PROVINCETOWN — Recreational marijuana stores are coming to the Outer Cape in a big way, but it’s not clear that any of them will provide medical formulations of the drug to patients with prescriptions.
Curaleaf opened its doors in Provincetown last week, and the Cannabis Control Commission (CCC) is currently reviewing five more applications for stores in Provincetown, as well as two in Wellfleet and two in Eastham.
In its host community agreement with the town Curaleaf agreed “to provide free or reduced-cost medical marijuana to qualified residents of Provincetown.” But the host agreement did not lock in that provision in the event that the corporation, which is the largest distributor of legal marijuana in the U.S., decided not to conduct medical sales.
Recreational and medical sales are conducted differently, and while it’s possible to do both at the same location, the state’s rules don’t make it easy. The financial rewards of selling recreational pot and the difficulties of dispensing medical prescriptions mean that most or all of these new shops could open as recreational-only, leaving medical marijuana patients without a local option.
No Medical at Curaleaf
Phyllis Ewen, an artist who lives in Cambridge and Wellfleet, didn’t realize that Curaleaf was recreational-only until she arrived at the store last week. Ewen has painful arthritis, and she prefers tinctures that can be carefully measured and dosed, and that take effect immediately rather than sneaking up on her later.
“Fortunately, I don’t use particularly high doses of anything,” said Ewen, “and I did like what I found at Curaleaf. It’s a totally different line of products than the medical shop back in Cambridge, though.”
For a customer, the first differences are dosage and price. The strength of recreational products is tightly regulated. Edibles, for instance, are almost all sold in packages that include 100 milligrams of the active ingredient THC, divided into 20 equal doses of 5 mg. Because it is prescribed by a doctor, medical marijuana can be much stronger, with doses of 25 mg or more being common.
It’s possible to just buy lots of recreational pot to reach that higher dosage, but that’s generally not the cheapest alternative. Also, medical sales are tax-free, while recreational sales are taxed at 20 percent. For people who use medical marijuana daily to manage pain, nausea, PTSD, or other conditions, the cost difference can add up quickly.
While medical cannabis is important for patients, it’s not that easy for a dispensary to be both medical and recreational.
“Co-located dispensaries are supposed to keep the user experience completely separate,” said Spencer Knowles, a member of the Cannabis on Cape Cod advocacy and networking group, and an executive at Sira Naturals. “They’re supposed to divide their space so that medical and recreational don’t mix at all — separate the customers, the staff, the product, even the inventory storage areas. They don’t have to have separate doors, but it’s pretty close to that.”
Having enough space for two parallel operations isn’t the only challenge though, explained David DeWitt, a longtime pot farmer and founding member of Truro’s High Dune Craft Cooperative. There are also two different sets of rules. For instance, medical sales are all logged and tracked back to the patient in a statewide database, whereas nothing like that exists for recreational sales.
There are about 60,000 patients in Massachusetts who are signed up in the Medical Use of Marijuana Program — a much smaller market than recreational, although arguably a more dedicated one. And the out-of-state tourists who flock to the Outer Cape in summer can’t participate in Massachusetts’s medical cannabis system, but they can shop at a recreational dispensary.
In other words, choosing to be medical only on the Outer Cape means forgoing a lot of tourist-driven income, and choosing to be both medical and recreational takes a lot of space. DeWitt and Knowles agreed that the Outer Cape might not see a medical dispensary anytime soon. (In addition to his own businesses and the High Dune Craft Cooperative, DeWitt is also a manager at the Provincetown Curaleaf store.)
Rose Cain, a nurse practitioner who is licensed to certify patients for medical marijuana, has seen this problem before. She calls patients without a local dispensary “medical refugees.” The nearest dispensary to the Outer Cape is in Mashpee. Cain estimates that a quarter of her patients grow their own cannabis or get it free from friends; the rest are driving long distances, signing up with a delivery service, or buying outside the medical system.
Cain also pointed to an aspect of medical use of marijuana that’s rarely present in recreational use. “The medical community is interested in all of the other bioactive compounds in marijuana strains, beyond just THC and CBD,” she said. “These other compounds enhance each other, and they’re all part of the healing effects. Recreational strains tend to max out the allowable cannabinoids with THC and aren’t especially cultivated for the diverse other molecules that medical patients are looking for.”
As it stands, three of the businesses that are currently being reviewed by the CCC have told town hall they intend to pursue medical and recreational licenses, said Provincetown’s Assistant Town Manager David Gardner. None of them, however, is obligated to follow through, and none has promised to do so.
In its earliest filings, Curaleaf was to be a medical-only shop on Harry Kemp Way. Then it was medical and recreational. Now it’s open with only a recreational license. When and if the pending licensees are approved by the CCC, the local licensing boards will be the first to find out if plans for medicinal pot are still alive or have fallen by the wayside.