Iowa’s medical marijuana program still in the weeds

Cannibidiol (or CBD, here shown in oil form) has been shown to benefit patients with epilepsy, PTSD, ALS, MS, cancer and other conditions. — photo by Zak Neumann

Proponents of Iowa’s medical marijuana program say it must expand to sustain itself, but no clear path has emerged this spring.

Their wish list includes making more medical conditions eligible for treatment, additional medical cannabis dispensaries across Iowa and a higher limit on permissible levels of tetrahydrocannabinol, or THC, a mind-altering compound in marijuana.

Advocates say these changes would help to keep the program afloat financially, provide an alternative to addictive opioids and bring relief to patients who aren’t eligible now, such as those with post-traumatic stress disorder, or PTSD. Patients with PTSD often struggle with flashbacks, frightening thoughts and intrusive tension.

“They need to have something to calm down, and opiates are not a good option,” said Carl Olsen, founder and director of the organization Iowans for Medical Marijuana.

However, Brenna Smith, press secretary for Iowa Governor Kim Reynolds, said Reynolds “believes further study would be needed before expanding the program,” noting that the Medical Cannabidiol Advisory Board charged with overseeing Iowa’s cannabis operations made no recommendation about upping THC levels at its December meeting.

Cannabidiol is a non-psychoactive compound in marijuana.

Olsen said Iowa took a “huge” step late last spring, when lawmakers updated the law to allow cannabidiol manufacturing and dispensing within the state. But those who don’t qualify for treatment view the progress as “extremely slow and dragging,” he said.

Lucas Nelson, general manager of outsourcing services at Kemin Industries, said there is a need for looser restrictions on qualifying medical conditions — the current list includes nine — as well as a higher THC cap. He said a limit above the current 3 percent would allow patients more effective doses in smaller portions, making the treatment more affordable and accessible.

Further reading: A quick guide to cannabis

As things stand, many Iowans won’t have access to the treatment as the state rolls out the new program, a situation that will detract from the program’s financial sustainability and mission to help Iowans with chronic illnesses, Nelson said.

“The patients are the ones who are hurt here,” he said.

MedPharm, Iowa’s sole cannabidiol manufacturer, shares an owner with Kemin: Chris Nelson. Kemin will aid MedPharm on the production by way of a contractual agreement.

Lucas Nelson said the program must expand not only to reach new patients, but also to stick around and continue reaching those patients who are already eligible, like Iowans with Crohn’s disease, multiple sclerosis and AIDS or HIV.

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He described the need for expansion as “urgent.”

“I think that is necessary right now in this legislative session,” Nelson said.

Sarah Reisetter, deputy director at the Iowa Department of Public Health, said the door is not closed on possible changes before the end of 2018. The Cannabidiol Advisory Board could still take up discussion of the THC cap and qualifying illnesses in the coming months.

“It’s possible but not certain,” she said.

The board can add or remove eligible medical conditions. Proposed changes undergo a non-legislative, multistep process, starting with approval from the Iowa Board of Medicine. Any change to the THC limit would require legislative action, Reisetter said.

Citizens can petition to add qualifying conditions through the Iowa Department of Public Health website, she said. She hears the call for expansion, but said the program is young, and there is still a lot to learn.

“I know there’s a lot of concern out there,” Reisetter said.

According to Reisetter, these concerns stem in part from a low number of registered treatment cardholders in the state. Officials estimated the program would serve more than 6,000 patients in its first couple years, she said, but the state had issued less than 350 cards by early April.

Iowa Senator Joe Bolkcom, a Democrat from Iowa City, said the program must expand to sustain its costs. He said the current plan for five dispensaries is “woefully inadequate,” calling for dispensaries in the Cedar Rapids and Iowa City area, locations recently passed up in a state selection process.

MedPharm will operate two dispensaries in Sioux City and Windsor Heights at a cost Lucas Nelson estimated at almost $1 million apiece, in addition to the roughly $10-million cost of establishing as a manufacturer. Have a Heart Compassion Care and Iowa Cannabis Company will operate the other locations in Council Bluffs, Davenport and Waterloo.

Reisetter said geography was a deciding factor as the state chose locations, noting the law calls for balanced distribution. The program will cost Iowa roughly $600,000 annually, mostly on staff, she said.

Amid calls for expansion, an Iowa Senate Ways and Means subcommittee recently considered a plan with a goal of opening up access to the medical marijuana program.

But Bolkcom and Senator Mike Breitbach, a Republican from Strawberry Point, expressed varying concerns with the measure, which failed to advance before its final legislative deadline. The proposal would have eliminated the THC cap and given doctors wider latitude to certify illnesses for cannabidiol treatment when they deem it “medically beneficial,” among other changes.

Breitbach said in an email that the bill “could be resurrected” in a different form, but he would not expect this development so late in the legislative session. He expressed concern about a lack of definition for “medical practitioner” in the bill, and noted that federal law prohibits doctors from prescribing marijuana.

Bolkcom said the bill, while well-intended, likely would not yield the expected result, noting that many doctors are reluctant towards medical marijuana and would not welcome increased discretion. Instead, he said he prefers a measure that would open medical access to the entire marijuana plant and increase the list of conditions to include PTSD and others.

But such a bill would be hard to pass in the current political climate, he said, adding that “House Republicans are still fighting the war on drugs.”

Although the medical marijuana program’s future is unclear from several angles, developments are taking shape in terms of permissible forms of treatment and a potential second manufacturer.

Reisetter said the cannabidiol board recently recommended an approved list of treatment options including oral forms, like capsules and liquid, as well as topical, inhaled, rectal and vaginal forms. The recommendation would clarify administrative rules to accompany the 2017 law and would not require legislative approval. She said they could take effect as early as June 27.

The state also plans to seek a second manufacturer sometime in April, Reisetter reported, after its initial search last fall yielded MedPharm as the only applicant.

Meanwhile, Olsen remains hopeful for additional changes. He noted the legislature approved last year’s measure with little time to spare.

“We’re going to have to hold our breath and wait until the very last second,” he said.

Holly Thayer, poet and fact finder, is still trying to figure things out. That’s good, right? This article was originally published in Little Village issue 241.