Earlier this month, the Cannabis Center of Excellence (CCE) launched a research project to identify the ways in which U.S. veterans use medical cannabis. The Massachusetts-based nonprofit set out to determine where gaps might exist for veterans interested in accessing legal cannabis products in the state—and whether there may be opportunities to improve their lot.
The CCE is working with Patriots Helping Vets, licensed cultivator Gibby’s Garden and the University of Massachusetts Dartmouth Institutional Review Board to complete the project.
The groups are looking for 450 qualifying veterans in Massachusetts to sign up.
Here’s what happens next: “After completing a baseline survey, veterans will be able to purchase [at a discount] a cannabis product bundle consisting of Gibby’s Garden products and one of the four retail outlets in Massachusetts. The bundle includes 2 ounces of cannabis flower, 2 strains of pre-rolls, and 15 ml of cannabis tincture. As part of the research study, veterans will be asked to report on access to cannabis issues, product(s), and its impact on their health and wellness via paper-based forms or a mobile medical cannabis app called Tetragram.”
The idea is to bring veterans together and then provide a streamlined point of access to medical cannabis products. The Gibby’s Garden bundle will give each veteran a small variety of products to check out; from there, the individual note-taking will help direct the research.
The project came together in the wake of a 2019 study on veterans’ cannabis consumption.
According to CCE President Dr. Marion McNabb, 76% of the veterans from that 2019 study reported that medical cannabis was helping improve their quality of life, while also helping them to reduce unwanted use of prescription or over-the-counter medications. The top conditions they were treating included chronic pain, PTSD, anxiety and depression.
A similar number of respondents said at the time that, yes, their VA health care provider was aware of their cannabis use. But almost all of those respondents followed up to say that, no, it wasn’t very clear whether the VA supported cannabis consumption at all.
McNabb said that was the first gap identified by research: an education gap.
The bigger problem was the access gap.
“We also, in that survey in 2019, asked, ‘What are the major barriers for you accessing medical cannabis?’ And the number one barrier was costs related to purchasing and accessing the product consistently. Second was the cost to access a medical card. Another interesting barrier, which was probably about fourth or fifth down the list, was owning a firearm, and this is really important for a veterans, too.”
As adult-use markets come online and proliferate across the U.S., the question of basic access to cannabis can easily get lost in the broader conversation about the development of the industry itself. McNabb is a member of the Massachusetts Cannabis Advisory Board (and chair of the board’s research subcommittee), and one goal on the board’s table is the “deverticalization” of medical cannabis in the state. Adult-use cannabis businesses in Massachusetts are allowed to hold down a one-off license, like a retail license or a cultivation license. Medical cannabis businesses must be vertically integrated: a financial barrier to business that can easily trickle down and become a financial barrier at the patient level.
Understanding medical cannabis patient needs—specifically veterans’ needs—is one way to accelerate that proposed regulatory reform and ameliorate any access issues for patients across Massachusetts. McNabb wants to do away with the anecdotal evidence that adult-use markets, when they materialize, outpace and overshadow medical markets.
“I've traditionally looked at the adult-use market as a little shortsighted for overstepping the medical cannabis market,” McNabb said. “Why? Because medical cannabis patients are chronic patients. They're customers that will come in everyday because they need your medicine and they need consistent medicine. In an adult-use market, you have to invest money into marketing approaches.”
The immediate goal of the veterans access research project is to better understand just that: veterans’ access. But a deeper narrative may emerge, which would provide regulators a more detailed perspective on how the medical cannabis market works.
First comes the research, though, which means that veterans across the state will be carefully logging their experiences with medical cannabis grown in Massachusetts. While the researchers offer a pen-and-paper format for note-taking (acknowledging the wide range in ages and technological know-how among the subjects), Tetragram’s digital interface is an important part of this project.
The app was developed and founded by Otha Smith, who set out to give patients and consumers alike a clearer picture of their own individual cannabis use. Tetragram provides helpful templates for users to track their consumption—and, more to the point, the effects of that consumption. After purchasing a new live rosin cartridge, say, a consumer can then go home and try it out, keeping track of THC content and terpene profiles and, inevitably, the suite of effects. Relaxation? Euphoria? High-quality sleep? Having that data, according to Smith, allows consumers to become better educated about cannabis and their own endocannabinoid systems, leading to more targeted and nuanced purchasing habits at the dispensary. Since launching the app in 2020, Smith has noticed a significant veteran population logging their experiences.
“They see the true benefit of cannabis,” he said. “This [research] will be a telling sign to show how beneficial cannabis is.”
While it’s too early to get into even preliminary results from this project, Smith said that veterans have shared insightful reports on the app thus far. Most often, he said, veterans reported finding success with lower-dose 1:1 gummies, which might include 5mg of THC and 5mg CBD. Those products tend to be easier on a patient who might otherwise not feel comfortable with a higher THC dosage and the possibility of anxiety taking hold.
Within the Tetragram interface, veterans (and anyone else) can track the specific cannabinoid and terpene profiles that led to desired outcomes, like a sense of calm or a restful night’s sleep. This is helpful, if only because an emerging understanding of the cannabis plant leads the industry to believe that, in fact, THC alone is not the most relevant indicator of a product’s effects.
“It’s not about just THC—it’s about that composition,” Smith said. He pointed to similar projects, like We Decode, which provides genome sequencing services to align specific cannabis product formulations with an individual’s genetic disposition. This personalized approach, he said, may be the next step for anyone who keeps good data about his or her own cannabis consumption.
Results from the Massachusetts veterans access research project will be shared at the conclusion of the study, and already the CCE has additional projects in mind for cannabis patients and consumers.
“This is part of a larger program … to allow cannabis, consumers, patients and now veterans to connect with cannabis brands—to study, to create research partnerships and to create education partnerships,” McNabb said.