ST. PAUL — Patti McArdell needs medical marijuana to ease her aches and depression, but she has to pay $400 out of what little money she has each month to get it.
Paul Johnson would have to spend at least three times that to treat his intractable pain, so he buys his marijuana illegally at half the price.
Patients in Minnesota’s medical cannabis program and even those who designed it point to this as its main flaw. It is too expensive for those who need it. It is a money loser for those who grow and sell it. And it is leaving people in pain with few options: pay up, enter a risky illegal market or take addictive opioids that are covered by insurance.
Last year alone, more than 3,400 new patients dropped out of the program, state data show.
McArdell’s pain is both physical and mental. The ligaments that keep her joints in socket are like stretched-out rubber bands, forcing her to stiffen her body to hold them in place. Her depression can make getting out of bed as hard as walking through “knee-deep mud.”
With medical marijuana, the 55-year-old St. Paul resident has found relief in a single drug.
“I really truly believe it saved my life,” said McArdell, one of more than 15,000 Minnesotans who are certified to use medical marijuana.
“(But) the price of it is ridiculous," she said, echoing a complaint shared by nearly two dozen current and former patients who spoke to the St. Paul Pioneer Press.
The high costs have not turned big profits for the state’s two producers, who have lost millions in their first years in business. Leafline Labs and Minnesota Medical Solutions say they cannot lower their prices until regulatory burdens are struck from the law.
Minnesota’s medical marijuana law, which was passed in 2014, is widely seen as one of the most restrictive in the country. The plant form of marijuana is banned, leaving only pills and oils for the patients with one of 13 severe conditions who qualify.
“We’ve done the best that we can within the framework of the legislation that we were given,” said Michelle Larson, former director of the Office of Medical Cannabis within the Department of Health. “It’s expensive, we know that. … There are legislative issues that have not been addressed, and we know constituents have brought them up.”
As the debate over full legalization continues at the Capitol, some argue that lawmakers should focus on a medical program that has struggled since its launch.
The costs start early
The costs pile up before patients even enter the program.
First, they must find a doctor who will certify their condition. Then comes the enrollment fee, which is $200 unless the patient is on medical assistance, in which they could pay a reduced fee of $50. Patients must repeat this process each year.
If sticker shock has not set in yet, it may when patients walk into one of the state’s eight medical marijuana dispensaries.
At Minnesota Medical Solutions, product prices range from $29 to $299. At Leafline Labs, they run from $28 to $228. Both manufacturers offer customer loyalty programs and 15 percent discounts for patients who receive medical assistance.
Patients said they spend anywhere from $200 to $700 per month on the medication. The costs could be offset if insurance companies covered medical marijuana, but they will not do so until the federal Food and Drug Administration approves it, according to the Minnesota Council of Health Plans.
The Department of Health surveyed nearly 800 patients in 2016 and found that 86 percent said the drugs are at least somewhat unaffordable.
Health Department data also show that more patients are dropping out of the program than are staying in. Fifty-four percent of patients who enrolled in the program in 2017 did not re-enroll the next year.
“The patients have been programmed out of this,” said Paul Johnson, a former medical cannabis patient from St. Paul who now buys his marijuana illegally. “Make it affordable (and) I’d (re-enroll) in a heartbeat.”
A black market alternative
Johnson, 51, has a genetic nerve disorder in which 27 tumors are impinging on his spine. His doctors had him on 22 prescription drugs at one point and were ready to put him into an assisted-living facility.
He ditched the pills for medical marijuana but could not afford the $1,400 worth of medicine he needed each month for his pain.
Johnson now buys an ounce of marijuana a week from a dealer who soaks the plant in medicinal oils. He smokes every few hours to ease his pain.
“Within a minute … I can feel my whole body, from my shoulders down, just relaxing,” Johnson said as he released a billowing puff of smoke inside his St. Paul apartment on a recent weekday. “And that relaxation, I believe … gives my body the opportunity to stop fighting itself and recover a little bit.”
Like Johnson, some patients go around the law to buy more of the drug they say helps them the most.
Not only is marijuana cheaper on the street, but it also comes in its true form, which the program does not allow.
Patrick McClellan, a 51-year-old medical marijuana patient from Bloomington, buys it through the program and from a dealer. He uses marijuana to treat his mitochondrial disease, a rare form of muscular dystrophy that brings on bouts of crippling muscle spasms.
“The medications are awesome — they are just way too expensive," McClellan said. "It’s just not possible for me to ... use that alone.”
‘There's opiates, there's cannabis’
Those who do not want to buy on the black market turn to prescription drugs to supplement their medical marijuana use.
For patients in pain, that often means opioids.
Abuse of the highly addictive painkillers caused the deaths of more than 400 Minnesotans in 2017. Drug overdose deaths are on the rise in Minnesota and across the country as opioid addiction has reached epidemic levels.
Yet opioids, which are covered by insurance, are a more affordable option for those who need to manage chronic pain or illnesses.
“There’s just not a good option. There’s opiates, there’s cannabis …” said Sarah Wellington, a St. Paul school teacher who has multiple sclerosis.
When Wellington takes opioids, she is less engaged with her husband and three kids. When she uses medical marijuana, her head is clear and her pain and muscle spasms are "severely diminished."
Dr. Adam Locketz of Timewise Medical has certified about 2,800 patients at his clinics in Lake Elmo and Hibbing. Hundreds of those patients have used medical marijuana to wean themselves off opioids and other drugs, he said.
Low-income patients are not as lucky, said Dr. Jacob Mirman, who has certified more than 1,600 patients at Life Medical in St. Louis Park. They often leave his clinic with opioid prescriptions because that is what their government assistance pays for.
"And the patients who can afford it get the better drugs, meaning cannabis,” Mirman said.
From seed to sale
The state’s two medical marijuana producers say they cannot lower their prices until the Legislature revises parts of the law that make it hard to do business.
Under current law, Leafline Labs and Minnesota Medical Solutions are charged with running all supply-chain operations — growing the plants, processing them into pills and oils and selling them in stores.
And because of a provision in the law, the companies are not allowed to write off their business expenses. This has led to high operating costs that get passed on to patients.
“That tax burden, it’s drastic,” said Bill Parker, CEO of LeafLine Labs. “And it does cut into profits, and it affects everything.”
The two producers lost a combined $11 million in their first two years in business. Financial documents obtained by the Pioneer Press show that Minnesota Medical Solutions turned a small profit in 2017, while LeafLine Labs lost another $5.3 million.
The companies will post losses again in 2018, according to their CEOs. LeafLine Labs has invested about $20 million in the business to date.
“There’s been a lot of money invested and there hasn’t been a lot of money made in this market with less than 20,000 patients annually,” said Jay Westwater, CEO of Minnesota Medical Solutions. “There are some fundamental issues with the highly regulated program that the Legislature enacted.”
‘IT JUST WAS NEVER GOING TO WORK’
It has been almost five years since Minnesota legalized medical marijuana.
The strict law was the result of a compromise between the DFL-controlled House and Senate and former Gov. Mark Dayton.
There were two proposals on the table:
- A House bill that mirrored the program in place today.
- A Senate bill to establish a network of growers and 55 dispensaries that could have served up to 38,000 patients a year.
Dayton said he would only sign a bill that law enforcement and physicians could live with; some doubted the drug’s effectiveness and others worried it would pave the way for full legalization. So lawmakers sent him a compromise that resembled the House version.
The impact of that decision is not lost on former Republican state Sen. Branden Petersen, who co-authored the Senate bill. He voted against the compromise.
“It just was never going to work from the very beginning,” Petersen said. “Right now, we’re not helping many folks and those that we are doing it at a high cost.”
Not much has changed since, other than the addition of new qualifying conditions. A task force charged with evaluating the program had not met in two years before its latest meeting in January.
Some state lawmakers are pushing to improve the program this year, but it is too early to tell if the bills have enough support to pass through both chambers. Party leaders in the House and Senate have signaled support for changes.
Wellington, the patient and St. Paul school teacher, argues that now is the time to address these issues; marijuana is on the minds of many as advocates push for full legalization.
“These two issues are integrated,” Wellington said. “This is the time for changing the medical program.”