Medical marijuana: What’s taking so long?

WHEN LISA COLE puts her 6-year old-daughter Maddie to bed at night she worries that she might die. So far she has survived epilepsy, but her cognitive development is severely delayed due to the disruptions caused by intractable seizures. Her twin sister Kelsie learns at the pace of children her age, but Maddie has not yet learned to talk. The Leicester mother of three knows that children in Colorado have access to medical marijuana, which enables some young patients to get relief from seizures. What Cole doesn’t understand is why she still cannot get medical marijuana for her daughter in Massachusetts.

Politicians blame the policy framework. But there are no real problems with the medical marijuana law. Those looking for an elegant explanation of where we are now may be inclined to look for a phrase in the law or accompanying regulations that could be tweaked to fix everything. But the real issue isn’t policy; it is a much more amorphous problem that put politics before patients.

It has been more than two-and-a-half years since Bay State voters overwhelmingly approved the medical marijuana ballot initiative, but no dispensaries have opened their doors yet.

Despite the mandate from the voters, former governor Deval Patrick failed to lead on medical marijuana. Rather than moving forward expediently and sensibly, the administration took a political approach to dispensary licensing. They decided to do as little as possible.

The Massachusetts law is a blend of the best practices from around the country. It allows patients safe access to a medicine recommended by a doctor, ensures that communities remain secure, and includes measures to prevent abuses such as a patient trying to purchase more marijuana than his or her doctor recommends.

Most of the licensing decisions were made by the Patrick administration after regulations were promulgated. State public health officials designed a licensing process that eliminated applicants and did not support small businesses that attempted to meet a demonstrated need. That’s how an initial 181 applicants dwindled down to only 15.

Many of the applicants were completely capable of running dispensaries. Last fall, the Massachusetts Patient Advocacy Alliance called on Patrick to move forward with licensing at least 50 more dispensaries. Several setbacks in the dispensary registration process in 2014 were not due to administrative problems, but rather the administration’s reaction to scrutiny by the news media.

In January 2014, DPH announced that 20 dispensaries had been selected to receive licenses.  But the Boston Globe reported soon afterward that one company’s application contained a clerical error. Instead of defending the process or taking swift action to remedy this situation, the Patrick administration put everything on hold. Little to no progress was made over the next year, with state officials slowing implementation even more by kicking more applicants out of the process through the summer of 2014.

Lack of leadership was also apparent at the local level. At a Boston City Council hearing last year, councilors expected DPH to attend and explain how the program would work. Not one state official showed up.

Patients wonder if the Baker administration has the political will to follow through. At this juncture, the governor appears to be willing to move forward with the boldness and compassion that Patrick lacked. Baker looks poised to get the licensing process back on track with an improved, rolling registration process, which would allow dispensaries to open as state officials approve licenses, rather than releasing licenses in batches.

Hardship cultivation, which allowed patients to access medicine while waiting for dispensaries to open their doors, also needs to be addressed. Current hardship cultivation regulations allow caregivers to grow medicine for only one patient. A patient seeking medical marijuana must appoint a caregiver and then wait three to four months for the medicine to grow before they have access to their medicine.

Until more dispensaries open, caregiving is an essential part of the medical marijuana system. It will remain crucial for patients facing financial difficulties and for those who do not live near dispensaries. Rhode Island and Maine caregivers can provide medicine for multiple patients. Bay State caregivers should have the same flexibility. This regulation should be modified as soon as possible.

Moreover, patient input is essential to the licensing process. There should be patient representatives in the agencies and on the boards that make decisions about licensing, regulations, product testing procedures, and overall program implementation.

The need for safe access to medical marijuana is clear and compelling, but patients like Maddie continue to suffer and their families grow frustrated as the regulatory process drags on. Creating a viable medical marijuana program is not simple, but the continued delays are inexcusable.  Thousands of patients across the Commonwealth hope that the Baker administration moves to implement a truly workable and transparent program that will finally put patients before politics.

Nichole Snow is the executive director of the Massachusetts Patient Advocacy Alliance.