For Abbe Kruger, the day she sat bedside with her terminally ill mother was the day she started believing in medical marijuana.
Abbe’s mother died of pancreatic cancer four years ago after enduring months of pain that Abbe said could have been alleviated by the drug.
Now, Abbe has taken her advocacy to a higher level as the CEO of one of 27 companies awarded a permit by the state to dispense cannabis-derived pills, oils, creams and other substances for medical treatment in what is expected to become a multibillion-dollar industry.
“In all honesty, that experience, if I wasn’t a believer before, certainly it solidified my belief in patients’ ability to have access to medical marijuana,” said Kruger, a 47-year-old Shavertown resident who leads Justice Grown Pennsylvania LLC.
As the state’s nascent industry develops, patients who have a state-issued card will be able to pick up medical marijuana from Justice Grown’s dispensary in the Gateway Shopping Center in Edwardsville starting sometime early next year.
At this point, just three months after the state Department of Health gave specified companies the go-ahead to grow, process and dispense medical marijuana — and halfway to the deadline for those entities to be up and running — several questions remain industry-wide. Among them, Kruger said, is what the demand for the drug will be.
“We have kind of a theoretical client base,” she said during a visit to the empty storefront that will be renovated into one of two dispensaries permitted in Luzerne County. The other is Columbia Care Pennsylvania LLC, which will open in a storefront at 765 Kidder St. in Wilkes-Barre.
Justice Grown, based in Chicago, has extensive experience in growing and cultivating marijuana, and Pennsylvania will serve as its entrance into the dispensing component of the industry.
“This will be kind of a flagship location for us,” Kruger said.
The medical marijuana permits — 27 for dispensaries and 12 for growers/processors — are scattered across six regions of the state based on the patient population and where the anticipated need will be for treatment of 17 serious medical conditions identified in the state’s Act 16. Otherwise known as the Medical Marijuana Program, it was signed into law on April 17, 2016, by Gov. Tom Wolf.
Cancer, post-traumatic stress disorder, epilepsy, glaucoma and severe chronic or intractable pain where opiate therapy is ineffective are among the conditions.
“So we have a number of patients here that are suffering with conditions they can’t find alternative means to alleviate within this area,” Kruger said.
The painkillers administered to her mother were ineffective, said Kruger, a former attorney who struggled with abiding by the law as she helplessly watched her mother suffer.
“To not be able to give someone something that can’t kill you … it just seemed sinful,” she said.
There is some concern by those who run the dispensaries, however. The Gateway site and others throughout the state don’t know when in early 2018 that medical marijuana will be available and won’t know what to order. They will have to rely on growers and processors within the state, including Standard Farms LLC in White Haven, for the various forms of medical marijuana.
“The hardest part in terms of projections — and we’ve seen it in Chicago — is the rollout of the program,” dealing with everything from permitting to budgeting, estimating the number of clients, and determining how much marijuana to stock, Kruger said.
That’s been the experience for dispensary Columbia Care, too, according to Corey Fitze, director of government affairs for the New York City-based company.
Fitze, who grew up in Tunkhannock, said it takes time for a market to mature. He and his father, attorney Judd Fitze, provided information to the Wilkes-Barre Zoning Hearing Board in August about Columbia Care, the largest medical marijuana company in the country, serving approximately 35,000 patients a month.
Besides New York, its operations include Boston, Washington, D.C., and Chicago.
“In New York, we have the only dispensary in Manhattan,” Fitze said. “We were only open three days a week for the first year and a half, simply because the demand was not there.”
He attributed the low demand to the fact that “it takes awhile for markets to mature.” He also said projections of a potential client base in an area don’t necessarily translate into patients “coming through the door on Day 1.”
Fitze and Kruger emphasized that the dispensaries in Pennsylvania will not be selling marijuana plants or dried leaves.
“We want to be very clear — you are not smoking this,” Fitze said.
In order to enter a dispensary, a patient must have a state-issued card that will take some effort to obtain.
“This is strictly a medical program where you have to have a qualifying condition as deemed so by your physician,” Kruger said. “Your physician has to be registered with the state to write this certification, which I guess is akin to a prescription.”
Technically it’s not a prescription because the U.S. Food and Drug Administration has neither approved nor recognized the marijuana plant as medicine.
The federal government has civil and criminal enforcement powers for the possession and use of marijuana under the Controlled Substances Act. But under guidelines the U.S. Department of Justice issued in 2013 that set priorities for federal authorities regarding marijuana, it’s unlikely participants in the state’s medical marijuana program will be prosecuted, according to the Pennsylvania Department of Health.
With that understanding, the state is registering patients and physicians to participate in its medical marijuana program. Physicians are required to complete a four-hour training course, and patients must sign up and pay a $50 registration fee.
Once a physician is approved by the state, he or she can see a patient and make a recommendation to the Department of Health for issuance of a medical marijuana card, Fitze explained. It’s unclear how long it will take the state to make a decision on the card.
There is a time limit on how long the card is valid, however.
“It expires after one year, and you have to go back to get a new card every single year,” Fitze said.
Additionally, the state has set a cap on the amount of medical marijuana a patient can receive each month, Fitze said.
More public outreach is planned due to the intricacies of the new and heavily regulated program, which keeps track of everything from seeds to sales by software, Kruger said.
“Patients need to be educated, and we’re going to try to play an active role in communicating information in town halls and other community events so that they have an understanding of what products are available to them, what they can possibly do for them in terms of their conditions,” Kruger said.
She’s been asked whether medical marijuana produces a high for patients.
“It can and it can’t,” Kruger said.
Marijuana contains cannabinoids such as the non-psychoactive cannabidiol, or CBD, and tetrahydrocannabinol, or THC, which is pyschoactive and affects a person’s mind or behavior. Certain ailments are more receptive to one or the other, while some ailments respond to a combination, Kruger explained.
“So it is possible, yes, to get it as a medicinal form where you will have no psychoactive effect. But there are plenty of products that will have some psychoactive effect” depending on the illness being treated, she said.
Columbia Care will offer a variety of ratios of THC and CBD.
“Some products can increase energy, while others promote relaxation. Our staff provides guidance based on the patient’s needs, and most patients discover certain ratios that provide the best relief for their individual symptoms,” the company said in a statement.
The cost of medical marijuana in the state has yet to be released, but the drug likely won’t be covered by insurance.
“As a business, we work to develop a pricing model that allows patients to access the medicine they need at prices they can afford,” Columbia Care said. “For instance, we have discounts and subsidy programs for seniors, veterans and low-income patients.”
As more states make medical marijuana available — 29, plus the District of Columbia, have so far — people are becoming more aware and supportive of it, Kruger said.
Those who have lost a loved one already are believers.
“I don’t think that anyone should ever have to choose between breaking the law and helping someone they love or not,” Kruger said. “That’s a terrible decision to have to make.”
But, she added: “Some people, their minds might never be changed.”