How a new Colorado law affects medical cannabis

Leading medical marijuana advocates are convinced a new Colorado law will limit patient access and potentially drive some people back to opiates and other pharmaceuticals. The law’s sponsors insist this was not at all what they had in mind when they passed HB21-1317 in a stated effort to keep teenagers from getting and using high-potency cannabis.

For cannabis consumers, especially those under the age of 21, this law will bring new purchase limits, strengthened tracking and enforcement of purchases, and new standards for doctor-patient relationships.

But it is too soon to know everything that the law portends for medical patients because the future of cannabis access for medical patients will be sorted out through a state rulemaking process that kicked off last week. It will culminate with new rules issued by Jan. 1 by Mark Ferrandino, the former speaker of the House who was appointed by Gov. Jared Polis to lead the Department of Revenue.

Here’s a fact check on what’s going to change, and what remains to be decided.

Purchase limits

A key provision of the law states that medical marijuana patients can purchase up to eight grams per day of cannabis concentrate — only two grams a day for patients ages 18-20 — which is commonly vaporized but can be consumed in other ways, too. The previous limit was 40 grams.

Concentrate is usually at least twice as potent as even the highest-end bud, and eight grams is more than enough to get casual users high many times over. But some patients consume several grams a day, often in the form of specific products that few medical dispensaries sell.

Patients are peeved at the prospect of having to re-up every week (or more often) under the eight-gram limit. The limit presents a particular problem, they say, for people who live far from their providers; there are no medical dispensaries in one-third of Colorado counties.

“There’s not that many medical shops right now. A lot of these patients travel quite a distance just to get their limit,” said Thuy Lam, who owns Kind Meds medical dispensary in Denver. “I have patients who come from the (Colorado) border … and now they have to travel multiple times just to pick this up.”

The law provides an exemption to the new daily purchase limit for people who can demonstrate physical or geographic hardship, those who obtained their medical cards before the age of 18 and those whose doctors recommend high dosage. There’s a lot of room for interpretation, because the law left the definition of hardship up to the rulemaking process.

Serving sizes

The legislature asked Ferrandino to rule on a lot more than access and purchase limits.

His charge also includes creating new rules for how dispensaries demonstrate reasonable serving sizes of concentrates — think segmented edibles. But, like edibles, these products vary in form and potency so there is no easy way to standardize serving size. Plus, tolerance levels vary, so serving-size guidance that might be appropriate for casual consumers is of no use to many medical consumers.

“I take three grams a day,” said Bridget Serrit of Colorado Springs, who is a medical cannabis patient with multiple autoimmune diseases. “I no longer get high. … And cancer and hospice patients take more than I do.”

Serrit is organizing a protest of the new law noon Monday at the Capitol, where a group will dress for a funeral and lay fake gravestones in front of the governor’s office.

They object to many aspects of the law, including the serving-size requirement, which is paired in the law with a mandate that recreational and medical marijuana shops give consumers a “tangible educational resource” at the point of sale so they are more informed on responsible use and potential harms.

The content of that educational handout is left to rulemaking, and ultimately to Ferrandino. He was speaker of the House when Colorado’s first recreational dispensaries opened in 2014, and he said that at the time, he’d never even heard of cannabis concentrate.

“You don’t have some of the federal regulations that give baselines that we would have in other industries,” he said.

Differing views

Ferrandino is being advised by an advisory group with a few dozen people — mostly representing the cannabis industry — who are now taking a couple months to brainstorm on Zoom. Defining hardship has already proved controversial.

“I think it’s important that the decisions around hardships be made right then and there, with those specific doctors, the ones who are the experts,” Truman Bradley of the Marijuana Industry Group, the state’s largest trade association in this sector, said at the group’s first meeting, Aug. 3.

He noted that some people who may present as fully able in fact are debilitated by unseen medical conditions, and worries they could miss out on exemption.

Several in group proposed patients with hardship be able to formally declare their dispensary of choice. Doctors are legally barred, however, from recommending a specific provider. They can only recommend product type or treatment.

One family has sued Polis in part because they believe the law would essentially ask doctors to issue prescriptions, which could be seen as in violation of federal laws that do not recognize cannabis as legitimate medicine.

Dawn Reinfeld, a work group member from Boulder who helped agitate for the new law, alleged at the group’s first meeting that the industry’s preferred level of flexibility on things like hardship definition and consumer education would violate the law’s spirit.

“Philip Morris — did they give us great advice all those years about their products?” she said.

Ferrandino said he’ll assess the recommendations he receives and compare to the legislature’s intent, which current House Speaker Alec Garnett said was “not to hamstring legitimate patients from getting access to their medicine.

“It was to clean up big loopholes in the system to make sure there wasn’t diversion onto high school campuses, and teens weren’t getting access.”

Other parts of the law that won’t have to go through rulemaking include:

  • The Colorado School of Public Health must produce a report by July 1, 2022, on the effect of THC on the developing brain. This research could inform future policies.
  • Enforcement of purchase limits, which government and industry officials openly admit has never been done in a comprehensive or consistent way in Colorado.
  • Stricter rules for physicians who recommend patients for medical cards. They’ll need to meet with prospective patients in person and examine their mental health histories to determine if the person has “an issue that could be exacerbated by the use of medical marijuana.” Patients 18 to 20 will have to get recommendations from two separate doctors — an equity concern for opponents of this law, who note that those appointments can exceed $300 apiece.

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