On Sept. 22, 2014, the first delivery of medical cannabis was delivered to The Healing Corner in Bristol, Connecticut; later that same day, the store made the Marijuana is regulated as a schedule II drug — codeine and oxycodone fall into this category as well — and can only be purchased with a medical recommendation and from a licensed pharmacist at a dispensary.

 

THE PROGRAM

Connecticut’s Medical Marijuana Program, operated by the Department of Consumer Protection, is one of 23 such programs in the nation. It consists of four producers, six dispensaries and over 5,000 patients in the state.

It is one of the first programs in the nation to follow a pharmaceutical model, said Jonathan Harris, commissioner of the DCP. Marijuana is regulated as a schedule II drug — codeine and oxycodone fall into this category as well — and can only be purchased with a medical recommendation and from a licensed pharmacist at a dispensary.

The model, developed in 2013, has brought together state-certified growers, dispensaries, physicians and patients. Dispensaries apply for licenses, while physicians licensed to practice medicine in Connecticut certify patients who suffer from a designated debilitating medical condition. The list of conditions has grown since 2013 to accommodate petitions from patients.

When applications for dispensary licenses first opened up in September 2013, the DCP received 27 submissions. From those, the first six dispensaries in the state opened in Bethel, Branford, Bristol, Hartford, South Windsor and Uncasville, with four growers selected from 16 applications statewide to supply the dispensaries.

Now, as patient demand has increased across the state, the DCP is soliciting applications until Sept. 18 for up to three more dispensaries. Laurie Zrenda, owner of Thames Valley Alternative Relief, a dispensary in Uncasville, has noticed an increase in the number of interested patients — in her first days of operation last year, she saw around eight patients per day. Now, she sees 40 to 50 patients per day and her total patient count has increased from 188 to 715.

“It’s going to be tough to avoid longer wait times when a dispensary starts getting over 1,000 patients,” Zrenda said. “As the population increases, we’re going to have to start opening more.”

Zrenda’s dispensary serves the New London area, and her patients travel as much as 45 minutes from towns in northern and eastern Connecticut. But people in southwestern Connecticut — Greenwich or Stamford, for instance — often face long commutes to the nearest dispensary. The target areas for new dispensaries are in New Haven and Fairfield counties, where there has been a rise in demand, Harris said.

 

THE PATIENTS

Marijuana has become a part of Tracy Gamer-Fanning’s daily routine. Gamer-Fanning, who was diagnosed with a brain tumor in 2006, uses medical marijuana to alleviate the pain and shaking on her left side, where she was once paralyzed.

Her use of the substance began before medical marijuana was legalized in Connecticut. Her doctor, Andrew Salner, suggested that medical marijuana might be a better treatment than her daily regimen of eight Percocet tablets, which she said made her feel isolated.

Salner gave her a prescription for Marinol, an FDA-approved cannabinoid with synthetic THC, but noted that the actual drug would be more effective, with the disclaimer that it was illegal. Later that day, a friend came over to Gamer-Fanning’s house with some marijuana. Gamer-Fanning smoked it and she has been a firm advocate of the drug ever since.

Legalization of the drug for medical use in Connecticut has allowed Gamer-Fanning and similar patients, who previously purchased marijuana from street dealers, to obtain their medication in more dignified and safe ways, she said.

“It’s a relief to use the medicine without feeling like I’m going to get arrested,” she added.

During the early months of the MMP, Zrenda observed a similar trend of patients flocking to the MMP after years of treating themselves with marijuana illegally. The adjustment to the legal drug can be difficult for some of these patients, she added, since they are used to the more potent marijuana strains that they are used to handpicking from dealers.

Across the state, the number of certified patients has jumped from 1,681 in September 2014 to 5,357 in August 2015. With this increase over the past year, Zrenda’s patient demographics have expanded to include more “marijuana-naïve” patients who are looking for alternate options to treat their illnesses.

“The word is out that [medical marijuana] is available, and the numbers are growing,” Zrenda said.

 

THE PHYSICIANS

When registration for the MMP opened last year, Salner, a radiation oncologist and director of The Helen & Harry Gray Cancer Center at Hartford Hospital, was one of the first physicians to register.

Since the MMP began, Salner has certified 50 patients for the program. He said cannabis is not effective for all patients with debilitating illnesses. Most patients, he has found, respond well to conventional medications. But, he recommends medical marijuana to those who have exhausted conventional treatments or are experiencing debilitating side effects from their medications.

Salner is one of a minority of physicians in Connecticut who have embraced the MMP. When registration initially opened, only 108 physicians registered to certify their patients for the program. The number has been steadily increasing, Harris said, and as of the end of August, there are 257 physicians registered. That, though, is still a small number compared to the total number of physicians in the state.

In June, the DCP began a campaign to increase awareness of the program. Harris said conversations with patients and physicians showed that many people were not aware that Connecticut has a legalized medical marijuana program, an observation that Gamer-Fanning echoed based on her interactions with patients.

“We wanted to make sure that doctors were aware of the program,” Harris said. “They have access to another tool in their tool kit, if they choose.”

The campaign used public service announcements on the WNPR radio station, Web advertisements on sites frequented by physicians and print ads in medical journals.

However, Salner thinks there’s more to do to increase use of the program among doctors. Physicians often hesitate because, technically, prescribing marijuana — even in a medical context — is prohibited by federal law. But, they are not officially prescribing it to patients; instead, they are recommending it, and federal law will not prosecute physicians working within the constraints of a state program.

“A lot of obstacles include trying to remove the myths about it,” Salner added. “We need to take away the stigma of marijuana being a street drug.”

Many physicians are reluctant to recommend medical marijuana because of a lack of scientific evidence in support of the drug, said David Emmel, an ophthalmologist and the legislative chair of the Connecticut State Medical Society. He added that much of the rationale behind using medical marijuana is anecdotal.

Emmel said it is also concerning that medical marijuana is not subject to the same FDA standards to which other pharmaceuticals are held. The purpose of these trials is to ensure the efficacy and safety of drugs, he added, so physicians are wary of recommending marijuana without this information. Doctors also do not know what the active ingredients in marijuana are, he said, so they don’t have a basis for dosage instructions.

Salner agreed that clinical trials could help convince many physicians. However, marijuana is still a schedule I drug at the federal level, so there is no funding for FDA-approved trials.

Gamer-Fanning said that success stories such as her own are a powerful tool in educating physicians. Her doctors at the Yale Brain Tumor Center have mixed feelings about her use of medical marijuana, but are watching her progress carefully.

“People are more open and asking more questions,” Gamer-Fanning said. “Anything that moves progress forward is positive.”

In 2012, Connecticut became the 17th state to legalize medical marijuana.