Kolmac Outpatient Recovery Centers

Editor’s Note: The Natalie M. LaPrade Maryland Medical Cannabis Commission recently voted on Stage One license pre-approvals for 15 growers and the first 15 processors. The names of these entities will be released and posted to its website on August 15. It is against this backdrop that I wanted to share my recent experience visiting a recreational cannabis store in Washington State.

During a June vacation trip to the state of Washington, I took a tour of “Paper and Leaf,” a recreational cannabis store on Bainbridge Island, to learn first-hand about how the process was evolving in a state that appeared to be addressing the issues of medical and fully legalized cannabis in an orderly and thoughtful way. Here are five things that I learned during my brief visit.

1. The level of knowledge by the staff about cannabis, albeit based more on experience than science, made me aware of how I as a physician have been disadvantaged by the curtain of ignorance so effectively created and maintained by the Drug Enforcement Administration. The staff was welcoming and business-like, discussing details about the experiences to be expected from the use of the well-displayed and clearly labeled products that were offered for sale.

2. The distinction between medical dispensaries and recreational outlets is being dissolved. The Liquor and Cannabis Control Board (formerly the Liquor Control Board) has so tightened regulations that some of the medical dispensaries are being closed and others are transitioning into recreational stores. Physicians’ recommendations will no longer be necessary, and the staff at recreational stores are receiving training on how to advise patrons about using cannabis for medical purposes. The tax structure is being altered so as to eliminate the previous price differential between medical and recreational products that had created a gray market around the medical cannabis products.

3. The labeled THC concentration of some of the cannabis strains was as high as 25 percent, with even higher concentrations available in wax and other preparations. Strains with high CBD levels, for medical purposes, were being offered and were more expensive than the higher THC strains because of production costs. They even offered the “Charlotte’s Web” strain developed by the Stanley brothers in Colorado, made famous by Sanjay Gupta’s “Weeds” documentary.

4. The prediction about the expected size of the market for recreational cannabis, based on estimates of the level of illegal use, had been inaccurate. The volume of legal sales is far exceeding expectations.  

5. Regulatory activity by the state is very active. The Control Board has installed numerous surveillance cameras and conducts frequent site visits as well as “sting” operations, sending in under-aged customers. The store owners were very aware of the importance of addressing the issues of product contaminants and accurate labeling of contents if their businesses are going to remain viable.

In regard to relaxed laws about cannabis, Nora Volkow has said, “That train has already left the station.”  I tend to agree. The issues now are 1) how well the process will be managed, 2) how the discrepancy between state and federal law will be addressed, and 3) how to deal with intoxicated driving, particularly when cannabis and alcohol are combined.

Other important matters to track will be whether:

  • the under-aged use of cannabis will increase
  • we will see a decrease in social disorder
  • the tax revenue will meet expectations and how the money will be used

These issues are tied to overarching concerns about how much an increase we will see in the incidence of cannabis use disorders and what the impact will be of the entry into the market of large scale commercial, investor-driven businesses. I will continue to follow these issues and would be interested in hearing from you about any first-hand observations as they evolve.

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