Medical Patients Will Benefit from Montana’s ‘Untethering’ of Program, According to Dispensary Managers, Advocacy Groups

Following Montana’s “untethering” of medical patients, allowing them to purchase cannabis from more than one dispensary, industry stakeholders say patient access is improving in the state.

In the roughly one week since untethering went into effect June 2, Keva Aguirre, manager of Collective Elevation’s storefront in Helena, said she has seen more patients come in the door and more variety in the types of products those patients have been buying.

“I think the biggest thing for the cannabis movement in general over here with untethering is that if there is something that a patient needs that a certain dispensary can’t provide, maybe another dispensary elsewhere can provide it because it’s still a growing industry, and not everybody is on top of everything at the moment,” Aguirre said.

The Collective Elevation location in Helena sells a variety of products including flower, concentrates and edibles, Aguirre said. The vertically integrated company also operates dispensary locations in Billings, Bozeman, Butte and Missoula.

With about 33,531 patients and 235 licensed providers in Montana, according to Missoulian, patients are trying new locations, and that means some of the patients that were previously “tethered” to Collective Elevation are purchasing from competing businesses as well.

“I knew that everybody’s going to go around [to different businesses], but I would say the majority of them have stuck with us,” Aguirre said.

The untethering has facilitated communication between patients and employees about the broader—and now, more open—marketplace. “Now, we’re hearing different things of different dispensaries that have maybe lesser quality in this or the flower was better here or whatnot,” Aguirre said. “It’s cool to see that.”

Aguirre said she thinks the state’s qualifying conditions list provides good access for patients. For example, she said the addition of post-traumatic stress disorder (PTSD) through the 2016 Montana Medical Marijuana Initiative was a positive, particularly for veterans. At the same time, she said, Montanans with anxiety and depression would benefit if the state added those conditions to the list.

She also said patients have reliable access to doctors and the ability to secure a medical card, the latter of which requires an “annual cardholder license fee [that] may be not less than $20,” according to Montana Senate Bill 265. (Cannabis Business Times and Cannabis Dispensary were unable to determine the specific price through legislative or regulatory documents, or with Montana’s Department of Public Health and Human Services after numerous email and phone-call attempts.) “I think we’ve got access to so many different doctors in so many different towns, and we have a lot of traveling doctors,” Aguirra said. “So, it’s so easy to gain access to doctors and information about doctors as well.”

For Antoinette Lininger, president and co-founder of Sacred Sun Farms, another one of Montana’s vertically integrated medical cannabis operators, with dispensary locations in Bozeman, Glendive and Wolf Point, untethering patients from providers is undoubtedly a win for those patients. But it can also be nerve-wracking for the state’s businesses, who are unsure what kind of demand they may be up against in the coming weeks and months.

“We’re getting a better insight into Montanans’ demand because we’ve had people check us out for specific things,” Lininger said. “We are hoping that we can keep everything in stock, … but it’s brand new, so we don’t know what demand is going to bring.”

Historically, supply has lagged behind demand in the state, she added, especially during the COVID-19 pandemic, and some dispensaries have had to restrict the amount of product that patients can purchase in one visit.

As part of its response to the coronavirus crisis, Montana increased its purchase limit of one ounce per patient per day, Lininger said, to allow patients to purchase their full month supply of five ounces of flower at one time (or the equivalent, which Aguirre said is 40 grams of concentrate and 4,000 milligrams of edibles, but which CBT and CD were unable to confirm through legislative or regulatory documents, or with Montana’s Department of Public Health and Human Services through numerous attempts). Lininger said that some dispensaries have struggled to keep products in stock.

“We are not in that boat,” she said. “We were in that boat last year where we had to restrict patients with the amount they could buy, under an ounce, but then we put the whole business into high gear and we have expanded our grow operations and our workforce a lot. I think we’ve probably doubled in size in the last year and a half, so I’m hoping other providers have seen this and are trying to get prepared.”

A Long Time Coming

Patients have been permitted to use only a single dispensary since Montana’s medical cannabis program launched in 2004 due to regulations that Kate Cholewa, a lobbyist for the Montana Cannabis Industry Association (MTCIA), said were meant to closely track the cannabis being sold through the regulated market.

“I think the whole philosophy or the reasoning behind it by lawmakers was chain of custody, being concerned about cannabis moving outside of the parameters of medical markets,” Cholewa said. “They wanted to make sure you can only buy it there, you can only sell it to these people, and I would say it wasn’t very effective, but then again, I think a lot of these laws … went into place at a time before the sophisticated regulatory mechanisms that we have now. … Once you can track and test and assure the safety in a statewide market, there’s just no reason for customers or cardholders to be tied to one provider.”

The MTCIA has long advocated for untethering patients from the state’s dispensaries, and as Montana’s medical cannabis law slowly evolved over the past 16 years, she said, the need to make the change became clear.

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“We wanted to put in place the proper regulatory mechanisms like tracking [and] testing, so we’d know we had a safe, tracked market statewide,” Cholewa said. “Then, once that’s in place, there’s no reason why patients should remain tethered. That was our goal since 2016, going into the 2017 legislature, to normalize the market and make sure that it was the patients who got to decide whose quality and service they want. So, this is a long time coming.”

Last year, the Montana Legislature approved a bill to untether patients from dispensaries, and now, just over a week into the new program, it is difficult for stakeholders to predict exactly where the market is headed, although many are celebrating the rule change.

Applauding Increased Access

Lininger said the untethering of patients from dispensaries will not only increase patient access and product selection but will also spotlight many of the smaller businesses in Montana that may be off the beaten path.

“The fact that they are free to wander is incredible for them,” she said. “I think there are a lot of really small providers that have some great products. … I’m very excited for this new step toward an industry that is more cohesive.”

“This is a pretty significant change, and it really empowers the customer for the first time to sort the market and really be able to compare and learn what the range of quality is in the market, the range of prices [and] what different products might [offer] the therapeutic effects that they’re needing,” Cholewa added. “For the first time, they’re able to use products from different growers and different providers to put together the package that serves them best. It’s really quite radical, and it’s funny—it’s radical and normalizing at the same time.”

The national nonprofit Americans for Safe Access (ASA), which represents medical patients, researchers and doctors, is currently looking at the details of Montana’s medical program, alongside medical programs in the rest of the states, for its 2020 State of the States Report, to be published “within the next few months,” said ASA Interim Director Debbie Churgai in an email.

“Americans for Safe Access applauds the new untethering law,” Churgai said. “Having access to multiple dispensaries means more access for patients traveling within the state and more options in terms of products. The quality and price points of cannabis products can vary from dispensary to dispensary, so this new law will allow patients to shop around for the best prices and the best selection of products.”

This election year, workers in the cannabis industry should research and vote in local, state and national elections for candidates with whom they agree on cannabis-related issues, Churgai said.

“Growers or people who work for dispensaries and other cannabis companies are private citizens and have not only the right, but the responsibility as concerned citizens to call, write, or meet with their elected officials to urge them to improve the medical cannabis program in their state,” she said.