Op-ed: Recreational cannabis falls short for medical patients

Editor’s note: Rebecca Cahill is a cannabis coach and educator. 

Jason Berger marvels at the against-all-odds progress he’s made in his 19-year battle against cancer. “My doctor said, ‘The fact that you and I are having a conversation right now is truly remarkable,’” Berger said. “At one point, I could not walk. I could not see. I could not speak. I was told I was going to die. Today, I’m doing all three.” 

A former police officer with Valley View and Independence, Jason was diagnosed with primary central nervous system lymphoma, a rare and terminal form of brain cancer. What sets his journey apart is his reliance on cannabis, which he credits as instrumental in his unlikely survival and current health. “I do believe cannabis is a huge part of my longevity,” Jason said.

Jason is one of approximately 403,500 individuals registered in the Ohio Medical Marijuana Control Program (OMMCP), a program in which only 178,703 patients are actively using, or about 1.5% of the state’s population. With the approval of Issue 2 by Ohio voters in November, it’s commonly assumed that the legalization of cannabis would enhance access and affordability for medical patients — and proponents of Issue 2 indicated it would — but this isn’t the case.

As the Ohio legislature debates and finalizes adult-use legislation this month, and the Department of Commerce prepares to establish and maintain both the recreational and the medical programs, it’s crucial that the state remembers the patient. “If we’re going to have a medical program, it should be maintained and managed and given the respect that any other branch of medicine would be given,” said Dr. Noah Miller, one of Cleveland’s first medical cannabis-recommending doctors and a physician with Compassionate Cleveland, a medical marijuana and behavioral health care practice. 

Here’s what the Ohio legislature should be addressing now.

Ohio should adjust fees and requirements for the medical program to ensure affordability; patients still need it.

The medical program imposes a significant financial burden on patients. Consultations with a doctor to obtain proof of a qualifying diagnosis and an additional appointment with a medical cannabis doctor, which are not covered by insurance, contribute to this. In Ohio, cannabis doctor appointments range from $75 to $225. Additionally, patients need to pay $50 annually to the state of Ohio for database registration, and every renewal requires a new doctor’s appointment. Patients who qualify for indigent or veteran status can have their registration fee reduced by 50% and must provide documented proof. The Ohio legislature should make adjustments to the annual registration requirements and fees for the medical program, especially for patients managing chronic or long-term medical issues, in order to address affordability.

Legalizing recreational cannabis may seem like a solution to the high cost of the medical program, providing an alternative way for patients to buy medication. However, there are potential tax consequences for patients to consider. Currently, patients only pay standard state and local sales taxes (5.75% to 8%). However, Issue 2, as amended by the Senate on December 6, proposes a 15% excise tax in addition to state and local taxes on recreational marijuana purchases. This means $100 of medication, not covered by insurance, could become $123, while a registered patient may pay $108. Patients medicating daily can save hundreds of dollars annually by remaining in the medical program, despite the fees. 

Patients need more medical guidance and care standards.

Due to cannabis’s federal illegality and lack of FDA approval, doctors can’t prescribe it, only provide a “recommendation.” This distinction often confuses patients about how to, when to, and why to use their cannabis medications. Though each state can create its own education standards, there is no universal education for medical professionals and dispensary staff in Ohio, leading to potential risks for patients like worsened symptoms, drug interactions, and side effects. Some states, like Missouri, have employed third-party standards committees to ensure professional education, which Ohio should consider for patient care and safety. 

While Ohio’s medical program offers a monthly newsletter and an 800-number for patients, both are aimed at explaining the program’s confusing operations. Dr. Miller, regarded by patients for his unique, patient-centric approach, is often left frustrated with this insufficiency. “I feel like I’m spending more time in my appointments with my follow-up patients, talking about how the system works and how to use it versus their actual medicine, treatment, and health,” he said. A focus group of patients and healthcare providers should be created to assist the Ohio Department of Commerce in identifying and addressing the program’s issues. 

Ohio licensing fees should be reconsidered to lower costs.

Adding to the challenges of patient affordability, Ohio imposes some of the highest licensing fees in the country for cannabis businesses. For instance, a dispensary pays over $85,000 for initial opening fees plus an additional $70,000 biannually. These fees support the administration of Ohio’s medical program and affect the price of cannabis products — the higher the licensing fees, the more expensive the medication. A reassessment of fees, ensuring businesses are not burdened with unnecessary costs, should be carefully considered. 

Dispensaries and licenses should be planned carefully with the patient in mind to ensure genuine access.

While recreational cannabis laws will increase the number of dispensaries from Ohio’s current count of 114, the new legislation barely addresses this deficiency, planning to distribute only 50 more licenses over the first two years, exclusively to existing medical license holders. Compared to neighboring Michigan, which supports 330 medical marijuana dispensaries and over 660 active recreational locations for a population nearly 1.7 million less, this is a concerning disparity. 

Theresa Daniello, a policy advisor and cannabis educator adds her perspective, noting that new dispensaries often go to large population centers, and rural and small-town patients, many with conditions that make driving challenging, are left to manage hours of travel for their appointments and cannabis medication. Local governments can also restrict or limit dispensaries in their areas, and it’s unclear if separate medical-only dispensaries will exist, leaving patient access further unresolved. 

Ohio’s list of qualifying medical conditions needs to be updated and less restrictive.

In November 2022, President Biden signed the bipartisan Medical Marijuana and Cannabidiol Research Expansion Act, streamlining the process for scientific researchers to access cannabis for research purposes. This move, in support of recognized medicinal benefits of cannabis, marked a significant step toward the easing of years of research restrictions. However, Ohio’s list of qualifying cannabis conditions, limited to 26, is outdated, excluding many well-researched conditions like autism and insomnia, keeping potential patients away from the medical program. 

Ohio must improve dispensary regulation for vital medications.

Ohio patients consistently face challenges in obtaining essential medications at dispensaries, a problem that proponents of Issue 2 claimed would be alleviated with adult-use availability. However, the cannabis industry controls dispensary shelves, lacking oversight or standards for consistent availability of essential products. For example, a full-spectrum CBD, derived from the entire cannabis plant and valued for its medicinal “entourage effect,” contains higher THC levels. As a result, it’s only available at dispensaries and notably missing from Ohio’s menus. This gap prompts patients to seek options outside Ohio, resorting to the illegal market, exploiting legal loopholes, or turning to unregulated CBD sources. 

Dr. Miller underscores this problem, stating, “A full-spectrum CBD is really ideal for a lot of people. Not being able to find that at a dispensary still to this day is a problem. They need to figure out a way to put that all under the same roof now. We’re not making it easier for them, so they’re turning to online options, and things are less regulated.”

Ohio needs to protect patients’ employment, housing, and legal rights.

Patients and potential patients have raised concerns about the absence of employment protections, ineligibility for government-subsidized housing, and the lack of safeguards in potential custody disputes, parental rights, and firearm ownership. Although Issue 2 didn’t address employment protections, it did include anti-discrimination provisions protecting consumer rights in child custody disputes and organ transplant eligibility. Unfortunately, the Senate’s proposed changes removed these protections, highlighting the necessity for the House to reconsider and reinstate these critical measures, while also considering additional workplace protections.

It’s important to make your voice heard.

As the legislature debates adult-use cannabis into 2024, with both programs falling under the oversight of the Ohio Department of Commerce, it’s crucial to tackle the ongoing challenges patients face to preserve the medical program. “All you have to work with is one patient who has been affected, and it changes the whole. If people had more understanding of what cannabis can really do, they might think differently,” Dr. Miller emphasizes. 

To make an impact, call upon your legislators through letters, or offer written or verbal testimony as the legislature is debated at the Statehouse into January. Collectively, we can work toward cannabis programs that are truly equal, placing emphasis on accessibility, affordability, and thorough education for those who need it most — our patients.