COLUMBUS – All of the pills Bo Emery takes to stay alive, to keep his muscle spasms at bay, to prevent his legs from snapping backward, can’t be contained in a single plastic serving bowl.

A year ago, Emery was healthy, except for what he thought was gout in his leg. Four months later, the 51-year-old was in a wheelchair and consulting with a long list of doctors about the ways his body was attacking itself.

Doctors still haven’t figured out exactly what’s happening, but they say Emery suffers from Stiff Person Syndrome, a rare autoimmune disease.

There’s one drug that makes everything bearable: cannabis.

But Emery had to go 11 days in October without it because of the tight controls Ohio officials have put on medical marijuana purchases. One of those controls is expected to be tweaked to prevent what Emery went through, but it won’t take effect for several months.

Meanwhile, patients are turning to the unregulated black market or Michigan stores to get their medicine. That frustrates Ohio’s medical marijuana businesses, many of which are still trying to recoup their initial investments.

The pharmacy board says the restrictions prevent anyone from ever going over the 90-day supply limit, even accidentally, which would be illegal.

But the result has been the opposite: Patients rarely come close to the limit and told The Enquirer they regularly can’t get what they need.

Counting to 90

Ohio’s medical marijuana law limits patients to a “90-day supply,” in part to prevent marijuana from being diverted to non-patients or children. The exact amount was decided by the Ohio Board of Pharmacy, which oversees medical marijuana dispensaries and the patient registry.

The board enlisted the help of pharmacists to determine a limit based on average levels of THC, or tetrahydrocannabinol. The compound is known for generating a “high” but also used to treat pain, suppressed appetite and other conditions.

The board set a limit of 8 ounces of marijuana over 90 days, or 5.3 ounces of higher potency marijuana, citing research that shows effectiveness and safety diminish with greater amounts of THC. They also set a minimum amount that could be sold – one-tenth of an ounce, or 2.83 grams of dried flower, which fits inside a canister the size of a baby food jar.

‘Fuzzy’ math

A medical marijuana recommendation doesn’t work like a regular prescription.

For starters, the 90-day clock starts as soon as the doctor makes the recommendation in the patient registry and 90 days is a “use it or lose it” amount.

If you wait a week to finish registering for your card or make your first purchase, you’d only be able to buy 83 days worth of product. Wait a month and you’d only be able to buy 60 days.

But the clock doesn’t totally reset on day No. 91. The 90 days is also a rolling amount so whatever was purchased in the previous 90 calendar days also counts against what patients can buy.

That’s created a situation where patients are waiting days or weeks for past purchases to “fall off” before they can buy anything more.

Dr. Solomon Zaraa, a Cleveland-area psychiatrist certified to recommend medical marijuana, said “fuzzy math” has made the program unnecessarily difficult. Zaraa said he’s never heard of a patient buying the max.

“It seems like no matter what, the patient always comes up short,” Zaraa said. “The patient always gets less than what they expected.”

This information is supposed to be available on a patient ID card website. But patients told The Enquirer their count is frequently incorrect. Some have resorted to calling the pharmacy board to find out how many days they have left before making what can be a long trip to the nearest dispensary.

A pharmacy board spokeswoman said the agency is working with the software vendor to fix the problems with the website.

There’s one other quirk that has forced Emery and others to go days or weeks without their medicine.

Finding what works

Emery had never used cannabis before. He bought smaller amounts to experiment with different strains of cannabis to find the right combo of THC and CBD, a therapeutic cannabis compound.

Problem is, the smallest amount doesn’t divide equally into 90 days, so the state rounds up. Each 2.83 gram container counts as a two-day supply. Two tenths? That’s four days. But the same amount of cannabis in one container counts as only three days.

Emery quickly racked up days, despite being well under the 90-day limit. He bought about 1 ounce in the span of 60 days before he was locked out of the system. He was told he’d only be able to buy 2.6 ounces total in his first 90 days.

Medical marijuana isn’t covered by health insurance, so patients are paying out of pocket, usually with cash, for their medicine. The only time a patient can buy a full 90-day supply is within the first five days of a doctor’s recommendation. But at an average price of $330 an ounce, that could cost more than $3,000.

Patients on fixed incomes, like Emery, can’t afford to regularly buy larger amounts.

“Why should a person be penalized for not being able to buy what they need?” Emery said. “What do you think they’re doing? They’re turning to the street – they have to.”

Pharmacy fix

None of the patients who have shopped at Ohio Cannabis Company in Coshocton have bought their 90-day supply at once, according to co-owner Brian Wingfield. On a Monday in December, 17% of the patients who walked into the dispensary couldn’t buy what they wanted or even make a purchase.

The rounding problem emerged in the weeks following Jan. 16, the first day Ohio sold medical marijuana, as patients returned and were confronted with a lot of math.

Businesses lobbied the pharmacy board for months for a change. The board of pharmacy announced in December it wants to change the minimum amount to 2.52 grams, which equals 1/90th of 8 ounces. This way, every container will equate to a number of days.

Wingfield said that will resolve problems for many patients: “One day is one day and that’s an easy concept.”

The change likely won’t take effect until March at the earliest – three years after the pharmacy board first proposed the limits.

The board says it has no plans to change the “use it or lose it” restriction.

That was made to prevent someone from buying a lot of marijuana close to the expiration date of their recommendation, pharmacy board patient and caregiver liaison Grant Miller said. Without a valid recommendation, possessing marijuana is a crime.

“It’s a safeguard so patients, even unwittingly, don’t go outside their 90-day supply,” Miller said.

The pharmacy board couldn’t provide information about how many patients have actually bought a full 90-day supply. But Miller said a lot of patients get to the full amount over 90 calendar days after their first few months in the program.

More complicated than other states

Marijuana remains illegal federally. Each of the 33 states that has legalized medicinal cannabis set different limits for how much patients can buy.

For example, Alaska limits patients to 1 ounce per transaction. Other states range from 2.5 ounces per month (Connecticut) to 24 ounces at a time (Oregon). Pennsylvania limits patients to a 30-day supply; the exact amount is left up to the patient and the dispensary pharmacist.

New Mexico has the same limit as Ohio – 8 ounces of marijuana over three months. But the state uses a common unit – 1 gram – and only restricts purchases to 230 units less what was bought in the last 90 days.

William Wainright of Toledo was locked out after buying 25 days of product. Wainright, 25, said it would be easier for him to drive 20 minutes to Michigan than deal with Ohio’s restrictions.

Dispensaries there accept out-of-state patient medical marijuana cards, and a handful of stores are selling for recreational use. But once that product crosses state lines, it’s illegal under Ohio law.

“I don’t think there should be a limit,” Wainwright said. “It’s marijuana. It’s not a narcotic.”