How many plants a patient needs has become quite the hot topic among law enforcement and the medical community lately. How many are too many?
The Medical Board has decided that more than 75 plants is too many, even dangerous, unless the patient has cancer. They’re even suspending licenses of good doctors based on this flawed criteria.
The Colorado Constitution says that 6 plants is the baseline, but it also allows for medical necessity:
(II) No more than six marijuana plants, with three or fewer being mature, flowering plants that are producing a usable form of marijuana.
(b) For quantities of marijuana in excess of these amounts, a patient or his or her primary care-giver may raise as an affirmative defense to charges of violation of state law that such greater amounts were medically necessary to address the patient’s debilitating medical condition.
Note that the constitution says that it’s up to the patient and caregiver to determine the amount of medicine required and makes no mention of doctors in this capacity. However, the State has allowed doctors to take on that authority; therefore they should have equal protection.
But how does one determine the amount that is “medically necessary” to treat a specific patient?
Let’s just say, it’s complicated.
There are a lot of questions, and many do not have clear-cut answers. Here is a list of questions doctors, caregivers and patients need to consider in determining plant count.
First, let’s talk about the growing environment.
Who is growing?
Many patients choose to grow their own medicine at home for a variety of reasons: cost, quality assurance, organic, need for specific strains, or simply because they enjoy the horticultural therapy of cultivating the medicine that is healing them. Others choose to turn their plants over to a caregiver or medical marijuana center for cultivation. All these choices are within a patient’s rights.
What is the cultivator’s skill level?
Many patients don’t have a lot of experience growing cannabis, and despite what some may tell you, it’s not easy. At least not if you want to harvest something of quality. Home cannabis growers have to deal with all of the same issues any home vegetable gardener has to face like droughts, floods, hail, bugs, mold, and wind. And just as with any gardener, some are better at it than others. How much a plant will yield depends a lot on how skilled the grower is. The average patient may harvest just 1-2 ounces of usable material from each plant. Put those same plants in the hands of a master grower working in the marijuana industry and the yield will be much greater.
Where will the plants be grown?
Many patients and caregivers choose to cultivate outdoors under natural sunlight or in a greenhouse. In our Colorado climate, they are likely to only get one harvest per year. Some may choose to grow indoors so they can get multiple harvests in a year, but indoor cultivation isn’t without its challenges including bugs, mold and lower production in addition to infrastructure and energy costs.
How many harvests a year?
If there will only be one harvest a year, the patient gets just one shot at cultivating everything they need for the entire year until their next crop is ready. That requires a much higher plant count because they have to grow everything all at once.
What strains are they growing?
The strains that have been bred to be big producers tend to be high in THC. Many patients are looking for strains with a more robust cannabinoid profile, especially those higher in CBD. Those strains tend to be much lower producers, requiring more plants to supply the amount of cannabis needed.
Are they growing from seed or clones?
Seeds are unpredictable. They might not sprout at all, and if they do, there’s a 50-50 chance the plants will be male and discarded. Clones require a stable “mother” plant to take cuttings from, which can use up some of a patient’s plant count. Some clones are weak and unhealthy and will need to be discarded.
Simply put… the natural variations of the plant as well as variations in growing conditions must be taken into account when determining how many plants a patient needs.
Now, let’s talk about the individual patient.
What condition or symptoms is the patient treating, and how severe is the condition?
Many cannabis patients are trying to cure late-stage cancer, severe chronic pain, intractable seizures, intense dystonia, or a number of other conditions that demand high amounts of cannabis for treatment.
What variety of strains do they need?
Not all cannabis is the same. Many patients, including me, suffer from what we call “strain-lock” when what has been working becomes less effective. The medical community calls it “tolerance.” This can easily be alleviated by changing to a different strain, or rotating through a selection of strains. Different strains are effective on different symptoms. If the patient is treating a complex chronic condition like fibromyalgia, they may need a variety of strains to treat pain, fatigue, insomnia, muscle spasms, anxiety and cognitive difficulties.
How is the patient consuming?
Although many people associate cannabis with smoking, there are so many other ways to consume. People who choose edibles, tinctures, topicals, suppositories, concentrates or juicing raw leaves require much greater amounts of cannabis to make the products they need. The quality of the source material along with the skill of the person making the products will affect the amount of cannabis a patient needs to grow.
How quickly do they process cannabis out of their system?
Some patients have a more efficient digestive system and process cannabis very quickly, particularly if their lifestyle has little environmental toxins or they haven’t been exposed to pharmaceuticals. These patients may need to consume more cannabis to get the continual effect they need.
How much body fat?
Patients with higher body fat may process cannabis much more slowly and store more cannabinoids in fat cells throughout the body. Those with little body fat, particularly those suffering from cachexia or eating disorders, may require more cannabis to achieve therapeutic doses.
How does the patient respond to cannabis?
Probably one of the most difficult challenges regarding cannabis is that each person responds to this amazing plant differently. I’ve met patients who can’t stand edibles, while I rely on them as an important part of my treatment for fibromyalgia. I know patients who start to feel woozy at very low doses, and others with very high tolerance levels so that they are able to ingest enormous amounts with little, if any, psychoactive effect. One patient with epilepsy may do well using primarily CBD, while another will require higher amounts of THC, even though they are treating the same condition. In my experience, and I’ve talked with a whole lot of patients using cannabis, the plant gives each one of us what we need. Some need more. Some need less. But we all need cannabinoids.
As you can see, determining how many plants a patient needs to achieve the medicinal results they want is very complicated. All these factors must be considered when making this decision.
Unlike pharmaceuticals, there is no established effective dose of cannabis. Each plant is different. Each patient is different.
The decision of the Colorado Medical Board to penalize doctors who recommend plant counts above 75 for patients who have cancer, but not for others, claiming that it’s outside of “standard medical care” ignores the reality, and the constitutionality, that the patient is the final decision-maker when it comes to plant count.
The patient, in cooperation with their doctor and caregiver, is the final authority on what is and isn’t working, on what is needed to achieve the desired effects, and how many plants need to be grown. The Medical Board and law enforcement have no right to interfere with or restrict that authority. And they certainly shouldn’t be penalizing doctors based on an over-simplification of what is a complicated decision-making process that they are unfamiliar with, have little knowledge about, and are unwilling to engage in themselves.
— Rx MaryJane (Teri Robnett)
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