In a June 14 public hearing, the Georgia State Board of Pharmacy is considering proposals to make authorized medical cannabis products available at independent pharmacies, in addition to dispensaries.
Georgia law can license a maximum of 12 dispensaries—only two of which are currently open. If implemented, the proposed regulatory amendments would bring the state’s limited medical cannabis program to certain rural areas, even while it leaves larger barriers to access unchanged.
For people on parole or others form of state surveillance that subject them to mandatory drug testing, access to authorized medical cannabis products is particularly fraught.
“My own [parole officer] actually put me on this journey,” Floyd*, a Georgia resident who’s been attempting to enroll in the state’s Low THC Oil Registry for several months, told Filter. “It was his suggestion. So here I am.”
“Every single doctor that I’ve talked to about this refuses … I’m really at a standstill.”
Georgia’s medical marijuana program does not permit use of actual cannabis flower or edibles, but does permit cannabis oils with under 5 percent THC. In 2015, the state authorized possession of low-THC medical products, but no legal route for patients to access them. In 2019, it authorized in-state production. In April 2023, the first licensed dispensaries—one in Macon and one in Marietta—finally opened, bringing the number of the legal access points for patients enrolled in the state’s Low THC Oil Registry up to two. The registry currently has approximately 27,000 patients.
Some people with qualifying medical conditions are still struggling to get on the registry to begin with.
“I’m having complications right now with the registry,” Floyd said. “From what I’ve been told, I must get a primary care doctor to okay my usage and sign off on a portal that has something to do with the health department. Sounds simple, right? Not quite!”
Registry hopefuls pay $25 for a physician to fill out a waiver that outlines their qualifying medical condition. If approved, they get a card that authorizes access to regulated low-THC products for two years.
“Every single doctor that I’ve talked to about this refuses,” Floyd said. In particular, he described them as hesitant as to whether the waiver upheld patient privacy protections. “So I’m really at a standstill for now.”
Anytime a medication is assigned extra bureaucratic hurdles that don’t exist for other medications, prescribers become much more reluctant to engage. Under federal law, “full-spectrum” CBD is only authorized to contain THC concentrations up to 0.3 percent. And most people on the registry have no reasonable means of legally acquiring the products that the physician would be clearing them to use.
“My own [parole officer] actually put me on this journey.”
Low concentrations of THC in state-authorized products can sometimes show up on drug tests for marijuana. While this could be a substantial harm for any registry patient who’s subject to mandatory drug testing, it could be a blessing for the lucky few assigned to an understanding parole officer.
Drug testing is typically conducted via urinalysis. The urine sample cup is equipped with a handful of immunoassay strips—like fentanyl test strips, but each one testing for a separate class of substances, such as THC. These tests provide results in a couple of minutes, but only as a binary—either a substance is detected, or it’s not. If no one sends the sample out for confirmatory testing at a lab, nothing further can be gleaned about whether it contained a lot of substance versus a little.
This means that in addition to medical CBD and low-THC oils, Floyd may be able to use the regular marijuana he prefers, with his parole officer attributing the presence of THC in his urine to be merely a byproduct of the low-THC oils dispensed to him per doctor approval.
If, that is, Floyd can find a doctor to do the approving, and a licensed distributor within driving distance to do the dispensing.
Both of the state’s open dispensaries are operated by Trulieve Cannabis Corp, the largest cannabis retailer in the United States. Trulieve has around 180 storefronts across nine states, but is in the midst of a mass-shuttering in states where tax regulations and competition from other companies have made its ventures less profitable, including closing all locations in Massachusetts.
“Not being stressed about being returned to prison is a huge relief … it just takes time.”
But the Florida-based company is faring better in the South, and currently has what amounts to a monopoly in Georgia. Trulieve is one of only two licensed manufacturers, and the licensing process has not been marked by transparency. The second, Botanical Sciences LLC, is expected to open its first two dispensaries by fall 2023. Trulieve is also expected to open two more within the same timeframe.
The Georgia Access to Medical Cannabis Commission is the regulatory body that licenses traditional dispensaries, but the Pharmacy Board has the authority to establish Low THC Pharmacy Dispensaries. Chain pharmacies like CVS would not be eligible to participate, as they’re usually located in densely populated urban areas. Independent pharmacies, on the other hand, are better positioned to serve areas not likely to get one of the 12 dispensaries.
“This is a great thing,” Floyd said of the potential for increased access. “Not being stressed about being returned to prison for allowing myself to relax, unwind, get high, without consuming alcohol or fearing criminal repercussions, is a huge relief … it just takes time.”
*Name has been changes at source’s request
Photograph via Centers for Disease Control and Prevention