Things have changed in New Mexico's medical cannabis industry.
After eight years under the Susana Martinez administration (a government that was, to say the least, inhospitable to the plant and its medical benefits), the new governor, Michelle Lujan Grisham, is making strides in the state's medical program.
Patient license renewal now requires fewer hoops, and more conditions qualify for permission to use cannabis. Plus, producers are permitted to grow more plants. As a result, New Mexico's patients and cannabis providers find themselves in a very different environment than they did less than a year ago.
Officials added opioid use disorder and autism last month as qualifying conditions, a move that was celebrated by activists and producers even as it heightened fears of under-supply. Lujan Grisham named recreational marijuana a priority for the 2020 legislative session and pledged to still preserve the integrity of the medical program. Overall, patients and growers whom the Department of Health polled in May seem to appreciate the new direction.
Many have hopes for change far beyond what the administration has already put in place.
"Unfortunately we spent the last eight years under an administration that was very hostile to cannabis," Bryan Krumm, a psychiatric nurse practitioner from Albuquerque, said at a Medical Cannabis Advisory Board Meeting in March about opioid use disorder. "We had an evil, cruel, vindictive governor who spent her career as a prosecutor destroying the lives of cannabis users. And Secretary of Health Lynn Gallagher chose to be a lapdog to Governor Susana Martinez. They now have blood on their hands."
Krumm argues that many people who have died from overdoses would still be alive had opioid use qualified for a medical cannabis card sooner.
Lujan Grisham's spokesman Tripp Stelnicki agrees there's a necessary change in tack underway. "At the heart of it—and I don't think this was the case in recent years—we recognize medical cannabis as a benefit to patients, essential to treat certain symptoms of many painful and debilitating disorders," he writes to SFR in an email.
Research into dosing and new strains and education-raising efforts are also on the docket, Stelnicki says.
What might New Mexico's state of mind on cannabis look like in the near future?
Tip of the Cap
Before she went off to Washington, DC, to represent New Mexico in Congress, Lujan Grisham was the secretary of health when the medical cannabis program was first established by the Erin and Lynn Compassionate Use Act 12 years ago.
During these first six months she's been governor, dispensaries in New Mexico have operated under what's known as the plant cap. Their agricultural operations are limited to 450 plants at a time, including seedlings, saplings and clones. The cap put such a limit on supply that producers and patients sued the state. The courts forced the Department of Health to act, and it instituted a temporary emergency increase to 2,500 plants. A new cap is set to be determined this month.
Officials have scheduled a meeting Friday July 12 to hear public comment on their proposed 1,750 plants. Next, a hearing officer will make a formal recommendation, but the final say belongs to Department of Health Secretary Kathy Kunkel. One critical element included in the new rule: The cap would apply only to adult flowering plants, meaning that growers are less constricted by growth rates and can offer more saplings to patients who hold a personal production license.
"There's really a different approach in this administration to which I belong towards the treatment of the symptoms of some of these disorders," Kunkel tells SFR.
But a higher plant count won't satisfy everyone.
"I don't think we should be putting limits on people's medicine," Josh Alderete, chief operating officer at the New MexiCann dispensary, says while walking between rows of plants in his Santa Fe greenhouse. "We should be able to have certain strains that we know are going to be in our tinctures. We should always [have] this CBD Harlequin for our daytime products," he adds, pointing to the plant in question as an example.
Alderete and Rod Chavez, marketing director for New MexiCann, continue to chat as they step over puddles of water on the greenhouse floor, past distinctive seven-sided leaves whose colors ranged from green to blue and yellow, going back and forth about the way things used to be and the way things are now; greenhouses have replaced backyard enterprises and garage grows and budtenders have superseded street corner dealers.
"Did you see the leaves on this one?" Chavez calls out from further down a row. "Monstrous."
New MexiCann plans to soon add outdoor growing to its production, but the area is not yet planted—and that turned out to be fortunate for the growers. Golf ball-sized hail fell the week prior to SFR's visit. Outdoor grows are more energy-efficient, Alderete says, using natural sunlight rather than heavy heat lamps. Indoor grows provide a more controlled environment, but Alderete still likes growing outdoors.
"What doesn't kill them makes them stronger," he says with a grin.
A survey of producers commissioned by the Department of Health released in May found widespread frustration with the current cap on plants.
"When asked how many plants they estimate they need to grow, per year, in order to meet current patient demand (including for products their company does not currently produce), the plurality of medical cannabis producers say they estimate they need to grow 2,500 plants," the report reads.
Brian Egolf, the speaker of the New Mexico House of Representatives—as well as the attorney for Ultra Health, the largest dispensary network in the state—fears that a plant count that is too restrictive could, in addition to hurting dispensaries, push patients towards the black market.
"I think it's very clear that there's tremendous patient demand for affordable medicine," Egolf tells SFR. "And I think it's not going to be too surprising that when people need their medicine and they don't have their particular strain or variety or product at any of the vendors, then they will meet that demand through the illicit market—which is something that I don't want to see happening. I'd rather anyone who wants access to the medicine be able to get it from a licensed, regulated store, not from someone on the street corner."
Alderete says when patients come into New MexiCann in Santa Fe looking for a particular strain that isn't available at that time due to the plant limitations, budtenders can often find a similar variety with the same effects.
Chavez, the marketing director, says it's more than simply not getting a preferred product. Certain strains can treat specific symptoms among patients, he says, and the unavailability of a particular strain can mean that those symptoms don't go away, or that there are side effects that otherwise would not be present.
"When I smoked way back in the day, sometimes I'd think I'd have gotten crappy weed," Chavez says. "And I know now that my body prefers indica. There are different strains or different terp profiles that just didn't sit with me," he says, referring to the chemical in cannabis that gives the strains their varying scents and is often indicative of the effect of the strain.
At one point under the old plant count, New MexiCann had to stop selling clones because they needed every plant they could get to keep up with demand.
"We're constantly growing, just to try to keep up with supply," Alderete says.
According to the Department of Health survey, 68% of dispensaries say their patients want products that they do not provide. Overall, though, patients are happier with the program than producers are. Of the 607 patients polled by the Department of Health, 80% said that they were overall satisfied.
"As a customer, no, I've never had a supply issue," John Reid, a Santa Fe patient who uses cannabis to treat PTSD symptoms, tells SFR. "Walking into a store, you can always find what you need."
However, many of the patients polled by the Department of Health want greater availability of strains. More than a quarter of the patients polled in the study report they couldn't get a particular strain when they visited a dispensary, and had to wait an average of 16 days before it was back in stock.
Some of the anonymous testimonials featured in the survey cited lack of variety and higher prices than other states as an issue.
Laurie Harris, a 62-year-old chronic pain patient who was able to kick the opioids she's been taking since a spinal surgery more than a decade ago, tells SFR she's had issues with supply.
"I've run into shortages," says Harris. Sometimes she wants a strain with particular traits and and it's not available, she says. "I've had that problem in the past at a number of dispensaries. They just don't have it."
So why does the plant count even exist? According to Kunkel, protecting against oversupply is a large factor, but even more important is fending off "diversion," or an overabundance of plants that then spills into neighboring states like Texas with more restrictive rules.
"It's very difficult to prove, but if we know based on all of our calculations that our patients are not consuming any more than a certain amount, it has to go somewhere," Kunkel says, noting program staff believe the emergency number is too high to remain in place.
There's no consensus about how much is enough, though, and Medical Program Director Kenny Vigil did not return an interview request for this story to explain the math.
"I would call this a monumental issue to us organizationally, but I believe this is an even bigger issue for the 73,000-plus patients in the program, and the tens of thousands more that are likely to enter over the next year," Marissa Novel, spokeswoman for Ultra Health, tells SFR.
"We know the problem is real," adds Duke Rodriguez, CEO of Ultra Health. "And their latest proposal of 1,750 will go nowhere near fixing the problem."
Ultra Health successfully sued the state over plant counts in 2016, and has filed lawsuits related to the fee structure of cannabis producers versus cannabis product manufacturers and gross receipts tax revenue.
Egolf says he's concerned with the overall concept of a plant cap. "I think it's old thinking, " he says, "and I hope that it doesn't take root in the new administration. There's no need for it."
Pot not Percocet
"The governor made it clear in her campaign that she was going to add opioid use disorder as a qualifying condition," Kunkel says. That's just what happened last month, when the Department of Health announced that a number of new conditions, opioid use disorder and autism spectrum disorder chief among them, would now qualify patients for a medical license.
Studies like one published in JAMA Internal Medicine in 2014 demonstrated that medical cannabis can have a positive effect on habitual opiate users, whether the drugs they take were recreational or self-medication or prescribed as painkillers. There is anecdotal evidence as well that opioid users respond positively to cannabis use as a treatment for withdrawal symptoms and pain relief.
"Cannabis helped substantially with the withdrawal process from opioid drugs," says La Cienega resident Harris. Though she turned down weed when she worked on Wall Street in the '80s, she tried it more recently. "Thanks to the palliative qualities of cannabis, I have remained opioid-free for eight months and have no intention of going back on opioid medications. … This has been a liberation and has had a positive effect on my quality of life."
Harris adds that opioids have their place, for people who are recovering from surgery, like she did, or for those who are dying. But for others, people "with a life ahead of them," the answer is clear to her: "Cannabis is 100% better than opioids."
In 2005, New Mexico had the highest rate of opioid-related deaths in the country. And although the state's rating has dropped to 16th in the nation, the change is not a sign that the crisis is abating. New Mexico's rate is still climbing—just not as fast as states in the South and Midwest.
The Medical Cannabis Advisory Board, a body comprised of medical professionals and under the jurisdiction of the Department of Health, recommended that opioid use disorder be added as a qualifying condition for two years in a row, but the Martinez administration refused to do so.
It's not clear exactly how much enrollment will increase as a result of the new qualifying conditions, especially because many of the patients in need of opioid treatment could have been receiving medical cannabis for another condition that does qualify, like PTSD. But enrollment in the program has continued to increase exponentially since its inception, even during Martinez years. At the end of 2013, for example, there were 10,708 patients with medical cards. Four years later, that number jumped to 46,645, and it now sits above 70,000.
Funny How Time Slips Away
Officials say that there's more in store for the medical cannabis program, and the July 12 meeting is the next big step for the plant in New Mexico. The creation of a working group to begin crafting a recreational cannabis bill in the legislative off-season is another.
Lujan Grisham formed a task force at the end of June to pursue recreational cannabis. Led by Albuquerque City Councilor Pat Davis, its other members include Javier Martinez, D-Albuquerque, who sponsored last session's recreational cannabis bill; Picuris Pueblo Finance Director Les Rubin; Emily Kaltenbach of the Drug Policy Alliance; and various other attorneys, legislators, cabinet secretaries, business leaders and healthcare professionals. The goal of the working group, according to a statement released by the governor, is to "ensure we begin the next session with a credible, equitable and cohesive legalization proposal that will incorporate all public safety concerns, workplace regulations, labeling requirements that protect underage children and all manner of other issues."
"I want New Mexico's introduction and management of recreational cannabis to be the envy of the country," the governor added. "We can and will incorporate lessons learned from other states so that New Mexico provides for a well-regulated industry that, crucially, does not infringe on or harm our expanding medical cannabis program, upon which so many New Mexicans rely."
Davis agrees that preserving the medical program is crucial to a potential adult use bill.
"We can't have patients lose access to medicine, those strains that have been developed," Davis tells SFR. "The last thing you need is to have a seizure medication that works for you and then have it become unavailable because your supplier decided to switch all their efforts to adult use."
But Davis is optimistic about a future legalization bill's chances.
"The governor, on the last day of the session, set one priority: legalizing cannabis," Davis tells SFR.
He believes elements of the previous legalization bill made it unpalatable to advocates, and that time simply ran out for the legalization bill. The proposal made it further than such a bill has ever gotten during a session of the New Mexico legislature before dying in the Senate committee process.
And that progress proved that something seen as radical only a decade ago has legs.
Avoiding the pitfalls that befell the last legalization bill is a big reason for the task force: Davis says that presenting a coherent piece of legislation to the statehouse and providing plenty of time to iron out details is a primary focus of the task force. That's crucial because the Legislature's next session is a short one—just 30 days.
Another positive move for cannabis during this year's session was a bill that reduces penalties on unlicensed marijuana possession. It took statewide effect on Monday, so those caught with small amounts of marijuana and who don't have a prescription will get off with a small fine and a "civil penalty." The previous structure imposed $1,000 fines and carried the possibility of jail time.
But rec still languished, despite positive effects in other states. For example, since it legalized recreational use in 2014, Colorado recently hit the $1 billion mark in tax revenue from cannabis sales—all of which is used for state projects like education and road maintenance.
One of the other positive externalities of medical cannabis is the mainstreaming of the plant as a treatment. The reduction in stigma cannot be understated. Cannabis is rapidly shifting from something associated with stoner culture to a legitimate field of medical study and a legitimate business operation.
"This is a medical operation," says Chavez, of NewMexiCann. "We operate under more restrictions than most places do. I know when I first got my card, I was skeptical of the medical industry." But his skepticism has been assuaged. "The opioid epidemic has started to decrease. It's real. The research is there. It's not just something that everyone wants to help. It's not a placebo effect. There's actual medical benefits."
The opposition, according to Harris, the patient who used cannabis to rid herself of opiates post-surgery, says that the fears surrounding the plant are ungrounded.
"There's people on the Right who say it's a slippery slope: cannabis into opioids or cocaine or meth," Harris says. "No! No. No."