Debbie McPherson-Nau sits in the dark, a laptop in front of her, surrounded by about 40 people who are listening intently as she makes a PowerPoint presentation about her experiences at Delaware’s lone medical marijuana dispensary.
“You may get wanded down. You’re not allowed to wear your coat in, not allowed to bring cell phones in or your purse. It’s very strict,” she says. “We’re working on getting that changed, too. We certainly don’t have to go through all that to go down and pick up oxys (oxycodone) from the CVS pharmacy.”
A chuckle rises from the crowd, accompanied by emphatic nods and an “exactly.” They know her struggle well.
McPherson-Nau, a medical marijuana program cardholder who suffers from fibromyalgia and herniated disks, has emerged as one of the local leaders in the medical marijuana movement. Among her efforts since 2009, she helped form and fund the Delaware Patient Network. The DPN has monthly meetings such as this one to educate prospective and current patients about the state’s medical marijuana program.
Many of its members are critical of the state. Though medical marijuana was approved for use in Delaware in 2011, the state’s only dispensary, the First State Compassion Center in Wilmington, did not open until 2015 due to a lawsuit over its ownership and Gov. Jack Markell’s subsequent suspension of the program. Members of the program, those who would be members and advocates for marijuana use have since complained about the state’s management of the program.
“Obviously, we are happy that we have medical marijuana policies,” says Cyn Ferguson, head of the Delaware chapter of the National Organization for the Reform of Marijuana Laws. “But the implementation of them—there have been some problems with that.”
As of early October, there were 1,893 Delawareans who were members—otherwise known as cardholders—of the state’s medical marijuana program, according to Paul Hyland, who heads the program for the Division of Public Health. That number of patients has more than doubled since March 2016. He says it is expected to grow to around 5,000 people—caregivers, agents, pediatric patients and guardians—in the next four years, which would easily outpace the state’s initial enrollment estimates. Launching and growing the program was bound to have a few bumps. The state says it’s managing.
“What I think we are doing well is providing a very safe, controlled environment for patients to receive medical marijuana,” Hyland says. “Because we grew ours a little slower than some people liked, we got in front of all the problems, like the testing, and some of the issues that some states are having, we’ve got a much tighter handle on that.”
Use of cannabis for medical reasons is different than recreational use, which is legal in four states and the District of Columbia, where the laws still run counter to federal regulations. Medical use has been shown to relieve the symptoms of certain illnesses or conditions, such as pain, insomnia or loss of appetite from diseases or conditions such as cancer, HIV/AIDS and some forms of post-traumatic stress disorder. That makes marijuana desirable—sometimes desperately so—to very ill people, and they are very different than any stereotype of a pothead.
To qualify as a medical marijuana patient, one must live in Delaware and be under the care of a physician who can certify a debilitating medical condition. In August, legislation was signed to extend coverage to those with a terminal illness, and in September, Markell enacted legislation that allows medical cannabis materials on school grounds. Pediatric patients are limited to only pediatric medical marijuana oil.
Hyland says he believes the state is doing well in most aspects of managing the program, though there are some areas that need improvement. He also says the slow initial progress helped the state avoid some of the technical and procedural problems that have hampered similar programs in other states. The state studied medical marijuana programs in Massachusetts, Rhode Island, Arizona, New Mexico and New Jersey, which allowed it to make modifications in such ways as avoiding the use of pesticides on its marijuana plants. Arizona passed its medical marijuana law about the same time as Delaware, but has since run into pesticide issues.
“I think that’s going to separate us from a lot of places,” Hyland says. “We’re going to have a high level of confidence in the products, that it’s safe and that the person will get the same effect from the same product every time. The goal is consistency, time after time, but also consistency throughout the product.”
Critics such as McPherson-Nau, however, remain frustrated. Despite the law’s provision for one dispensary in each county, First State Compassion Center remains patients’ only option, and experiences there have been uneven.
A study released by Americans for Safe Access in January gave Delaware’s medical marijuana program a C+ overall. It targeted the geographic issue in its summary.
“With one dispensary to serve the entire state, the Delaware medical cannabis program’s biggest fault is obvious, and the solution is for the state to allow for more dispensaries and cultivation sites,” the report states. “Patients in the state are restricted to a single access point that is in one geographic corner of the state.”
McPherson-Nau believes two more locations will fix some problems, but she thinks the state needs to help patients in the interim.
“Do you know how many complaints I get from downstate patients? ‘I don’t have a car. I have no money. I have no way to get up there,’” she says. “They have not worked with the state to devise some sort of delivery program. That would have saved a lot of their heartache. There have been a lot of complaints from the get-go.”
Ferguson also cites location of the dispensary as the biggest issue. But to that she adds the enrollment fee of $125—a price she views as too high. She also criticizes the state for issuing cards to approved patients too slowly, with some waiting up to six months.
Remedies are in the works, Hyland says. The Kent County Compassion Center was announced in September. It is scheduled to open in the second half of 2017. As of mid-October, the Division of Public Health had named a Sussex County vendor and was nearing a deal with an independent testing lab to further ensure product safety and consistent quality.
Hyland admits to some initial hiccups in issuing cards due to a meticulous process for validating patients’ illnesses, but the process is streamlining. Increased manpower in the program’s office staffing has contributed to shorter wait times for approvals. And he points out that there are income-based and disability-based fee waivers for cards.
“About half of the [enrollees] are getting no- or low-cost cards, so you can see that once I get to 4,000 patients, I’m only getting 2,000 who are paying every year,” Hyland says. Revenue from the cards and licenses for compassion centers appears to be just enough to sustain the program. (It receives no government funding.)
Technological refinements, such as improved databases and more online features for patients such as payment portals, are also being researched.
The state monitors the program through the Medical Marijuana Oversight Committee, a group of doctors, patients and legislators who meet twice a year to discuss the problems and improvements. State Sen. Margaret Rose Henry, a member of the MMOC, describes the problems with the program as “growing pains.”
“Because it’s still against federal drug law, we wanted to be careful and make sure we were doing everything correctly,” she says. Overall, she is pleased with the program’s progress. Henry plans to introduce legislation in January that will legalize marijuana in Delaware for adults over 21, though Hyland said he could not speculate on how that might affect the medical marijuana program.
Hyland has heard the voices of patients who not only depend on medical marijuana for relief, but who have lodged complaints. He meets often with everyone from individual patients to patient advocacy groups to physicians.
“Do I feel that pressure? You bet I do,” Hyland says. “I have enormous empathy for all of these patients, and the parents, the caregivers. That’s something I take home at night. It’s not like paving a road, where you can look at it and say, ‘Oh that’s good. Let’s go to the next one.’ I cover this ground over and over again to make sure I’m doing it right.”