Cheryl Tuttle was thrilled when she first heard there was momentum at the Iowa Capitol to update the state's medical marijuana program.

Under the existing law, the 63-year-old retired nurse from Urbandale can use capsules, creams and oils containing THC — the chemical that makes recreational marijuana users high — to treat severe back and leg pain caused by arthritis and curvature of the spine.

But Tuttle said the law’s 3% cap on THC in such products prohibits her from getting full relief. She had hoped lawmakers were on the brink of passing a bill that would replace the percentage cap with a gram measurement that could give some products more potency.

Now, with perhaps just days left until this year's legislative session ends, Tuttle fears lawmakers could wind up further limiting how much THC she can obtain. “I’d probably be better off if they just leave it the way it is,” she said.

The state’s medical marijuana law is still in its infancy after being enacted in 2014. It was expanded in 2017 to include a manufacturing and dispensary system, but there are conflicting ideas about how to develop it.

On one end are patients like Tuttle, who argue Iowa's program is too restrictive about the THC potency of allowable products, hindering their relief. That's echoed by marijuana manufacturers who warn the law isn't designed to make their business financially viable in the long run. At another end is a state advisory board, created under the expanded 2017 law, that's run primarily by physicians who give recommendations to lawmakers about the program and are leery of quickly expanding it.

Earlier this month, that board recommended removing the THC percentage cap and replacing it with a THC limit of 4.5 grams over a 90-day period. That’s drastically more restrictive than a limit of 25 grams of THC in a 90-day period that the Republican-controlled House approved nearly unanimously last month.

The advisory board members sent a letter to Gov. Kim Reynolds and lawmakers explaining their recommendation. The board said a 25-gram limit for 90 days would allow "an extremely large amount of THC for a medical program that seeks to avoid becoming a recreational program." The board said such a loose limit could make physicians reluctant to certify patients for the program.

Lucas Nelson, general manager for MedPharm, said he was disappointed by the advisory board's April 16 recommendations, which include a lower THC ratio cap for minors. The company, which is the state’s first licensed medical marijuana manufacturer, had sent the board a letter detailing how Iowa's THC cap compares with limits in other states. Nelson supports the House-approved bill, with the 25-gram limit.

"What we've been trying to bring to the table is that voice for our patients and saying, 'Here's what we're seeing in our actual dispensaries. Here's what we're seeing from real patients, real Iowans,'" he said. "...That should be an important part of the discussion, too," he said.

For Tuttle, the board’s recommendation would translate to about 50 milligrams of THC a day, that's less than a third of what she’s legally taking now.

Tuttle said the marijuana-derived medication she takes from MedPharm has helped her cope with constant pain after her doctors weaned her off most of the prescription painkillers she used to take. “It takes the worst of the worst of the edge off,” she said.

Tuttle said she rarely leaves the house because she has so much trouble getting around. She said she spends about $1,000 per month on MedPharm products. The company contends such customers wouldn’t have to buy so much medication if producers were allowed to make stronger versions.

The bill is sitting in the Republican-controlled Senate. Sen. Brad Zaun, an Urbandale Republican who supports the higher 25-gram limit, said he doesn't want to change the bill, which would force it to go back to the House.

"Our time is running out," he said. "I don't know what exactly we'll do. ... My goal is to get it on the Senate floor and send it right down to the governor."

Sen. Mariannette Miller-Meeks, R-Ottumwa, attended the medical advisory board's April 16 meeting to get more context about members' views on the THC gram recommendations.

Miller-Meeks, who is a physician, said she doesn't know how she'll vote, but indicated she understood the board's reasoning.

"Our program is a new program," she said. "Sometimes it helps to go slow so that you know what you're doing, you know what the effects are."

Over in the House, Rep. Steven Holt, R-Denison, has dropped his support for the 25-gram limit, which he voted for just weeks earlier.

Holt said he only voted for the bill because he was under the impression that the advisory board had recommended the 3% limit be changed to 25 grams over 90 days. In fact, at that point, the board had voted unanimously to leave the 3% THC limit in place. A day after the House voted for the bill, one of the board members quit in protest.

Holt said if the Senate bounces the bill back to the House, he’ll vote to lower the THC limit to reflect the board's new 4.5-gram recommendation. If the Senate sends the bill straight to Reynolds, Holt said he’d contact her office to personally request that she veto it.

“We're way over what the medical board believes is safe, and that was not our intention when we passed the legislation," Holt said. "Had we known that, we would not have passed it.”

Reynolds was noncommittal at a news conference this week when asked about the bill.

For now, people like Tuttle feel stuck. If the state tightens the limit on THC she can buy legally, she would like to move to a state with fewer restrictions. But she said she needs to stay in central Iowa to be near her elderly father and her husband’s mother. She said she’s considered buying marijuana illegally to obtain more THC for less money. She chuckled at the prospect, however.

“I have been a goody-two-shoes nurse. I wouldn’t even know where to get it,” she said.

Barbara Rodriguez covers the Iowa Statehouse and politics for the Register. She can be reached by email at bcrodriguez@registermedia.com or by phone at 646-385-1212. Tony Leys covers health care for the Register. He can be reached by email at tleys@registermedia.com or by phone at 515-284-8449.