A few months ago, Mark Tucci was smoking a joint of Cheesehead, a strain of marijuana he’d never tried before. Tucci says he’s probably smoked three or four joints a day for the last decade, so there aren’t many kinds he hasn’t tried. But unlike some of his favorites — including God Bud, AK-47, TNT and Train Wreck, all of which are “kick-ass heavy” indica strains — Cheesehead didn’t do much for him.
Still, Tucci doesn’t complain. It’s his job to sample every strain of medical marijuana grown by the Vermont Patients Alliance, the state-licensed nonprofit dispensary in Montpelier. Before each strain is distributed to patients, he reports back to the staff on how it performed, informing them not only about its look, feel, taste, smell and potency, but also how it affected his body and his mood.
In all, Tucci has smoked or eaten more than 30 marijuana strains for the dispensary, providing staff with advice and suggestions from himself and dozens of other patients on the state’s medical marijuana registry. He has also acquired, from his vast nationwide network of patients and caregivers, many of the seeds, clones and cuttings the dispensary now uses to grow its plants. For Tucci, who turns 57 this month, it’s by far the sweetest gig of his life.
But, before anyone turns green with envy, it’s worth keeping a few points in mind. First, Tucci earned his coveted job — technically, he’s an independent consultant — only after years of fighting for Vermonters’ right to grow, possess and consume cannabis for their chronic, debilitating and often life-threatening conditions.
There’s another reason why most people wouldn’t trade places with him: Since his diagnosis with multiple sclerosis in 1996, Tucci’s condition has steadily worsened. Although he estimates that his daily cannabis use has given him an additional seven years of mobility, his doctor says it’s only a matter of time before the degenerative disease gets the better of him.
“Last year I went to vote, stood up out of the wheelchair in front of my car and couldn’t move my legs,” Tucci recalls. “They say I’ve got maybe six to eight months of functioning left.”
And then what? “I’ll be JELL-O guy, living up here [in Burlington] in a nursing home.”
In the meantime, Tucci, who currently lives independently in a cabin in southern Vermont, plans to work for as long as he can toward a single goal: to ensure that Vermont’s marijuana dispensary patients have the best medicine money can buy. To that end, he has largely eschewed taking other, non-cannabis meds to treat his symptoms so he won’t corrupt his research.
One Washington County physician who serves on the board of the Vermont Patients Alliance says that Tucci is giving the dispensary an invaluable service: bridging the gap between science and anecdotal evidence. The dispensary’s state-of-the-art laboratory supplies the former: It has a gas chromatograph for testing the plants for their spectra of cannabinoids, or active compounds; and a dissecting microscope for examining them for mold, mites and other parasites. What was missing, until Tucci came on board, was someone who could provide the patients’ subjective perspective on how well the marijuana actually works.
“As physicians, we want scientific research and evidence,” says the physician, who asked that his name and employer not be identified owing to the legal and political complexities that still surround medical marijuana. “When Bristol-Myers Squibb is studying a new drug for Alzheimer’s, they’re spending $2 billion on clinical testing at 50 or 100 different hospitals worldwide. That’s the kind of evidence doctors are used to, not a few patients in one state. But the kind of evidence we’d like to have just doesn’t exist yet.”
Nor is it likely to appear in the foreseeable future. As this doctor points out, the vast majority of drug studies conducted in the United States are funded by either the pharmaceutical industry or the federal government, neither of which has shown any interest in furthering this particular body of medical research.
In the absence of such evidence, physicians like this one have turned to the relatively few high-quality, peer-reviewed articles about medical marijuana treatment that are based on randomized, double-blind, placebo-controlled studies of the kind used in approving conventional medicines.
But even their scope is limited. When it comes to knowing precisely which cannabis strain to recommend to patients, for which symptoms and in what quantities, this physician says, “There is no dosing chart … There are more standards for soil and water testing.”
Hence the work Tucci performs, as both patient liaison and adviser, functions as a sort of informal clinical trial. Patients trust Tucci because he’s one of their own and has years of firsthand experience to draw from. He authored the medical marijuana patient survey, which was released last year by the Vermont Department of Public Safety. Those patients, in turn, advise Tucci about how each strain performs for them, so he can recommend new strains or hybrids for the dispensary to acquire.
“For years we were told we were crazy by doctors,” Tucci says. “We were told that cannabis had no medical value and [that] if you used it as medicine, you were a drug addict or self-medicating for depression … and [that] anecdotal evidence had no value at all. But it does.”
The flow of information goes both ways. Recently, for example, Tucci learned from the dispensary’s chemist that there’s a scientific reason why the Cheesehead strain didn’t do much for his pain or muscle spasms. A gas chromatography analysis revealed it’s high in delta-8-tetrahydrocannabinol, one of the more than 70 unique cannabinoids in marijuana. As the dispensary’s expert pointed out to Tucci, he’s had similar bad experiences with other strains containing high levels of delta-8-THC, which he now avoids.
“Who the hell would know that just from smoking weed?” Tucci asks. “No one.”
Tucci didn’t seek out this job — it came to him, largely because of all the work he’s done in the past on behalf of Vermont’s medical marijuana community. As Seven Days described in a May 6, 2009, cover story about him, “Growing Legit,” Tucci was instrumental in the passage of Vermont’s first medical-marijuana law in 2004.
Three years later, he lobbied the legislature to expand the scope of the law to allow more patients and conditions to qualify for the state-run registry, and to allow patients to possess more plants and processed weed in case their plants died or got contaminated by mold or insects.
Later, when it became obvious that many medical-marijuana patients were either too incapacitated to grow their own or too fearful about going on the black market to buy medicine of unknown source and potency, Tucci pushed for the passage of Act 65. That law, signed by Gov. Peter Shumlin in May 2011, allowed for the creation of up to four state-licensed medical-marijuana dispensaries in Vermont. Three are up and running today; the fourth is due to open sometime next year.
Over the years, Tucci has helped hundreds, if not thousands, of Vermonters cultivate their own medicinal plants. His 2006 self-published book The Patient’s Simple Guide to Growing Medical Marijuana is still the bible of Vermont’s DIY pot patients and their registered caregivers. And, despite his own physical incapacity, Tucci still helps educate and advise patients who, for a variety of reasons, have opted to grow their own rather than sign up with a dispensary.
Board members of the Montpelier dispensary approached Tucci about six months before it opened earlier this year, seeking his expertise. By that point, the dispensary had already gone through the state’s rigorous application process, which included providing the Vermont Department of Public Safety with its detailed business and security plans — and $22,500 in nonrefundable application and licensing fees. The business plan called for someone to serve as a patient liaison. Tucci was the obvious first choice.
How does Tucci go about his work? Because he suffers from neuropathic pain, which is among the more difficult types of pain to control, he says he’ll take a strain and smoke it exclusively for about two days, at different times of day, to see how it affects his conditions. After that, he tries incorporating the strain into his usual regimen and seeing how it works.
“In the morning when I wake up throbbing and spasming, I need a kick-ass indica, a Skunk or an AK, to break down my pain,” he says. “In the afternoon, when I’m trying to function and I just want to get through the day, I smoke a [sativa/indica] blend, some Skunk or Amnesia Haze, so I feel some pain-relief benefits, but also so it doesn’t knock me out.”
At night, Tucci turns to the heavier indicas “so I sleep better and don’t go to the bathroom a hundred times during the night,” he says.
Thanks in part to Tucci’s work, the dispensary now carries what he calls its “staple strains” — five basic varieties that come in smokeable form, such as buds and hashish, as well as tinctures and edibles. So, for instance, if a patient finds the strain called Train Wreck effective but doesn’t like to smoke in the morning, he or she can eat a cookie or put a drop of tincture under the tongue. Having options is crucial, Tucci explains, as patients often have to manage many different symptoms throughout their day.
“It’s like prerolled joints,” he says. “Nobody ever thinks to preroll until they become a quad [quadriplegic] and rolling a joint takes 20 minutes. It’s huge just to have these joints ready for you.”
Since patients react differently to different strains, Tucci advises them on how to manage and refine their own cannabis use. He can help identify strains based on properties such as high content of cannabidiol, a cannabinoid known for controlling pain and other symptoms without producing a “high.” He says these strains are good for children, old people and others who don’t want the mind-altering psychoactive effects. Others, he says, prefer strains that both relieve pain and improve their overall mental attitude about their incurable conditions, “because that’s really important, too.”
Variety is also crucial, Tucci adds, because patients can quickly develop a tolerance to one particular strain, rendering it less effective. He tells patients to try several kinds and keep track of which work best and at which times of day. When a patient asks his advice on a condition with which he’s unfamiliar, Tucci has friends in the medical-marijuana community across the country to whom he can turn for advice — or more. If there’s a particularly beneficial strain that the dispensary doesn’t carry yet, for instance, Tucci can usually track it down and get someone to donate seeds or cuttings.
Another important aspect of Tucci’s job is providing emotional and moral support to patients who may have little or no prior experience with marijuana. He recounts the story of a woman in her seventies who had end-stage bone cancer and couldn’t eat anything but thin soup. As he recalls, the woman was reluctant to try marijuana, which her doctor had suggested as a way of boosting her appetite. Her fears weren’t allayed by her doctor’s assurances about marijuana’s outstanding safety profile compared with the antibiotics and opioids she was taking, which are lethal in high doses; or by his promise that it wouldn’t interact with those meds.
Tucci recalls, “I had to say, ‘Good God, honey! What are you afraid of? You’re dying!’”
Eventually, Tucci convinced the woman to “just treat it like any other med.” Every few hours, take two or three hits, he instructed, then wait 10 minutes and see if it makes a difference. It did.
“Her husband shows up at my house a few weeks later with the biggest smile on his face,” Tucci recalls. “He says, ‘You’re not going to believe it. She’s eating again.’ Some of the things people say cannabis does for them, even I don’t believe.”
Tucci endured years of stoner jokes and Cheech and Chong references while he lobbied for the compassionate treatment of the disabled and terminally ill, many of whom have since died. Such stories about his patients keep him going.
And, all weed humor aside, he’s still willing to answer a burning question: Do you ever get high when you smoke?
“Every now and then — thank you, Jesus! — there will be a strain I haven’t smoked in a while, and I’ll get a good old buzz and feel good about life,” he says with a smile. But, like his ability to stand up and walk, those moments are rare and fleeting.
How much longer will Vermont’s medical marijuana patient No. 77921 be able to continue his work?
“I do not know. God, I don’t know,” Tucci says, shaking his head as he sits in his wheelchair. “As long as I think it’s doing some good.”
The original print version of this article was headlined "Vermont's Best Bud"
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