Medical marijuana legal, still hurdles to fill prescriptions

For medical marijuana card holders in southeast Iowa looking for a place to fill their prescription, they'll have to travel to Have a Heart Compassionate Care, a dispensary in Davenport, to purchase their products.

Following the signing and passage of the Medical Cannabidiol Act by the Iowa State Legislature in 2017, the law mandated that a maximum of two cannabis manufacturers and five dispensaries could be opened across the state. Dispensaries are the only legal locations in Iowa that residents with medical cards can go to purchase products.

In a push to expand the initial law passed in 2017, House File 732 was passed by Iowa's House and Senate at the most recent legislative session, only to be vetoed by Gov. Reynolds. The new act would have allowed nurse practitioners and other medical professionals, who are not strictly doctors of medicine, to certify patients for cards, as well as raise the Tetrahydrocannabinol (THC) concentration limit on products. Recent statewide polls conducted earlier this year found that nearly 80 percent of state residents were in support of the expansion of the program.

However, the rollout of the law legalizing medical marijuana in the state has been a slow and intentional process, according to Mike McKelvey, a member of the state's Medical Cannabidiol Advisory Board. The board member noted that with the limited amount of dispensaries, the state's Department of Health strategically spread the locations of the dispensaries to ensure accessibility. Including Davenport, the other four dispensaries in the state are located in Council Bluff, Sioux City, Waterloo and Windsor Heights.

The current law in place limits the production and distribution of the medicine in order to ensure regulation of products. The law also includes a 3 percent cap of THC concentration in the medical marijuana sold in the state. Iowa is the only state to have enacted a cap with its medical marijuana program.

'It started slow as a process as it got rolling to make sure they could keep up with it, versus allowing the thing to go wide open. It was a legislative move,” McKelvey said.

McKelvey, who works at the Mason City Police Department, is the only member of the medical advisory board who is not a doctor. The Iowa State legislature wanted to include one member of law enforcement would be serving on the board to provide a different perspective on the issue. The board's main function is to make recommendations on the use of medical cannabidiol, including denying or approving qualifying conditions and reviewing research on the effects of medical marijuana products.

'People want an all-natural option, and I can understand that reasoning,” the board member said.

For McKelvey, the greatest concern is the lack of education surrounding products and access to CBD products that may or may not be properly tested. CBD products, which do not contain THC, the chemical that creates a physiological effects, are still illegal under federal law. The products are not considered pharmaceuticals and therefore are not often approved by the FDA.

'Some people don't know what they're consuming ... with the gummies, sometimes kids think they're candy, people don't understand the different rates and concentrations ... there's just not a lot of education,” McKelvey said.

McKelvey went on to explain that, from a law enforcement standpoint, the main worry is surrounding black market products that may be sold online or underground.

'Legal products are cost prohibitive, you're not going to see a lot of diversion in products purchased because of cost. It's all out of pocket, there's no insurance or copay. It's just the black market stuff, or out of state concentrates, vape cartridges, coming into Iowa. Those accessing medical marijuana are a small fraction of marijuana using people in Iowa,” McKelvey said.

Tan Ho, a Mt. Pleasant pharmacist who runs Capstone Pharmacy, said because the restrictions surrounding medical marijuana are still very stringent, he noticed various potential manufacturers and dispensaries drop out of the licensing process due to the price it would cost to participate in the new program. Ho also noted that he hasn't had any customers come to him to attempt to fill marijuana prescriptions. According to data from the Iowa Department of Public Health, Henry County currently only has 10 medical marijuana card holders.

'I've read that it has benefits for certain things like glaucoma and chronic pain … I think it will be interesting to see in five years, when we can see how it's worked in other states,” Ho said about his own opinion on the use of marijuana products to treat illnesses.

The Iowa Department of Public Health notes that 64 percent of medical marijuana users in Iowa have been certified because of untreatable pain. Following that condition, 8 percent of people who are prescribed products are going through cancer with severe or chronic pain.

'People have come to buy CBD oil but we don't sell those,” Ho said. With the adoption of medical marijuana in the states across the country, enforcement of CBD products has become more lax as well. In addition, the Rohrabacher-Farr amendment prohibits the Department of Justice from spending funds in pursuing medical operators in states where there is a legalized medical marijuana program. This subsequently places CBD products in various gray areas that allow local law enforcement to decide whether to permit the sale of products. Currently, CBD products at .3 THC levels or lower are legal under federal law, however most products go above that mandated level.

The number of medical marijuana card holders in southeast Iowa is relatively small. In Washington County, there are currently 29 medical marijuana card holders; Jefferson County has 7. However, services available in the area are sparse for those who may need them. Various factors contribute to the limited access. In addition to stringent laws and limit on dispensaries in the state, many hospitals do not have systems to help certify patients. General costs to sustain dispensaries and licenses also deter companies from pursuing business in the state.

Amy Vetter from the Washington County Health Center noted that the center currently does not have any process to help patients get a license or card and declined to comment on the subject.

Lucas Nelson, the general manager MedPharm, an Iowa-based medical marijuana manufacturing company and dispensary, said the company spent 10 million dollars on the manufacturing facility alone.

'Iowa is a state with one of the most limited products and sheer number of conditions approved, which affects the number of patients and without patients, you can't sustain business … then there are the individual requirements, which include cameras, generators, and the nitty-gritty details to building,” Nelson noted.

Nelson also added that big hurdles patients face in terms of access include 'having trouble finding a doctor who will certify their condition.”

'What we do know and what the literature bears out is that this can be a very effective tool for some people … and our general position is, why not make it an option by those who are suffering … many people feel left behind by traditional medicine and are in pain, who don't want to take opioids … and adding this to the tool in the tool kit is so important … to not give those people the option, I feel, shows an … incredible lack of compassion,” Nelson concluded. Nelson feels the law needs to be expanded to include more conditions in order to help more people. Most crucially, he believes post-traumatic stress disorder should be considered a certifiable reason to be granted a medical card.

Because of the hurdles they face, patients looking for medical marijuana products often turn to alternatives like CBD products. Various chain stores in Iowa have begun carrying CBD products, including Family Video. Ashlee Hardeman, the manager of the Family Video in Fairfield noted that the store sells products from Natural Natives and Green Roads. The store began selling products close to 4 months ago, though the chain began shelving products close to a year ago after the initial implementation of the medical marijuana program. Products sold at the store include gummy bears, sprays and water.

Hardeman noted that staff at the store participated in additional training.

'Our regional manager came around and held meetings and trainings … basically what we learned was to help customers figure out what product to get, how many milligrams. We explain what the different products do and what they help with,” she said.

Hardeman also explained that each of the products the store carries has a QR code customers can scan to read about test results in case they have any concerns about the safety of the product.

'The products are pretty popular, just in general. We have an email that goes out each week with customer testimonials. Many of them talking about finding relief from using the products. We sell at least $2,000 worth a month,” Hardeman said.

Sarah Gordon, owner of Holistic Gypsiez, began selling CBD products because of her personal experience with the hemp bombs. Gordon, who was previously an addict, went from being on 30 medications a day to just five in the span of two years. She credits her ability to wean off pharmaceutical medications to her use of CBD products.

'I only sell things that I have used … my whole approach is from a healing standpoint. I just want to help people,” she said.

'My doctor has seen me transform over the years from being on a bunch of medication to owning my own small business and thriving … she's all for it but she can't prescribe it to me because her hospital doesn't allow it due to malpractice,” Gordon added.

'Most of my products are hemp concentrate ... people aren't getting high off of them,” she said.

Gordon, who was aware of the gray area in which CBD products stand, took initiative to identify herself to local law enforcement when she opened her store.

'There hasn't been any altercations or anything like that,” Gordon said.

Currently, the selling of CBD products fall under the purview of each county and city. While some have allowed sales, others have shut down local businesses.

'I think there should be regulation. Then we wouldn't have so many black market products and we wouldn't have the problems with the THC tanks,” Gordon said. Gordon hopes Iowa will eventually expand the law so that CBD products can be sold legally and supervised more closely.

'There needs to be lab reports and we need to know where they're coming from,” she added.

'I think people need to be educated about the products so I really encourage people to research and understand what the products are,” Gordon concluded.

Carl Olsen, the co-founder of the advocacy group Iowans for Medical Marijuana, also believes the way to better regulate marijuana is through legalization and legislation. Olsen is currently working with the state's Medical Cannabidiol Advisory Board to file an exemption with the federal government that would officially legalize the manufacturing and distribution of marijuana products under federal law. When he proposed the exemption, the board unanimously agreed to move forward with the application.

'It's really dysfunctional. All these states have basically authorized a state law that violates federal law … I guess the idea is that if a whole ton of people are violating federal law, the federal government will eventually fall to its knees. That's not good for the country,” Olsen said.

'I am advocating for it because it's a plant that was put on here by God and when people say they can separate you from nature, that's a problem. God didn't put this plant on here so that we could eradicate, so I'm doing everything I can to advocate that we get rid of these ridiculous laws,” Olsen added.

Olsen began his lobbying group in 1990 and began holding peaceful demonstrations outside of the state capitol. His group was later represented by the ACLU in 2008 for a petition that was submitted to the state's pharmacy board that resulted in medical marijuana being reclassified. The pharmacy board ultimately concluded that marijuana did have medicinal uses.

'Basically we've given people no alternatives to pharmaceuticals … when you're being threatened with prison for choosing a natural alternative, that's not free choice or free market. That's not freedom,” Olsen said.

With the recent veto by Gov. Reynolds of House File 732 in the last legislative session, medical marijuana is expected to come up again as a topic of discussion in the legislature next year. Whether an expansion on the current law and program will be passed still is unclear.