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Everything You Need to Know About Legalized Medical Marijuana in Hawai‘i

After 15 months of nail-biting delays—and 17 years after the state decriminalized pot for patients—medical cannabis is finally available for legal sale. Who does it help? How does it work? Is this the crop that will replace sugar? And, if it is, who profits?


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Medical marijuana

photo: courtesy of aloha green

 

Hannah Metsch was 7 years old when her mother, Shana, decided to give her medical marijuana. “We had heard about CBD, or cannabidiol,” says Shana, “but never dreamed of using it on our very young and medically fragile daughter.”

 

Hannah’s seizures had started shortly after birth. Consultations yielded a diagnosis of partial epilepsy and infantile spasms, and prescriptions for more than a dozen antiseizure medications. But they left her groggy and failed to slow the attacks, which take a toll on the developing brain; she was still having hundreds a day, ending up back in the hospital.

 

“We needed to do something different to save her life,” says Shana, a real estate agent on Kaua‘i. “We asked her doctors how much more medication Hannah could take before the [drugs] killed her and they didn’t know. We were in fear every day that she could pass.”

 

Hannah and mom

photo: mallory roe

 

With seizures coming from both sides of her brain, surgery was deemed too dangerous; the family turned to alternative medicine, including a vagus nerve simulator and a low-carb diet. When they didn’t work, CBD was next. After trying CBD for the first time at age 7, Hannah’s seizures slowed in just 24 hours.

 

Today, Hannah is 11 and almost completely weaned from antiseizure medications. She suffers from the consequences of the medications and damage created by the seizures, but her daily functioning is not affected by CBD. “We are finally able to see Hannah thrive and have the energy to work on her life skills, school and therapy,” says Shana. Instead of the groggy, sedated child they knew, “We finally got to meet our daughter.”

 

“We are finally able to see Hannah thrive—we finally got to meet our daughter.”
—Shana Metsch

 

Meanwhile, a veteran who suffered major bodily and traumatic brain injury, Michelle Tippens, has also been getting reacquainted with her old self thanks to medical cannabis. Tippens has PTSD, pain and neuropathy, which she treats by smoking cannabis—something she tried when her brother used it during his cancer chemotherapy. Tippens had 28 different prescriptions, with the green light to take up to “85 pills a day. They were literally meals,” of pills. Today, completely off prescription meds, she is healthy to the point that, when she parks in a handicap spot, she gets hassled. “People say, ‘You don’t look sick to me.’”

 

Tippens and Metsch are holders of a Hawai‘i medical-marijuana 329 card, obtained from a physician who certified them for a qualifying condition. Their doctors are presumably among the 76 percent who approve of medical-marijuana use, according to a 2013 study in the New England Journal of Medicine. As of 2000, and the passage of Senate Bill 862, if Tippens and Metsch could obtain cannabis, they could smoke it, take it as a capsule, bake it, apply it as a lotion or drip a drop under the tongue.

 

There was only one problem. The state Legislature never set up a legit way for patients to purchase pot. “There was no legal way to get marijuana,” says state health director Dr. Virginia Pressler. Patients could grow a limited number of plants, but not possess seeds for growing. An ad hoc system evolved—“No one asked where it came from,” says Pressler—but prosecution was always possible. For Hannah’s parents, the fear was that, if that happened, they might lose their daughter to foster care—and so they relocated to Colorado for her first treatments.

 

It’s hard to imagine this is what the Legislature wanted. But a second unintended consequence was to turbocharge an already healthy black market: By 2006, Hawai‘i was the fourth-largest producer of (illegal, of course) marijuana in the U.S., its 2.35 million pounds trailing California (7.9 million pounds), Tennessee (2.9 million) and Kentucky (2.7 million), and Hawai‘i was the No. 1 exporter, too, according to drugscience.org, a research and advocacy group.

 

After a decade of controversy, a 2011 legislative push, backed by Big Island Sen. Kalani English, proposed legalizing the growth of medical marijuana and its sale from “compassionate care centers.”

 

The Politician Who Came Around

The plan put forward by English and other advocates had a homespun, sincere quality. We already grow it; there are people who use it for medical complaints. Why not take medical marijuana out of the shadowy black market, slap a tax on it to make politicians happy and, as a nice by-product, plant the seeds for a new legal industry—and, down the road, tourist attraction?

 

“Hawai‘i is a state known for its ridiculously tasty and potent cannabis,” opined a reposted 2011 blog on English’s webpage titled “MMJ Tourism in Hawai‘i?” High Times, the venerable stoner rag, noted the progress of Senate Bill 1458, which “could eventually permit medical marijuana patients from the Mainland to partake of strains like Pineapple Express while on vacation.” Slam dunk!

 

Medical marijuana

Photo: Courtesy of Aloha Green

 

But that bill went up in smoke. Part of its demise was due to an attempt by Sen. Josh Green to eject patients whose complaints he considered subjective, including pain and muscle spasms. To Green, an ER physician at Kohala Hospital, only cancer, M.S. and neuromuscular disorders would’ve counted.

 

Green’s concerns arose, he said at the time, from 2011 Narcotics Enforcement Division statistics that showed a one-year jump of 1,500 cards and a large number of young people obtaining them. “Sadly,” he wrote in a public posting, “over 50 percent of those prescribed medical marijuana are under age 30, with no concrete diagnosis ... 97 percent of scripts statewide had no medical diagnosis other than pain or spasm, which is not medically sound practice.”

 

A parent of two young children, Green admits he is “an outspoken guy. And I can be wrong.” By the time a new bill rolled around, in 2015, Green was also an evolved guy. “As a doctor, I see extreme value in having medical marijuana available,” he now says. “If we honestly feel marijuana doesn’t hurt anyone, as I do, then, as long as young people aren’t smoking it, let’s legalize it for recreational use.”

 

“As a doctor, I see extreme value in having medical marijuana available.”
— Sen. Josh Green

 

What changed his mind? Seeing patients in pain, he says. Walking his district, Kona-Ka‘ū, also known for its marijuana output, and talking to local law enforcement. “They say, ‘We don’t worry about marijuana, we worry about the hard stuff.’”

 

And yet, after the January 2015 passage of SB 321, sponsored by Rep. Della Au Bellatti, Green sparked another conflagration in a medical cannabis working group. As co-chair, he balked at a merit-based system of choosing who would be allowed to open dispensaries. Instead, he proposed letting anyone grow.

 

The system—which is the one Hawai‘i ended up with—only allows a tightly regulated number of dispensaries, eight so far, that can grow the cannabis they sell. This would squeeze out longtime local growers, Green felt. And merit-based selection, he says, was a code word for awarding legal licenses to a favored few.

 

“In my opinion,” Green says now, “they were going to set the rules up to fit the big players who were bidding. I thought it better to let anybody” grow and sell. Interestingly,
Pressler had a parallel concern. Worried about meeting demand, she says, “We originally wanted 26 dispensaries.”

 

In the end, Green was removed as co-chair of the medical cannabis working group. Then the Legislature extended its session to accept the process that is now in place.

 

Medical marijuana

Dana Ciccone of Steep Hill Hawai‘i, the first lab to qualify for marijuana testing in Hawai‘i, and Chris Whelen, Hawai‘i state lab director.
Photo: Aaron K. Yoshino

 

After a rocky 15 months, on July 31 of this year, the last obstacle to the opening of a dispensary was removed, when the health department certified the first lab, Steep Hill Hawai‘i, whose job it is to test the cannabis for microbes, contaminants, pesticides, solvents and potency before it goes to market.

 

On Aug. 8, the first dispensary, Maui Wellness Group (doing business as Maui Grown Therapies), received approval to open its doors. At the head of the line of customers bearing their 329 cards was 74-year-old Fred Rickert.

 

Three days later, the first O‘ahu dispensary, Aloha Green, ran out of cannabis, followed by Maui Grown Therapies. “They’d been sending us pretty small batches to test,” says Steep Hill CEO Dana Ciccone. “One, two and three-pound batches. You can run through nine pounds pretty quickly.”

 

The Providers Who Waited

For the licensees, the announcement couldn’t have come a moment too soon. Four were up and running, paying salaries, growing, harvesting—and couldn’t sell even a leaf. Meanwhile, the entire establishment, business as well as government, seemed to be competing in a red-tape rodeo to see who could hog-tie the cannabis trade.

 

On July 15, the date the Legislature originally set for dispensaries to open, Helen Cho, director of strategy for licensee Aloha Green of O‘ahu, expressed the fear other licensees soft-pedaled: “If this goes on for a few more months, the financial hole that we’re in may be too deep for us to recover from.”

 

It was a long way from their euphoria at the awarding of dispensary licenses in April 2016. “When they announced our group Lau Ola,” wrote Big Island farmer/entrepreneur Richard Ha on his website, “it was like we were watching the Super Bowl and somebody scored a touchdown.”

 

The excitement reflected Hawai‘i’s lack of game-changing economic opportunities. The eight that won out, over a field of 58 applicants, bested former Honolulu mayor and prosecutor Peter Carlisle, software mogul Henk Rogers and actor Woody Harrelson.

 

Medical marijuana

Brian Goldstein of noa Botanicals.
photo: courtesy of noa botanicals

 

The list of eight read like the cast of a Hawai‘i reality show. There was a former pineapple CEO (Maui Wellness Group’s David Cole of Maui Land & Pineapple); farmer Ha (Lau Ola); a serial entrepreneur who’d turned around an aquaponics shrimp business in Kona (Brian Goldstein of Mānoa Botanicals, since renamed Noa Botanicals); a son of a longtime Kaua‘i home grower (Justin Britt of Green Aloha); a former head of the state’s Department of Business, Economic Development and Tourism, partnered with the head of the investment arm of Island Insurance Co., who sits on the rail board (Richard Lim and Colbert Matsumoto, of TCG Retro Market 1); a Native Hawaiian venture capitalist paired with a Silicon Valley icon, originally from Kapahulu (Bill Richardson and Vernon Oi of Hawaiian Ethos); a group advised by Dean Okimoto of Nalo Farms, also chairman of the board for the Hawai‘i Agricultural Foundation (William Mitchell Jr. and Robert Wong of Pono Life Sciences); and an O‘ahu partnership that scored highest in the selection process (Thomas Wong and Charles Lee of Aloha Green).

 

Citing profit margins, Ha had already quit raising his award-winning tomatoes the year before and pinned his hopes on a license. “I was elated, and then I thought, ‘Holy smokes.’ It’s a huge deal, and I am thinking about the big picture.”

 

Indeed, the existence of something bigger than the medical market hinted at a tidal shift to come. “Hawai‘i has this built-in brand in marijuana,” says Justin Britt of Green Aloha, Kaua‘i’s sole dispensary. “We’re known for having the best.” Britt knows of what he speaks, coming from, he says, “a multigenerational family business,” in pot. (His memories of weeding his father’s 3.5-acre plot are not entirely fond, adding he thought “marijuana was evil” growing up.)

 

Medical marijuana

Left: Family photo of Justin Britt’s grower father.; Right: Justin Britt in the Green Aloha grow room.
photos: courtesy of justin britt

 

By 2017, delays mounted and licensees met resistance on several fronts. “The regulators in Hawai‘i have terrorized the local banks to the point that they won’t accept any money,” says Bill Richardson, CEO of Hawaiian Ethos, a Big Island dispensary. Son of the state Supreme Court justice the law school is named after, Richardson had a long career as a venture capitalist on the Mainland. His partner, ‘Iolani grad Vernon Oi, “became one of the lead scientists at Stanford doing monoclonal antibodies, DNA testing and modification. He actually made Stanford over a billion dollars from his research.”

 

In other words, here were two of Hawai‘i’s finer minds, reversing the brain drain and having the door slammed in their faces. “I’ve had a couple of personal bank accounts closed because they don’t want affiliation with this so-called illegal drug,” says Richardson.

 

To be fair to Hawai‘i’s bankers, the issue is a national one that has effectively turned cannabis dispensaries into all-cash businesses. The shutout is driven by the fear that handling proceeds of a Schedule I controlled substance could make federally chartered banks and financial institutions vulnerable to a charge of money laundering.

 

But there are more than 300 banks willing to take legal cannabis money on the Mainland. “I mean, banks are in the risk business,” says Goldstein, of Noa Botanicals. “It’s what they do.” Richardson says he may overpay his dispensary taxes in cash in order to get back “clean” money via a refund check.

 

The state armored car contractor, Loomis, announced it would refuse dispensary cash. The state insurer, HEMIC, dropped worker’s compensation. “What happened with the HEMIC board still rankles me,” says Sen. Rosalyn Baker, chair of the health committee, who also backed HEMIC’s charter. “They were created to be the insurer of the last resort. We’ve given them all kinds of research into medical cannabis. There is a Department of Justice amendment to the Controlled Substance Act, the Cole Amendment, that stipulates that, if any states are using their own laws to regulate medical marijuana, the DOJ can’t use federal funds to intervene.”

 

But the real sticking point was the state’s delay in certifying any of the three independent labs that are supposed to test the batches of marijuana. Back in April, Keith Ridley, chief of the health care assurance department, graciously took the hot seat at a gathering hosted by the Hawai‘i Dispensary Alliance, a cannabis advocacy group. “We anticipate at least one certified laboratory before summer,” he said, according to minutes of the session. “Maybe by April 30, May 31.”

 

“I disagree that labs will be available by summertime,” responded Michael Rollins, chief administrative officer of PharmLabs. “We have been working with DOH for over a year on our application. We are now taking steps backward, not completing the issues at hand.”

 

At a lengthy mid-July sit-down with HONOLULU, the Health Department went into depth about the process. Early in 2015, the state looked at other states’ best practices, before settling on Oregon’s 56-element testing regimen. Then they asked state agricultural experts for a list of Hawai‘i-specific pesticides to test for. The profile grew to 70 compounds, more than any other state.

 

The major difficulty is that marijuana is a plant—a millennia-old, evolving botanical which features up to 483 natural chemicals of which 113 are cannabinoids—and not a manufactured pharmaceutical with a predetermined molecular profile, one which is always the same. For comparison, Advil has one active ingredient, ibuprofen, and 11 inactive (the compounds which make up the pill and its color, preservatives, etc.). Of its 113 active ingredients, cannabis has two that draw the most attention: tetrahydrocannabinol or THC, which gets you high, and cannabidiol, or CBD, which doesn’t, although it does have pharmalike effects. One of the most intriguing aspects of cannabis is the interaction of its many elements; working together, they seem to be what makes it effective and easy for the body to absorb and tolerate without side effects.

 

Studies are few, however. “Everything is complicated by the fact that cannabis is still illegal,” says Pressler. If you can’t obtain test samples, you can’t do studies—it’s the law.

 

At least the Department of Health had gone through a similar fire drill in an effort to certify oyster farming in fishponds at Kualoa Ranch and elsewhere. It took 18 months, and “an intense federal recertification and training process,” according to the National Oceanographic and Atmospheric Administration fisheries website, to bring oysters to market in 2014.

 

An oyster, while considered an aphrodisiac by some, is not a medicine or a pharmaceutical. But holding pot to higher standards is a national trend. Steep Hill Labs, which has successfully opened in six states, recently called for stricter standards in several, including Washington. “I was recently talking to an officer in a state I won’t mention and they’re desperately trying to get control of their testing,” says Pressler. “They don’t have the rules that we do.”

 

Medical marijuana

 

King Cannabis?

If certain proponents have their way, and make a successful push for adult recreational legalization, King Cannabis could be our new cash crop.

 

“It’s been on my mind ever since sugar cane went away,” says Britt, Kaua‘i’s licensee. “Wow. That was a big part of what Kaua‘i was and what Hawai‘i was. Now those jobs are gone. That is the new vision for cannabis. Nowhere else in the U.S. can you grow all year long. Given the cost of the end product, I really believe we could create a sustainable industry and provide 10,000 or more jobs in Hawai‘i.”

 

Even if adult use doesn’t come to pass right away, a workaround is already in place across the U.S.—the idea of reciprocity, where states honor each other’s medical cannabis cards. The dispensaries are eager to beef up their slim operating margins—serving Hawai‘i’s current 18,000 cardholders doesn’t appear to be very lucrative, especially since dispensaries are limited to serving specific islands. But what if they can leverage the cardholders who may visit as tourists?

 

“We could get 100,000 cannabis visitors to the Big Island,” says Richardson. “If we’re allowed to sell to medical-card tourists from California, Washington, Florida, that multiplies our market by a factor of 10.”

 

Make no mistake, cannabis is big business. Sales are up from $4.6 billion in 2014 to $5.7 billion in 2015 and to $6.7 billion in 2016, according to Forbes. In one year, the cannabis sector—29 states and the District of Columbia approve medical use, and eight of those approve adult use—“grew an unprecedented 30 percent,” Forbes wrote.

 

So what are we waiting for?

 

“There has not been an honest discussion,” says Green. While politicians and many in the public are eager to put the tax windfall to work paying down public-worker pensions, filling potholes, air-conditioning schools—whatever sounds good—Green says few seem to take seriously the social damage a pot-based economy could wreak.

 

Green and others worry kids may see marijuana as further legitimized and smoke at ever-younger ages. “The population most affected by cannabis use are those with developing brains,” says Dr. William Haning, professor at the John A. Burns School of Medicine at the University of Hawai‘i, director of the M.D. programs for the medical school and director of addiction psychiatry and medicine residency training programs. “Kids from 12 to 17 in age, who are still amassing brain mass, seem to develop unremitting problems in later life.”

 

Richardson agrees: “I’m actually not in favor of recreational legalization. I see all the problems with our younger generations, where it can lead to other, bigger problems. And there are other unintended consequences.”

 

One of those consequences—the economic equity one—is equally fraught, in the opinion of Green and the homespun grower and user communities. Right now, medical pot is legal if grown in small amounts for personal use. As SB 321 is written, however, the exemption for medical cannabis is to be phased out in 2023.

 

This gives credence to Green’s fear of a protected category of cannabis suppliers, who, under the guise of regulation, can ask law enforcement to drive their self-growing competition out of business. “I do worry about a slick political trick when and if it is legalized for recreational use,” says Green. “That they will make it legal, but you have to buy it from a dispensary. If that happens, then it was a rigged game for the powerful to bid on these licenses.”

 

Still, even if his worst suspicions were to come to pass, he wouldn’t count out his grower constituents. “Nobody’s going to drive 50 miles to go to a dispensary,” he says. “There are plenty of guys on the Big Island who have plenty of experience growing pot. They’ll rely on their own abilities. And the Big Island will probably end up the leader of the marijuana universe.”

 

His next step? “I’m going to float a legalization bill next year.”

 


 

Who does it help?

Though technically illegal on the federal level since 1970, and a felony at that, cannabis is cautiously touted by the federal government’s own National Institutes of Health website for cancer, as reportedly effective against seizures, nausea, anxiety and pain. In Hawai‘i, illnesses approved for receiving a medical card include cancer, glaucoma, M.S., HIV/AIDS, PTSD, Crohn’s Disease and cachexia (wasting disease). More general claims are made for well-being by a dozen advocacy organizations, including using cannabis as a painkiller instead of opioids.

 

What’s allowed?

A holder of a 329 card, obtainable from a physician, is allowed to buy 4 ounces of cannabis every 15 days per certified user or certified caregiver. Prices are not regulated, but are expected to run from $300 to $400 a month. Purchases are tightly controlled by tracking software; patients won’t be able to go from dispensary to dispensary. Nor will they be able to buy rolling papers, prepared joints, bongs or other paraphernalia. Or brownies. “The dispensary I visited in Colorado,” says Sen. Rosalyn Baker, health committee chair, “they had all kinds of edibles, premixed shakes, candies that looked like the finest truffles. We’re not going to have any of that.”

 

Medical cannabis in the workplace

Medical marijuana

If you plan on using medical cannabis and then showing up for work the next day, or even month, be forewarned. Any requirements an employer may have about drug use in the workplace are not changed or affected by legalization. The physician’s certification is not a prescription. If your employer or union forbids pot, then even the Americans with Disabilities Act won’t save your job if you test positive for medical marijuana, which does tend to stay in the system for days, and longer, in trace amounts. And don’t even think of using it at work. There is one benefit to legalization, however; you may be fired, but you won’t be arrested.

 

Forget flying with cannabis

Medical marijuana

Anyone with a 329 card can buy legal cannabis at any dispensary, but if you’re visiting a Neighbor Island, don’t plan on taking any home—because you “can’t legally fly with it over international waters,” says state Health Department director Virginia Pressler. That means federal, not state, regulations apply, with marijuana possession subject to Schedule I felony prosecution.

 

HAWAI‘I’S MEDICAL MARIJUANA PATIENTS

NUMBER OF PATIENTS BY COUNTIES

Medical marijuana

 

BREAKDOWN OF PATIENTS BY GENDER

11,512 
male

6,065
female

11 
male to female

03
female to male

 

BREAKDOWN OF PATIENTS BY CONDITION

Severe pain: 15,416

Muscle spasms: 3,144

PTSD: 1,463

Severe nausea: 1,179

Cancer: 941

Cachexia: 448

Glaucoma: 332

Seizures: 316

HIV or AIDS: 119

SOURCE: HAWAI‘I DEPARTMENT OF HEALTH​

 

READ MORE STORIES BY DON WALLACE

 

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