The concept of cannabis as a medical tool, as literal medicine for any number of potential ailments, isn’t exactly a new one. Various cultures have made use of the cannabis plant for medical purposes over the course of thousands of years, and the majority of U.S. states have steadily adopted at least some level of medical cannabis access for their residents since the mid-1990s. In most places, accessing cannabis for medical or recreational purposes has never been easier … but with that said, major hurdles remain in terms of residents of some states being able to get any medical value out of their local medical cannabis industry. Case in point: Virginia, a state currently caught in a deeply illogical chasm between medical and recreational cannabis. It’s a state where almost anyone can easily obtain “medical” weed, but residents still increasingly choose to buy illegal cannabis instead, thanks to the woefully disorganized state of the industry and its numerous drawbacks. It’s an illustration of just how badly medical cannabis can be executed on a statewide level, while simultaneously encouraging the growth of a massive marijuana black market in just a few short years.
The most elemental challenge faced by medical cannabis in general, of course, is the incredulous attitude it inevitably generates from both state residents and legislators, particularly given that cannabis remains technically illegal on a federal level. There will always be those who simply don’t perceive cannabis as a form of legitimate “medicine,” and to these skeptics the existence of a medical cannabis industry is inherently a joke. They see all forms of “marijuana” as equal and interchangeable. As a result, they’re likely to see medical cannabis as simply a way of disguising the sale of recreational weed, which, let’s be honest, is certainly a reality for some users. But Virginia in particular has created a medical cannabis system that caters only to recreational users, while ignoring and poorly serving the people it is meant to provide for. And thanks to recent developments in the Governor’s office, it’s not going to be fixed anytime soon.
Because when I see “Hypothermic Huckleberry Ice,” I obviously think “medicine.”
Virginia’s Cannabis Access Problem
Let’s say you’re a Virginia resident with a condition such as chronic back pain, and you obtain a prescription for medical cannabis. Immediately, the variety of cannabis products you’re able to access is going to be limited and determined by which of the five “health service areas” of the state you live in. The state’s medical cannabis plan first established in 2018 assigned a single pharmaceutical cannabis processor for each “service area,” although one of the five still doesn’t have a processor of its own, eight years later. Residents in that part of the state have no local access to medical cannabis, even though it’s legal and decriminalized. In each other service area, meanwhile, a single company effectively controls the entire industry, with a lack of competition unsurprisingly driving up prices as the companies maximize their profits on everything they sell, beneficiaries of a state-granted monopoly. Recent data suggests that average prices per gram of medical cannabis in nearby Washington D.C. are merely 62% of Virginia’s average price, incentivizing VA residents to make their purchases outside the state. A product costing $60 in Virginia, meanwhile, costs $35 in Philadelphia … from the same parent company. The gouging is blatant and shameless.
But say that money isn’t an issue for you: You’ve got your prescription and you’re willing to pay extra for the convenience of shopping at a local dispensary. Your goal is to determine a few cannabis products that work well in treating your back pain, and purchase those products regularly.
As a medical patient, and as a consumer with access to medical cannabis, I think it’s safe to say you probably expect the following two things:
A: To have access to knowledgeable, licensed cannabis experts who can recommend specific products that are well tailored specifically to the nature of your condition, the reason why you’re buying medical cannabis in the first place.
B: To then be able to access and regularly purchase the products–medicine, as the state defines it–that these people recommend for you.
That tandem of expectations is the most basic necessity of a medical system, but the Virginia medical cannabis industry fails on both counts–it can’t leverage the necessary expertise to inform a patient of what they actually need, and then it can’t reliably provide the very products it recommends to them. The whole thing feels like a ruse that everyone has just collectively agreed to ignore, while state legislators continue squabbling about the opening of a long-delayed recreational marketplace that is seemingly still far away.
These issues with the Virginia medical cannabis industry are not something I’ve really experienced firsthand–I am not a regular cannabis user, but I have several close acquaintances who are enrolled in the Virginia medical system. It’s through their frustrations that I’ve come to be both familiar and frustrated with how poorly the current system serves them.
To use one specific acquaintance as an example: Jane is a young woman who has had medical cannabis access in Virginia since 2021. She uses a very modest amount of THC and CBD products compared to many more active recreational users, as a way of helping with chronic leg and nerve pain, largely in the form of vape cartridges and gummies. Jane is a legitimate medical cannabis user, the kind of person for whom this system was intended in the first place–she consumes THC products with no real intention of “getting high,” but as part of a physical therapy plan to help with chronic health issues. She buys all her products through the state’s medical cannabis dispensaries.
But here’s the thing: Despite having used the system since 2021, Jane still doesn’t really know what products would actually be best for her condition, because no one in the Virginia medical cannabis industry can offer a genuinely helpful medical opinion on the matter. When she visits a dispensary, she’ll commonly ask which products might be best tailored to her, but the technician–the so-called “weedtenders” or “budtenders,” who accept tips in jars labeled “weed money”–rarely has anything helpful to say, often merely recommending the most potent product available rather than displaying any knowledge of subjects such as terpenes, THC/CBD ratios or the makeup of various strains. And the next time she visits? Another weedtender will offer contradictory advice, making it impossible to know who to listen to.
This leaves Jane to make medical decisions based on her own personal experience with the products, which sounds fine, right up to the point that you realize that consistent access to the same products doesn’t exist in Virginia. Every time Jane visits the dispensary, in fact, she’s confronted by an array of entirely new vape cartridges and gummies, featuring different strains, different product names and different packaging. She’s essentially never been able to buy the same products twice, even when they work well, because they’re always replaced by new products. This has the effect of making every single dispensary visit into a random dice roll: Will the cart she picks up this time work well for its intended medical purpose? Or did she just waste $50 on an ineffective vape cartridge that doesn’t help her condition?
Virginia “medical” cannabis dispensaries advertising themselves as “your 420 destination,” as any legitimate medical provider obviously would.
Now ask yourself: In what other medical industry would this kind of randomization and disregard for the patient ever be tolerated? When you go to the pharmacy, does the pharmacist tell you “We no longer carry your prescribed drug from last month, but we have this really great new one you can try” on a monthly basis? Legitimate medicine doesn’t get swapped out for new medicine every time you refill your prescription. How can the state of Virginia even pretend that this system serves medical patients, when those patients don’t have access to a consistent product on a regular basis? Only because we’re talking about cannabis is this considered acceptable.
But wait, it gets better–patients of the Virginia medical cannabis system can also shop online from the dispensaries, where they’re confronted with page after page of products that are largely bereft of any useful description or information. Do the companies describe the potential effects of each new vape cartridge or gummy, so the medical patient will have an idea of how it should be used? No, they don’t, because that would presumably be too onerous a job when the product lineup is in constant flux. Do they describe the parentage of hybrid strains? Nope. Do they even hint at the flavor of something labeled as “Durban Poison” or “Gator Breath”? That’s another no, believe it or not, despite the fact that some products are apparently artificially flavored without indication on the packaging, according to users. The customer is instead invited to choose blindly among a constantly changing sea of nonsensical, absurdist strain names, or consult the user reviews that exist for some (but not all) of the products. In every case, the customer is left to piece together all the information on their own.
And by the way: user reviews? Constantly contradictory, expletive-laden, indecipherably written online user reviews? This is supposed to be a tool that a medical cannabis patient in the state of Virginia is going to find helpful in deciding which products to USE AS MEDICINE for their pain, epilepsy, cancer or glaucoma? Because that is absolutely ludicrous at best, and reprehensibly negligent at worst. What are you supposed to do, exactly, when user A says a cartridge is “good for sleep,” and the next one says the same cartridge filled him with nerve-wracking anxiety? What of the fellow below, who says he enjoyed a cart except for the part where he was “coughing up a foamy white mucus?” Is this guy’s opinion valid medical information that the medical cannabis patient should take into consideration? The state of Virginia seems to think so. Do they also recommend people suffering from hemorrhages and boils consult home remedies on Yahoo Answers?
The user reviews on the dispensary websites are equal parts hilarious and horrifying.
This attitude of carelessness the state has toward the medical cannabis field is all encapsulated in what one of the “budtenders” recently told Jane when she asked yet again for advice on which products would best suit her: “At the end of the day, weed is weed.” No other medical field is treated with this kind of aloof haphazardness.
Why the Virginia Medical Cannabis System Fails
I want to now highlight the opinion of a man who is deeply embedded in the world of legitimate medical cannabis operations and science. Bart Dluhy first took an interest in the medical cannabis world after his wife was diagnosed in 2006 with MS, and then breast cancer. In the years since, she’s had more than 30 surgeries and continues to battle numerous chronic issues, but finds great virtue in the use of medical cannabis for pain management. Deciding to get more directly involved, Dluhy started growing, extracting and refining cannabis, learning to make topicals, edibles, tinctures and oil. He moved to Las Vegas, where he entered the cannabis industry as a budtender, while working on certifications in cannabis healthcare, medicine and cultivation. He’s subsequently become involved in market and medical research. He ultimately moved to Virginia, where he worked for one of the state’s processors as a product technician, a job he eventually chose to quit when he determined the state system wasn’t doing an adequate job of caring for its patients.
“I have a pretty wide breadth of experience and knowledge in growing, processing, and use of cannabis as medicine, and in coaching people how to use cannabis effectively,” Dluhy said in an interview with Paste. “And you can’t just tell someone ‘go smoke a joint and you’ll feel better.’ It’s not that simple.”
The average person, in Dluhy’s eyes, still has a “pretty minimal” view of how cannabis can be helpful in the medical world, and unfortunately that lack of familiarity extends as far as the pharmacists legally required to be present at dispensaries in Virginia–too many of them lack a genuine professional interest in the field of medicine they’ve been assigned to preside over, and thus can’t offer genuinely helpful information to patients.
“Even the pharmacists working in the dispensaries are mostly just reading off a sheet the company has given them, and they haven’t done much of their own research on the medical uses of cannabis,” Dluhy said. “It can be very disheartening for medical patients. If I’m rating on a 1 to 100 scale, in terms of being a helpful or valuable resource to medical cannabis patients, I’d say Virginia’s at about 20% right now of what they could be doing. That’s not necessarily due to the companies or dispensaries; they’ve partially been put in this position by the legal maneuvering of the state. But overall it’s pretty poor.”
One of the biggest problems is the relatively small scale of the legal cannabis industry in Virginia, which makes for a much less robust marketplace than in other states. As of 2023, the state’s Board of Pharmacy reported only 50,000 patients were currently signed up for medical cannabis in Virginia, a number that may actually be lower now. Compare that with the more than 160,000 patients signed up for neighboring Maryland’s medical cannabis system, despite a significantly smaller state population. According to Dluhy, this leaves the dispensaries primarily courting the recreational user who doesn’t mind spending extra money, rather than the legitimate medical patient.
“As things get more and more recreationally focused, there are fewer resources put toward actual, medical use of cannabis,” he said. “It will be treated as medical in name only, but it’s all about the money. These companies are trying to survive, so they can’t carry a huge inventory because they don’t have the volume. And because they’re trying to sell to the recreational market through the guise of medical, they have heavy turnover in products because the recreational market always wants the hot new thing, the hot new strain. This is what leads to a lack of regularly available core products–they’re trying to satisfy the more profitable recreational market by sacrificing the medical patients. They could grow the same cultivar and produce it repeatedly, but that would make them less money.”
Virginia dispensaries don’t sell boring products like THC pills for medical users, but you CAN buy a fine selection of fanciful glass pipes!
On some level, the root of many of these problems is the state’s botched plan to legalize cannabis in the first place without a concrete roadmap for how things would progress afterward. After the establishment of the medical market in 2018, general possession of moderate amounts of cannabis was legalized for all of Virginia’s residents in 2021. The assumption was that within the next few years, the Virginia General Assembly would codify the state’s laws for a recreational cannabis market, but constant delays, Republican opposition and eventually the election of a Republican governor (Glenn Youngkin) killed all momentum toward what had been seen as a quickly approaching reality. That left cannabis in Virginia caught in limbo, with possession and use of weed fully legalized–you can even legally grow up to four plants in your home–but the recreational market DOA.
Some of the medical cannabis industry problems, meanwhile, might be alleviated by the enshrinement of full-scale recreational weed in Virginia, which would bring an influx of competition, lowered prices, and more steady access to consistent products. This would help users like Jane to at least be able to access the same products on a regular basis, but it’s not a reality that will become the law of the land in Virginia anytime soon. Despite both houses of the Virginia General Assembly passing legislation that would have established the recreational cannabis market in Virginia beginning in 2025, that legislation was vetoed by governor Youngkin in March, citing fearmongering concerns about increased access to a drug that, might I remind you, is already legal in the state. Instead, Youngkin is happy to continue empowering the one element of cannabis in Virginia that is rapidly growing: The illegal black market.
Virginia’s Booming Illegal Cannabis Industry
The grand irony of so much Republican opposition to expanding Virginia’s cannabis access is that their feet-dragging has already resulted in expanded access, but not via legal means. Instead, the current state of affairs in Virginia has contributed to massive growth of black market cannabis, which is easier than ever to grow, possess and sell in lieu of the state moving forward with its planned expansion to recreational weed. Right wing politicians in Virginia continue to moan and gnash their teeth about the potential criminality of legal, regulated, recreational cannabis in the state, while ignoring the surge of a legitimately criminal drug industry that is now estimated to be worth nearly $3 billion.
Lest we forget, that dollar value is money that theoretically should be benefitting the state via excise taxes on recreational cannabis, though the struggles of the state to capitalize on it should be no surprise, given that VA has also struggled for literally years just to figure out a way to sell products such as limited release bourbon whiskey. Instead, the current system provides zero excise tax dollars for Virginia, squandering a potentially huge source of revenue. Meanwhile, the product being pushed by illegal growers and sellers in Virginia is able to dramatically undercut the overpriced “medical” weed (because of the state-enabled monopoly), while representing a genuine threat to public safety because it’s obviously untested and held to zero quality control standards. This is the worst possible outcome for the consumer.
The existing status quo, on the other hand, is pretty much exactly the scenario that the black market growers and drug dealers would draw up as their preferred system if they could, because everything about it incentivizes the average customer to buy illegal cannabis. The penalty to buying illegally has been removed, so customers don’t have to worry about it. Nor do dealers have to worry about getting caught with moderate amounts of cannabis on them, after it was decriminalized. Or you can just leave the state to score cheaper, higher quality weed. Is it any wonder that illegal drug enterprise has flocked to Virginia since 2021? They’re just capitalizing on an underserved market.
Everyone in Virginia is using weed … but the main people benefitting are drug dealers, rather than taxpayers.
“Consumers don’t know whether they’re getting a safe product or one contaminated with potentially dangerous adulterants,” said JM Pedini, development director of the National Organization for the Reform of Marijuana Laws (NORML) in a statement. “Unregulated cannabis isn’t lab tested for purity and it isn’t sold in packaging that is both childproof and not appealing to children. Ultimately, Governor Youngkin will have to decide if he’s more interested in allowing unlicensed, unregulated, illicit operators to continue controlling cannabis in the Commonwealth or if he’s finally ready to apply the same commonsense provisions used to regulate the legal sale of medical cannabis in Virginia to adult-use retail.”
The medical side of the industry, meanwhile, will seemingly continue to languish. In January of 2024, control of the medical program passed to the Virginia Cannabis Control Authority after years of being overseen by the state’s Board of Pharmacy. The CCA will reportedly provide more detailed data and statistics about the program at some point in the future, but with the office of the governor blocking most cannabis-related legislation, it seems unclear how any genuine improvements would be expected. Reaching out to CCA Acting Head Jeremy Preiss, I presented a laundry list of questions, grilling him on everything from the lack of consistently available “medical” products, to the merits of online user reviews of drugs the state is supposed to be treating as medicine. Preiss elected not to comment on any of those questions, offering only this generic statement about the issues I raised with Virginia’s medical cannabis system:
“We are also working to identify opportunities for improvement in the program so that it is as responsive to patient needs and medically centered as possible under the framework created by Virginia’s legislature. We intend to publish data regularly on the medical cannabis program as soon as we establish new systems to collect and disseminate such information.”
Yes, it does seem as if the medical program should probably be as “medically centered as possible,” now that you mention it. Maybe if patients weren’t expected to peruse user reviews of “Azure Biscuits” or “White Widow” cartridges in order to obtain relevant medical advice, the Virginia medical cannabis industry would be seen as less of a joke? Or is any expectation of the state taking this seriously just another pipe dream?
Jim Vorel is a Paste staff writer and resident craft beer and liquor geek. You can follow him on Twitter for more food and drink writing.