Posted by StreetWise in Magazine Articles
Dankrupt: Medical Marijuana Rollout a Weedy Mess for Business Owners and Patients
by Brian Dudley
The Illinois Medical Cannabis Pilot Program is withering before the harvest. Application numbers are low, business owners are rethinking decisions and patients here still face months of waiting before any medicine is available.
Some 18,400 residents have begun the application process, according to the Illinois Department of Public Health (IDPH), but the number is misleading. Only 2,500 individuals have submitted any supporting documents for approval. Those include a patient application form, a physician certification form and fingerprinting obtained from a licensed vendor.
The number of approved stands at an approximate 1,600 patients.
Tammy Jacobi says low patient approvals are already impacting business. She is CEO of Good Intentions, a medical marijuana service group operating in Chicago and Michigan that consults with patients, physicians, cultivators and dispensaries.
“We need to extend this pilot program so that we do have quality providers,” she says. “You’re not going to get a cultivation center to invest $25 million into something that may go away in 18 months.” Patients, she maintains, will suffer as quality providers are “cut down.”
It’s a sentiment shared by others concerned with low patient counts and the looming January 2018 expiration of the pilot program.
Jeff Goldman, VP of Communications at GTI Clinic Illinois Holdings, LLC (GTI), says Illinois needs to have 10,000 registered patients by year’s end. Some industry consultants peg the number at 30,000.
“There were estimates early on,” Goldman says, “that there were 75[thousand] to 100,000 patients available in Illinois based on the ailments that were listed and approved.”
Goldman is confident enrollment numbers will increase over time, but GTI nevertheless hedged its bets in February and chose not to secure a surety bond and pay state fees associated with a license to cultivate in State Police District One.
“It was a business decision,” Goldman says, not to pursue a facility in Dixon, IL. “In order to operate successfully, we had to make a choice to give up one cultivation license. Two grow facilities will be ample to service the patients of Illinois now and in the future. We are choosing this because it is best for the patients, the long-term viability of the program and our investors.”
The company will operate a dispensary in Lake County and cultivation centers in Oglesby and Rock Island, IL.
“What the state needs to focus on is increasing the patient count,” Goldman says. “I think getting the patients up and helping the patients register is key in this entire process.”
Restrictions within the law contribute to low patient numbers, according to Chris Lindsey, a legislative analyst at the Marijuana Policy Project. Lindsey says two issues really set Illinois apart when compared to other states with medical marijuana.
First, the law requires physicians making marijuana recommendations to be only those physicians who specifically treat the underlying condition.
“That’s pretty unique in the medical world. You don’t really see that type of restriction when it comes to prescribing other types of medicines such as harmful narcotics or other prescriptions that can really be harmful if taken over a long period of time.”
Illinois also limits the types of conditions approved for medical marijuana. “Doctors do not have very much latitude to use their own professional medical opinion,” says Lindsey, “ even if they think a patient would benefit.”
There are currently 37 qualifying medical conditions (sidebar). The IDPH accepts patient petitions to add conditions to the program twice each year. One such petition window closed at the end of February and another is open throughout July. Petitioners must provide a detailed description of a debilitating condition, an explanation of conventional treatment that describes why it isn’t sufficient and a justification including evidence and letters of support for how marijuana would be an effective medicine.
Lindsey calls the Illinois process burdensome but notes public petitions and legislatures have successfully added conditions in other states. According to Lindsey, the condition most likely to be added is Post Traumatic Stress Disorder (PTSD).
Petitions have added PTSD in other states including Arizona, Michigan and Nevada. Elsewhere, lawmakers in Oregon, Delaware and four additional states added PTSD through legislative action. In Illinois, SB33, introduced this session by state Sen. Michael Hastings (D-Matteson), would add PTSD if passed and signed into law.
Lindsey also believes patient registrations are low because “many employers of doctors, including hospitals and pain clinics actually have company policies that prohibit their physicians from making recommendations for medical marijuana.”
Danny Chun, a spokesman for the Illinois Hospital Association (IHA), says the organization hasn’t taken a position one way or the other. In a statement distributed to over 200 member hospitals and published on its website, the IHA states a “physician can choose to provide written certification that a patient has a debilitating medical condition that would benefit from the medical use of cannabis.”
“The law is the law,” Chun says, but “it’s up to each hospital to decide how they’re going to comply with the law.”
Many hospitals, it seems, have not made a decision.
Public Relations Specialist Charles Jolie at Rush University Medical Center says he could not determine whether RUSH had implemented or was otherwise working on an official medical marijuana policy.
And while Megan McCann, manager of media relations atNorthwestern Memorial HealthCare, did confirm a group of physicians, nurses, pharmacists and other members of leadership had been considering the issue for a few months, she did not say if physicians had been provided any interim instructions.
In a move that is perhaps telling, physicians at both institutions refer patients to Good Intentions in Chicago. Staff members there work with patients to ensure a client’s doctor possesses and submits the necessary recommendation form to the state. Clients without doctors are referred for care. Once a patient’s doctor has submitted paperwork the client returns to Good Intentions to complete the application and fingerprint background check.
According to Good Intentions CEO Jacobi, over 400 of the approved patients in Illinois used the company’s services to file paperwork with Illinois. The count is based on the number of clients who reported back having been approved.
Good Intentions also assists individuals with uncovered conditions and has filed over 200 petitions with the state on behalf of those clients, Jacobi said.
“Illinois doesn’t have chronic or severe pain and so the problem that we’re seeing is back issues,” Jacobi says. This includes people who have herniated discs, sciatica problems or any major back conditions not classified as a spinal disease or disorder. Jacobi says Good Intentions has also filed petitions for hips, knees, irritable bowel syndrome, migraines and PTSD.
North Shore resident Barry Flanagan, 61, is using Good Intentions to assist with his application. A veteran, Flanagan reports suffering from PTSD but due to Illinois restrictions against the disorder he is citing severe cervical spinal stenosis in his application for medical marijuana. A car accident 25 years ago crushed his spine flat between the c3 and c6 vertebra.
Flanagan self-medicates both conditions with marijuana he illegally obtains.
“I’m a stoner from way back, so come on.”
He says the decision to seek out legal medical marijuana is based on safety and addiction.
“The federal government is more than happy to load me down with Oxycontin or Vicodin or Percocet,” he says. “I don’t want to go down that road. With pot I don’t have to worry about absolutely needing a fix everyday. I don’t see myself getting psychologically or physically addicted to the point I can’t live without it.”
Marijuana helps ease Flanagan’s neuropathic pain, a condition common to spinal cord injuries and one often resistant to prescribed opiates and narcotic pain reducers. Medical cannabis has been shown to ease nausea, anxiety, spasticity, drooling, dysautonomia, weight loss, pain and wasting in patients with other conditions.
Federal Law prohibits the United States Department of Veterans Affairs from recommending cannabis as medicine. As such, Flanagan and other veterans in Illinois aren’t required to submit a physician recommendation but must instead request release of VA medical records and submit those along with a copy of a certified document indicating character and dates of service.
Victoria Mendicino, an intern at Good Intentions who assisted Flanagan, says it will take about a month for him to receive his records from the VA and thereafter complete his application. An approval letter, she says, probably won’t arrive until June.
But even then Flanagan may have difficulty obtaining medicine.
Marijuana cultivation centers still have to be built or retrofitted, and construction must comply with rules enforced by the Illinois Department of Agriculture.
All marijuana must be grown in closed and locked indoor facilities, and Illinois law requires these plants be nurtured from clone or seed, a process that takes approximately four months. Additional rules cover building materials, pesticide usage and the packaging and labeling of marijuana products.
Jeff Goldman says GTI doesn’t expect its Oglesby and Rock Island cultivation centers to be running until the fourth quarter of this year because of construction time and the need to plant from seed.
Industry experts suggest these delays, coupled with the sunset provision in the law, significantly hinder the ability of cultivators and dispensaries to provide quality care.
Good Intentions estimates dispensaries won’t have marijuana available until late July or August at the earliest. Despite obstacles, Tammy Jacobi says she’s focused on providing hope for patients.
“This is the compassionate use of marijuana act and we need to remember that there’s a reason we have compassion in the title,” she says. “Illinois will get its act together. We will get these dispensaries and cultivation centers up and running. We will do it on behalf of patients. And it will be successful.”
Qualifying Debilitating Medical Conditions
Acquired Immunodeficiency Syndrome (AIDS)
Agitation of Alzheimer’s disease
Amyotrophic Lateral Sclerosis (ALS)
Arnold-Chiari malformation and Syringomelia
Chronic Inflammatory Demyelinating Polyneuropathy
CRPS (Complex Regional Pain Syndromes Type II)
Human Immunodeficiency Virus (HIV)
RSD (Complex Regional Pain Syndromes Type I)
Residual limb pain
Rheumatoid arthritis (RA)
Seizures, including those characteristic of epilepsy (Starting January 1, 2015)
Spinal cord disease, including, but not limited to, arachnoiditis, Tarlov cysts, hydromyelia, syringomyelia
Spinal cord injury
Spinocerebellar Ataxia (SCA)
Traumatic brain injury (TBI)