Advocates, patients: Va. med cannabis lacking

RICHMOND, Va. – A former Virginia medical cannabis employee initially got into the business to help his wife with her multiple chronic ailments, including multiple sclerosis.

For the past five years, Bart Dluhy has grown plants and made extracts to see what might help ease his wife’s pain, he said. He began his cannabis career as a budtender in a Las Vegas medical facility, where he helped patients select products for particular ailments.

Dluhy completed online cannabis certificate programs through Syracuse University in 2022. He is certified in cannabis health care and medicine, and cultivation. Dluhy is also an official “ganjier” — think sommelier, but for cannabis.

His experience led him to work in a Virginia medical facility operated by Jushi, Dluhy said, where he made cannabis edibles, vape cartridges and various extracted products. Dluhy left after about three months on the job.

“Part of the reason why I left is I didn’t feel good about myself working for a company that was not taking care of the patients that were their consumers,” Dluhy said.

The medical cannabis market is the only way to legally purchase cannabis in Virginia. But, current Virginia patients point to the program’s shortcomings, and cannabis advocates say top state officials and lawmakers are actively suppressing it. The main issues reported range from registration fees, inconsistent supply, high prices, low potency, and overall access.

Virginia lawmakers decriminalized cannabis possession in 2021, with specific parameters. When the General Assembly adjourned this March, they did so without creating the anticipated recreational cannabis market that lawmakers have discussed for years.

“Virginia started as a medical state, and technically, we’re still in a medical state,” Dluhy said. “You can’t go and purchase it legally unless you get a prescription from a doctor.”

How it works: Buying cannabis

Virginia residents must first obtain a written certification from a registered practitioner, for a cost upward of $100, depending on the provider. The certification must be renewed annually. Medical cannabis patients are no longer required as of July 2022 to register with the Board of Pharmacy for a card to access medical dispensaries.

But the card, which costs $50, can help verify a patient is approved to use cannabis for medical treatment, which can be a factor in employment. It also has to be renewed annually.

Approximate cost then would be $150 annually for a patient, in addition to any purchases. Cannabis is still considered illegal by the federal government, and patients could run into issues with insurance plans covering referrals and medical cannabis purchases.

There are 18 dispensaries located in Virginia. A government-issued ID must be presented at the dispensary with the certificate in order to make the first purchase.

Sales: Climbing, but losing Virginia patients to D.C.

The estimated number of patients with a medical card in Virginia is approximately 50,000. That’s based on BOP-provided information of the number of cards issued as of June last year before the card was not required, and the total number since 2018. Otherwise, the number of medical patients with just a certificate could not be provided, according to the BOP.

Virginia medical cannabis purchases are tracked through the state Prescription Monitoring Program.

The number of products dispensed last year increased 156% from 2021, when a medical card was required. The information is tracked by “dispensations.”

There were almost 562,000 “dispensations” in 2021, according to info provided by the BOP. That total was over 1.44 million, in 2022. The BOP did not provide a total cash sales figure from the medical program by time of publication.

Maryland’s medical program had almost 163,000 patients at the end of December. Its program officially launched in December 2017, after years of figuring out standards and regulations. Washington D.C. has just under 30,000 currently registered patients as of March, but the population is smaller and there is a thriving “gifting market” as a work around to district law.

The small size of the Virginia medical market limits what processors can produce and sell, Dluhy said.

“It’s expensive for what you get, and when I don’t have some of my own growing, I’ll actually drive to Washington D.C. because they have much better products, much better regulations on their products, and have a better variety,” Dluhy said.

Washington-area medical dispensaries can sell to Virginia customers who have a certification and valid state ID. They used to require a BOP card.

There were over 1,200 unique Virginia patients served in Washington in March, according to the city’s Alcoholic Beverage and Cannabis Administration.

It is easier to find out exactly how many Virginia patients were served in D.C. in March than it is to get a detailed overview of the state’s own medical program. Both D.C. and Maryland post numbers on the managing authority’s website and compile public-facing reports.

The Cannabis Control Authority will begin tracking patient sales and totals when it takes over from the BOP next January, the Authority told Capital News Service. It will make that type of “data transparent and accessible” like the district and Maryland.

Control: Three out-of-state companies own the market

When Virginia lawmakers introduced medical cannabis in 2016, they allowed for one pharmaceutical cannabis processor per each one of the five Virginia Department of Health’s designated health service areas. Pharmaceutical processors are facilities with permits to grow cannabis plants, as well as produce and dispense medical products to patients.

“The biggest issue is that there are only four companies in the entire state and each company has its own specific region, and what that does is that limits competition,” Dluhy said.

The state’s four licensed pharmaceutical processing firms are actually now owned by three out-of-state companies valued at hundreds of millions and traded on the stock market, based on Capital News Service analysis in 2022.

JM Pedini is the developmental director of NORML, the National Organization for the Reform of Marijuana Laws Virginia chapter. Policymakers and advocates alike increasingly consider the state’s limited licensure vertical models outdated, though the model is not unique, according to Pedini.

Patients in health district one, in the Northwest area, have to travel or rely on cannabis delivery. No medical processor has been assigned to the district because of a legal roadblock involving the company PharmaCann Virginia. The lawsuit was recently finalized, allowing the VBOP to re-open applications for patients in the area.

Patients are impacted by the lack of access in health district one, and some have medical conditions that make it laborious to travel, according to Dluhy.

“Either they get fatigued or their back is gonna ache from being in the car for so long,” Dluhy said. “Or maybe they just have troubles with vision or lightheadedness and they don’t want to be on the road on [Interstate] 66 on a big highway for two hours out of their day.”

Patient complaints: Product cost, quality and offerings

There are many registered medical patients who complain about low product quality and limited offerings. A Reddit channel dedicated to Virginia medical cannabis users features regular posts about customer issues. The subreddit has over 6,000 people subscribed to it.

There are also posts where patients state they prefer the current medical system over illegal sales.

“There are certain things that a medical facility would do to optimize the product as medicine as opposed to recreation, and a lot of those things that should be done aren’t being done,” Dluhy said, who is active on the subreddit.

Virginia also offers a limited number of product types compared to other states, according to Dluhy. Virginia products can contain THC, or CBD, or a combination. Many other cannabis compounds can be medicinally helpful, according to Dluhy.

Cannabis compounds such as CBG have proven to be anti-inflammatory in mice and helped to slow the growth of colorectal cancer, according to Harvard Health. THCV has shown promise in test trials to help stabilize insulin levels and facilitate weight loss.

“All of these compounds have excellent medical value and different ones are good for different ailments,” Dluhy said.

Other states offer products with different ratios of these compounds, something Dluhy said is important because everyone tolerates cannabis differently. Some medical programs can offer 20-to-1 ratios, or even 5-to-1 ratios of different THC and CBD combinations. This can make it easier for patients to find the exact product to help their ailments, Dluhy said.

Virginia dispensaries are owned by corporations that operate in other states, but the same company in California can legally offer more variety due to demand and stronger products. Virginia medical cannabis sales are currently capped at 10 milligrams of THC per dose.

Other frequent complaints include pricing and inconsistent product availability, which can be hard for a patient who finds a medicine that helps but can’t find it again.

Similar products offered at a Virginia dispensary can cost less at the same company’s dispensary in another state, according to a Capital News Service review of products matched by brand, potency and sales tier. A product that costs $60 in Virginia costs $35 for the same amount in Philadelphia, Pennsylvania — from the same parent company.

Medical patients turn to the black market, and use apps like Telegram to buy cheaper products that may also be better quality, according to Dluhy. However, this can be especially risky for medical patients, as black market products are not screened for heavy metals, pesticides, or other contaminants that would be found through state-mandated testing, he said.

Dluhy blamed these widespread issues on government restrictions and lawmaker delay to create a legal recreational market.

“The longer they wait, the longer people are putting themselves at risk, wasting money, not getting the medicine that they legally should have access to,” Dluhy said. “I really put the fault of this on the government.”

“No one wants to sell crap, but they are restricted because of the legislation,” he added.

Legislation: Does Virginia stay or does it grow?

The Virginia medical program needs to evolve, and the governor’s administration needs to help facilitate that growth and expansion, according to Pedini.

There were some failed legislative efforts this session to expand the medical program.

Sen. Adam Ebbin, D-Alexandria, introduced Senate Bill 1090 to increase the number of allowed cannabis processor permits from one to two for each health service area.

Del. Dawn Adams, D-Richmond, introduced House Bill 2369 to increase the annual number of cannabis dispensing facility permits from five to 12. It also removed the requirement that dispensaries must be owned by a pharmaceutical processor.

That would have allowed more competition in the market, which could help drive down product costs.

Medical cannabis-related legislation that passed this session included companion bills HB 1846 and SB 1337, which originally extended the shelf life of products to 12 months without stability testing. Stability testing measures a product’s longevity and integrity.

Stability testing is for products that expire after six months and there is a 10% allowed deviation. The new bills expanded that deviation to 15%. The governor amended the legislation and kept the 15% deviation, but shortened the testing period back to anything after six months.

The legislation also allows for registered cannabis products to have slightly more THC than the allowed amount per dose by increasing the allowable product deviation from 10% to 15%, without having to submit a new registration to the BOP.

Any slight variance in a product requires it to be listed under another name, which can be hard to explain to customers, according to Pedini. Virginia has one of the lowest variances allowed in the country, according to Pedini.

Companion bills SB 788 and HB 1598 transfer oversight of medical cannabis to the Cannabis Control Authority. The Authority was created in 2021 with the anticipation it would regulate aspects of recreational sales.

The medical program will still operate the same, but patients will be better suited under an agency where regulators have an expertise in this area of policy, according to Pedini.

Jeremy Preiss is the acting head of the Virginia Cannabis Control Authority. It will oversee the medical program starting January 2024. The Authority plans to connect with “patients, practitioners, and providers” closer to the date to provide “full awareness” of transfer details, Preiss stated.

“Legislation was passed this session to address this and other patient-specific concerns,” Pedini stated in a follow-up email. “While improvements were made, many more are still needed in order for Virginia’s program to meet the expectations of patients and practitioners.”

Capital News Service is a program of Virginia Commonwealth University’s Robertson School of Media and Culture. Students in the program provide state government coverage for a variety of media outlets in Virginia.