On Friday, Iowa’s Medical Cannabidiol Board voted to add chronic pain to the list of qualifying conditions for medical marijuana, substituting it for the previously approved condition of “untreatable pain.” The edit is expected to expand access to the program, but many who are involved with the cannabis industry and its patients in the state are getting frustrated with Iowa’s slow evolution of marijuana policy.

The substitution of chronic pain for untreatable pain was the result of a campaign to add to the list of qualifying conditions in the state, led by dispensaries and patient advocates. They also wanted to include post- traumatic stress disorder, obsessive-compulsive disorder, schizophrenia, and opioid abuse disorder. Though the board did not give an instant go-ahead to any of the other proposed conditions, it did decide to delay the decision on PTSD until it meets in November.

During a public comment session on Friday, various industry advocates expressed their concern about the lack of further approvals. Many targeted Iowa’s relatively slow pace in cannabis regulation as compared with neighbors like Illinois, whose Governor signed a bill to legalize recreational marijuana last month.

“There’s been a failure to recognize that people are suffering,” said MedPharm dispensary manager Lucas Nelson. “Traditional medicine has left them behind, and they’re going to do whatever it takes to get relief.”

“Today we are at a critical point in our program,” he said. “There is no longer time to proceed slowly.”

Iowa policy makers have echoed his concerns. “It’s time to face facts,” said state senator Joe Bolkcom, who did not mince words when it came to his thoughts on the current state of Iowan medical marijuana access. “You’ve created the worst program in the country. In Iowa, the medicine is too expensive and not potent enough to help most people. Patients want choice and want the choice of medical cannabis.”

The state’s medical marijuana guidelines stipulate that patients are to have access only to CBD oil products that contain no more than 3% THC. The substance can be consumed in capsules, tinctures, topicals, and vape pens. A bipartisan group of policy makers was able to pass an expansion package this year, but it was vetoed by Governor Kim Reynolds, who took exception to its THC percentage increase.

Reynolds said her decision was based on the recommendation of a state medical marijuana board. “Ultimately, I believe Iowa must proceed cautiously to ensure that any expansion of our medical [cannabidiol] program is thoughtful and deliberate,” the governor commented at the time.

But Iowa has been actively evolving its list of qualifying conditions for its medical marijuana program. In December, the Iowa Board of Medicine voted to add severe autism and ulcerative colitis. Severe autism has also been added as a qualifying condition for a cannabis recommendation in states like Michigan, Minnesota, and Florida.

Other conditions that have been approved in the state include certain types of cancer, seizures, Crohn’s disease, severe multiple sclerosis, HIV/AIDS, amyotrophic lateral sclerosis, Parkinson’s disease, and any terminal illness that has left the patient with a life expectancy of less than a year.