patient needs over profit. We are about to see a massive acceleration in cannabis research, but we must work to ensure this research prioritizes patient outcomes instead of just pharmaceutical profits. We need to fund research for rare disorders and remove barriers to reduce initial production costs for promising medications.
- Advocate for tax and fee relief. Dispensaries that offer medical services should have huge tax and fee benefits, and patients should get their medicine tax-free. Most states only offer reduced taxes, and some offer no tax breaks at all.
As our laws change to meet public demand for reform, we can either have an overly controlled pharmaceutical model that leads to an explosion of black market activity and negative health consequences, or we can have responsible state-controlled recreational and medical markets that focus on equity and healthcare. It’s up to us how this pans out. We aren’t at the end of our journey as activists. Our work has only just begun.
The post The Hidden Costs of Cannabis Legalization: What About the Patients? appeared first on Business of Cannabis.
Continue reading...
