When Tamara Netzel decided to get up in front of Virginia lawmakers and talk about medical cannabis oil, she worried about a backlash.
She didn’t have to worry about derailing a career because her multiple sclerosis had already forced her into medical retirement from her former job as a teacher in Alexandria. She wanted to explain that when she drops hemp-derived oil under her tongue a few times a day, the pain in her arms and hands turns to warmth, bringing relief she says she couldn’t get from a needle nerve block or other government-approved drugs.
Still, she felt uneasy about what people might think if she publicly associated herself with something linked to marijuana.
“I think there are people out there who know this helps,” said Netzel, a 48-year-old military wife and mother of two Eagle Scouts. “But they are afraid to speak out.”
There was no negative feedback. And there was virtually no opposition in the General Assembly to bipartisan legislation to expand access to cannabidiol (CBD) and THC-A oils, just as the state prepares to issue licenses for what will be Virginia’s first dispensaries for medical cannabis products.
Within the next few weeks, the Virginia Board of Pharmacy will open a competitive application process for up to five cannabis-oil facilities, one for each of the state’s five health regions.
The system will put Virginia among a handful of states in the Southeast with medical cannabis programs, though the restriction to oils will make it far less robust than the full-blown medical marijuana setups in states like California and Colorado. With efforts to decriminalize possessing small amounts of marijuana gaining little traction in the legislature, legalized recreational marijuana doesn’t seem imminent.
But supporters say the action on medical oils shows state lawmakers are getting more comfortable about moving away from a “hyper-restrictive” model and could go further in the next few years.
“Basically what we’re doing in Virginia is starting with the sickest patients and we’re going to serve them first,” said Jenn Michelle Pedini, executive director of Virginia NORML, the state chapter of the National Organization to Reform Marijuana Laws.
Cannabis-derived oils are not approved by the U.S. Food and Drug Administration, but proponents say they help relieve pain, inflammation, seizures, muscle spasms and nausea, without the high that comes with smoking or ingesting marijuana. The oils only contain a minimal amount of THC, pot’s psychoactive compound, and Virginia law limits THC levels to 5 percent. THC-A, or tetrahydrocannabinol acid, only becomes THC when exposed to heat.
Some health stores carry products marketed as CBD oil. But they’re usually derived from hemp and, because they’re unregulated, it’s not entirely clear what’s in them.
In 2015, the General Assembly passed a law creating an “affirmative defense” to possess cannabis oils for medical reasons, but it only applied to patients with severe epilepsy. This year, lawmakers expanded that protection by freeing doctors to recommend the oils for patients with cancer, Crohn’s disease or any other medical condition.
A recommendation from the state’s Joint Commission on Health Care, the policy change was presented as a way to let doctors decide who should have access to the oils, instead of lawmakers being asked to add new medical conditions one by one. The bill passed the state Senate and House of Delegates unanimously. Because it had an emergency clause, Gov. Ralph Northam, a medical marijuana supporter, signed it into law on March 9.
“He thinks this is a positive step in the right direction that will help improve the lives of people who suffer from many conditions,” said Northam spokesman Brian Coy. “But he hopes to continue working toward a broader legalization of medical marijuana.”
It’s not clear how many people might take advantage of the easier access to CBD oil, but advocates estimate it could benefit 5 percent of the state’s population, or about 423,000 people.
The push for state-sanctioned medical cannabis oils began five years ago, when the parents of children with severe epilepsy began lobbying Virginia lawmakers for legal access to medicine they said their children needed.
Del. Eileen Filler-Corn, D-Fairfax, one of several lawmakers involved in the CBD-oil push, said the “parent warriors” and their personal stories had a major impact on legislators’ attitudes.
“This is a huge deal,” Filler-Corn said. “But honestly I think the credit all belongs to the families.”
Several lawmakers said the gradual approach – starting with epilepsy and building on the law over several sessions – helped ease legislators’ fears and gave the executive branch time to craft a detailed set of regulations.
“You build consensus in many ways by building confidence. And we have pushed the envelope surprisingly far,” said Sen. Siobhan S. Dunnavant, R-Henrico, an OB-GYN doctor who sponsored the Senate version of the 2018 bill.
Under the affirmative defense system, patients who register with the state can obtain a doctor-signed certificate that would theoretically serve as a get-out-of-jail-free card in case of legal trouble. But with no way to get the oils from a state-sanctioned seller in Virginia, patients and their families have had to run the legal risk of getting them elsewhere and transporting them across state lines.
Policymakers have also taken steps to solve that problem.
In 2016, the General Assembly passed legislation to slowly establish a state-regulated system of “pharmaceutical processors” that could supply CBD oil to Virginia patients.
In preparation for inviting companies to compete for one of the five licenses, the pharmacy board crafted 24 pages of regulations that set rules for every stage of the CBD oil process.
The regulations range from dictating temperature and humidity settings for the rooms where cannabis plants will be grown to how to properly dispose of leftover oil (the guidelines say it should be mixed with something gross, like coffee grounds or kitty litter).
To ensure nothing goes missing, there are detailed security specifications for alarms and video cameras. Any employees working around cannabis have to wear clothes without pockets.
Before purchasing any oil, patients and their doctors have to register with the pharmacy board, and there are other safeguards to ensure the supply of oil is closely tracked. Patients will have to travel to a dispensary for their first transaction, but once they’re in the system the oil can be delivered to them at home.
Caroline Juran, the executive director of the Board of Pharmacy, said the General Assembly’s action to expand the patient population will require some additional work on the regulations, but won’t delay the planned mid-April opening of the dispensary application process.
“It doesn’t prevent us from moving forward,” Juran said.
One medical cannabis entrepreneur predicted Virginia could get several dozen applicants for the five licenses.
Jake Bergmann, the founder and CEO of Atlanta-based Surterra Holdings, said his company, which was among the first to get medical cannabis licenses in Florida and Texas, is hoping to do the same in Virginia.
“We’ve been watching this for a while with some interest,” Bergmann said.
Surterra has made political donations to Northam and former Gov. Terry McAuliffe and has retained lobbyists from Richmond-based McGuireWoods.
The company, which calls its stores “wellness centers,” offers a variety of cannabis oils, patches, vape pens, lotions and sprays. Prices for Surterra oils vary, but they range from $85 to $270 for a 30-day supply.
A big part of Surterra’s mission, Bergmann said, is educating people about what medical cannabis is.
“The most important part of the process for a new patient is they’re going to have a lot of questions,” Bergmann said.
One question on the mind of many medical marijuana advocates is where things will go from here. Future reforms could include expanding the program beyond oils to include patches and sprays, or raising the THC cap.
But lawmakers say they want to take time to see how the system works before expanding it.
Though Netzel has joined the push for reform, she said she’s been a little frustrated by the slow pace.
When a friend first suggested CBD for her multiple sclerosis, she dismissed it as “snake oil.” When she tried it and found that it worked, she was surprised and confused about why it’s not fully legal.
Netzel said she’s heard people say medical cannabis could hold the cure for MS. But if it continues to exist in a legal gray area, she said, she’ll never know whether that’s true because it won’t be seriously researched.
“I want it regulated. I want to know what I’m getting,” Netzel said. “And I want to know if it could be helpful to my disease.”