Hawaii’s cannabis program is at a crossroads. Legislators passed Act 230 in 2015 to establish a statewide, patient-centric, public-health-oriented medical cannabis dispensary program intended to offer safe and reliable access to cannabis medicine. Two years later, tensions are peaking among the patients, dispensaries, legislators, the state Department of Health, and the Ige administration. The dispensary program that started with such promise is now overburdened by government regulations and is failing patients.

Early versions of Hawaii’s dispensary legislation featured a horizontal licensing structure — separate licenses for different types of cannabis businesses — and would have allowed for as many as 26 licensees to participate in the new industry. Unfortunately, the final legislation left Hawaii with a restrictive dispensary program, awarding only eight vertically integrated licenses for the entire state. Each licensee is required to grow, produce, manufacture and retail its own medicine, and permitted to open no more than three retail dispensaries.

The current medical cannabis regulations — a tool that lawmakers crafted to assuage their own fears and apprehensions toward cannabis — severely limit marketplace competition and create a state-sponsored oligopoly, rather than the patient- centric program intended by the original law.

After more than two years, just three of the eight licensees have opened a single retail store each in their respective counties, and none of those have reached the maximum number of grow facilities or plants to service their current retail outlets. Vertical integration and the associated costs of maintaining every aspect of the supply chain are chief causes of these shortcomings.

As a result, retail prices in the first two dispensaries to open were two- to three-times higher than the black market, and the diversity of medicine is extremely low. Out of a possible 2,000 cultivars (strains) of cannabis, each with its own unique medicinal profile that helps alleviate specific symptoms, fewer than 10 cultivars have been made available by each dispensary. Imagine, for example, going to Longs Drugs for migraine medicine, only to find two options: Vicks VapoRub and Pepto-Bismol. The current strain selection at dispensaries leaves much to be desired for patients suffering from conditions that range from severe epilepsy to terminal cancer.

Vertically integrated medical cannabis programs have failed in state after state — Hawaii is no exception. Legislators in New York and Maine, two states facing failing vertical programs, recently took action to increase the number of licenses to allow more market competition and better product diversity. New York doubled its number of licensees, and patient numbers jumped from 805 to 17,000 in one year. Maine scrapped its vertical licensing system in 2016 in favor of a horizontal one, and its patient population nearly doubled.

Hawaii needs a similar Legislature-led transition to a horizontal program — a program that encourages more licenses, more competition, more medicine, lower prices and better public education.

A horizontally integrated dispensary system in Hawaii would also create more jobs, foster new agriculture and research opportunities, and help thousands of patients who have waited 17-plus years for the state to make good on its promise to deliver a patient-centric medical cannabis program.

The Hawai‘i Dispensary Alliance advocates for horizontal integration and provided a roadmap to a sustainable and robust medical cannabis industry in our 2016 white paper, Hawaii’s Medical Marijuana Economy. Now is the time for patients and would-be patients to contact their legislators, as the 2018 legislative session opens in January. We need a medical cannabis program that offers safe access to a diverse array of cannabis products, and prices competitive enough to stamp out the black market.