During Prohibition beginning in 1920, doctors could prescribe liquor such as whiskey and brandy to patients for medicinal purposes.
The prescriptions allowed patients to purchase alcohol at pharmacies during a time when such sales were otherwise prohibited. But the prescriptions were controversial because the scientific community largely agreed alcohol should not be used for medical purposes.
“We believe that the use of alcohol is detrimental to the human economy,” the American Medical Association declared in a resolution passed in 1917. “The use of alcohol as a therapeutic agent should be further discouraged.”
When Prohibition was repealed in 1933, the prescriptions quickly disappeared while the recreational market grew.
Fast forward 85 some-odd years and a similar dynamic is playing out with the legalization of recreational marijuana. Most states – including Massachusetts – that now permit recreational marijuana had first legalized medical marijuana. Doctors today can prescribe medical marijuana cards giving patients access to products at dispensaries, which are essentially marijuana pharmacies. And like prescriptions after prohibition, sales of medical marijuana are in decline in other states where recreational marijuana sales have been legal for more than a year.
Unlike during the medical alcohol market of the 1920s, however, marijuana advocates believe access to cheaper, more potent marijuana products — along with a growing scientific community that supports its medicinal value — could help keep afloat the medical marijuana market well into the future.
“I believe the (recreational market) will make the medical market grow,” said Angela Brown, co-founder and president of T. Bear Inc.
The Wareham-based manufacturer of marijuana products recently received a provisional license to buy marijuana from licensed growers, create marijuana products – such as concentrates and candies – and sell them to retailers.
The company is refurbishing an 8,000-square-foot facility on Cranberry Highway with a goal to open in the spring. Brown’s optimism about the future of the medical market is based on a few indicators, including the increasing number of dispensaries — where medical marijuana is sold — that have opened since recreational marijuana was approved in 2016.
New rules also allow medical marijuana and recreational marijuana to be sold out of the same building — from different points of sale — which Brown believes will expand access for both branches of the marijuana industry.
“There’s not going to be that limitation on locations,” she added. “There’s going to be a whole ecosystem.”
So far, the number of medical marijuana patients in Massachusetts who purchase medicinal products continues to climb. In November, 36,837 patients bought medical marijuana, more than doubling the 17,241 counted in November 2016 when recreational marijuana was approved by voters, according to data compiled by the Massachusetts Department of Public Health.
The upward trend could certainly change moving forward, considering retail sales first started in November. But even then, some patients may stick with the medical market for other purposes, including potency. The state limits the dosage that can go into recreational marijuana products, which isn’t the case for medical. For patients with certain conditions, or those who prefer a higher dosage, medical may still make sense.
Economically speaking, some may also stick with medical marijuana, where products are not taxed. The recreational market, meanwhile, is taxed at 20 percent.
“There’s certainly the incentive of not paying taxes, which is 20 percent off the price of the merchandise. That’s going to be the primary factor in the medical market continuing,” said Jim Borghesani, a marijuana advocate and spokesman for the campaign to legalize recreational marijuana in Massachusetts.
But patients may still want to evaluate their individual needs before making a decision one way or another, as the medical market also comes with costs.
For new patients seeking a medical card, it requires a qualifying condition and about $200 to see a doctor who will allow the medical card. The cost to renew that card is $50 each year.
To achieve savings in the medical market, new patients would need to spend $1,000 on medical marijuana products in the first year. Twenty percent of $1,000 equals the $200 spent at the doctor’s office. Each year afterward, savings for medical patients would begin after the first $250 spent.
How exactly this math will impact consumer behavior in the future is tough to predict. The CCC, which assumed authority over the medical market in December, declined to comment on this story.
However, other states offer some evidence that suggests medical activity will fall as recreational sales grow. In Colorado, recreational sales started in January 2014 and the number of medical patients has since decreased 23.2 percent to 85,207 in November.
Medical marijuana sales, meanwhile, have also fallen while recreational sales have skyrocketed. Marijuana sales in Colorado totaled $5.8 billion through the first 10 months of 2018 compared to $683.7 million for all of 2014.
Shannon Gray, marijuana communications specialist with the Colorado Department of Revenue, confirmed the trends, but declined to speculate why sales were moving in one way and another.
“We have seen (recreational) sales increase relatively steadily and medical sales have plateaued,” she said.
In Oregon, which has a similar marijuana tax structure to Massachusetts, the relationship between recreational sales and medical activity looks similar to Colorado. Recreational sales first started in 2015 and the number of new and renewed medical card applications has since declined quickly, according to data compiled by the state.
Of course, there’s no certainty the same trend will play out in Massachusetts. And because each state establishes its own regulatory framework, it’s possible no two states will look alike in five or 10 years. For many in the industry, there’s confidence the medical market will be doing just fine.
“There are some tangible benefits to the medical market, and I think you’ll see an increase in people who go out and get the medical card because they need it and they can put it to use,” Brown said.
Eli Sherman is an investigative and in-depth reporter at Wicked Local and GateHouse Media. Email him at esherman@wickedlocal.com, or follow him on Twitter @Eli_Sherman.
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