A detailed dispatch from last week’s hearing on the lack of access faced by patients in the Bay State
Last week’s explosive hearing in Worcester was only the latest outcry from the Massachusetts medical cannabis community, organized as advocates or otherwise. For several years, patients and those who need weed the most have lamented a worrisome decrease in access, while troubles with the system meant to serve their needs date back to when the Medical Use of Marijuana program was still under the purview of the Department of Public Health.
Since jurisdiction fell under the Cannabis Control Commission in December 2018, many have argued that medical concerns have been largely forgotten. The agency has demonstrably increased outreach and made workers available to help patients with the cumbersome and confusing process of registering and finding providers and subscribers. But aside from customer service, the outlook is grim, and the impacted parties are frustrated and scared.
Last Thursday, CCC commissioners held a listening session for stakeholders in their office to air out all of the above and more—much more. It was one of the appointed body’s heaviest meetings in years. I was there in person, and it reminded me of the town hall interrogations I attended in the 2010s where people with the most severe ailments and disorders imaginable plucked the heartstrings of skeptical commonwealth residents. I regret not being able to include all of the deeply moving statements, but I tried my best to represent the range of woes.
“This is an emergency. People are losing access as we speak.”
Compared to how far the adult-use cannabis industry has come in the Bay State, on the medical side of things, we’re not too far from where things started. Last month, the CCC released a newly completed Review and Assessment of the Massachusetts Adult and Medical Use Cannabis Industries. The report mostly covers the time period “from inception and implementation of adult-use retailers in November 2018 through April 2024,” and came more than a year overdue per statute.
In the time since the assessment was supposed to be submitted to state lawmakers, it has become clear that the medical program is deep in a tailspin. Still, the review offered some significant new insight into patient needs and demographics across Massachusetts. Among the revelations: more than 50% of diagnoses are for mental and behavioral disorders, while diseases of the nervous system like carpal tunnel syndrome constitute roughly 30%.
And then there are the troubling numbers, most of which were previously known and cited in prior pleas for help from medical cannabis advocates. From the report: “Year-over-year sales increased from 2018-2021, then decreased for the first time from 2021-2022 (-13%), with the trajectory continuing to 2023-2024 (-16%).”
And then there’s what was not in the assessment. There are currently just under 90,000 certified patients, compared to nearly 100,000 in 2023. Also, the agency had zero new medical-side applicants in 2024, while nine medical dispensaries went under in 2024. Three of those were in Boston, where the number of med shops resultantly went from six to three, with two closures in Cambridge and one in Arlington, making the most populated region in the state especially underserved.
Though they were somewhat silent about this erosion for some time, regulators have clearly acknowledged the problem of late. At last week’s public hearing, Commissioner Kimberly Roy said, “The medical program is near and dear to my heart.” She and others have lived up to that claim, traveling the state to introduce the agency to seniors and other groups, but the current situation begs for more deliberate, immediate action.
“We are at an inflection point,” Roy said, telling those queued up to testify that their words will inform the body’s response. “We need to make investments, we need to fine-tune it.”
Meeting the gravity of the moment, with familiar and unfamiliar faces filling the stackable chairs in the room, Commissioner Nurys Camargo said that in order to curtail the bleeding, they may have to “rip up” some of the relevant state regulations. Acting Chair Bruce Stebbins, citing access and other critical issues that would come up in the subsequent testimonies, stated outright: “I have staggering concerns about our medical program.”
Islands with no access to medical cannabis
The metaphors rang loudly through the Union Station headquarters of the commission last Thursday. Some quite literally, as fire tests sounded sporadically, at times interrupting medical cannabis advocates as they testified to alarmingly diminishing access. Other comparisons came via impassioned words from people like Jeremiah MacKinnon, the president and executive director of the Massachusetts Patient Advocacy Alliance.
“Last year, at the listening session in Martha’s Vineyard, MPAA warned the commission that failing to eliminate vertical integration would only buy time—not fix the problem,” he said. “And now? Those 234 patients you were so worried about losing access? They are literally on an island, with no access to medical marijuana at all.”
MacKinnon came to Worcester with his brother Zachary, who is a registered patient with severe autism and epilepsy, and his mother Jeannine who uses cannabis for her fibromyalgia and Chron’s disease. The MPAA president added, “Martha’s Vineyard was the warning. Don’t let it be the fate of our entire program.” (You can read his testimony here).
With the camaraderie thick in the hearing room, encouraging applause provided a segue into comments from another one of the Mass medical community’s most visible and outspoken activists. Frank Shaw is a long-term HIV/AIDS survivor who has piloted initiatives to get meds to those who can’t otherwise afford or access them. He’s also a member of the CCC’s Cannabis Advisory Board (CAB), where he has regularly raised these issues. Typically more soft-spoken, Shaw pulled no punches last Thursday.
“… and what has the commission done? Nothing!” he said. Like others who spoke, Shaw noted the unreasonably high entry costs for medical facilities, and employed language to highlight the threat. He addressed commissioners directly: “This is an emergency. People are losing access as we speak. If you continue to do nothing, there will not continue to be a medical program left.”
Bill Downing, an accomplished MassCann organizer, outlined multiple potential hurdles to having an equitable, sustainable medical program that adequately serves patients statewide. Among the most burdensome: vertical integration. As Downing, also a pioneer CBD retailer, explained: “Licensing requires all three functions: growing, processing and retailing. Unlike recreational licensing, a medical cannabis licensee is required to finance all three types of cannabis operations. Only the very wealthiest businesses can finance such a venture. Lack of capital is the number one reason businesses fail.”
“While still breathing, the medical marijuana industry in Massachusetts is gravely ill,” Downing said. “It cannot adequately serve my community and suffers from onerous licensing and regulation.”
The difficult business of selling medical marijuana in Mass
It’s not just the vertical integration requirements and high licensing and employee badging costs that are contributing to what one medical operator called a “dwindling market” that is “less and less sustainable.” It’s a problem that spurs new quagmires as it metastasizes; for example, that same speaker, Ellen Kasper of ACS Compassion in Hull, explained how they now have to do more and more outreach to find people across medical cannabis deserts. Needless to say, “It’s not cheap to advertise services in dozens of towns.”
Tim McNamara of Suncrafted Cannabis recognized the merits of dropping the verticalization requirement, adding that he thinks there is also “more that can be done.” McNamara said he is probably the only person in the state trying to open a second medical dispensary, and walked the commissioners through a labyrinth of senseless requirements that companies like his face.
Meghan Dube drilled down further. A watchful eye on the inside, Dube is the CCC’s business operations manager, and was recently suspended from the agency for unspecified reasons after speaking to reporters about various hot button agency topics. She offered remarks to accompany a 40-page white paper that she gifted her CCC colleagues detailing seven specific recommendations with supporting information. They include requiring certification providers to have continuing education, and establishing a directory for medical cannabis subscribers and service providers, so “we can see how people are educating themselves.”
Lizz Palmer, a longtime patient who is also the marketing director for Bay State Extracts, shed light on how lackluster business-side systems—coupled with the punishing compliance—foster impediments for patients.
“The check-out process takes three-to-five times longer than a single recreational customer due to the manual inputs, redundancies, and allotment checks that need to take place per CCC regulations,” Palmer testified. “Now a single medical patient is costing as much to process as seven to ten recreational customers.”
She continued, “Yes—many dispensaries meet the bare minimum—but is the bare minimum enough to make your patients comfortable to pick up their medicine?” (You can read Palmer’s testimony here.)
Medical cannabis, lab testing, and safety
Last week’s testimonies came amidst increased attention on laboratory testing, particularly since a lawsuit was filed last month by the Framingham-based MCR Labs against eight other Massachusetts Independent Testing Labs (ITLs) for alleged “violations” of the state’s cannabis law, “intentional interference with advantageous business relations,” and “unjust enrichment.”
Against that backdrop and a recent public health advisory over contaminated products, Coalition for Cannabis Worker Safety Co-Founder Danny Carson said he has identified more than two-dozen contaminated products that failed off-the-shelf testing that his group facilitated. “Every one of these contaminated products has the potential to reach patients, including those who are immunocompromised, putting people at significant risk,” he said.
A former supervisor at the Trulieve facility in Holyoke where 27-year-old employee Lorna McMurrey died in January 2022 after going into cardiac arrest, Carson also called out several labs and cultivators by name, and said that unless commission members recognize “the problem for what it is, the problem will remain out of reach.”
Marco Troiani, a seasoned chemist and lab manager currently with Digamma Consulting, read from a prepared statement, noting, “Although recreational users are affected by mold contamination as well, medical patients are uniquely vulnerable to contamination of their medicine due to complications such as weakened or compromised immune systems.”
Troiani submitted a small trove of technical documents related to lab testing and accuracy. He said it was a “dense” packet, but his team wanted it included in the public record, since it addresses concerns at the “center of many pain points in the Massachusetts cannabis industry.”
A chorus for compassion
As I affectionately mentioned, last week’s hearing was a throwback to the days when there were more regular reminders of how many people need access to good weed for medical reasons. Many voices from that town and city hall era have remained persistent, and were among those who testified over the course of five hours on Thursday, in the process suggesting the innumerable interwoven aspects of cannabis freedom in the balance.
Stephen Mandile, an Uxbridge Selectboard member and former Army National Guard sergeant, extolled proposed legislation that, per the Telegram & Gazette, “would ease access to medical marijuana cards issued by the state for military veterans while also exempting the patients from the state’s 20% tax imposed on recreational marijuana products. It also allows for sale of products with a higher dosage of THC, the active ingredient in cannabis, as well as greater amounts of the substance.”
Ellen Brown, a US Air Force veteran, industry compliance trainer, and CAB member, spoke about reciprocity: “We have some of the best hospitals in the United States, and people visiting those hospitals should be able to get their [medical marijuana] tax-free.”
Gary Gill illustrated the impact of medical dispensary closures. A caregiver for people in the Salem area, including many who are HIV/AIDS affected, he said he’s “poured [his] heart into working with seniors, helping them with med cards, and “telling them that it is worth it.” But lately, he’s not so sure.
“We smoke marijuana,” Gill said. “It gives you the ability to eat, it gives you the ability to have a life.” Addressing CCC members, he added through tears, “I don’t get it. … Advocates have been warning about these barriers from the beginning. … Why haven’t you acted?”
Bill Flynn said he walked away from the regulated industry for about six years due to his own medical issues, which he treated in part using cannabis—only to return to a program and environment that was a shell of its former self, and not at all what he had hoped it would be.
“This has been going on for years,” Flynn said. “If I grow my own and I take it to a lab, I should be able to sell it to my friends. It’s not hard. It’s a business. A small business. Regulations—cut some of those down. You shouldn’t have to have $500,000 in escrow to take care of patients.
“The compassion is lost here. … You have to listen to the people. The people in the field.”
