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Sam Poquette has long mixed medical-grade cannabis with recreational hemp products to self-manage pain and post-traumatic stress, so he was happy to try hemp gummies that were legalized in Minnesota this month to see if they help.

"I have kind of a daily routine but I do adapt if I'm having certain symptoms," said the 31-year-old from New Ulm. "I will change and do different products. I have a whole drawer full of legal hemp products."

Whether people such as Poquette abandon or reduce their reliance on Minnesota's medical cannabis program in favor of new recreational options was a little-discussed wrinkle of the latest state expansion. Once resigned to picking between expensive medical cannabis and cheaper illicit drugs, people in need of disease or pain management now can evaluate multiple options, including those containing elevated levels of hemp-derived THC, the psychoactive ingredient in marijuana.

People are likely to dabble with the new recreational edibles, which can be obtained without the $200 fee to enroll in the state medical cannabis program or the cost of a doctor visit to get certified with a qualifying health condition, said Chris Tholkes, director of Minnesota's office of medical cannabis.

"I don't know that these hemp products are going to have a dramatic downfall for our program," she said. "But I think some people who may prefer to participate in our program will sort of be nudged toward (them) because that's what they can afford."

Minnesota's medical cannabis program has seen steady growth since its launch in 2015, adding qualifying conditions such as chronic pain, which was a listed condition for 19,878 of the state's 32,464 certified patients at the end of March.

The addition in March of a smokable flower form of medical cannabis generated a predicted boost for Minnesota's two licensed distributors. Dispensary visits increased from 19,047 in February to 35,506 in March, according to the state's medical cannabis dashboard.

Poquette said that addition is likely to sustain the medical cannabis program, because many people find immediate and stronger relief from the smokable cannabis that isn't available in a legal recreational form in Minnesota.

The state also is adding gummy forms of medical cannabis on Aug. 1, but that could result in comparison shopping. Recreational hemp gummies can contain up to 5 milligrams of THC per serving.

The new medical cannabis gummies can contain 10 milligrams per serving, but if they cost too much people might just double up on the recreational alternatives, said Patrick McClellan, a longtime consumer advocate who has muscular dystrophy and takes medical cannabis to reduce pain and muscle spasms.

If a gas station sells hemp edibles at a third of the cost, "then everybody is going to buy at the gas station and nobody is going to buy from the program," he said.

Over time, McClellan believes the competition will be good for the state program, because people with qualifying conditions who were hesitant in the past might try the recreational hemp and then feel more comfortable with medical cannabis.

An expansion of the program next year with more qualifying conditions seems unlikely. Petitions so far this summer have been rejected because they proposed adding conditions that have already been denied, Tholkes said. The state will review medical literature to see if there is new evidence to support medical cannabis for anxiety disorders, and will weigh research for irritable bowel syndrome and obsessive compulsive disorder.

Weighing consistency and cost

Medical cannabis distributors have responded to the new recreational competition with branding and messages that emphasize the quality of their natural products. Those products are tightly regulated and tested under state law to ensure that they are providing the amount of THC claimed on the packaging.

"We believe our current medical cannabis patients will continue to count on us for safe, high-quality, consistent products that are backed by years of experience," said Sarah Lynch, commercial general manager of RISE Minnesota, which through a corporate acquisition has replaced LeafLine as one of two state-licensed distributors.

The other distributor was rebranded in 2020 from Minnesota Medical Solutions to Vireo Health Minnesota and switched its storefronts to a more organic-sounding name, Green Goods.

Poquette works in a tobacco shop that sells the new recreational gummies and said he was shocked at the long lines of middle-aged women, senior citizens and even some political conservatives looking to buy the products last week when they first became available.

Recreational users will tolerate variations in the potency of each gummy, but people taking them for pain relief are going to expect consistency, he said. If medical cannabis remains more reliable, "I think people will pay a little more, but not much more."

Poquette said combinations of cannabis and hemp help with his PTSD, pain and migraine headaches. He drives to Bloomington to purchase a high-dose THC tablet because a closer store in Mankato charges three times the price for half the dosage.

A recent state pricing study found that people were spending more than $300 per month on average in 2019 for medical cannabis in Minnesota.

Many people were expecting prices to go down this year when the new smokable flower forms became available, but that didn't happen, he said. The resulting frustration could prompt people to drop out of the state program now that other options are available.

"I've gotten mad a few times and thought about it," he said, "but I don't think I will."