Virginia initially established a medical cannabis program to provide additional treatment options for patients with intractable epilepsy in the Commonwealth. The program has been expanding since 2015, with significant changes occurring in the 2020 Regular Session of the General Assembly. Virginia law allows for five pharmaceutical processors, one in each health service area established by the Department of Health, with up to 30 dispensing sites to dispense medical cannabis products. Patients can legally obtain a broad range of cannabis oil products that may contain up to 10mg of tetrahydrocannabinol (THC) per dose, with dose not defined by the Code of Virginia. While most states have a list of qualifying conditions, practitioners in Virginia can recommend medical cannabis for a patient based on a diagnosed condition or disease. Currently, four pharmaceutical processors are permitted to cultivate and process cannabis, with three of those four open for dispensing cannabis oil to registered patients. Cannabis dispensing facilities, which will not cultivate or process any cannabis, are expected to become operational in 2021. For a full summary of the program’s structure and history, see Appendix I.

The Virginia Medical Cannabis Work Group was established by HB 347, or Chapter 711 of the 2020 Acts of Assembly. The legislation charged the Secretary of Health and Human Resources to:

“…convene a work group to review the Commonwealth's medical cannabis program and issues of critical importance to the medical cannabis industry and patients, including expansion of the medical cannabis program and the medical use of cannabis flowers. Work group members shall include the Secretary of Health and Human Resources, the Director of the Department of Health Professions, the executive director of the Board of Pharmacy, one member of the House of Delegates, one member of the Senate, three representatives of the medical cannabis industry who are currently licensed as pharmaceutical processors by the Board of Pharmacy, one person with expertise in issues of importance to patients who use medical cannabis for treatment or alleviation of the symptoms of a diagnosed condition or disease, and one member who is a physician who is currently registered with Board of Pharmacy to issue written certifications for use of cannabidiol oil and THC-A oil."

In alignment with the statutory requirements, the work group was comprised of medical cannabis industry representatives, patient experts and advocates, physicians registered to recommend medical cannabis, and representatives from the Virginia House of Delegates, Senate, Department of Health Professions, Board of Pharmacy, and Secretary of Health and Human Resources:

• Dr. Daniel Carey, Secretary of Health and Human Resources
• Catherine “Catie" Finley, Assistant Secretary of Health and Human Resources
• Dr. David Brown, Director of Health Professions
• Caroline Juran, Executive Director of the Board of Pharmacy
• Delegate Glenn Davis, Member of the House of Delegates
• Senator David Marsden, Member of the Senate
• Ngiste Abebe, Director of Public Policy, Columbia Care
• Dr. Sam Caughron, Charlottesville Wellness Center Family Practice, designated by the Medical Society of Virginia (MSV)
• Jack Page, Chief Operating Officer, Dharma Pharmaceuticals
• Sara Payne, Senior Corporate Counsel Jushi, parent company, Dalitso, dba Beyond/Hello
• Jenn Michelle Pedini, Executive Director of Virginia NORML
• Lisa and Hayley Smith, patient representatives
• Joy Strand, Vice President, Green Leaf of Virginia
• Dr. Preston Grice, University of Virginia (note that Dr. Grice only attended the first meeting and then submitted a statement and narrated powerpoint presentation)

The work plan and discussion topics were established by consensus under the leadership of the Office of the Secretary of Health and Human Resources. The work group met five times between August and November, 2020. All meetings were open to the public and were held virtually via WebEx due to the COVID-19 public health emergency. For a full summary of the work group’s charge, membership, and work plan, see Appendix III.

The most significant program change the workgroup considered was introducing the medical use of flower, or botanical products, into Virginia’s medical cannabis program. Currently, Virginia only allows processed products such as oils and concentrates. The work group also discussed a number of policy changes that would likely increase access to medical cannabis. A couple realities became clear through workgroup discussions. First, medical cannabis patients often face significant costs in obtaining their medication, in part because insurance does not cover the products. Additional issues related to patient cost are discussed throughout the report. Second, some patients face barriers to obtaining medication ranging from logistical hurdles to stigma and lack of provider education.

Virginia should continue to explore ways to increase access for patients for whom medical cannabis treatment is beneficial. Virginia should look to remove unnecessary, onerous requirements, while encouraging safe use by patients. Similar to other regulated medical drugs, medical cannabis has both therapeutic benefits and a potential for abuse. Unlike other medications, medical cannabis remains illegal at the federal level. In addition to the legal implications, its federal status has implications for the amount of high-quality research on its positive and negative effects. The report below begins with an overview of cannabis health effects and research. It then summarizes work group discussions on several issues and details potential policy changes.