‘We Won’t Stop Working for Patient Access’: Georgia Regulators Weigh Options After Receiving DEA Warning About Pharmacies Dispensing Medical Cannabis

The Georgia Access to Medical Cannabis Commission (GMCC) met Dec. 13, in part, to discuss how to handle a recent warning from the U.S. Drug Enforcement Administration (DEA) against pharmacies in the state dispensing medical cannabis, and commissioners made it clear that they intend to continue fighting for patient access.

Georgia’s two medical cannabis operators, Botanical Sciences and Trulieve, launched operations and opened dispensaries in the state earlier this year. Each licensee can operate up to five retail locations and can also, in a first-of-its-kind model, dispense medical cannabis products at independent pharmacies throughout the state. Botanical Sciences and Trulieve both began selling their wares through partnering pharmacies in October.

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The unique sales model has since caught the attention of the DEA’s Diversion Control Division, which notified pharmacies last month that because they are registered with the DEA, they are required to comply with federal law, which of course prohibits the processing, handling and dispensing of cannabis.

GMCC members said during Tuesday’s meeting that the DEA’s warning highlights conflicting federal and state cannabis policy and they plan to continue fighting for patient access.

Jansen Head, general counsel for the GMCC, noted that the DEA’s notice to Georgia’s pharmacy “doesn’t state anything now” regarding the agency’s stance on cannabis.

“This is the same position that the federal government has had since its Controlled Substances Act became law in 1970,” Head said. “That’s over half a century ago. We’re aware of different federal laws being in place and needing to be updated. And it does take time, but it doesn’t mean that it may be overdue for a change.”

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Head pointed out that several congressional appropriations bills have included riders prohibiting the U.S. Department of Justice (DOJ) from using appropriated funds to prevent states from implementing and regulating cannabis programs.

“Although DOJ has reaffirmed their position about marijuana growth, possession, trafficking and whatnot still being illegal, they recognize that states have already implemented and carried out their own programs,” Head said. “They even mentioned that their enforcement of federal law has generally been focused on criminal networks involved in the illicit marijuana trade. So, when you look at the congressional budget bill, the rider, on its face—and [federal] courts have talked about this— … precludes the DEA from taking legal action against the states and in Georgia.”

Head estimated that more than half of Georgia’s medical cannabis access points are pharmacies, which are now at risk of no longer being able to participate in the program.

“I think we all know that our patients have been through more than enough and they have fought to get us here,” Head said. “They’re leaning on us, the state, to carry this through and continue to fight for them.”

GMCC Executive Director Andrew Turnage emphasized the importance of pharmacies being able to dispense medical cannabis to patients and said the model was originally envisioned by former Speaker of the House David Ralston, who Turnage said was “instrumental” in including the pharmacy sales provisions in the Georgia Hope Act, the state’s medical cannabis law.

“There’s something really important about a licensed professional being between a regulated drug and a patient with a medical need,” Turnage said. “And that’s what the speaker envisioned. The General Assembly obviously passed the Hope Act, and to the extent that we have been able to under the framework of our state’s law, the commission and the Board of Pharmacy have carried that vision into reality. [We] have licensed pharmacies and they have been able to dispense to patients. As a matter of fact, Georgia has a national model for providing access to safe and laboratory-tested medicine through those independent pharmacies where patients can discuss their healthcare needs with medical professionals that they already know and that they trust.”

Turnage said that since the number of licensed dispensaries in Georgia is limited by statute, there aren’t enough retailers to ensure that patients have access to medical cannabis within their communities.

“With those severe, critical … end-stage conditions, that may really be a challenge for patients because of their transportation limitations,” Turnage said. “Our dispensaries are also subject to the distance requirements at the local and state government level that not only create barriers, but sometimes complete roadblocks to creating access to medicine.”

Turnage echoed Head’s sentiments that the commission must keep fighting for the best interests of Georgia’s patients.

“We won’t stop working for patient access,” he said. “That is our goal and our focus every single day.”

Turnage said that as the commission continues to evaluate next steps following the DEA’s warning, he would like to see pharmacies continue to offer medical cannabis to Georgia’s patients but acknowledged that the issue of federal policy is beyond the GMCC’s control.

“That’s an item that obviously Congress and [the U.S. Department of] Health and Human Services as well as the DEA are going to have to pick up and potentially address as it relates to the scheduling of marijuana as a drug,” Turnage said.

While Georgia’s medical cannabis program is currently the only one in the DEA’s crosshairs—because it is the only one that allows pharmacies to dispense cannabis—Turnage noted that other states that may be interested in a similar model are also at a disadvantage under federal policy.

Turnage said that he and Head recently presented to the Cannabis Regulators Association, and the pharmacy model was a popular topic of discussion among other state regulators.

“Following Jansen’s presentation, a number of states approached Jansen to discuss what we do with the model here in Georgia,” Turnage said. “And the feedback that we received in that environment was simply, ‘This is exactly the way that it should have been from the beginning.’ This model makes perfect sense. But they also expressed concern as it relates to finding out about the DEA’s letter because the DEA’s letter addresses a register.”

Some of the other state regulators noted that the DEA could extend its warning to Georgia’s pharmacies to practitioners in other states who hold DEA registrations and recommend medical cannabis to patients.

“Again, it’s a federal issue, so we don’t have the authority to intervene, but we certainly want to encourage everyone to reach out to their members of Congress and make their wishes and concerns known about this issue,” Turnage said.

In the meantime, it is unclear how pharmacies in Georgia will respond to the DEA’s warning, as well as how the DEA will respond if pharmacies continue dispensing medical cannabis after receiving the DEA’s notice last month.

Bill Prather, a member of the GMCC, as well as a licensed pharmacist and the past president of the Georgia Board of Pharmacy, noted his interpretation of the DEA’s letter at Tuesday’s meeting.

“I no longer own a pharmacy or any part of a pharmacy,” he said. “If I did, I would take the letter from the DEA as, in my opinion, exactly what it is, which is a direct threat to pharmacies saying, ‘If you dispense this product, we’ll pull your DEA permit. And if they did that, that would mean that as a pharmacy, you could not dispense scheduled drugs. You could still dispense other drugs, but not scheduled drugs, which in a lot of cases would put you out of business.”

Prather concurred with the other commissioners that the issue is largely a federal issue and therefore out of the GMCC’s hands.

“I think it will be a big help if the federal government would reschedule [cannabis] to a Schedule III or a Schedule IV [drug],” he said. “The classic definition of a Schedule I is a drug that has no accepted medical use in the United States of America. I think it has been proven that is not the case with cannabis at this time.”

GMCC Chair Sid Johnson noted that he doesn’t advocate for—and doesn’t want to get in the habit of—ignoring federal laws, and he asked Head and Turnage their opinions on how to engage appropriately with the DEA and resolve the federal-state tension that has arisen in Georgia.

Head acknowledged that it is a difficult question to answer, especially since the GMCC must work with the Board of Pharmacy—and potentially other state agencies—to find a path forward.

“I think whatever path is taken and whoever takes that lead, I think at this point, the letter’s so fresh that we’re trying to understand what the right channels are, what’s going to be most efficient, and Georgia should have a united position in some way,” Head said.

One area state officials should rally around, she added, is doing what’s right for Georgia’s patients.

And the stakes are high for not only patients, Head said, but also other states that are looking to Georgia as a model for regulating medical cannabis sales through pharmacies.

“I know a lot of states who are also medical states, [and] they’re kind of eager to learn more about what Georgia will do,” she said. “They’re really looking at how Georgia’s going to handle this tension. So, as a commission, as your staff, we may not have all the resources and all the answers, but I would still think that we would be open to at least helping people be informed and just being that assistance and that process to make sure that however things play out at the federal level, we do what we’re authorized to do under state law, which is promulgate rules, issue licenses. … For the patients, for the licensees, don’t think the state is quiet. Right now, we’re gathering information and seeing, what’s the best way to move forward while also keeping in mind the interest of our patients and the industry?”

Johnson concluded the portion of Tuesday’s meeting dedicated to the DEA’s warning letters by saying that the commission remains focused on implementing the Georgia Hope Act.

“As always, we’re going to stay focused on our mission and our part in implementing the Hope Act, and that specifically translates to the licensees and the dispensaries and making sure we have access to safe product across the state.”