Medical marijuana card renewal system isn’t working for patients 

click to enlarge Red cards — which aren’t red anymore — can be hard to renew. - COLORADO DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
  • Colorado Department of Public Health & Environment
  • Red cards — which aren’t red anymore — can be hard to renew.
Lots of people find that it’s not easy to work with the government. That’s certainly been my experience, going through the state’s Medical Marijuana Registry, a division of the Colorado Department of Public Health and the Environment (CDPHE), for the eight years I’ve been a medical marijuana patient.

Maintaining my status with the state as a patient has required planning. MMJ cards, or red cards as they’re commonly known, are only good for one year, so I’ve had to think ahead, and schedule a medical exam well before my card’s expiration date.

That process has grown more complicated since the state switched to a difficult-to-navigate online renewal system. In the early days, patients applied for medical marijuana status on paper forms that needed to be filled out perfectly, including in the right color of ink. The process (which is still available) involved getting a money order for the state fee, cash for the doctor, and going to a post office to send the forms by certified mail (the procedure recommended by the companies that perform MMJ evaluations). Patients then waited four to six weeks for their card to arrive. If there was a problem, like incorrect information on the form, they started over again and waited another four to six weeks.

This “old school” approach was begging for an upgrade. And it would seem that the state’s new system — in which patients apply online, then print out their own cards from the website or download the pdf onto their phones — would fit the bill. Being a fairly computer literate person, I thought, “How hard can it be?”

Last September, when my expiration date was less than a month away, I went to the state website to set up my account (tinyurl.com/CO-red-card). I knew time was running short, but my doctor’s appointment was scheduled for the following week. I assumed the new process would be quick and easy.

Silly me.

Soon, this typically unwieldy government site had me stumped and I was unable to proceed. The online directions didn’t help much, so I looked for a phone number for technical assistance. No luck there, the line was always busy.

The site said that patients with questions should email the state registry and expect a response in three days. My frustration was mounting, and I began to fear that my current card could expire before the new one was approved, meaning I would be unable to buy my medical marijuana, which I use to treat chronic pain and inflammation from injuries and arthritic joints and to sleep soundly.

According to Natalie Riggins, who manages the registry, the state realized in 2013 that a better red card renewal method was needed than the old paper forms, but it took until January 2017 to roll out the online system. Naturally, the transition from paper to digital was rough — the system had bugs, patients needed a lot of help, and the registry did not have the resources to provide technical assistance. The registry receives around 1,000 emails and 500 calls per week, she estimates, although those are not all about problems with the system.
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Riggins says that fall 2017, when I renewed my card, was a particularly bad time in the transition. The registry had long outsourced customer service to a call center — a system that had worked well for the paper cards but proved to be inadequate for the online system because the nature of patient inquiries had changed to more technical requests. In August 2017, a decision was made to bring the technical assistance in-house with four staff persons currently handling requests for help. But the staffing hasn’t been enough to meet demand.

Riggins says the department knew that four staffers wouldn’t suffice but says, “it’s important to understand how the system is financed.” The registry has to operate with the money it earns from the annual $15 fee paid by MMJ cardholders — an amount established in 2013 by the state’s Board of Health. Riggens says that fee is inadequate to properly staff her department and thus a $10 increase is now proposed, pending approval later in March by the board.

“The income will be used to maintain and improve the Medical Marijuana Registry System and customer support,” Riggins says in an email, but she didn’t offer any specifics. She added that the computerized registry is “still in its infant stages and that many system enhancements have been made” since my bad experience last fall.

But I know that the problems did not stop for all patients in 2018 — a family member of mine faced similar issues in January when trying to access his account to print out his card. At the time, patients across the state were scrambling to comply with a new regulation from the Medical Marijuana Enforcement Division that required them to present a full-sized card (or the pdf from the registry) for purchases. Many dispensaries had shrunk the 8½-by-11-inch paper cards down to wallet-size, and laminated them as a convenience for their customers. Suddenly, these weren’t valid, and patients were turned away from dispensaries, unable to buy their medicine without an original card.

The patients that rushed to the state’s new online system, in many cases, lacked the user information needed to sign in to the registry and print out their cards. When my family member went online and tried to set up an account, he received a message saying, “this Social Security number is already in use.”

Again, little technical assistance was available immediately. Back and forth emails with registry staff eventually resolved the problem, but he was without a usable red card for several weeks.

At some point, in my opinion, the hassles of the new system probably exceed the benefits. The number of active patients on the Medical Marijuana Registry has dropped in recent years, from 110,979 in December 2013 (just before Amendment 64 went into effect, legalizing recreational marijuana) to just over 93,314 in February 2018, a decrease of over 17,000 patients. When asked about this drop, Riggins says that “fluctuation is expected.” She speculated that the advent of recreational marijuana has had an impact on the number of medical patients.

But recreational marijuana, which earns more tax revenue for the government, is not good for patients. It costs more and is less suited for medical problems. And while switching to recreational cannabis may work for residents of the Denver area, where it’s readily available, the same cannot be said for El Paso County. With only two recreational stores in Manitou Springs serving the entire county, the stores are crowded with locals and tourists. Staffers can’t be expected to help patients with their medical questions.

Perhaps that’s why patients in El Paso County don’t appear to be abandoning their red cards. While the state numbers for MMJ patients are dropping, the opposite is happening in El Paso County, which has seen an increase in card holders from 15,320 in December 2013 to 19,808 in February 2018. The county’s medical marijuana patients now account for over 20 percent of the state’s caseload, a much higher proportion than any other Colorado county.

As difficult as the state’s computerized system may be for some patients, it appears that most are making it work for them. Some have done so with help provided by companies doing medical exams. Aisha (who didn’t want her last name used), the very busy intake coordinator at Medical Alternatives Clinic in Colorado Springs, says her company chooses to act as an intermediary between the registry and patients who come back for help, even though that’s not their role and it takes extra time. “They [the state registry] need to take patients into account,” she says. “Many are not computer literate, and they can’t get through on the phones.” Aisha has not noticed any improvements in the system during the 15 months that her clinic has been using the state’s online registry, and she says many patients still have difficulty with it.

Riggins, though, has confidence that things are getting better, noting that the website has more information to help patients now and that further system enhancements are planned. Having the customer support in-house allows the state to evaluate the issues people are having and use that information to make improvements, she says. “As with any new system, once users began using it, we have learned and will continue to learn of ways to improve the end user experience,” she says via email.

Let’s hope the state does improve the system. Especially in El Paso County, where recreational marijuana is in short supply, it’s important to keep medical marijuana available to a growing patient population.

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