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Growth, challenges highlight first year of sales for medical marijuana

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Medical marijuana has offered relief for thousands of Pennsylvanians during its first year as a legal medicine in the state, even as Pennsylvania's permitting process has been a magnet for litigation.

Marijuana became legal for medical use in Pennsylvania in April 2016, with the first licenses for dispensers and growers issued in 2017. This year they began selling medicine to registered patients.

But as operations ramped up, two companies denied permits filed lawsuits against the state, claiming that there were problems with the permitting process.

Bethlehem-based Keystone ReLeaf LLC, filed two applications to open dispensaries and one application to grow and produce medical marijuana. All three were denied. ReLeaf claimed in its suit that the state was not transparent enough in its permitting process and that it arbitrarily awarded points and waived requirements for certain applicants.

Elemental Health Group LLC, of Montgomery County, applied for a permit in northcentral Pennsylvania to grow and process medical marijuana. It also was denied. Elemental’s suit against the state claimed that Terrapin Investment Fund 1 LLC, a grower/producer that received a permit in Elemental’s place, had provided false information on its application and that the Department of Health’s vetting process was to blame.

In both cases, the state’s appellate court found that the companies had not exhausted their appeals processes with the department and judges did not issue a ruling. However, judges in both cases acknowledged that the suit’s claims deserved a hearing.

In response at the time, the department said the ruling showed that its permitting process is fair and consistent.

Terrapin Pennsylvania said at the time that it was pleased to have the dispute resolved and that it would continue to provide medical marijuana to state residents.

For the pharmacists working with patients in dispensaries and the physicians that certify patients as suffering from conditions approved for treatment, the state’s legalization of medical marijuana is working as intended.

A nascent industry

Organic Remedies Dispensary in Hampden Township, Cumberland County, was one of six dispensaries to open on Feb. 15, the first day that medical marijuana could legally be sold in Pennsylvania.

The dispensary – with marijuana leaf décor and a counter filled with patches and vaporizers printed with marijuana strains like “indica” and “sativa” –  feels like a doctor’s office. Although the building has more security than an average pharmacy, patients speak to their pharmacists as if they were their doctors, talking about how treatment has helped and what dosages of medicine they should be taking.

Pharmacists at Organic Remedies recalled that when the dispensary first opened, there were problems with getting patients the exact doses they needed. Only a few grower/processers were operating and selling product. So on its first day, Organic Remedies had only 20 products for sale, all from the same company. The dispensary now carries over 200 products, which makes it easier to find the right medicine for each patient, according to Tammy Royer, a pharmacist with the dispensary.

The variety has been particularly helpful for medicine with high levels of CBD, a chemical compound used to treat pain.

“In the beginning we didn’t have as many high-CBD strains,” Royer said. “Now there have been several more grower/processers. There is a greater variety of product and more dosage forms.”

While there are now more products and a greater variety of dosages, inconsistent supply continues to be a problem. Because the medicine is plant-based, according to Royer, issues with a particular batch may mean that patients can’t regularly buy the specific product that works for them.

“We may find something that works really well but it might not be available to purchase,” she said. But, she added: “If there is an issue with the batch growing they can’t help it.”

Thousands of patients are shopping statewide: According to the state Department of Health, the number of patients registered for the medical marijuana program was 97,250 as of Dec. 13. The department also announced 23 new permits for marijuana dispensary companies on Dec. 18, bringing the total amount of companies with permits to 50.

Each company with a dispensary permit can open three dispensaries. There are currently 42 dispensaries operating in Pennsylvania. Eight of operate in Central Pennsylvania including RISE dispensaries in West Manchester Township, York County; North Middleton Township, Cumberland County; and Steelton in Dauphin County and Cure Pennsylvania in Manheim Township, Lancaster County.

Organic Remedies owns two dispensaries in the state with a second dispensary in Chambersburg. The company is planning to open a third central Pennsylvania location in 2019.

The state has permitted 25 grower/producer businesses, including WP Health Foundry in Lebanon City, Lebanon County and Parea BioSciences LLC in Coal Township, Northumberland County.

Eric Hauser, a pharmacist with Organic Remedies, said that the department has been a great resource as dispensaries learn the ins and outs of the field. He said his contact in the department answers questions at any time of the day.

Premier Medical and Rehabilitation Center in Camp Hill has registered patients for medical marijuana cards over the past year. Physiatrist Jordan Klein views medical marijuana as a medicine he can recommend to patients when other medications backed by more clinical research have proven unsuccessful.

Klein also said he has seen patients who rely on opioids for pain relief move completely to medical marijuana.

“They can taper down their narcotics and that’s a huge success,” Klein said. Klein said over the past year, he has seen physicians become less fearful of recommending that their patients speak to him about medical marijuana despite it still being illegal under federal law.

“I was calling up primary care physicians and explaining to them why I think it is important patients use it,” he said. “Now people are asking me to see their patients.”

Klein commended the state on how it has handled its medical marijuana program, noting that Pennsylvania has taken the medicinal qualities of the plant seriously.

“To be seen by a physician, have a full evaluation and take a four-hour course about the drug, it’s really treating it as a medication as it should be,” Klein said. “There are tons of drugs we get out of plant-based medicine.”

One area where the state is struggling to make progress in is its research program. The Department of Health recently declined eight applicants and is facing a suit alleging that the department’s methods for authorizing registrants is unlawful.

Klein said that the state needs to begin research because while he and other experts are seeing changes in their patients, they still do not have clinical testing to back it up.

“I am an evidence-based doctor and I want to know if it’s actually helping my patients,” Klein said.

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Ioannis Pashakis

Ioannis Pashakis

Ioannis Pashakis covers health care and Lancaster County. Email him at ipashakis@cpbj.com.

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