In less than three months, Rhode Island's first compassion centers will open their doors to the thousands of patients seeking a state-regulated source of medical marijuana.
After months of careful deliberation and an initial rejection of all 15 applications in the fall, the Rhode Island Department of Health announced its three selections from the second pool of applicants March 15.
A 2009 amendment to the 2006 law legalizing medical marijuana allowed the department to license up to three non-profit compassion centers, according to the Department of Health's website.
The law defines a compassion center as a non-profit organization that cultivates and dispenses "marijuana, or related supplies and educational materials," to card-carrying patients who have designated the center as a primary caregiver.
Until the amendment was passed, patients lacked a state-regulated source of marijuana. The act allowed patients to designate up to two caregivers — often family members or friends — to cultivate and provide them with the drug. Each caregiver is allowed to cultivate up to 24 plants and service up to five patients. A center may provide marijuana for an unlimited number of patients, but like individual caregivers, it is only allowed to dispense two and a half ounces of usable marijuana per 15 days to each qualifying patient.
Though there is still work to be done, the compassion center selections signal a move towards broader acceptance of marijuana, said Jared Moffat '13, president of Students for Sensible Drug Policy. "We're trying to re-contextualize this plant," he said, "to put it in a place where we can have it as a part of community and society without treating the people who use it like criminals."
The Department of Health is currently receiving 50 to 75 new applications per week — up from around 30 in November 2010 — for both caregivers and patients, according to spokeswoman Annemarie Beardsworth. With the recent licensing of the compassion centers, she said the department expects the number of individual caregivers in the state to decrease.
Not-for-profit?
All three centers are required by law to operate as non-profits. Compassion centers must allocate profits to fund the centers' operations or donate them to a charitable cause.
Revenue projections for all three centers are expected to top $1 million by 2012. Summit Compassion Center, projected to be the most profitable by far, expects to generate revenue in excess of $25 million by that time.
The Slater Compassion Center, named in honor of the state rep who served as a primary sponsor of the bill to legalize medical marijuana, will be located in Providence. The center estimated that it would need $1.6 million in start-up funds.
The center plans to serve 550 patients beginning in July 2011. The application projects that Slater will provide marijuana to 1500 patients, employ 32 full-time workers and generate a total revenue of $3.9 million and $206,570 in profits by 2013.
Slater has budgeted approximately $3,700 per month for advertising purposes, according to the application. The majority of this money will go to advertising that medical marijuana is available in a safe and legal manner through the center. Slater plans to take out advertisements in the Providence Journal and Rhode Island Monthly, along with various other publications.
Dr. Seth Bock, a current caregiver and owner of an herbal dispensary, will head the Greenleaf Compassion Center. The center, which will be located in Portsmouth, expects to serve a chronically ill patient population in Newport and Bristol counties, according to its application.
At $400,000, Greenleaf's start-up funding need is the smallest of the three centers. According to Greenleaf's application, the money has been raised from a "group of investors that have pledged financial support through personal non-guaranteed loans."
Its application projects that Greenleaf will generate $1.9 million in total revenue by 2012, employ nine full-time employees and provide medication to 533 patients. Summit, the largest of the three centers, will be located in Warwick.
According to Summit's application, Cuttino Mobley — a former University of Rhode Island and NBA basketball star — will be the sole funder of the center and the only one to hold a security interest in the center's property. He is donating $500,000 to the center as well as providing a $3.5 million line of credit that is available for immediate use.
By the end of its third year of operation, Summit plans to employ 80 people and service 8,000 patients. The center projects total profits of $16.5 million.
Assessing the need
JoAnne Leppanen, executive director of the Rhode Island Patient Advocacy Coalition, said she was in favor of Greenleaf's application from the start because its less central Portsmouth location means it can serve patients that otherwise could not access medical marijuana.
Though Summit's application was "impressive," it came as "a bit of a surprise because there is so much out of state involvement," Leppanen said, pointing to the fact that the center's entire line of credit comes from a person "with no authority" over the center's leadership.
The Department of Health estimates 40 percent of medical marijuana patients are Medicaid, Supplemental Security Income or Social Security Disability Insurance recipients, according to Greenleaf's application. Nick Testa, a caregiver from South Kingstown, explained that some patients currently receive their medication for free from friends or family.
"If it's one dollar, it's too expensive," he said of these patients.
Though the centers plan to charge prices ranging from $40 to $80 per eighth of an ounce depending on the strain, all three plan to provide reduced-cost or free medication to patients who demonstrate financial burden.
Summit's board of directors will determine the amount of capital necessary to reinvest in the operation. The remaining balance of net income will be used to provide discounts and free medicine to those living with cancer and AIDS, as well as those on medical, state or federal disability.
Ultimately, Leppanen said, she hopes the relationship between the three centers will be a collaborative one. If one center runs out of a particular strain of marijuana, for example, it should feel comfortable enough to call on another center for help.
While Bock said the three centers have communicated about plans to collaborate, they have been preoccupied by preparations for their respective official openings. After the centers are up and running, he hopes to sit down with the other two teams to find ways to work together, he said.
Marijuana education
Some patients, given the option of a compassion center, might still choose to resort to an individual caregiver. For some, growing their own medication is more than a hobby, "It's a lifeline," Leppanen said.
For patients who are unable to grow their own marijuana and who would otherwise face chronic pain each day, caregivers are "unsung heroes," Leppanen said.
Testa said he began to grow the plants for "personal reasons." His friend was "extremely sick" and providing him with a reliable source of medication was one of the best ways to help.
But patients must find a doctor willing to sign off on their medical marijuana cards, which can prove difficult.
According to Beardsworth, the Health Department is legally prohibited from informing patients of doctors willing to prescribe medical marijuana.
The current application, available on the Health Department's website, requires a physician to check off one of six conditions that would make a prospective patient eligible for the card.
"The education level is fairly low," Bock said, pointing to the Rhode Island medical community. One of the most important goals of his center is to provide doctors and patients with the k
nowledge necessary to understand the basics of the program. But there will be no direct connection to physicians, though he hopes the center will gain a better understanding of which doctors regularly prescribe marijuana, Bock said.
According to Leppanen, the more doctors know about the program, the more receptive they will be to the drug. Often, patients have to educate their doctors about the benefits of medical marijuana.
Leppanen said her organization tries to promote medical marijuana as a chance for people to regain their lives from pain, rather than an opportunity for profitable drug distribution. "We want them to talk in terms of medicating, not smoking," Leppanen said.
"We don't need people trying to hijack this program for their own personal goals," she added. "This is a medical program, and it has to be respected for that."
In the future, Leppanen said her organization hopes to be able to screen qualifying patients at the center and call doctors with the option of either taking the patient or rejecting them. In this way, "there's not the risk of the doctor falling under the category of ‘pot doc,'" she added.
‘Pot doc'
Josiah Rich, professor of medicine at the Warren Alpert Medical School, is one of ten physicians whose name was published in the Providence Journal in March 2010 as a top prescriber of medical marijuana in the state.
Though some doctors were outraged by the article, Rich said he was not because it's part of his practice.
While some patients approach him for the card for instances of nausea and pain, others are looking for recreational use.
"In both these instances," he said, "I'm happy to fill out the paperwork." Rich said that he feels it is unhealthier for his patients to get arrested than it is to smoke marijuana legally.
Rich said he thinks the centers will provide doctors a level of comfort. "Now patients have a place to go," he said.
Caregivers and patients across the state have also voiced concerns that three centers won't be sufficient to satisfy the demand for medical marijuana. Beardsworth said the department plans to monitor the need on an ongoing basis. If there is more demand than the centers are able to fill, the department will raise the issue with the General Assembly.
According to Leppanen, there are currently about 3,500 patients in the Rhode Island system. Greenleaf's application projects the number could increase by 40 fold.
Rich expressed surprise at the number of patients that the centers expect to be serving. "I can't see a whole lot of physicians running to prescribe a whole lot of marijuana in Rhode Island, but I might be wrong," he said.
A database of physicians provides a way for the Health Department to monitor overall prescription trends, Beardsworth said. "If we see anything that raises a question mark for us, then we can take a look."
‘Nightmare scenario'
Rep. John Carnevale, D-Providence and Johnston, recently introduced legislation that would end the individual caregiver system by 2013, allow the state police to conduct unannounced inspections of compassion centers and prevent anyone with a drug conviction from being licensed as a caregiver.
Should Carnevale's bill pass, patients would have no choice but to get their medication from the compassion centers.
Leppanen called this a "nightmare" scenario, saying a compassion center with unlimited money could bring on what is known as "the Wal-Mart syndrome." A center that charged far lower prices could run the others out of business and secure a monopoly.
Bock was quick to express his distaste for the bill. "I think that there is a way for the compassion centers and the caregiver and patients to work synergistically together," he said.
Rep. Edith Ajello, D-Providence, said she sees the legislation as a "typical law enforcement response," adding that "moneyed interests" seeking to profit from the marijuana industry could be a driving force behind the bill.
"Somebody keeps pushing this bill," Leppanen said. "We want to know who." She said most people she has spoken with think the legislation has almost no chance of passing.
On the other end of the spectrum, Ajello introduced a bill last month that would legalize marijuana in Rhode Island for everyone over 21 years of age.
Bock expressed concern that a move to legalize marijuana could "diminish" the center's work.
Though Ajello said members of the bill's committee were "clearly interested" in the proposal, she does not expect it to pass in Rhode Island for at least a couple of years. This would give the compassion centers time to "get up and running," Ajello said.
But it is important to remember that these centers have yet to prove themselves, said Moffat of SSDP. Despite the optimistic patient and revenue projections of the applications, there is no guarantee that the centers will be efficiently distributing medication or even still running in two to three years, he said.
