Two weeks ago, a new health clinic opened its doors in Burlington to do in Vermont what it has already done in several other states: bring thousands of new patients into the state’s medical cannabis program.
Canna Care Docs bills itself as a “medical marijuana evaluation and education center," and in places like Maine and Massachusetts, it has created an efficient new avenue for patients to gain legal access to medical marijuana.
Marta Downing, chief operating officer at the company, says Canna Care doesn’t disclose the number of clients it’s enrolled in medical marijuana programs. But its former medical director was alone responsible for certifying nearly 6,000 medical marijuana patients in Massachusetts.
Downing says Canna Care aims to be responsible for 50 percent of all medical marijuana certifications in states where it operates.
“Canna Care is not looking to keep people out of medical marijuana programs,” Downing says. “We’re looking to get people into your state medical marijuana programs.”
Downing says until recently, the Canna Care model simply wasn’t viable in Vermont.
“In Vermont it’s been kind of a struggle,” she says. “I mean, there’s a lot of hoops you have to jump through.”
Those hoops recently got a little wider thanks in large part to the addition of chronic pain to the list of conditions for which patients can become eligible for medical marijuana in Vermont.
"We have this sort of artificial barrier where you need a medical marijuana card to get safe legal access if you want to use cannabis. And Canna Care Docs has seen that ... the people who want to use cannabis legally, they really need help navigating how to do that." — Marta Downing, Canna Care Docs
Chronic pain has an ambiguous medical definition and, perhaps because of that, accounts for about 70 percent of medical marijuana cards issued nationally. Now that it’s on the list here, Downing says Canna Care can begin to connect Vermonters with legal access to a drug she says many people are already using to manage ailments.
“We have this sort of artificial barrier where you need a medical marijuana card to get safe legal access if you want to use cannabis. And Canna Care Docs has seen that ... the people who want to use cannabis legally, they really need help navigating how to do that,” Downing says.
In Vermont, they’ve also needed a health care provider that’s willing to sign them up for the state’s medical marijuana program; Canna Care is looking to serve that role in a way no other health service has attempted.
But the company’s nascent quest to connect more Vermonters with medical cannabis certificates is making some people uncomfortable.
Dr. Simha Ravven is an assistant professor in the division of law and psychiatry at Yale Medical School and serves on the Vermont Board of Medical Practice’s Medical Marijuana Appeals Board.
“My concern would be that they would be getting a lot less than in terms of careful, thoughtful, thorough medical care than if they went to their family physician or a specialist,” she says.
Ravven says the doctor-patient relationship is foremost when it comes to determining the appropriateness of medical marijuana as a treatment. She says Canna Care's kind of approach seems to sidestep that relationship.
“They’re not seeing someone who knows their history,” she adds.
Ravven says for certain clients — people with underlying psychiatric conditions among them — cannabis can exacerbate physical or mental health symptoms.
South Burlington Rep. Ann Pugh helped write Vermont’s medical marijuana law, and says the Legislature took great pains to keep it from becoming a de facto route to legalized recreational use.
Pugh says lawmakers were particularly attuned to the experiences of California and Colorado, where companies with names like 420MD — referred to sometimes as marijuana “script mills” — made it so just about anyone who wanted a medical marijuana card could pop into a clinic to get one.
“So we require a doctor-patient relationship, and that’s defined by a period of time,” Pugh says.
A three-month relationship, to be exact. But Downing says Canna Care has that provision covered.
Under the Canna Care model, a patient’s relationship with the provider begins the day he or she arrives for a consultation. Downing says a second visit three months later satisfies the requirement.
“We are looking at doing that second visit virtually,” Downing says.
Pugh isn't familiar with the Canna Care model or the company, but says the rough outlines give her pause:
“To be honest, that’s not a relationship in my mind.”
Pugh says she’s also concerned Canna Care Docs is advertising its services so broadly — the company is running ads on radio and in Seven Days.
Some marijuana advocates, however, say Canna Care could fill a badly needed role in Vermont.
Laura Subin is the director of the Vermont Coalition to Regulate Marijuana, group advocating for legalized adult use in Vermont. She says many patients here need help getting a card.
"Many individual physicians are members of associations that have taken public positions against marijuana legalization, and even though it's legal under Vermont's medical law, they're still afraid to be associated with the issue." — Laura Subin, marijuana legalization advocate
Not so with the lone certified nurse practitioner who’s now seeing patients at the Canna Care clinic on Pine Street. Certified nurse practitioners and physician assistants are among the types of providers that can get patients on the medical marijuana registry in Vermont.
“We’re gonna work with you to get into the Vermont medical marijuana program, and that includes getting a little bit of a medical history,” Downing says. “But it’s not a test, it’s not overwhelming. It’s easy, and we’ll help you.”
Downing says the comprehensiveness of the physical exam varies, depending on the Canna Care clinician a patient sees. According to the company’s website, the exam will likely consist of having vital signs taken and going over your paperwork. All of this costs a flat fee of $210 — but, customers get 75 percent of their money back if Canna Care doesn’t successfully enroll them in the medical marijuana registry.
Downing, who lives in Portsmouth, New Hampshire, says Canna Care can help the kind of people who might struggle to obtain medical marijuana certificates going a more conventional route.
Consider, say, a reasonably healthy 30- or 40-something.
“Maybe he’s a skilled custom cabinet maker. He’s been working independently his whole life. He hasn’t been to the doctor in 10 years. He’s a skier, he’s a mountain biker,” Downing says. “You know, he’s got all kinds of chronic issues from working with his hands and being on his feet. And he comes in and says, 'I’d like to be a legal patient. Do I have a qualifying condition?' Yes.”
Canna Care has hit some regulatory potholes along the way. Last June, its medical director, Dr. John Nadolny, had his medical license suspended by the Massachusetts Board of Registration in Medicine.
Nadolny had issued 5,792 medical marijuana certificates, and the board said he violated protocols by letting nurse practitioners use his ID to issue medical marijuana certificates.
Three months later, an administrative magistrate reinstated Nadolny’s license, saying he did nothing wrong.
Downing — a shareholder at Mad River Glen — is unapologetic about her company’s mission, and she’s passionate about what she calls the cannabis “space." She came to the industry by way of a career on Wall Street, where she worked as a block trader and institutional equities broker.
“It was really as bad as everyone read about in the papers,” Downing says of her former career. “It was vacuous, unethical, materialistic, and it was a terrible fit for me.”
With cannabis, Downing says, she found an industry she could work in with integrity.
There are already nearly 5,000 patients on the medical marijuana registry in Vermont. To hit its market-share goals here, the company would have to enroll another 5,000 on its own. But with less than 1 percent of the state population now on the registry, Downing says Vermont has plenty of room to grow.
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