For Kirk Root, the relief seemed like it was nearly instantaneous when he tried medical-grade cannabis for the first time. The 30-year-old Orlando, Florida, resident has a number of medical conditions, including cerebral palsy and epilepsy.
“I got on my crutches and strolled across my living room floor,” he told Weedmaps News. “I'm usually rolling around in a wheelchair because the pain in my leg is so bad. Thanks to cannabis, I'm able to function like a normal person.”
And it was with the help of a Florida-based organization, Rainy Day Foundation, that Root was able to afford the required doctor's recommendation and the cost of his state medical cannabis card. Root relies on federal Supplemental Security Income of $770 a month to live. The cost of a doctor's visit and a medical cannabis card — about $325 on the low end — would have eaten up nearly half of his monthly income. That doesn't even include the cost of the actual medicine.
“Most people that do find medical cannabis helpful end up spending $200 to $300 a month,” said Dr. Julia Arnsten, chief of the Division of General Internal Medicine at Montefiore Medical Center, located in the Bronx, New York, amid some of the poorest congressional districts in the United States. “When you tell them they're going to have to spend at least $100 to even get enough medical cannabis to determine whether it's helpful for them, many of the patients just start crying. They say, 'Are you kidding me? Where am I going to get $100?' It's unfathomable to them to be able to spend that kind of money.”
Medical marijuana patients who count on disability income can find their medicine can account for a sizable chunk, if not most, of their monthly budgets.
As a result, Arnsten said patients sometimes underdose to stretch their medicine or return to taking opioids that are covered by insurance. Montefiore is affiliated with Albert Einstein College of Medicine in New York, where Arnsten is a professor. A soon-to-be-published review of about 350 of their medical cannabis patients found that only half were able to purchase the cannabis they needed due to such factors as high costs, a lack of access, and transportation issues.
More Legal Cannabis Doesn't Always Mean More Access
Thirty-three states have broad medical cannabis programs and 11 states, plus Washington, D.C., also have legalized adult-use programs. But for low-income patients, the barriers are numerous and mounting.
In some states where adult-use programs have come online, there have been precipitous drops in participation in medical cannabis programs, by as much as 50%, according to Cristina Buccola, an attorney, advocate, and adviser in the cannabis industry. Many patients who were previously in the medical program find that adult-use dispensaries suit their needs, despite limits on purchasing and dosages, but there are others who can't afford additional costs.
“What ends up happening is if medical dispensaries in the state program are not somehow incentivized to continue their operations, they phase out,” she said. “You end up creating these incredible cannabis deserts for patients.”
Similarly, as states put limits on THC amounts in edibles and other products, the regulations created another access barrier for low-income medical marijuana patients, according to Buccola. “If it's $30 for a 100-milligram candy bar and someone needs upwards of 1,000 milligrams, are they going to spend $300 a day? That's ridiculous,” she said. “Those limits absolutely do hurt low-income patients.”
A new study by Arnsten found that adult-use dispensary customers aren't buying cannabis just to get high, but rather to treat medical ailments. Of 1,000 Colorado dispensary shoppers surveyed for the study, 65% use cannabis to relieve pain and 74% use it for better sleep. A majority of those surveyed claimed it helped them reduce the use of other medications.
“Our motivation for conducting this study was that there are numerous anecdotal reports of people getting help for insomnia, pain, and a variety of other conditions from cannabis purchased from adult-use dispensaries,” Arnsten told Weedmaps News.
In California, the situation for low-income patients worsened when adult-use legalization enacted in 2018 created burdensome new requirements. Long-standing compassionate care programs that had been providing free or low-cost medical cannabis to needy patients were required to pay state taxes on donated cannabis, forcing many to shut down. SB 34, which would apply to cannabis donations, is currently making its way through the California Legislature to remedy the situation. A similar bill was vetoed by then-Democratic Gov. Jerry Brown in 2018.
According to a 2017 University of Arizona College of Public Health study, “Structural barriers in access to medical marijuana in the USA — a systematic review protocol,” cannabis use skews toward wealthier, working patients. The study found that “medical marijuana use is more common among individuals who are employed, have health insurance, and earn high incomes.” Many expenses, some obvious, some hidden, that are associated with medical cannabis programs contribute to the disparity.
Notably, medical marijuana isn't covered by insurance and buying it requires payment in cash, according to Mary Lynn Mathre, the president and co-founder of Patients Out of Time, a national nonprofit organization dedicated to medical cannabis education. “We get calls all the time from people asking for help who do not know who to turn to,” said Mathre, a registered nurse.
Besides the initial doctor's visit, the medical card, and price of the medicine, there are the costs accrued by cannabis companies that often end up getting added on at the consumer end. Mathre said those passed-along costs include the initial outlay for the business license, security, and testing. Cannabis businesses also cannot take federal tax deductions that other businesses enjoy because cannabis is listed as a Schedule I substance, she said.
Patients also must bear the cost of transportation to and from dispensaries, an often overwhelming barrier for many low-income patients, according to Arnsten. Many of her patients have to take multi-leg bus, train, and subway rides, or a costly car service. One of her elderly patients spent $200 in a month on travel to dispensaries. Lack of access compounds the problem: The Bronx is a “cannabis desert” because it is served by a single dispensary for a borough with 1.8 million residents, Arnsten said.
Further, access is worsened when dispensaries and distributors are unable to obtain a license because regulators are slow to issue them, or cities and counties ban cannabis businesses outright.
A small group of state nonprofits has arisen to help reduce the costs for patients to acquire medical marijuana.
Easing the Cost Burden
Two years ago, Montefiore launched a practice aimed at low-income patients to evaluate patients for medical cannabis participation in New York's program. “Through Montefiore Medical Center, we were able to start this practice embedded within primary care so patients don't have to go to a special place to see a doctor,” Arnsten said. “We now have that going at five different sites.”
Montefiore's program is just one of a loose patchwork of agencies, nonprofits, city governments, and other entities providing a modicum of financial relief for low-income medical cannabis patients.
The foundation has helped “thousands of people” over the years, Angel said. Among its various charitable efforts, the nonprofit has provided moving expenses to whom Angel calls “medical refugees,” families who have had to move to states with less restrictive cannabis laws in order to get the medicine they required.
“There was a financial need because there's no insurance reimbursement available to these families,” Angel said. “We're really just bridging the gap.”
Rainy Day Foundation, a nonprofit started in February 2019 helps low-income, disabled Florida residents pay for doctor's referrals and the $75 cost of the state's medical cannabis card. The organization has helped 10 patients so far and has a waiting list of 400, according to Morgan Haas, who helped found the nonprofit.
“We're just getting started,” Haas said. “Our waitlist is growing exponentially. The need is there.”
The organization was founded to help others in situations similar to Haas. The 38-year-old has been treated three times for cancer and has osteoporosis, arthritis, neuropathy, and other medical issues. He lives on $860 a month in Social Security Disability Insurance.
Root, who is Rainy Day Foundation's treasurer, was also its first beneficiary. “That's kind of the whole mission of Rainy Day, to provide access to patients like myself who are in that weird income bracket where the need for medicine is there, but the cost is too much.”
Angel said he believes the need for organizations like his have expanded with the increase in cannabis availability.
“There used to be arguably more compassion in the gifting of product,” he said. “As it's become more commercialized, there's less leeway for companies to do that, especially with some of the regulatory limitations that are enforced. If there isn't some kind of third party helping these people, they get left on an island,” Angel said. “And that's not fair.”
Feature image: The high costs of cannabis, in addition to doctor's fees, medical marijuana card fees, and transportation to pick up the medicine are keeping marijuana out of reach for low-income and disabled patients. (Photo by Weedmaps News)