Serious questions linger about the fate of medical marijuana in Iowa as Republican lawmakers find themselves considering an eleventh-hour deal that would expand the program to more patients.
The state’s sole manufacturer of medical cannabis oil worries that, once sales begin in about seven months, many patients will realize treatment would be unaffordable, impractical or unobtainable due to restrictions placed on the fledgling industry. The lack of a robust market, in turn, would jeopardize access for those who still could benefit.
“We’ve provided some false hope,” said Sen. Joe Bolkcom, an Iowa City Democrat who has backed efforts to expand access to medical marijuana. “There are thousands of Iowans counting on us to deliver.”
Iowa legalized possession of cannabis oil in 2014, but there was no legal means to obtain the substance until a bill approved last year allowed for its manufacture and for five dispensaries— planned for Council Bluffs, Sioux City, Davenport, Waterloo and the Des Moines suburb of Windsor Heights. The expansion was part of last year’s budget negotiations, and it was one of the final bills following all-night negotiations on the last day of the session.
Last year’s deal capped the amount of THC, the most psychoactive compound in marijuana, at 3 percent for any legal cannabis oil. That limit has been the main target of advocates seeking to further expand medical marijuana in the state.
A lot of people misunderstand how Iowa’s THC cap works, said Lucas Nelson of Des Moines-based Kemin Industries, which is the lead consultant for MedPharm Iowa, the state’s first and currently only cannabis oil manufacturer. Nelson’s uncle, who is the president and CEO of Kemin, is the founder of MedPharm Iowa. Nelson oversees the relationship between the two companies, which share a campus in Des Moines.
The state limits the ratio of THC in medical cannabis oil products — not the overall amount given to a patient. So, Nelson said, a patient who may benefit from a large dose of THC could still obtain it, but would have to consume more units of low-THC products. Essentially, patients would pay for “filler” that would cost several times the equivalent of high-THC products.
Those costs would price out many patients, who would be paying out of pocket for MedPharm Iowa’s pills, droppers or creams. Some patients might not be able to take a large number of pills or other delivery methods, Nelson said, placing access to medical marijuana out of reach. Iowa prohibits smoking or eating medical marijuana.
“With this cap in place, there are too many people who can’t be treated,” Nelson said. “If this program is to be sustainable, what that means is we have to be able to give the patients what they are actually seeking so they can actually treat their conditions.”
A bill to remove the THC cap received a preliminary vote in the Iowa Senate last week. The legislation also would expand the list of qualifying conditions, which currently includes cancer, epilepsy, untreatable pain, multiple sclerosis and terminal illnesses. And, the bill would allow doctors to recommend the cannabis oil be used as a treatment for other conditions not listed if they believe it would be beneficial.
Peter Komendowski, president of Partnership for a Drug Free Iowa, a private nonprofit organization that works to minimize high-risk behavior in Iowa’s youth, said the state’s current THC limit already sets a “dangerous precedent” that could result in further marijuana legalization. His group remains skeptical about medical use of marijuana and argues it’s not a proven treatment for pain.
House Speaker Linda Upmeyer, a Clear Lake Republican, said she would prefer to wait for the recommendation of an advisory board created as part of last year’s last-minute deal. The advisory board is charged with making recommendations on Iowa’s medical marijuana program, and the board plans to have the THC limit on its agenda at an August meeting. A report from the board would be finished in November.
Upmeyer said legislators could look at the board’s recommendations next session, which begins about a month after cannabis oil sales are scheduled to begin. She said legislators should wait for the board to weigh in, but she did not rule out holding a vote soon on the Senate’s bill.
Medical marijuana is one of several issues — including bills on abortion and the opioid crisis —that have received support from just one chamber in the Republican-controlled Legislature that could be brought forward as leaders negotiate a compromise on the state budget and tax cuts to wrap up the session.
Nelson said it would take several months to ramp up production of high-THC products, so delaying a vote could leave people uncertain if or when they’d have adequate access to medical marijuana.
MedPharm Iowa has invested more than $10 million in its manufacturing facility to prepare for sales to begin Dec. 1. The state is accepting proposals for a second manufacturer, which would be selected this summer and would bring products to market starting in July 2019.
Nelson said MedPharm Iowa has committed to remaining in the market, but he cautioned that more patients are needed to make the business sustainable. He said the implications of the THC cap took some time for everyone to understand following the passage of last year’s legislation.
As of Thursday, 725 people were registered to purchase medical cannabis oil, according to statistics distributed by the Iowa Department of Public Health. MedPharm Iowa hopes to see that figure grow to 12,000 patients able to receive treatment.