“I’m frustrated with the process,” she said.
Paulson, 50, has suffered from multiple sclerosis for 16 years. Four years ago she was diagnosed with atypical trigeminal neuralgia, a rare disorder of the fifth cranial nerve that causes severe pain in the facial area.
She knows marijuana products can help. This summer Paulson went to Washington, one of eight states that has fully legalized marijuana, and tried a cannabis oil product high in CBD, a non-psychoactive cannabis component, and experienced something she hasn’t in years despite dozens of medication and treatment regimens: five days without pain.
“That doesn’t happen,” Paulson said.
But a lot must happen before patients like Paulson are able to access medical marijuana. On Nov. 6, the Department of Health’s medical marijuana division released its proposed rules for the program, all 50 pages of them, and the public how has 90 days to weigh in. Public hearings will be held across the state next month, including a Dec. 14 meeting in the Grand Forks County Office Building. Once the public has commented, the North Dakota Legislature’s Administrative Rules Committee will meet in March to consider finalizing the rules. The earliest date that can happen is April 1.
Only after those rules are finalized can potential “compassion centers” — dispensaries or manufacturing facilities — formally apply for a license. Only after those applications are accepted can a manufacturing facility be built or open. Only then can product start to be grown, a process that can take 10 to 16 weeks depending on the strain, or type, of marijuana being produced. Only after the first round of usable marijuana is ready to be distributed to dispensaries can qualified registered patients access the medicine.
“I would say the timelines are all tentative at this point,” said Jason Wahl, interim director of the division of medical marijuana.
The majority of the country, 29 states, have legalized medical marijuana. Eight states have fully legalized the product for recreational purposes for people over 21.
“We looked at a number of different states when identifying where rules could be established in terms of implementing the program, but the first step in the process was reviewing what the 2017 Legislature passed in regard to the law for the medical marijuana program,” Wahl said.
Wahl was named the interim director of the division of medical marijuana on Nov. 1. He is the third person to lead the division since the movement gathered enough signatures to become a ballot initiative in 2016.
The division of medical marijuana has just three full-time employees. Wahl said he might need to add staff to help process applications for potential dispensaries or manufacturing facilities. So far, more than 115 groups or companies have submitted letters of intent to apply to be a dispensary or manufacturer, among them a “Grand Forks Compassion Center.”
One local farm that was among the first in the state to grow industrial hemp has also submitted a letter of intent to grow medicinal marijuana: Adam’s Family Farm.
Chris Adams said his family became interested in applying because his mother and wife are both nurses who know the product could help people. Adams grows industrial hemp. Hemp comes from the same cannabis plant as marijuana but does not contain psychoactive properties. Despite that, the hemp industry remains highly regulated by the Drug Enforcement Agency and other state and federal authorities. Adams said he hopes his experience will help his family should they apply, but there are still things to consider.
“A concerning topic is the fact that the state has mentioned they will have product available by next year sometime and that doesn’t give anyone who applies a lot of time to get a growing facility set up,” Adams said. “Do we dump capital into something that we don’t even know if we will get accepted for? That is the question I cannot answer yet until I see the application and can analyze what they want and need from us.”
The application packet itself has not been finalized by the department yet, and Wahl said they’re still trying to determine how long to have an application period open for potential manufacturing sites and dispensaries. Those potential dispensaries and manufacturing facilities are also required by law to have pre-approval from local zoning authorities before they submit an application. Applicants must also pay a $5,000 nonrefundable fee.
Grand Forks Deputy Planner Ryan Brooks said dispensary and manufacturing zoning are on the city’s radar. There’s two general schools of thought: Treat a dispensary like zoning treats any other pharmacy business or more like a liquor store, which would mean avoiding places such as schools, churches or parks.
Brooks said the issue was discussed at a meeting of the state planning organization and that cities will look to guidance from the state on where to place the facilities.
Grand Forks County Planner Lane Magnuson echoed Brooks sentiments and said the county is beginning to eye potential rules. He said the plan is to have an ordinance amendment addressing medical marijuana facilities before county commissioners by February.
Competition over who gets to grow and sell medical marijuana will be fierce. The law only authorized two growing facilities and eight dispensaries in the state to start, but does allow for more in the future. Wahl said the application process, not logistics, will determine where the facilities are built.
“The department is aware of the maximum number of dispensaries in statute and the fact that we are a rural state,” Wahl said. “With that in mind the department did include in proposed rules the option for a dispensary to do deliveries.”
Similarly, people who qualify as “registered designated caregivers” can purchase marijuana for a total of five patients, themselves included. Those people are intermediaries who can purchase marijuana on behalf of qualified patients and administer the medicine to those patients. Unlike in other states, North Dakota caregivers are not allowed to grow marijuana themselves. State law only allows for the two manufacturing facilities to produce marijuana for the program. Caregivers can be registered patients, but do not have to be.
A date for when patients can talk to their physicians about getting a prescription is also not clear. Wahl said it will be after the manufacturing facilities get up and running.
“The department wouldn’t register individuals without knowing when usable marijuana would be available,” he said.
Registered patients must also pay a $50 annual fee to participate in the program.
Dr. Eric Johnson, an associate professor at the UND School of Medicine who specializes in diabetes care, said there are strong indicators that marijuana is beneficial for people with HIV and AIDS, who are undergoing cancer treatment, experience seizures and who suffer from chronic pain, among other issues.
“I think it’s legitimate,” Johnson said.
He said many in the medical community are open to prescribing marijuana as a supplemental treatment, but many are waiting to see how the program is implemented. He said how the program is implemented will be critical.
“I don’t think the state is dragging its feet, it’s more related to budget cuts,” Johnson said.
For some families, like the Renniches in Bismarck, frustration with the state is mounting.
Mary Rennich has tried everything. Her son, Sam, has suffered from epilepsy and experienced violent seizures for his entire life. Now 26, Sam Rennich has gone through endless drug cycles to combat his condition. Nothing has worked, and many of the drugs have made her son sluggish. Each week Sam Rennich has at least one day where he has a major seizure, with several smaller seizures during the week, Mary Rennich said.
Marijuana, particularly high CBD strains, have been shown to reduce seizures. Mary Rennich thinks it could work for Sam, too.
“This is our big hope, and it isn’t a false hope,” she said. “It’s helping a lot of people.”
Rennich said she wants the measure to be well regulated, but feels the process is taking too long because some in the state don’t want medical marijuana to be a reality in North Dakota. “There has to be some efforts to tamp this down and to stall it,” she said.
She was relieved when the ballot initiative passed, but still had a bad feeling about getting the product in time for her son to get relief. Watching Sam deal with heavy bouts of six or more prescription drugs at a time weighs on her.
“It’s so hard for me to take pictures of him, and look at him and always see behind his eyes just how sedated he is,” Rennich said. “I just have this terrible sadness, that only if we could get him off the six meds he’s on, how glad I would feel.”