Now that recreational cannabis is rolling out in Massachusetts, why do we need a medical cannabis system anymore? The short answer is that patients are different from recreational users and have more complicated, precise needs that recreational sales are incapable of handling.

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The cannabis industry, and to some degree, our lawmakers, would like to roll it all together. This supports their quest for the greatest freedom to sell and generate the greatest revenue, including that from taxes. How do we reconcile this with the vulnerable, and therefor protected, class of people, the patients?

Access to Medical Cannabis

While she pursues better pain control for her back, we don’t want a salesperson telling Grandma to do bong rips or dab high potency concentrates. Nor do we want her to feel pressure to spend her Social Security check on products that won’t work. The same is true for the 45-year-old who is struggling to beat cancer. Or the parent of an epileptic child.

In states like Colorado and Washington, the medical systems have almost vanished. This deprives patients of access to needed medication that simply isn’t exciting enough to be sold in the recreational system. It deprives that patient’s clinician of valuable data collected through the medical system that can help treat the patient. It incentivizes companies to mislead patients in order to make a sale.

Fix the System

The medical cannabis systems that are in place nationwide need a vast overhaul, and Massachusetts should lead the way. The following offers a simple start to fixing them.

The Association of Cannabis Specialists argues that any federal law must include at a minimum the following parameters:

• Exact prescriptions: A prescribing paradigm that provides a system to ensure patients need both prescriptions and products that support very specific and reliable regimens. Regulations that limit the amount that a dispensary can sell to patients, as per the prescription, and based on the regimen needed by that patient, rather than limiting the amount of medicine that a patient is permitted to have in its possession. (Watch the Casual Conversation episode on Prescriptions vs Recommendations here.)

• Medical claims: Prohibition of sales representatives from upselling or making medical determinations on a patient’s behalf. Regulation addressing claims made by manufacturers, as well as statements that are allowed by lay people, such as budtenders, who are selling these products.

• State-to-state interoperability: Patients must be allowed to travel with their medication, including by air, within all U.S. states, use their medication in all states, and purchase their medication in all states subject to their prescription. These conditions are crucial to proper and effective medical treatment.

• Common safety standards: A regulatory regime governing the growing, harvesting, manufacturing, testing, and packaging of cannabis medicine in such a manner consistent with other medications.

• Clinical Discretion: Regulations limiting the lists of qualifying medical conditions because physicians are more qualified than state lawmakers to assess what medications are appropriate for patients’ care.

• Purchase feedback: Regulations that mandate nationwide tracking of cannabis medicine sales in a HIPAA-compliant, protected, and de-identified (when appropriate) fashion so that system compliance can be monitored, scientific data can be extracted, and individual patient purchase information can be fed back to, and monitored by, their clinicians. Such a system would be similar to the PMP systems used for opioid, and other controlled substance, monitoring.

• Recreational system overlap: Regulations limiting dispensary sales teams from making medical recommendations to people presenting in the recreational market with medical questions. (For example, if a 50-year-old man at a retail cannabis establishment asks, “what have you got for my back pain?” the sales agent’s appropriate and legally constrained response should be, “I'm sorry I cannot address these questions. I would be happy to put you in touch with a physician who can.”)

• Research agenda: Regulations governing cannabis medication regarding efficacy and specific illnesses, as they do any other medications, through the promotion of ongoing research efforts. This should be overseen by the FDA and have a clearly defined pathway for both pharmaceutical and botanical forms of cannabis medicine.

As recreational shops continue to open across the Commonwealth, now is the time to address the unique needs of the medical patient and lead the nation in providing first-rate medical cannabis care.