SOUTHINGTON — Pharmacists preparing for the advent of Connecticut's medical marijuana industry gathered Wednesday to talk about the clinical aspects of dispensing a drug that has no federal approval nor the guidelines that go along with it.
The roughly 175 people in attendance also included doctors and some owners of state-designated businesses in medical marijuana — four producers to grow it, six dispensaries to sell it.
So far, about 2,000 patients are registered with the state to buy medical marijuana when it becomes available, said one speaker, John Gadea, a pharmacist and director of the Drug Control Division within the state Department of Consumer Protection, which regulates medical marijuana.
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Just when medical marijuana will become available still isn't exactly clear. Previously, officials had said the dispensaries could open sometime this summer. Some growers interviewed Wednesday, however, said their products would not be ready until later in the year.
The symposium hosted by the Connecticut Pharmacists Association touched on the many gray areas that face physicians and pharmacists when it comes to administering herbal medicine in a highly regulated pharmaceutical fashion. It also addressed some concerns about who should be using medical marijuana.
In Connecticut, a patient must have one of the 11 debilitating medical conditions — cancer, glaucoma, HIV or AIDS, Parkinson's disease, multiple sclerosis, damage to nervous tissue in the spinal cord or intractable spasticity, epilepsy, cachexia, wasting syndrome, Crohn's disease or post-traumatic stress disorder.
From a consumer's perspective, buying marijuana will be similar to visiting a doctor's office, said Nick Tamborrino, a pharmacist who owns Bluepoint Wellness of CT, a Branford dispensary. He will keep regular business hours, 9 a.m. to 6 p.m., on weekdays, and 9 a.m. to 1 p.m. Saturdays.
"So, patients make appointments," Tamborrino said. "You'll be seated in the waiting room. You'll get called in by one of the pharmacists. You'll get brought to a counseling room. That's where we'll go over a thorough medication history on you ... make sure your treatment goals are met."
Before even walking in the door of a dispensary, a patient will have to be certified by a doctor to use marijuana. Then, the patient must register with the state the dispensary where he agrees he will buy marijuana.
Featured speakers Wednesday came from the Center for Drug Discovery at Northeastern University; the Yale School of Medicine; the Canadian Consortium for the Investigation of Cannabinoids in Montreal; and other places.
Canada has had federally licensed cannabis producers for years who cultivate marijuana for patients. Mark A. Ware, executive director of the Canadian Consortium for the Investigation of Cannabinoids, has studied the dosage and administering of medical marijuana in Canada.
Pharmacists generally agree that marijuana has a lot of variability, so properly dosing medical marijuana for patients is an imprecise process.
In terms of dosage of the active ingredients THC and CBD, Ware said, medical marijuana typically has 1 percent to 19 percent THC (tetrahydrocannabinol) and 1 percent to 17 percent CBD (cannabidiol).
"In Connecticut, where you have standard producers and people who are regulated to do this, I think this goes a long way to ensuring that these patients are now getting product from quality-controlled sources," Ware said.
Marijuana will be available in many forms, but Ware addressed dosing for marijuana that would be smoked.
An average joint is half of one gram, he said. Most studies suggest that the average medical user consumes about 2 grams each day, and about 80 percent of users consume between 1 and 3 grams daily, Ware said.
"It sounds like a lot. People say, 'Four joints a day, that person's stoned all day long,'" Ware said. But much of the THC is lost in the "combustion" process, and only some gets absorbed — 20 to 50 milligrams by a patient.
Clinicians should be watchful if a patient is using more than 5 grams per day, which is about 10 joints, Ware said.
A Yale School of Medicine psychiatrist, Deepak Cyril D'Souza, cautioned the audience about the many short-term adverse effects of THC on the brain and on human behavior. He has spent much of the past two decades conducting studies with the main chemical in marijuana, THC.
The lasting adverse effects of THC — on brain development and memory, for example — are especially a concern for young people who use marijuana, D'Souza said.
"Most suggest if you are exposed before the age of 15, the outcomes are much worse," D'Souza said.
Growers, Dispensers Getting Ready
One of those attending Wednesday's symposium was Angelo DeFazio, who owns the only Hartford dispensary, Arrow Alternative Care at 92 Weston St. He said he hoped to open between Aug. 15 and Sept. 1 but cannot begin business until the producers have marijuana available.
"Our goal is to carry the largest medical marijuana selection and different dosage forms of any dispensary, and I think that that goal will be tailored specifically to the disease states that present themselves at our dispensary," DeFazio said.
Founder and chief operating officer of Curaleaf in Simsbury, April Arrasate, said the state's final inspection of her marijuana growing facility is in late July. The company is expecting to employ about 20 people. As with all medical marijuana businesses in Connecticut, the product won't be "buds," but rather marijuana ground into a "homogenized blend," she said. The purpose is to have marijuana available in a uniform, "standardized dose," she said.
Arrasate found the symposium useful, saying, "Something like this gives [the industry] legitimacy. Here are real researchers, real physicians, talking about real peer-reviewed research studies that are published. That matters."
Marc Gare, executive vice president of sales at the Advanced Grow Labs, said his marijuana growing facility in West Haven plans to grow marijuana from seeds this summer after the 26,000-square-foot facility has a final inspection by the state Department of Consumer Protection.