Where’s the Cannabis for the Sick?
Despite passage of the law, roadblocks remain in implementation.
Virginia Jenkins isn’t your typical 20-something pot smoker from Venice Beach. At age 57, she was diagnosed with late-stage lung cancer. She had been struggling with a severe cough and pain for several months prior to her diagnosis that eventually opened her eyes to medicinal marijuana.
“It was a shock to me and I didn’t know what to feel, I didn’t know whether to cry, get mad, or get angry, but then I realized I was always in pain and I didn’t know that I had cancer,” Jenkins said.
She later discovered the disease had already spread throughout her entire body. Her doctor suggested she leave Guam as soon as possible to seek better medical care in the U.S. mainland.
“It took a while for me to take it all in, and what really helped me and gave me strength was turning to prayer. I take every day as if it was my last and I give it all to God,” she said.
Jenkins described the pain associated with her cancer as unbearable. “My doctor prescribed medication for pain, but I didn’t like the feeling of it,” Jenkins said. The pills—meant to ease a stabbing pain in her neck and back—left her worse off than before she started.
“I felt like I was gonna die,” she revealed. “I felt my head was about to burst open. My sister had to massage my head and it was so unbearable that it wasn’t even helping me at all. The pain did go away, but the effect that it gave me…I felt very weak, I couldn’t do anything.”
Like countless cancer patients before her, Jenkins decided to try an alternative method of pain relief: marijuana.
“And that’s when it helped me ease my pain. It gave me appetite to eat,” Jenkins said. “Because I lost 14 pounds within a month’s time, it’s been helping. It helps me relax. It helps me go to sleep.”
Marijuana is used to treat medical conditions ranging from cancer, arthritis, and post-traumatic stress disorder to depression, anxiety, epilepsy, and glaucoma. But because Guam’s medicinal marijuana program has yet to get off the ground, Jenkins has decided to self-medicate by going to the black market.
“I call my supplier the doctor because I can’t get it from my [real] doctor,” she said. “It’s helping me, and I’m not ashamed to say that I smoke it just to help me deal with my pain.”
But with one collapsed lung and cancer in the other, smoking marijuana (as opposed to eating it or using oils) is the least ideal way for her to access the drug’s therapeutic effects. But with no dispensaries in operation on Guam, Jenkins does not know where else to go to get the help she needs.
“I’m just thinking of cooking it as a tea and drinking it as a tea, but I really think that Guam should look into it. The lawmakers, the governor, the leaders, they really need to look into this,” Jenkins said.
Joaquin KC Concepcion II Compassionate Cannabis Use Act of 2013
In fact, elected leaders have been looking into medicinal marijuana for several years now. Guam voters passed a measure allowing for the implementation of medicinal marijuana through a referendum back in 2014. However, two and a half years later, the program has yet to get off the ground. Known as the Joaquin (KC) Concepcion II Compassionate Cannabis Use Act of 2013, it would allow for the use of cannabis for medicinal purposes. The measure was named after local musician KC “Savage K” Concepcion, who died from stomach cancer in 2013. His father, Kin Concepcion, said witnessing medicinal marijuana and its impact on his son’s final years is what led him to become an advocate.
“He was given three months to live. It was stage 4, it was very severe. The cancer was gastric cancer, stomach cancer,” Concepcion said. Soon after learning the news he took his son, KC, to Alabama and Washington to seek better medical care. While originally given only three months to live, he would instead battle the disease for nearly two years.
“We went through the motions, we went through the chemotherapy and all this stuff, but he needed help. After each chemo session, he was useless for the rest of the day. Finally he took it upon himself and he went and he asked his oncologist for his medical records, and I said, ‘What are you doing?’ And he said, ‘I’m gonna go and see if I can get certification for the use of medicinal marijuana.’ And he did,” Concepcion recalled.
That’s the moment when everything changed. KC would treat himself with a dose of cannabis oil after each four-to-five-hour session of chemotherapy. While being rendered incapacitated in prior chemotherapy sessions, KC experienced immediate relief after his first dose of cannabis oil.
“The first time that he used it he came home after chemo, and I was making dinner and I said, ‘Hey, do you want to eat something?’ He said, ‘No, I don’t want to eat’. He went to the back of the house and he took the oil and stuck it under his tongue and then he went upstairs. Twenty to thirty minutes later he came downstairs hungry as heck, and he said, ‘Mm, I’m ready to eat,’ like nothing ever happened,” Concepcion recounted.
The change in behavior even surprised KC’s oncologist, who noticed the stark difference in his demeanor.
“He was in so much pain and just really bad off that he had to use a walker for his last visit to the oncologist before he took medicinal marijuana, and he was just, it was almost like hopeless, and he was just weak,” Concepcion said. “He came back after he took medicinal marijuana, and we were surprised, and told him, ‘Hey, you’re not supposed to be walking, you just waltzed in here like nothing ever happened, and he said, ‘I’m taking medicinal marijuana.’ Now, you have to remember that the oncologists over there in the state of Washington at that particular time did not really advocate for the use of medicinal marijuana. They are doctors, federally approved, but they said, ‘Hey, if it works for you, then it works for you’ without saying anything else after that.”
The benefits of medicinal marijuana are well documented, but it is not the lack of belief in the drug’s therapeutic properties that has prevented it from moving forward. Department of Public Health and Social Services Director James Gillan explained that the agency’s two years of work to implement the original law went out the window when that statute was amended by the Guam Legislature in 2016. An amended version of the Joaquin KC Concepcion II Compassionate Cannabis Use Act of 2013 was passed last year in response to concerns from a local medicinal cannabis advocacy group, the Grassroots Guam. The group argued that the rules and regulations crafted by Public Health under the previous law failed to serve the best interest of cannabis patients.
When the amended law went into effect in January of 2017, the process to create standards had to start over, according to Gillan. “I've made it known to people, I think this law is the most ridiculously illogical thing I've ever read, and despite all the good intentions of the people who wanted to change it from the original, you know we already had a set of rules and regulations that were ready to go,” he added.
Gillan contended that there are three major changes stemming from the new law. First, Public Health was forced to begin accepting cannabis applications for both businesses and patients 30 days after the law went into effect. Second, a certified patient-physician relationship is now required. And thirdly, a laboratory considered optional in the previous law is now mandated.
Half a year later and over half a dozen patients have now registered and become certified to use medicinal marijuana. However, businesses are not yet able to begin operations. The delay is due to the lack of approved standards, which Gillan said are still being drafted by Public Health.
“So even though someone could say, 'I want a permit' or 'I want an approved application, and I'm willing to pay the nonrefundable fee', they still won't be able to conduct any business because they won’t be measured against anything,” Gillan explained.
He added that the standards are being drafted with limited assistance from the Attorney General’s Office. However, because of the program’s complexity, strict local and federal requirements and the agency’s limited amount of manpower, the process has been slow and tedious. Once these drafts are finalized they will be forwarded to the AG and Legislature for final approval.
Some areas that need to be worked out include how to certify the patient-physician relationship. Gillan said the requirement might force Public Health to inspect health records to confirm doctor visits. “Because there have been cases in the states where people have gotten certifications and there’s no evidence of a patient visit,” he explained. “So if we’re serious about the medical nature of this application of marijuana, then I do think we have that authority.” Another area being worked on is a seed-to-sale system that would track the product from its inception to final sale.
However, Gillan said the most critical and unresolved component of the program is the required laboratory. The medicinal marijuana lab would test cannabis products for labeling purposes and to ensure safety.
“These are people who are sick, these are people who are in pain, they want to have access—some who cannot smoke—so they're not gonna be getting a product they can smoke. It will be oil or something they can mix,” Gillan said. “If you don't have a laboratory that says, ‘Yes, the THC level in this product or this oil is acceptable, and it has no pesticides,’ then the real serious part is when you distill some of this product, there are pesticides in it. The distillation process also increases the strength of the pesticide, so you could give someone oil, effectively poisoning them. So the lab is really important.”
But because marijuana is still outlawed at the federal level, any new lab must be funded with private sector or local money. While the Guam Legislature has set aside $100,000 for the lab from the Healthy Futures Fund, Gillan said that money is only enough to cover the lab’s administrative expenses. The bottom line is that without additional money from the government or from private investors, the program cannot move forward. To make matters worse, Gillan admitted he is not aware of any companies interested in investing in the lab business.
“If we don’t have the laboratory that can certify what’s being grown, what’s being manufactured is safe, I don’t see any way to move forward,” he said.
Gillan wrote to Speaker BJ Cruz explaining the dilemma earlier this year, with Cruz telling the Guamanian Magazine, “Although DPHSS has not been clear about its funding needs regarding this lab, I am actively working with the Office of Finance and Budget to remove any restrictions for this purpose and add additional funding where possible."
For Concepcion, the ongoing delays in implementing the law named after his only son are frustrating. “No lab, no medicinal marijuana. Right now we’re struggling to find someone that will invest in a laboratory so we can have the health and safety issues of that laboratory well secured,” he said. “That’s fine, but that should have been discussed since the very beginning. Let’s see, 2014…it’s now 2017, that’s three years, so how much longer?”
Grassroots Guam Managing Partner Andrea Pellacani said she is also frustrated by the amount of time that has gone by without a functioning program. “We know our government is busy, we know our agency directors are busy, we don’t begrudge any of that, we don’t doubt any of that,” Pellacani said. “But for me, the biggest disappointment is that this is a mandate of the people. There aren’t many things that the people of Guam mandate our government to do and ask directly for, this is one of the very few things. The electorate asked for it, it’s a mandate of the people, and yet to stand up the program has been…we just have felt that there has been a lot of roadblocks that have been put in place.”
Pellacani said the organization’s goal is to promote the responsible use of marijuana and to advocate for patient rights. “I think of the 19,692 people that did vote for medicinal marijuana, I think a lot of us do have a personal story to tell. My father died from cancer, and had I known anything about Phoenix Tears (a medicinal marijuana oil) or anything besides having to have to trust my doctor to give him some medications that maybe he shouldn’t have been taking, that could have given him a better quality of life. I wish I knew it at the time. And I think if you talk to any one of our partners at Grassroots Guam, we all have a story to tell” she said.
In fact, the group was instrumental in pushing for the law’s revision in 2016, with Pellacani arguing that the amended law leaves prospective patients better off. “For all the times that the Department of Public Health is on record saying, ‘Well we had rules and regulations, but they were rejected,’ they neglect to say that it wasn’t very supportive of safe access for patients. So that is our goal,” she said.
But while cannabis patients can now get certified, she’s hoping for more progress when it comes to cannabis businesses. “That’s where the holdup is, so really, essentially there is a legal demand with patients and with the way the current laws decriminalize [marijuana]—that possession under an ounce [merits just] a citation—so essentially we have a legal demand on Guam but have an illegal supply, and until we right that ship, we’re going to continue to empower and enable the black market,” she said.
As for Gillan’s concern over the lack of a laboratory, Pellacani thought that issue will be resolved once standards are created and approved. “The one thing that is prohibiting a lab from standing up right now is there are no standards. So nobody’s gonna plan a business to open a lab unless there are lab standards available, and until those become available I think to say anything else would be premature,” she said.
However, one small sliver of progress made in the past year is that cannabis businesses can now apply for business licenses, thanks to legislation passed by lawmakers in July. “That doesn’t mean they’d be able to sell anything. They would still have to clear with the Department of Public Health to do that. What it does do is allow them to set up their company so they can start planning, hiring legal help, getting accounting help, consultation, and that sort of thing,” Pellacani said.
While the cannabis business definitely is not for the faint of heart, she believed there is a strong interest from the businesses community and demand from local patients.
Gillan even sees the potential to expand the program to benefit patients in Japan, where medicinal marijuana is outlawed and considered unconstitutional. “They allow people to leave Japan for the purpose of getting access to medicinal marijuana, so that is a potential for us,” he said. “If we could get this off the ground, to have an industry that would also include people coming for medicinal purposes, that’s another industry that can get built up in terms of apartments and hospice care.”
However, first things first. Before the program can begin or expand, roadblocks including approved standards and a functioning lab must be resolved.
While Gillan and Pellacani may have their differences, in the end they are both working to get the program running. Gillan is even appealing to lawmakers for additional resources.
“I would ask the Legislature now to take action on funding a lab. We have enough friends across the country who can give us a pretty good estimate on what a lab would cost, and that would be fairly easy to do, put out a request for proposal, or bid, and just see whether we could get this off the ground. It cannot start for me. Without a lab, I don’t see how,” Gillan said.
For Concepcion, every day the program is delayed is a day lost for medicinal marijuana patients. He is asking lawmakers to step up to become part of the solution. “There’s absolutely a big need. One person, that’s a big need, wouldn’t it be? Two people, that’s still a big need. The point is that if it could prolong one life, would it be worth it? Out of those people that have cancer or another type of debilitating disease, how many people have died already? You can’t count how many people have died already since 2014,” he said. “You can’t count how many people could have lived another month, another minute, another hour. You don’t know. But I do know that there are a lot of people out there right now, you don’t really want to say it, but those people that need cannabis, and the more that you delay this thing, the more we’ll be denying our sick, the unhealthy, the right to survive.”
Late stage cancer patient Jenkins agreed. She said that while she will soon leave Guam to receive cancer treatment in the states, she hopes the future will hold greater treatment options for the island’s sick. “There are some really sick people out there that really do need this, and it will help them—it’s helping me,” she proclaimed.
“…essentially we have a legal demand on Guam but have an illegal supply, and until we right that ship, we’re going to continue to empower and enable the black market.”
—Grassroots Guam Managing Partner Andrea Pellacani