This story by Devan Monette was first published in The Commons on Jan. 14

BRATTLEBORO — The only medical cannabis dispensary in the region, CeresMed South on Putney Road, closed its doors on Dec. 12, significantly disrupting access for Windham County’s 235 residents with active state-issued medical cannabis cards.

For customers who relied on the firm to access medical cannabis products, the closure created a gap in access to relief for qualifying medical conditions.

“There are certain products and services that just aren’t available in adult-use dispensaries,” said James Pepper, chair of the state’s Cannabis Control Board (CCB), based in Montpelier.

Cannabis, also known as marijuana, has long been regarded as a legitimate treatment for certain conditions that cause physical and psychological pain. Over the years, while federal regulations have remained ironclad, an increasing number of states have progressively affirmed programs for both medical and recreational use.

While recreational dispensaries now let people purchase cannabis with valid identification, medical dispensaries still require strict credentials and oversight by the CCB.

Medical dispensaries generally offer higher-dosage edibles, the legal possession of larger quantities, and specialized products designed to deliver the pain-relieving properties of THC and other cannabinoids with reduced psychoactive effects, such as transdermal patches and suppositories, according to a guide for health-care providers by the University of San Diego’s Division of Professional and Continuing Education.

In addition, CeresMed South provided counseling services for its customers, staffed with employees who had the background to help patients select products best suited to their needs.

“People who purchased from us were incredibly loyal because we had relationships built on trust,” said Jenny Sault, who managed the dispensary for six years until the end of 2023. “They didn’t just come for our products – they came to us for advice.”

Yet, with adult-use legalization opening the doors to dispensaries across the state in the fall of 2018, it became increasingly difficult for medical dispensaries to compete.

“We were happy [that] patients had more options and no longer had to go through a gatekeeper,” said Sault, “but we lost a lot of business due to adult-use legalization.”

However, the shift also meant that patients were now purchasing cannabis products under the same taxation as recreational users and with diminished access to certain medical-specific items.

Many cardholders opted not to renew their registrations, choosing instead to pay the combined 14% excise tax and 6% sales tax imposed on cannabis products.

As anticipated, medical cannabis registrations fell significantly starting in 2018.

Within a year of the state permitting recreational cannabis use, “the patient registry dropped by 20%,” said Pepper. “Medical dispensaries had been ringing the alarm with the legislature for a number of years,” reflecting on feedback from the state’s medical dispensaries, which peaked at six.

Pepper stated how the CCB noted that “the economy and the scale of the medical program don’t match up.”

To address this decline, in 2022, the CCB approved three integrated licenses, allowing existing medical dispensaries to sell adult-use products under strict inventory management rules.

CeresMed’s South Burlington location was included in this initiative, but its Brattleboro dispensary did not obtain the licensure.

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Still, feedback from dispensary owners to the board emphasized the need to broaden regulations on who is qualified to purchase from Vermont medical dispensaries.

Pepper highlighted several policy suggestions raised in these conversations, such as implementing reciprocity to honor medical cards issued in other states, issuing retail licenses for medical dispensaries, and expanding the number of medical conditions for which a patient would qualify for the state’s medical use program.

“We have one of the most tightly controlled medical programs in the country,” said Pepper. “That’s really been a function of the Legislature keeping a very tight lid on the qualifying conditions.”

Initially, when Vermont became the ninth state to legalize medical cannabis in 2004, only patients with terminal illnesses were permitted to cultivate plants or possess cannabis.

Legislation in 2011 authorized four dispensaries to open in February 2014, including amendments to serve patients with certain “debilitating medical conditions” affirmed by their doctors.

Yet for many Vermonters, the benefits didn’t outweigh the cons.

Nicholas Joseph Luoma, a longtime Brattleboro resident, shared his hesitation about applying for a Medical Cannabis Card in 2016.

At the time, approval of a yearly application, including a $50 fee, permitted a card granting access to a medical cannabis dispensary.

“I had gone as far as filling out the paperwork with my doctor – they completed their portion,” Luoma recalled. “Ultimately, I decided not to send it in because I didn’t want my name on one of those lists.”

No one was more familiar with the weight of regulations than the dispensaries tasked with operating under them.

“We had to enforce their ridiculous laws even when we knew they didn’t make sense,” recounted Sault. “If you didn’t have your medical card with you, we couldn’t let you in.”

A lost card could result in weeks of denied access while waiting for a replacement to be processed and shipped.

“We had cancer patients or those with severe pain who we knew needed this medicine, and we’d have to turn them away,” Sault recalled with frustration.

For many patients who could benefit from state-sanctioned access, bureaucratic barriers to obtaining legal cannabis were a significant deterrent, even though its effects could help manage conditions beyond those officially recognized as qualifying.

“I think it’s really important that people have access to this medicine,” shared Luoma, recounting his personal experience. “I use it as a mood stabilizer, but it also helps with diet regulation because I take medication that requires food.”

Another advocate of cannabis, Brattleboro resident Heather Elisabeth, found it transformative in treating PTSD and major panic attacks.

Elisabeth, who stopped usage before legalization, found that daily cannabis use in tandem with therapy was life-changing.

“I just thought I was stuck in hell, and [it was] the one thing that saved my life,” she said.

When Elisabeth smoked it, “I could function,” she said. “I finished college with flying colors, got my degree in vocal performance, started directing choirs, and just started being very successful.”

In 2017, Gov. Phil Scott signed into law a bill that expanded the list of qualifying conditions to include post-traumatic stress disorder (PTSD), Parkinson’s disease, and Crohn’s disease.

Reflecting on her experience managing the CeresMed locations in both Brattleboro and Middlebury, Sault expressed feeling unsupported by regulators.

“The state decisions were very out of touch with what we were actually doing,” she said.

“It was a huge deal what we did for people, and I often think it was overlooked or viewed negatively by the very people who should have supported it,” said Sault.

Behind locked doors, only a select group of dedicated staff witnessed the profound impact medical cannabis had on patients.

“I’ll never forget an elderly man coming in, all emotional one day, excited to share that he was almost completely off his opiates for pain,” said Sault, her eyes beginning to well up.

“He cried as he told us he was finally able to attend one of his granddaughter’s recitals,” she continued. “He thanked us for giving his life back to him.”

For those with chronic conditions, higher doses of THC and other cannabinoids may be necessary to sustain relief throughout the day, making affordability a critical factor for many patients.

Without insurance coverage – which does not cover medical cannabis, still classified as an illegal Schedule I drug under federal law despite the surfeit of increasingly contradictory state laws – the quantities required for effective relief can be prohibitively expensive.

“Patients are losing access,” said Pepper regarding CeresMed South’s closure. “These are patients who, by definition, are the most vulnerable consumers of cannabis.”

Currently, only three dispensaries maintain active licenses in Vermont: Vermont Patients Alliance in Montpelier, Grassroots Vermont in Brandon, and CeresMed in South Burlington, which has announced plans to close soon.

Pepper noted that Grassroots is offering delivery services statewide to help address the gap in access.

“We’ll keep working for the patients, but the Legislature is the only [entity] that can really make significant changes,” said Pepper.

The CCB has proposed a medical-use endorsement to be reviewed by the Legislature. This would allow adult-use dispensaries to separately serve medical cannabis patients using a segregated inventory.

In addition to the proposed $250 to maintain this permitting, adult-use dispensaries would need to ensure patient confidentiality and uphold an educational standard for employees engaging with patients.

The earliest this legislation could take effect is July 1, 2025.

When asked about her vision for reform in the medical cannabis industry, Sault said, “People should be educated before making decisions that drastically affect others’ lives.”

Reflecting on her time at Ceres, Sault recalled that “the team there was top-notch, and the whole company has a heart of gold.” She noted that she resigned because she moved to Florida.

“Cannabis helps people, and I’d love to see a more mainstream approach,” she added. “It’s the people’s medicine and it should be treated as such.”