Recreational marijuana still isn’t legal in Virginia and medical patients face access challenges

Although Virginia has legalized recreational marijuana, the process of purchasing it in retail stores is still far from being completed.

In February, Republicans in Congress were elected to the House of Delegates Legislation that was killedThat would have allowed retail sales to be limited later in the year. The state’s recreational market is Scheduled to begin in 2024, but with a long regulatory road ahead, there’s a strong likelihood that products won’t become available until months or even years later, according to JM Pedini, development director of the National Organization for the Reform Marijuana Laws, or NORML. 

With recreational sales stalled for the foreseeable future, Virginia’s medical cannabis program remains the only way for most residents to legally acquire marijuana short of growing it themselves. Currently, though, there are only 46,935 registered patients in Virginia, according to data from the Board of Pharmacy — a small number compared to the state’s Population overallMore than 8.6 million 

Pedini, who also serves as executive director of Virginia’s NORML chapter, said that’s largely due to barriers that still exist within the program, despite significant growth over the last three years. Unlike the early stages of the state’s gradual foray into medicinal marijuana, patients now have access to a broad array of products, from edibles to flower, rather than the Low-THC oilThe program was initially offered. And Virginia’s licensed processors are now able to open up to five additional retail dispensaries, gradually increasing availability.

“So, in some ways, this program is amazing,” Pedini said. Pedini said that medical cannabis has struggled to gain more traction in Virginia in many other ways. Advocates point out that the registration requirements for providers, and patients in particular, are part of the problem. Patients often have to wait long periods before they can legally purchase cannabis. 

“Our process is so slow — in terms of the full process to get a card, historically — that it’s been difficult,”Del. Dawn Adams, D-Richmond, a nurse practitioner who’s also registered with the state to certify patients for medical cannabis. “People can’t just access marijuana after an appointment the way you could for any other medical product in Virginia.”

Del. Dawn Adams, D.Richmond. (Photo by Ned Oliver/Virginia Mercury

Patients who smoke cannabis must go through three steps. The first step is to obtain cannabis. Written certificationFrom a Registered practitioner — in Virginia, a doctor, a physician assistant or a nurse practitioner — attesting they would benefit from the drug. The second is registering with the state’s Board of Pharmacy and waiting for approval.

It’s that second step that leads to the largest delays, according to both Adams and Pedini. The program is open to practitioners. Traditionell, it was slowBon Secours and Sentara are major hospitals that forbid cannabis providers from offering certifications. According to the Board of Pharmacy, 703 of the 41,544 state-eligible doctors, physician assistants, and nurse practitioners are currently registered.

Despite the small number, Virginia’s medical cannabis program allows telehealth appointments, and many existing practitioners don’t view provider availability as a problem. Athena Baldwin is a Alexandria-based physician assistant. Started her own business offering certification appointments, said she’s seen 1,400 patients across the state since her company began in July 2020. They’ve included a large segment of people from Southwest Virginia, an area historically short of many providers.

“It’s fairly accessible for any practitioner who wants to do it,”She said. Patients, on the other hand, have to create profiles and register through the Department of Health Professions’ provider licensure portalAccording to Pedini, this is a complicated process that many people find difficult to navigate. This process requires a $50 fee. multiple documents, including copies of the  patient’s written certification and driver’s license.

Experts say the real problem is the waiting time. The Board of Pharmacy “working diligently to process all completed applications within 60 business days of receipt,”According to Diane Powers (spokesman), but it was recently reported There is a backlog of 8,000 applications. Adams stated that most patients wait months to get full approval. Then, they submit the same documentation to dispensaries. As legally required.

Pedini acknowledged that the long process has been a problem, but it could change by the end of this summer. Virginia lawmakers approved earlier this year. Legislation that is requested by the boardThis removes the requirement for patient registration and allows medical cannabis users to purchase products at dispensaries once they have received a written certificate from a provider. The bill is still waiting for Gov. Glenn Youngkin is still not signed, but advocates claim it would be a significant step forward for patients.

“We keep trying to make it easier and better every year, and we have seen success,”Pedini was also mentioned. “No other state has gone from allowing medical cannabis for a single condition” — in Virginia’s case, drug-resistant epilepsy — “to a program that dispenses every type of product, serves any patient, without a list of conditions or age limits.”

The state licensed medical processor and dispensary Green Leaf opened in November. It is a marijuana growing area in Richmond. (Scott Elmquist/Style Weekly)

Many providers and advocates say that there are still some limitations that prevent patients from participating, despite the advances made. There’s the procedural component, including finding a licensed practitioner, getting a written certification and finding a dispensary, which can be another challenge. There are currently Only 11 across the state, and one of Virginia’s Health service areas — a large swath of that includes Winchester and Charlottesville — doesn’t have any licensed processors, the result of an ongoing legal battle

There’s also the price. A written certification for medical cannabis is usually between $100 and $150. Virginia products are often expensive They can double their market share, including Washington, D.C., which some processors have attributed to the state’s extensive regulations. For example, a small tub of cannabis-infused salve made by one Virginia processor. Online price: $75.

Adams finds it more concerning that products are not readily available, particularly in the forms preferred by her patients. GLeaf Medical lists 20 different vape cartridges at its Manchester location but only a single tinctureThis is often preferred by patients with pain. At least currently, it’s not offering any nasal spray, a formulation that’s been used to Seizure patients should be treated.

“When you’re making vape cartridges that are 60, 70, 80, 90 percent THC, these are not medical products in my mind, at least for most people,” Adams said. “These are products that are for profit, and directed toward that sort of commercial market, which doesn’t exist yet.”

“We need tinctures, we need edibles, we need tablets, we need suppositories — we need products intended for medical delivery,”She added. “And we need product consistency.” Adams said one of her patients was affected when a processor changed the ratio of CBD to THC in one of the company’s tinctures, which made the treatment less effective for her.

The challenges faced by many patients underscore Virginia’s strange regulatory landscape as a state where marijuana is legalized but a recreational market still doesn’t exist. Ashley Allen, the vice president of government relations for Columbia Care — one of the state’s licensed processors — said the industry has been stymied in some ways by the lack of adult-use sales. 

Green Leaf Medical, Richmond, processes freshly harvested marijuana flowers. (Scott Elmquist/Style Weekly)

“We’re seeing what’s typical in many states, which is that prices at the beginning are higher because demand is pretty low,”She said. With less than 47,000 potential customers, processors are dependent on Virginia’s medical cannabis patients to sustain profits. Allen also said that if there’s a more than 10 percent variation in the composition of an existing product — a change in the Terpenes between different harvests of the same plant, for example — companies are required to register it as a new item with the Board of Pharmacy. 

“What you’ll see now is a lot of us have products just sitting and waiting for approval,”She said. As production increases with recreational sales, processors expect consistency to improve over time. 

When marijuana does become widely available in Virginia, Adams said she’d like to see Virginia’s medical program become even more patient- and practitioner-focused. Baldwin shared her concern that some practitioners view written certifications more like a business venture rather than a way of supporting patient care. 

Dr. Christopher Sendi is a psychiatrist and addiction specialist in Northern Virginia. He pointed out that most patients only visit a doctor once a calendar year to receive a certification. Although some providers might recommend certain products to patients, many patients decide what is best for them.

A cereal bar infused in THC, purchased from a cannabis dispensary owned by Senator Louise Lucas, D.Portsmouth. The Cannabis Outlet sells these products for $30. Virginia legislators want to ban the sale of synthetic THC products that have not been tested and are not regulated. (Ned Oliver/Virginia Mercury)

“The product itself — we’re not saying, ‘What’s the appropriate dose, what’s the end result?’” Sendi said. “We’re basically saying, ‘Go to the dispensary and get as much as you need to make yourself feel better.’ And it’s up to the patient to figure that out.”

Virginia requires pharmacists to supervise the production and sale cannabis. Dispensaries must also have them on-site to discuss products with patients. This mandate adds some cost, some processors claim. There have been other efforts to improve continuity between medical providers. The bill that removes registration requirements for patients also prohibits them from acquiring written certifications from more than one practitioner — an effort to crack down on what Adams described as “fly-by-night”Clinics that issue medical cards 

In the future, she’d like to see more training requirements for practitioners who offer medical cannabis certifications, as well as greater discussion on how to evaluate whether products are working for patients. But Adams said any new additions to the program should come after there’s better access to cannabis and more widespread availability. 

Pedini, too, said there’s wide frustration over the state’s inability to reach an agreement on recreational sales, leaving customers vulnerable to unregulated and untested products Made largely with synthetic THC

“Once again, there was no peace in the valley on this issue in 2022,” Pedini said. “And ultimately, it’s Virginians who are left holding the bag, with no legal access outside of the medical program and a rampant illicit market that frankly preys on consumers.”

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