HONOLULU (HawaiiNewsNow) – Big changes are coming to Hawaii’s troubled medical marijuana system to make it easier for patients to use cannabis for more conditions without resorting to risky or illegal sources.

Hawaii lawmakers rejected the idea of legalizing recreational marijuana in favor of shoring up the medical cannabis system, which is built around highly regulated dispensaries like Aloha Green Apothecary in Mapunapuna.

The legislature took action this year out of concern that the 12-year-old system was failing.

Aloha Green Apothecary president Ty Cheng said while it was laudable that the system developed to deliver effective, safe and tested products, the investment hasn’t paid off.

“I think there was some irrational exuberance about how successful the program could be and what it could become,” he said.

Dr. Clifton Otto is a cannabinoid medicine specialist with many patients in Hawaii. He said dispensaries are unable to provide products many of his patients want and are too expensive.

“They’ve had to make a huge investment in building cultivation facilities from the ground up, which has been a huge expense,” he said.

A committee report on House Bill 302, which became the vehicle for major reform of the industry, said the number of registered patients has been falling, from a peak of about 35,000 to 30,000 and fewer than half are using dispensaries.

Instead, patients grow their own, rely on a caregiver grower or buy on the black market.

After realizing the votes weren’t there in the House for legalizing recreational marijuana for adults, Senate Consumer Protection Jarrett Keohokalole pushed for the dramatic changes to the medical cannabis program.

“It’s clear it’s not working the way everyone would like it to work,” he said.

The new law will make it easier and cheaper to get a medical cannabis card by legalizing telehealth consultation with a doctor or advanced practice registered nurse, setting a formula to cap fees on the initial appointment, and freedom for providers to recommend cannabis for more conditions and side effects.

Andrew Goff, manager of the Department of Health Office of Medical Cannabis Control and Regulation, explained the change.

“If you have a condition that’s not on our defined list of debilitating conditions, but a provider thinks that cannabis could be right for you and could be incorporated into your treatment plan. They are empowered to do that,” he said.

It’s hoped that will mean more customers for the dispensaries.

Aloha Green president Cheng says despite the costs of cultivation, production, quality and potency testing and taxes, their pricing is now competitive.

“We normally see now we see product at about $100 an ounce,” he said. “Which is actually around what the grey market or illicit market would be pricing their product as well.”

But Otto said many patients prefer cannabis products they or their caregivers have grown.

The new law expands what caregivers can do. Prior laws allowed a caregiver to only grow for a single patient. They are now allowing them to grow 10 plants each for up to five patients.

“What we really want to do is just make the whole system more convenient for patients,” Keohokalole said.

The law allows more dispensary licenses and bans large growing cooperatives. That’s a reaction to a cooperative grow site in Mokuleia that claimed to serve over 1,000 patients, but that concerned law enforcement and competed with dispensaries, although its supporters said it provided an essential service.

The law limits shared grow sites to five patients or caregivers on one site.

“So that’s 50 total plants and patients can also collectively pull their resources and grow on one plot, but only up to five patients,” Goff said. “So, it is a limited access that way, but that is to curtail some of the more commercial operations.”

The law was also designed to crackdown on providers who certify patients without enough information about their medical needs, so it makes it clear that the government can examine medical records.

That alarmed patients and providers, like Dr. Otto, and nearly got the bill vetoed.

“We have to realize that the information in these medical records could be potentially incriminating,“ Otto said. “Because there is evidence in there that patients are engaging in the illegal use of a federal schedule 1 controlled substance.”

The manager of the medical cannabis program says the intention was to make sure that providers had meaningful discussions about conditions and side effects and whether cannabis products were safe for them.