Forced into the Black Market On July 1, Washington State's medical marijuana market disappeared. Here's why the most needy patients will likely suffer.

A life or death situation: Meagan Holt worries that recreational stores won’t carry the full plant extract oil that her daughter, Madeline, relies on to control her seizures. Michael Scott

On July 1, Washington State's medical marijuana dispensaries and collectives officially closed, leaving only state-licensed recreational stores to serve patients. This is a result of the Cannabis Patient Protection Act (SB 5052), which is perhaps the most egregious bit of doublespeak ever. The law does not protect patients. In fact, evidence suggests that it will put the state's most vulnerable patients at risk.

Both the Washington State Liquor and Cannabis Board and the Washington State Department of Health—the state's two regulatory agencies that govern the new medical cannabis system—have stated that they believe the only difference between medical and recreational use is the intent of the user. Essentially, that the needs of the medical market can be just as easily served by the recreational market. If only that were true.

Under the new system, the state's 1,500-plus dispensaries and collective gardens will disappear. To make up for the loss, the state issued just 222 new retail licenses.

That will directly impact patients such as Madeline Holt. She's three and a half years old and has a terminal genetic disorder that gives her frequent seizures. According to her mother, Meagan Holt, doctors didn't believe she would live this long.

"I was told on April 10, 2015, to take my child home for one more night before she died," said Holt. "Then I tried cannabis, and she's still alive." Not only is she alive, but her seizures have become less frequent since she started taking cannabis on a daily basis. While Holt says she still gives her daughter conventional drugs to counteract the seizures, cannabis is an essential part of her medical regimen.

"The importance of this medicine is life or death for Maddy," said Holt. Madeline takes a minimum dose of 90 mg of CBD oil and 40 mg of THC oil to treat neuropathic pain, muscle spasms, and other issues. The oil she takes is a very specific formulation referred to as full extract cannabis oil or FECO. It is prepared by Deep Green Extracts, a medical oil extractor, and donated to Maddy completely free of charge. (The medical cannabis community, despite being portrayed as "99.2 percent a criminal enterprise" by certain lawmakers, was often extremely compassionate.)

The situation is a precarious one, however, and Holt fears that the changes brought about by SB 5052 will threaten it. For one, she's worried that she won't be able to find the same products on the recreational market. "When you go into a rec store, you cannot find the oil that Maddy uses," said Holt. "Patients like her who rely on the medication that is in the dispensaries, it's not even available. We don't even have the option to go to recreational." While medical patients benefit from both THC and CBD in different ways, they're in particular need of high-CBD products, which can often be in short supply in the recreational market.

"There is no retail cannabis store that could keep a supply of what we need," said Holt. "I would be in there weekly getting all of the FECO that they have, I'm sure." While it's not yet clear whether Holt's assertion is true, the current climate around CBD seems to support her view.

Although SB 5052 allowed growers to expand their canopy area in order to help meet the new demand of the medical market, it did not require them to actually grow high-CDB product. Last week, I traveled to farms around the state to see how much CBD product is growing, and it wasn't promising. At Emerald Twist—a farm in Goldendale whose general manger, Jerry Lapora, is a longtime grower from the Oregon medical market—only about 6 percent of its canopy is dedicated to high-CBD cannabis. Lapora said the farm has discussed selling its CBD plants to Seattle-area processor botanicaSEATTLE for full-plant oil extraction, but those plans are in their nascent stage. Indeed, Chris Abbott, a partner at botanicaSEATTLE, said that sourcing was the biggest hurdle to getting new medical products to market.

"We plan to make these medical products," he said, "but it's vital that we can source a sufficient amount of pure and clean CBD plant material to serve the patient base. That has proven to be difficult in this market that has largely focused on high numbers of THC." Indeed, market pressure has made it very difficult for growers to add CBD to their portfolio.

Alex Cooley, the vice president and cofounder of Solstice, which began as a producer/processor of medical cannabis and has transitioned to recreational, had similarly dismal news: "When Solstice was operating its medical facility, 20 percent of the facility was always CBD rich [or CBD pure]. In adult use we have grown less than 2 percent with our partner farms and are about to harvest our first CBD-rich crop in our separate adult-use facility. This summer we have really bet on people wanting CBD since the two systems have been Frankensteined together." And that's a big bet. Lapora, of Emerald Twist, said he's still sitting on his 2015 harvest of CBD. Cooley and others may grow it, but there's no guarantee the patients will come. Indeed, they may not be able to afford to.

While pot grown and sold through the legal market comes with certain benefits—legality, safety, ostensible purity, et cetera—it's also more expensive. The requirements of "medically compliant" cannabis—which all higher-dose medical products will have to meet—will inevitably add to the overall cost of production. Although patients are eligible to buy their cannabis free of sales tax, many likely will not get that discount because they are required to sign up for the new patient registry to receive the benefit, and many aren't doing so for privacy reasons. Even if they do, the sales tax is a mere 9 percent of the cost. The marijuana excise tax, which they are still required to pay, is 37 percent.

"Even when we started looking into cannabis," Holt said, "the price that it cost to keep up with her medicine was unattainable. We knew we would need a community to surround us to help us. That community is shrinking really fast, and that's what's scaring me."

Holt's greatest fear is that, due to an inadequate supply of affordable medicine, she'll be forced to get hers illegally. "It's not necessarily the day of July 1, it's what happens after July 1," she said. "What happens after August when it starts cooling down and everybody starts running out? I've heard of people starting to stockpile medicine. I can't really do that. I can't afford to do that, so I'm forced into the black market and forced to just hope that I have people who will help us. Another sad reality of our situation is that my child is living on borrowed time, I'm her only caregiver, and I'm living on a fixed income."

Holt receives her daughter's medicine for free, but those types of donations will likely become less frequent in the highly regulated, highly taxed recreational market. Deep Green is getting a recreational license, but in order to continue to give free cannabis to Holt, the business would have to either sell it to a retailer at a 100 percent loss so that the retailer could give it away for free or sell it to the retailer at cost so the retailer could take the loss. Given that most legal cannabis businesses are struggling to stay afloat, it's hard to imagine that even the most noble-hearted ganjapreneur will give away product. Without donations, low-income cannabis patients like Madeline Holt are basically screwed.

While the market could adapt in a variety of interesting ways—fundraising drives for patients, increased cultivation of CBD plants, a legislative fix on taxes, sensible regulatory action—patients are going to suffer in the meantime. In Megan Holt's case, that means putting herself at risk of criminal prosecution to get necessary medicine for her daughter.

"I need clean medicine, and I'm going to do whatever I have to do to save my child's life," Holt told me. "That's really what this is about. I'm saving my child when the medical community gave up on her. They were out of options. I found an option, and I'm not going to let my child die because a few people in the legislature decided to strip us of our rights. I know what I'm doing is right."