When Randy Mire first learned about efforts to pass medical cannabis legislation in Louisiana six years ago, he immediately recognized the opportunity to help patients while expanding his business. Mire owns six pharmacies throughout Louisiana that ship specialty medications (not cannabis) to 35 states nationwide.
With a doctor of pharmacy from Xavier University of Louisiana and a decade of business experience, Mire knew that he was a good candidate to open a cannabis dispensary. “I felt that put us in a good position to apply for a medical marijuana license because it showed that we understood quality control, the parameters around doing it correctly,” he says. “I was excited because it was going to be treated as medication, and pharmacists would run it.”
There were a lot of risks to starting a new business, especially in the cannabis industry where licensing fees, construction costs, tax liabilities and banking costs tend to be higher, yet Mire felt he was ready. “I love being on the cutting edge of pharmacies and medicines that can help patients,” he says.
Capitol Wellness is located in a 4,000-sq.-ft. facility in Baton Rouge’s medical corridor near the area’s two largest hospitals, allowing patients easy access to his facility. Despite many challenges, including more-than-anticipated building security requirements and limited products, he’s pleased with the results so far.
“We couldn’t be happier we got into the cannabis space,” he says.
Although medical cannabis has technically been legal in Louisiana since 1978, when Gov. Edwin Edwards signed into law legislation legalizing it for glaucoma and chemotherapy patients, according to the New Orleans Times-Picayune, the state never put a formal program into place. Then, in 2015, Gov. Bobby Jindal signed a bill that set the regulatory framework for medical marijuana in the state. Over the next two years, Gov. John Bel Edwards signed into law bills that allowed doctors to recommend medical marijuana and expanded the number qualifying conditions.
By August 2019, Louisiana had become the first state in the Deep South to make medical cannabis available to patients. The Louisiana Board of Pharmacy approved nine dispensaries (referred to as “licensed pharmacies”) to operate in the state. Recommendations are only available for patients with a qualifying diagnosis, and patients must receive a recommendation before they can purchase medical marijuana.
According to state law, cannabis cannot be consumed in raw form or smoked. Approved products include oils, extracts, sprays, capsules, pills, solutions, suspension, gelatin-based chewables, lotions, transdermal patches, suppositories and metered-dosed inhalation.
When Mire learned of the opportunity, he put together a team of pharmacists and applied for a license for the Baton Rouge area. Earlier this year, the Louisiana Board of Pharmacy voted 9-0 in his favor, and Capitol Wellness Solutions opened its doors in August.
“From cancer patients to autistic individuals to chronic pain management victims, many of the pain doctors are realizing this could be added therapy,” says Mire. “The education piece has been really big. They’re realizing they have another alternative to turn to besides opiates.” His first patients included a Marine veteran suffering from post-traumatic stress disorder and a cancer patient.
Mire says his background in medical compliance made him a competitive candidate for opening a dispensary, but he wanted to put together a team of experts to help. When he applied, he hired iComply Cannabis, a national consultancy, to help him comply with regulations and better understand the cannabis industry, he says.
BUMPS IN THE ROAD
Mire’s two biggest challenges so far have been the limited number of products available in Louisiana and patients’ inability to use credit cards. That’s starting to change, but Mire hasn’t found a credit card company he’s been able to work with yet.
“That’s been one of the most frustrating things – people need the product, but they don’t have the ability to pay for it,” he says, adding that he’s now working with a new company to reach a deal.
Questions about cost have arisen statewide as some doctors are saying patients are finding the cost for medical cannabis too high, pricing them out of the market after years of waiting. Currently, the only cannabis product consumers could purchase in Louisiana was a concentrated liquid form in bottles up to 30 milliliters. Prices for a single tincture bottle range at Capitol Wellness from $98 to $198 for a typical 30-day supply. Some individuals may need a larger dosage, so they may need a bottle-and-a-half for a 30-day supply
“Patients want to have more access to a variety of products, especially to treat acute pain,” Mire says.
Additional products, especially higher-strength tinctures, could help drive prices down for consumers. “With the higher concentrated tincture oil, a patient that may need to buy three bottles at current strength, may be able to buy less, and with one package price the cost should be considerably less,” says Mire.
One of the biggest things Mire sees looking ahead is a need to educate patients and doctors about the benefits of treatment. Unfortunately, cannabis still carries a stigma, and many people are uneducated about it, he says. “It’s amazing that most of the time people still look at this as a last resort treatment. If we were more aggressive in terms of education, we could turn to it sooner.”
Although many of the state’s doctors are taking a “wait and see” approach, the number of doctors involved is growing, Mire says. To recommend medical cannabis to patients, physicians must get fingerprinted and undergo an additional series of background checks with their licensing board.
“Many doctors were waiting for the program to launch, and getting feedback from their patients about their level of demand,” Mire says. “Physicians are now signing up. We do see that growing rapidly. Part of the reason they were waiting was because of potential delays with the products.”
A unique aspect of Louisiana’s approach is that before they receive their medication, patients undergo a consultation with a pharmacist. It takes about 15 minutes. “We go through everything,” Mire says. “Are they cannabis naïve, what are the possible side effects, how to take the medication. From an experience standpoint, it’s really different. This creates compliance.”
Although Capitol Wellness Solutions has only been open for less than a year, Mire is excited about their impact. “The patient testimonials are amazing,” he says. “Countless patients are now able to reduce their opiates and have a better quality of life. Many are already getting a follow-up recommendation. They’ve seen so much benefit, they’re now returning monthly.”
Louisiana’s approach is also being closely watched by other states, according to Mire.
“We see other states following our same model, a medical-only approach in which a pharmacy is dispensing the medication and a doctor is involved in the recommendation,” he says. “I often get calls from politicians and industry leaders in other states that want to replicate what we’re doing in Louisiana.”
Mire has already identified a larger, 7,500-square-foot building he could expand into, he says. Given the industry’s growth so far, he wants to be ready. “As more doctors join, there’s greater patient awareness, and the stigma is further removed, I think we’re just going to grow more and more,” he says.
Lee Chilcote is a Cleveland-based freelance writer and editor whose work has been published in Vanity Fair, Next City, Belt, and many literary journals.