This commentary is by Catherine Antley, MD and Lisa K. Catapano-Friedman, MD on behalf of Physicians for Healthy Communities. Dr. Antley is a community physician in South Burlington. Dr. Catapano-Friedman is President of the Vermont Psychiatric Association. Additional signatories are listed below the text.
The House Government Operations Committee is considering amending Vermont law to allow high-potency cannabis to be sold at retail stores to patients with medical cards for marijuana. This would depart from the present law, which limits sale of high-potency cannabis concentrates to medical dispensaries only. This change would be a major step backward for Vermont, for two reasons.
First, although anecdotal stories exist from people who state they receive symptom relief, there is no convincing medical evidence supporting the use of high-potency cannabis (defined as greater than to 10-15% THC) for any medical use. Studies of the medicinal benefits of cannabis use have involved cannabis with no more than 15% THC content. This is undoubtedly because the health risks of high-potency cannabis are well-known, and it would be unethical to conduct double-blind experiments on human beings by exposing them to high-potency cannabis.
In April 2022, when testifying before the Senate Health and Welfare Committee against a cap, Cannabis Control Board Chair James Pepper reminded the Committee that the stated intent of the law is “consumer protection, public health and safety,” and he acknowledged that “these concentrates are dangerous … they are dangerous, you know, there are long term negative health consequences of consuming high THC concentrates.” That remains true today and is especially true for fragile patients with serious chronic medical conditions who require maintenance on pharmaceuticals, which also puts them at risk for dangerous drug interactions.
According to a patient survey, only a very small percentage of Vermont medical marijuana card holders (15%) chose to use high THC concentrates from the medical marijuana shops. A plurality of survey respondents identified themselves as 60-69 years old. This means they could be frail, ill or on multiple meds, putting them at risk for dangerous drug interactions. Putting these risky high THC concentrates in Vermont’s recreational stores to serve such a small population of users presents risks of diversion or selling under the counter. In Massachusetts we have reports of marijuana shops’ CEOs urging employees to “upsell” high-THC concentrates; in Vermont teens 18 years of age and over may obtain a medical marijuana card. High-concentration THC addicts more quickly and this is especially true for youth.
Second, allowing sales of high-potency cannabis at retail stores will wreak havoc on the heightened public-safety protections currently applicable to dispensaries. With limited exceptions, no one can be allowed to enter a dispensary without a marijuana medical card. Medical dispensary staff must maintain careful records of all patients and their cards and safeguard the privacy of this data.
It is inconceivable that retail store staff will comply with these protections. Already now there is widespread violation of Vermont’s existing laws and rules governing those stores. For example, despite complaints to the Board about widespread violation, and the resulting issuance of a warning by the Board to all licensees, James Dumont — the Vermont attorney representing Physicians for Healthy Communities — has stated based on our investigation that potential customers who enter a retail store are rarely handed a copy of the safety information flyer (point-of-sale flyer) that the statute mandates be given to every customer. In addition, lollipops and candies that are appealing to children are sold in recreational stores, in violation of the law. Info from the Northern New England Poison Center shows that the number of cases involving exposure to cannabis among children 0-5 in Vermont went from 1 in 2017 to 20 in 2023. It seems unlikely that the heightened protections needed for dispensaries would be honored, or when they are not honored, that the Board will have the time and energy to effectively inspect and sanction violators.
Linda Zamvil MD, APBN, Psychiatrist
Treasurer of the Vermont Psychiatric Association
Stowe
Kim Blake MD, Obstetrician and Gynecologist
South Burlington
David Butsch MD, General Surgeon
Barre
David Charnock MD, Otolaryngologist (ENT Surgeon)
Rutland
Melisa Gibson MD, Family Medicine
Essex
Deb Henley MD, Orthopedic Surgeon
Rutland and Manchester
Janet Kirwan MD, Cardiologist
South Burlington
Robert W. McDowell, MD, Anatomic and Clinical Pathologist
Newport
Paul Reiss MD, Family Medicine
Williston
Robert Edmund Tortolani, MD, Family Medicine
Brattleboro
Anita Licata, MD, Dermatologist
Williston