Bill Kedia

Dr. Bill Kedia, founder, chief medical officer and head of research at Terrasana, displays some of the medical marijuana products for sale at the company's Garfield Heights location. While business overall is steady, state regulations on advertising and delays in building the state's marijuana production infrastructure has hampered sales, he said.

After several fits and starts along the way, medical marijuana became available to patients with doctor recommendations at dispensaries throughout Ohio beginning in January. Six months later, the program is running fairly smoothly but there is still room for improvement, industry officials said.

According to the Ohio Board of Pharmacy, doctors have given 42,372 recommendations for medical marijuana with 35,162 recommended patients registered and 20,074 unique patients purchasing medical marijuana at licensed dispensaries as of May 31. Veterans make up 2,677 of the patients, 1,434 patients have indigent status and 385 patients have a terminal diagnosis.

Dr. Bill Kedia, a primary care physician with offices in Summit County, said the state system overall is working well with its expected bumps along the way. Business has been steady despite state regulations that hamper how dispensaries market themselves, said Dr. Kedia, founder, chief medical officer and head of research at Terrasana, a dispensary with locations in Garfield Heights, Columbus and Fremont. Another location is scheduled to open this month in Springfield.

“I think part of the issue is we’re not allowed to advertise significantly which is a huge problem, but again those are the state regulations so what are you going to do?” Dr. Kedia said. “We’re not allowed to do direct advertising,” he explained. “We can’t give away any kind of merchandising material.”

Ohio Board of Pharmacy data shows that medical marijuana sales have reached $9.68 million as of June 8, with 1,181 pounds of plant material and 12,152 units of manufactured products sold. Plant material averages $42 per tenth of an ounce, tinctures average $82 per unit, vaping oils average $175 per unit and edibles average $77 per unit.

The medical marijuana products are only available at state approved dispensaries like the one in Garfield Heights. It is not prescribed like traditional medications. Doctors must have special training to write a recommendation for medical marijuana for patients who take it to a dispensary.

Dr. Kedia said when patients go to a Terrasana dispensary, they have their photo IDs and medical marijuana cards validated and compared to the state database in a waiting room. Then they are taken into the dispensary where an employee talks with them about their specific condition and what strains and products of medical marijuana could work best.

“There are strains, there are products available that have very little THC, so much so that you won’t feel a thing but the CBD content, which is the big anti-inflammatory piece, is high enough that will help with your arthritis and your chronic pain, those conditions,” he said. “So getting people to understand that is a big issue.”

Terrasana’s supply is currently made up of mostly dry flower products with a more limited selection of tinctures, oil syringes, edibles, vaporizers and grinders, Dr. Kedia said.

“We’ll have (gummies) for a day or two and it sells out, then we won’t have it for a couple weeks,” he said. “As more processors come online, then we’ll have more supply of things like that.”

Not fully operational

With federal law prohibiting medical marijuana from being transported across state lines, dispensaries are dependent on more of the state-approved businesses opening up. The state program is far from fully operational. Those open for business as of this month include 18 of 56 dispensaries, four out of 39 processors, eight out of 17 Level 1 cultivators and nine out of 13 Level 2 cultivators licensed by the state, according to the Board of Pharmacy. Green Leaf Ohio is in the process of constructing a greenhouse and processing facility on a 7.88-acre parcel in Middlefield, with plans to partially open by October.

Ali Simon, Board of Pharmacy public and policy affairs liaison, said the board is working through various delays with licensed dispensaries to get provisional licensees operational as soon as possible, including reviewing construction schedules, permits and communications with local governments.

“The board is focused on implementing a patient safe and centered program,” she said. 

Board of Pharmacy data shows that 25,834 patients are registered with a chronic pain condition, the most common of the 21 approved qualifying conditions to use medical marijuana products. The age of patients is split fairly evenly, with 10 percent ages 18-29, 20 percent ages 30-39, 21 percent ages 40-49, 22 percent ages 50-59, 19 percent ages 60-69 and 8 percent over 70.

Dr. Richard Silver of Medical Marijuana Physicians of Ohio at Silver Lake Wellness Center in Newbury is certified to recommend medical marijuana and said approximately half of patients for whom he recommends suffer from chronic pain with an average age of 55-60.

“These are people that have confirmed problems in their life that they’re trying to get help for, and so I like to say that our patients are generally not trying to get high but trying to get help,” he said. “People come in and they give you a story.

“So do things make sense when people come in and tell you something? Well, you have to decide that, but most of our patients are older and truly have a problem,” Dr. Silver said.

Working in family practice, addiction and integrative medical work over his more than 40-year career in medicine, Dr. Silver said he sees marijuana as a viable alternative with generally minor side effects for qualifying patients compared to opioids or prescription drugs. He noted that research on the body’s endocannabinoid system is growing exponentially.

“Because marijuana has positive benefits on most of the organs in our bodies, where you can’t say that about alcohol and tobacco or many other drugs, I believe that it’s just logical that for people who we can treat with something less toxic we would want to do that,” he said. “We’ve only known about this system for 20 years which is why we’re just now starting to understand what this could potentially lead to other drugs that work on the endocannabinoid system to improve these other disease problems.”

Qualifying process

Dr. Silver said he and his staff have a thorough prequalifying and interview process and has found the state program to be working well with hiccups along the way including the state website not being the most user friendly and unclear regulations for caregivers approved to purchase medical marijuana for patients who are unable to or have a hard time getting to the dispensaries.

“I was disappointed that there were so many bureaucratic delays,” he said. “On the other hand, I think that anything that’s new if you want to do it right you have to expect that there’s going to be some unforeseen problems that even the best laid plans don’t address, and so all of us need to be tolerant of the problems that we have because we have to work together to make it work.”

Dr. Kedia said despite a lack of supply and restrictions on advertising, Terrasana is focusing on informing the general public on exactly what the program entails and what conditions medical marijuana can help treat. They are planning local educational programs for patients across Northeast Ohio, he said.

“I talk to the people who say, ‘I don’t want to smoke weed,’ or, ‘I don’t want to do that,’ but that’s not what this is,” he said, noting that Ohio’s current program prohibits smoking marijuana but does allow vaping. “This is very different than what you grew up with or you heard about back in the ‘60s, ‘70s, ‘80s, ‘90s. None of that stuff is true about what we’re supplying today and producing today.

“The biggest thing for us is to advise patients, get them to understand and help them to make an informed decision. It’s what I do on a daily basis in medicine. I give them the pros and cons.”

Dr. Silver said he would like to see the medical marijuana program in Ohio continue to expand to include more conditions including anorexia, anxiety and depression. He noted while anxiety linked to post traumatic stress disorder is an approved condition, generalized anxiety and depression is not.

“We’re giving people antidepressants, not everybody responds, so a result of not responding to medication might be shock therapy, electroconvulsive therapy,” he said. “So you’re going to shock the brain, but you’re not going to give them marijuana to try where it might help.”

Recent board action

At a meeting on June 12, the State Medical Board of Ohio voted against adding insomnia, depression and opioid use to the list of approved conditions and indefinitely delayed a vote on adding anxiety and autism spectrum disorder.

Meanwhile at the national level, U.S. Rep. Dave Joyce, R-Bainbridge, introduced the Strengthening the Tenth Amendment Through Entrusting States (STATES) Act of 2019 in April with Rep. Earl Blumenauer, D-Oregon, Sen. Cory Gardner, R-Colorado, and Sen. Elizabeth Warren, D-Massachusetts.

The bill would make federal law not apply to people and businesses complying with state and tribal marijuana laws; make clear that compliant marijuana transactions are not trafficking; continue to prohibit unsafe manufacturing processes, employing minors in marijuana operations and distribution of cannabis at rest areas and truck stops and prohibit sales of marijuana to people under 21 other than for medical purposes. Currently, marijuana operations that are legal by state standards could still be liable for trafficking or money laundering charges according to federal law if using traditional banking systems.

“I’m proud to be a part of the effort in Congress to protect the rights of states across the country, like Ohio, that have voted to implement responsible cannabis policies,” Rep. Joyce said in a written statement. “The current federal policy in this arena has stifled important medical research, hurt legitimate businesses and diverted critical law enforcement resources needed elsewhere.”

While the STATES Act is currently awaiting action in committee, it has gained 52 cosponsors, and organizations including the American Bankers Association, Veterans Cannabis Project, Ohio Bankers League, Epilepsy Foundation and Ohio Credit Union League have endorsed the bill.

“I look forward to continuing to work with my colleagues on both sides of the aisle to get this important legislation across the finish line and ensure states are free to make their own decisions regarding cannabis policies that are best for their constituents,” Rep. Joyce said.

The passage of the STATES Act could also have an impact on increasing the number of certified recommending physicians in Ohio. Some doctors and hospital systems including University Hospitals of Cleveland and the Cleveland Clinic do not allow their doctors to recommend medical marijuana due to the potential legal liability for violating federal law.

“Due to the discrepancy between state and federal law with regard to the legality of marijuana use, University Hospitals employed physicians are not able to recommend the use of medical marijuana at this time,” UH Senior Media Relations Strategist George Stamatis said.

Tim Tedeschi covers the Solon and West Geauga Board of Education, as well as statewide education issues, sports and features. He is a lifelong diehard Cleveland Indians fan and a graduate of Indiana Wesleyan University.

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