In the midst of the COVID-19 maelstrom, the recent shuttering of nonessential stores has created concern around access to cannabis, particularly for medicinal cannabis consumers. Those who depend on cannabis for therapeutic purposes will be relieved to learn that across the US, medical cannabis dispensaries have been deemed essential services, comparable to pharmacies.

As of March 26, 2020, the Marijuana Policy Project (MPP) reported that they were not aware of any jurisdictions where medical cannabis dispensaries have been ordered to close temporarily. In counties such as Denver, care has been taken to specify that while recreational dispensaries will close, medical dispensaries will remain exempt. Most state government agencies seem to be acutely aware of medicinal patients’ needs.

But even with the reassurance of ongoing access to medical dispensaries, a host of other questions have arisen: How can immuno-compromised patients safely access cannabis supplies without endangering their health? Is hoarding or stockpiling supplies prudent in light of soaring cannabis sales across the US?

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A letter of outreach co-signed by the Marijuana Policy Project, the Epilepsy Foundation, the Veterans Cannabis Project, and Doctors for Cannabis Regulation has urged legislative leaders of medical cannabis states to move to protect medical consumers.

The letter asks governors to enable online ordering, facilitate contactless cannabis delivery, allow patients to consult with physicians by telemedicine, and extend the expiration date of medical cannabis cards to diminish the burden on those patients. 

So, what is the current state of affairs?

How has access to cannabis changed to protect the immuno-compromised?

One of the most pressing concerns for medical cannabis patients is how to get access to supplies while safeguarding health. A large proportion of medical cannabis patients live with chronic illnesses that inhibit their immunity, rendering them more vulnerable to COVID-19 and its potential complications. Setting foot in a dispensary, even when observing protocol to social distance by six feet, can pose a real risk to health.

Most states with medical cannabis dispensaries are acutely aware of this danger and have responded by enforcing stringent, interim measures to protect patients. 

Online ordering and delivery

In some states, orders can be placed over the phone or online and then delivered directly to a patient’s home. 

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States with dispensaries that currently offer home delivery for medical patients include:

• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Florida
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Montana (some localities)
• Nevada
• New Mexico
• New York
• North Dakota
• Oregon
• Pennsylvania
• Rhode Island
• Vermont

Although Oklahoma and New Jersey do not yet offer delivery options, this may change shortly.

Telemedicine

Telemedicine is now increasingly offered in most states with medical cannabis programs and enables those who need it to consult with doctors to receive treatment recommendations without leaving home. That being said, the majority of states offering telemedicine are enabling virtual encounters for renewals, but not for initial appointments.

States temporarily allowing telemedicine consultations for medical patients during COVID-19 include:

• Alaska (renewals only)
• Arizona (renewals only)
• California
• Colorado
• Connecticut
• Delaware (renewals only)
• Florida (renewals only)
• Hawaii (renewals only)
• Illinois (renewals only)
• Louisiana (renewals only)
• Maine
• Maryland
• Massachusetts (renewals only)
• Michigan (renewals only)
• Minnesota (renewals only)
• Missouri
• Montana (renewals only)
• Nevada
• New Hampshire
• New Jersey
• New Mexico (renewals only)
• New York
• Ohio
• Oregon (renewals only)
• Pennsylvania
• Rhode Island
• Vermont (renewals only)
• Washington (renewals only)
• Washington, DC (renewals only)  

Curbside collection

Curbside collection has arisen as a useful, temporary stop-gap for dispensaries that do not offer delivery (or offer delivery yet) and need to enable safe patient access to cannabis. Patients or their designated caregivers can place an order online then head to a dispensary where a dispensary employee will deliver the cannabis to their vehicle. 

According to the Marijuana Policy Project and other news sources, these states are offering curbside service for medical patients:

• California (some counties)
• Colorado
• Connecticut
• Delaware
• Illinois
• Maryland (which recently opened a medical dispensary drive-thru) 
• Michigan
• New Hampshire
• New Jersey
• New Mexico
• Oklahoma
• Oregon
• Pennsylvania 
• Rhode Island
• Vermont
• Washington

States that are not identified in this list may be changing or clarifying their position daily, so it’s worth checking in frequently.

Increased sanitation protocols

Across the board, dispensaries that remain open are dramatically stepping up hygiene measures to minimize the spread of COVID-19. In some states, online pre-ordering is mandated. 

In dispensaries that remain open, social distancing of six feet is enforced at all times. The increased cleaning of surfaces has been implemented, the use of personal protective equipment is encouraged, and smell jars have been eliminated.

“Similar to grocery stores, some dispensaries have implemented special hours for the elderly or more susceptible patients,” said Howard Lee, CEO of SōRSE, a hemp extract and terpene emulsion technology company.

Ethan Anderson, Senior Vice President of Marketing for iAnthus, which holds dispensaries across the US, confirms that moves have been rapidly implemented to ensure increased sanitation in dispensaries and production facilities as well.

“iAnthus manufacturing employees continue to follow hygiene protocols and implement proactive strategies to minimize exposure for patients,” said Anderson. 

Increased sanitation of common area cleaning and touchable surfaces has been enforced, and a limited number of patients are allowed in the store at any one time.

“All employees are required to wear a new pair of sanitized gloves whenever near or in contact with products,” said Anderson. Only team members who are 100% well are permitted to attend work.

What about non-medical consumers who use cannabis for medical purposes?

Medical cannabis patients are not the only consumers of cannabis for therapeutic purposes—a proportion of recreational consumers also use cannabis to treat illness or pain.

In states where adult-use and medical cannabis are both legal, some patients have allowed their medical cards to lapse as many products are now available at the recreational level. Others rely on cannabis for medical reasons but have been able to source it recreationally, thus avoiding the registered patient route. 

These individuals sometimes cannot afford to see a doctor to register for a state program, or choose not to due to the wariness of formally registering for the use of a product that remains federally illegal.

These individuals may find access to cannabis challenging during the lockdown. For this reason, some advocates are recommending that any moratorium on recreational dispensaries be lifted.

Watch this space to see if it changes.

What’s happening with cannabis supply?

The mandate across a sweep of US states to shelter-in-place has sent cannabis sales skyrocketing. “The virus has absolutely triggered a surge in demand for cannabis products in the past two weeks,” affirmed Lee. 

There is concern that supplies may run out or that the reduced workforce carrying out harvest and extraction tasks may slow supply. The Marijuana Policy Project has urged state authorities to enable quick hires in the event that dispensaries are short-staffed by waiving standard requirements such as identification cards.

But the unpredictability of the current situation means there’s no conclusive answer. “We’re doing everything we can to maintain operational capabilities while continuing to put the safety of our employees and patients first and foremost,” said Anderson of iAnthus.

“Some of the supply chain issues we face are consistent with other healthcare professionals across the country, such as access to cleaning supplies and protective gear, which is now in high demand and therefore difficult to procure.”

Dispensaries may face a challenge in keeping sufficient product on the shelves to meet customer needs. “Some retailers worry that if the legal supply of cannabis dries up, then people may turn to the black market for products, especially in a state like California where the black market has a strong grip on the marketplace,” said Lee.  

What about patient possession limits?

Patient possession regulations may change. In Pennsylvania, for example, physicians can now recommend a 90-day supply, an increase from the standard 30-day restriction. In Massachusetts, the state has recommended patients with financial means to purchase their full two-week supply rather than making multiple trips. 

Such recommendations may become more common in other states in the bid to reduce the movement of people and the spread of COVID-19. 

How can I stay updated with what’s happening in my state?

Check in regularly with Leafly or your state’s Department of Health or cannabis regulatory bodies or commissions. Many states and counties are increasingly using social media channels such as Twitter to release updates at pace.

Emma Stone

Emma Stone is a journalist based in New Zealand specializing in cannabis, health, and well-being. She has a Ph.D. in sociology and has worked as a researcher and lecturer, but loves being a writer most of all. She would happily spend her days writing, reading, wandering outdoors, eating and swimming.