By late 2020, more than four million Americans were registered to legally receive medical marijuana for a host of conditions, the most common among them being chronic pain. With more and more states opening up to weed and remedies derived from it, those numbers are only going to grow. For chronic pain patients like myself, cannabis can be a game-changing treatment option.
When it comes to managing incurable illnesses, cannabis is often the only one in a jumble of long-term medications that doesn’t come with serious-commitment-level side effects — which in themselves, can feel like additional chronic illnesses — and one of the few with which relief is felt immediately. It’s also versatile: You can inhale it, you can eat it, you can rub it on the problem area as a salve. You can adjust the THC-to-CBD ratio to be as numbing or as subtle as you need it to be. Weed, as medicine, is a fundamentally personalized experience.
Unfortunately, it’s packaged in a way that often fails to consider the disabilities of the very people it’s intended for. In most states in which you can get it, medical marijuana must be sold in child-resistant packaging. But buyers have found that it’s so childproof it also ends up being patient-proof.
I first encountered this issue with Matter vapes, the house brand of Verilife dispensaries (formerly operated under the name of its parent company, PharmaCannis). With a THC-to-CBD ratio of two-to-one, Matter’s Aqua vape cartridge is potent enough to relieve pain in a noticeable way but balanced enough not to make me too stoned to go about regular daily activities. It’s been my go-to for years, becoming a key part of my routine for managing symptoms of lupus and fibromyalgia and, as multiple budtenders at multiple dispensaries throughout lower New York have remarked during my visits, it’s a patient favorite. Too bad it, along with all of Matter’s other vapes, is all but completely inaccessible to people like me.
They come packaged in a plastic tube that looks a lot like those travel-size canisters of Tylenol, with a push-down-and-twist top that’s equal in width to the body of the container. Covering that is a thick sticker with a perforated “Peel Here” label that doesn’t ever quite seem to line up with the rims, meaning it must first be cut before you can twist the cap. Actually doing any of this is exceedingly difficult; the sticker is hard to penetrate with a fingernail, and the small cap, about the diameter of a nickel, is hard to press and hard to twist, let alone do both at the same time.
Even on my best days, I can’t open it. Not with a knife, not with my teeth, definitely not with my hands. So I wait until someone else is around to do it for me, however long that may take.
The problems continued with other brands. Curaleaf, one of the leading dispensary names in New York, uses a shallow glass jar with a rigid plastic cap as a container for its microtablets; the packaging is too short to grip with your fingers but too inert to twist using only your palms. Dosist, a name you’ll come across in legal spots out West like California and Nevada, employs the old “press a button and slide” technique to open the clear plastic coffin it keeps its measured-dose vapes in. Opening it requires the use of both hands and a fair amount of dexterity.
That’s assuming you’ve even made it through the so-called exit bag, a Ziploc-style carryout package some dispensaries send you home with that comes with an additional locking mechanism to make the sliding clip more secure. That’s usually a button on the top of said clip that you must depress, sometimes while also squeezing the sides, in order to part the seal. I’m looking at you, MedMen.
The list goes on and, with no other options, patients have to make it work. As they struggle, pain begets pain.
“This is my arthritis medicine,” New Mexico medical marijuana user K.C. Murdock tells me. “If I can’t get into it, I’ve got to wait for my sister to get home. And I need it. Then my pain is increasing, which could lead to a bigger migraine or worse pain issues somewhere else in my body that can put me down for several days, if not a full week at a time.”
Murdock, who hosts the Down the Road Show podcast and is working on a docuseries about cannabis that drops this 4/20, is one of many frustrated medical marijuana users who responded to a query I posted in the NewYorkMMJ and MMJ subreddits. In an informal poll, 114 of 265 respondents voted in favor of the statement “I frequently find it difficult to open MMJ [medical marijuana] packages, but I manage.” That’s compared to just 42 who indicated they had no issues in this regard and 92 who reported they on rare occasions had “some” trouble getting into medical marijuana packaging. Another 17 indicated that they “cannot open MMJ packages without help.”
“I can’t open any of my MMJ products on my own,” one person commented. “I appreciate the child-safe concept but my kids can open the packages better than me.”
“There are definitely some packaging I struggle with. I have a weakened grip in my right (dominate) [sic] hand and depending on the day I’m definitely on the struggle bus,” wrote another.
Regardless of location, regardless of qualifying condition, the anecdotes piled on: “Sometimes I’m in so much pain I need others to open it for me which makes me Feel [sic] pretty useless.” “I have to have my boyfriend open them for me. I can’t do it at all.” “My injury is my arm doesn't work right lol. Imagine my frustration.” “They all need to be fixed. My wrists are what’s in pain. I’ve gotten the pliers out. There should be something a little easier and still safe.” “I have out and out had to use a knife to get into some of the packaging and my hands are quite fine!”
It is, in many cases, more difficult to access legal weed than it is to get into prescription pharmaceuticals. Some commenters offered tips, like opening and organizing your medical marijuana products on a “good day” so they’re ready for use when you need them. Of course, as that user noted, good days can be hard to come by among the chronically ill. “I understand we're trying to keep children safe, but why are we making things so difficult?” says Murdock, 46, adding that seniors make up a huge portion of registered marijuana recipients.
“Why are we making things so difficult?”
The answer to that is complex. For one, there are costs for companies to consider when choosing how they’ll package their products. And the ever-changing requirements have legal weed dealers trying to always think one step ahead.
If the package is childproof to the utmost degree from the start, a company is less likely to have to overhaul its supply when a new restriction hits down the line, explains Sandra Elkind, a Colorado medical marijuana user who founded sustainable cannabis packaging company STO Responsible with her sister, Nicole.
How accessible or inaccessible a company’s package choice ends up being essentially boils down to budget and whim.
The requirements for a patient-friendly, child-safe container leave a lot of room for interpretation and thoughtfulness — or lack thereof. It must first pass testing by a group of seniors who are given the package with instructions and have five minutes to show they can open and close it. After making it through the elder trials, the same units opened by the seniors are then given to children under the age of five to do their worst. If they can’t get into the packages within a set amount of time, even after being shown how to do it, consider it a success.
On its face, that might seem reasonable. Now imagine yourself trying to open anything for five minutes. Five minutes to get the cap off of an ibuprofen bottle when your hangover headache starts pounding. Five minutes to unscrew the itch cream when the deep-summer mosquito bites start blazing all at once. I’d be willing to bet those 300 seconds don’t pass very quickly.
STO has been working to offer marijuana companies a package that is actually usable and reusable for patients, rather than designing something meant to be destroyed and immediately thrown away. The team tries to see the unboxing experience from all angles, Elkind explains, working specifically with testers who have disabilities to ensure they’re accounted for.
“Yes, there are quite a few recreational states, but the majority of our customers in the majority of states, it's a medical market,” she explains. “There's a wide variety of disabilities that these patients might have, and we want them to have that same unboxing experience that a healthy 22-year-old male might have.”
While it might not be possible to individualize a design to a degree such that it works for every single case, one can certainly try. “You need to be able to speak to a much more inclusive group of people,” Elkind says. Not everyone has full range of motion in their fingers. Not everyone has two hands. These patients’ experiences matter, too.
As it stands, that train of thought still seems to be in the minority among the biggest names in medical marijuana. It’s been 25 years since California passed Proposition 215, legalizing medical marijuana in a U.S. locality for the first time, and patients there are still being presented with products they’re physically unable to open. The same is true for every state that’s followed suit.
Meanwhile, as legal recreational weed, which pulls in more money than medical marijuana, becomes more widespread, the rules surrounding its packaging are likely to change. For instance, it only took a few years for California to double down on child resistance after opening up to recreational use in 2016. That extra effort to access the product may be something non-disabled buyers can brush off as a minor annoyance, but it poses fresh challenges for patients and the companies supplying their medicine.
Input reached out to several medical marijuana companies, including Curaleaf and PharmaCann, for comment on patients’ accessibility complaints. Only one, The Botanist, responded by the time of publication.
The Botanist uses what’s considered a puzzle approach for its vapes, packaging them in cardboard boxes with pullable slots, not stubborn plastic tubes. These require less dexterity to open, but more logic — there’s always a tradeoff. Still, the products show a much clearer awareness of and effort to meet patients’ differing abilities than other, outside brands that can be purchased in Botanist dispensaries, like the aforementioned Matter. If all else fails, Botanist packages can be ripped open.
“There are regulations that make [accessible packaging], in general, very challenging,” says Sarah Confessore, director of packaging for Acreage Holdings, which owns the dispensary chain.
“There are regulations that make this very challenging.”
“Child resistance is the most common regulation in the cannabis industry from state to state,” she continues. “It’s cost-prohibitive. It takes a lot of time to design. So very few companies, very few cannabis manufacturers, are designing [their own packages]. We're kind of stuck with finding what the best options in the market are.”
Confessore, who herself has arthritis in the thumb, says, “It's frustrating as a consumer.” On the manufacturing side, however, she says the opportunity to approach packaging creatively to better meet people’s needs “is kind of exciting. It means that we have much more range.” Companies just have to want to do it.
Acreage is currently mulling ways to make the process better for patients, she notes, like providing instructional kits or in-person sessions, post-COVID, to help people learn the most effective technique to open their meds.
But what about the other 7,000-plus dispensaries in the U.S.? We won’t be holding our breath.
“It’s these simple things that I didn’t think about [prior to disability] that were going to be so difficult,” K.C. says. “Things that normal, healthy people take for granted every day. Pot just helps me so I can get out of bed to actually exist.”
Yet in 2021, the pain-free unboxing experience is still medical marijuana’s elusive beast, to the patient’s detriment alone. There are no bragging rights at the end of this escape room, no reward of legend for slicing through the Gordian knot or freeing the sword from the stone. When it’s relief you’re fighting to obtain, there is only frustration.