Medical marijuana is now available in Massachusetts, but for most, the process for becoming a cardholder is not a typical medical experience. Many people are skipping a trip to their primary care doctor and paying cash to see a Medical Marijuana Consultant. Those who are approved are given a certificate that allows them to hold a 60-day supply, but they are not able to pick up their pot at a dispensary. Instead they need to enlist the services of a Personal Caregiver or grow their own. It’s hard to imagine this is how the process was supposed to go.

In November 2012, Massachusetts voters approved the humanitarian use of medical marijuana by landslide (63% to 37%). The law states that a physician and other health care professionals under the physician’s supervision can provide a qualifying patient with a certificate that permits that person to use medical marijuana. But the distribution of marijuana certificates has been disproportionately provided by a handful of physician groups who strictly evaluate patients looking for medical marijuana.

Cannamed in Framingham requests that patients bring $200, a few forms of ID, and relevant medical records. Candidates are approved or denied based on their diagnoses, but the criteria for what qualifies is vague. “Larry” a 24-year-old Scituate man, says that he was given his certificate based on his diagnoses of anxiety and Gastroesophageal reflux disease (GERD).  These symptoms are far from rare. The National Institute for Mental Health (NIMH) reports that 40 million Americans have anxiety disorders. In addition, as many as 4 out of 10 Americans have symptoms of GERD. Considering these high numbers, it seems very possible that there could soon be a lot of legally stoned folks inhabiting the Commonwealth.

[CannaMed’s listing of Doctors on its website]

A patient registry that documents all cardholders has not been established. Instead, patients are given a certificate that gives them the ability to possess “10 ounces of dried flower” and grow plants in a locked container.  Conveniently, a certificate holder who wants to grow without getting dirty can pursue hydroponics. A certificate is valid for 12 months and must be renewed thereafter. When asked if he would use 10 ounces in 60 days, Larry suggested that he might be able to, if he quit his job. Instead of stock piling his weed, Larry prefers to make weekly orders with his personal caregiver who delivers to his home.

The Department of Public Health has attempted to establish dispensaries where medical marijuana cardholders can pick up their supply. They originally approved the application of 20 applicants, but 9 were removed after it was discovered that they were hiding profits, misleading the DPH, or had previous history with drug convictions. The process has been fairly arduous overall, but the remaining 11 dispensaries could be doing business in the Commonwealth as early as November.

While the dispensaries go through the final steps of becoming legitimate marijuana businesses, an alternative method for obtaining legal pot has emerged.  A network of enterprising caregivers is effectively distributing to those in need.

[The logo for Compassionate Caregivers of Massachusetts, one of the many local Caregiver listings available online]

The Department of Public Health has clarified that individual caregivers are only supposed to service one patient. There is evidence that is not happening. Instead, Caregivers have developed a quasi-legal market targeted at scooping up cardholder business. Cardholders are able to find nearby caregivers online. Once the relationship has been established, some caregivers are circulating weekly menus that include marijuana candies, butter, and wax (used in vaporizers).  These same caregivers request cash donations, and provide “suggested” prices ($350 for an ounce is a typical suggested rate). Caregivers not permitted to sell product, so requesting donations seems to be a way to sidestep the law. But it is questionable if their actions are legal, or if they are serving as de facto dispensaries without oversight and without paying taxes.

The Department of Public Health did not return requests for comment on this story. It is possible that they are dedicating their full attention to getting dispensaries up and running. The presence of dispensaries may effectively eliminate the market that caregivers have developed, but probably not. It is easy to imagine that cardholders will prefer to make online marijuana purchases, that will be delivered to their homes, rather than going in person to a dispensary. Without DPH oversight, caregivers will most likely be able to offer more favorable prices than dispensaries. The DPH may also need to better define the diagnoses that are required for patients to obtain a certificate. If not, the already high prevalence of GERD may grow further. This will all be moot of course, if Massachusetts decides to the follow the path of Colorado and Washington and permit the recreational use of marijuana. For the time being, don’t hold your breath.