THC vs. CBD for pain

              For thousands of years, cannabis has been used as a medical treatment for a variety of ailments, pain relief being one of the most common reasons. In the medical community, the use of cannabis for pain relief is studied by scientists, not only to understand the mechanisms of the components of cannabis, but also to provide the most safe and effective treatment for various types of pain including analgesic and neuropathic. While in recent studies, both tetrahydrocannabinol (THC) and cannabidiol (CBD) have shown pain relieving properties individually, the entourage effect has seemed to show that a combination of the components of cannabis, including THC and CBD, may be the answer to various types of pain relief.1

              When scientists discovered the endocannabinoid system, they also began to understand how CB1 and CB2 receptors regulate various internal processes, including immune function, appetite and digestion, inflammation, cognition, and behavior.1 Endocannabinoids are produced in the body, however phytocannabinoids, such as THC and CBD, are found in cannabis and hemp in varying concentrations.  THC is a partial agonist for CB1 receptors found mainly in the central nervous system that produces the psychoactive properties of cannabis.  It is also a partial agonist for CB2 receptors found elsewhere in the body, including the immune system.1   CBD can act as an antagonist for endocannabinoid receptors, but is also  an endocannabinoid modulator.1  Both THC and CBD concentrations in the body are dependent of method of administrations, with inhaling producing a shorter response time and half-life, while oral ingestion leads to first pass metabolism and production of metabolites that are longer lived.2

              In scientific studies, both THC and CBD have been seen to have pain relief properties, specifically analgesic and neuropathic.  The mechanisms by which CBD works in the body is largely unknown.  It can be a modulator of opioid receptors, which in turn can make it an analgesic.3 As well, CBD interacts with PPAR-gamma, a protein associated with anti-inflammatory properties.  The CBD and PPAR-gamma interactions may increase anti-inflammatory responses.3 On the other hand, THC is an agonist for CB1 and CB2 receptors.  CB1 activation in the endocannabinoid system is associated with a reduction in pain and inflammation.2 THC is also seen to have 20x the anti-inflammatory properties of aspirin and approximately two times that of hydrocortisone.3  THC works in various ways to produce pain relief, including its interaction with serotonergic, glutamatergic, and the endorphin and enkephalin systems.3 All of these interactions make THC an extremely effective pain relief option.

              The choice between CBD or THC for pain relief depends on two main issues – availability and effectiveness.  While CBD is widely spread available, the acquisition of THC is much more difficult, depending on individual state rules.  Perhaps the most important, though, is whether CBD or THC is more effective.  Because of a lack of research, effectiveness, especially in CBD, is based on anecdotal evidence. It is apparent, however, that the entourage effect allows a combination of THC and CBD to be the most effective for pain relief.  The entourage effect is the synergy of all the components of cannabis.  THC, CBD, terpenes, and flavonoids, along with the hundreds of other compounds found in cannabis, work together by different mechanisms to seemingly produce the greatest pain relief in a variety of circumstances, including neuropathic pain and hyperalgesia. Therefore, the answer to whether CBD or THC is better for these types of pain is not specifically clear.  Both research and anecdotal evidence has consistently shown that the combination of compounds in cannabis is perhaps the best pain relief option.1,2

              The major cannabinoids in cannabis, THC and CBD, both display pain relieving properties individually.  While the mechanism for CBD is not completely understood, it does seem to reduce chronic pain.  As well, THC works on various system to produce pain relief.  The question of which compound produces the best pain relief does not have a simple answer. In fact, the combinations of all the compounds in cannabis, including THC and CBD produce the best synergistic effect of pain relief.  The entourage effect, which includes other compounds like terpenes and flavonoids, shows that the whole plant may be the most effective in combatting both neuropathic pain, hyperalgesia, and inflammation.

  1. Mallick-Searle T, St. Marie B. Cannabinoids in Pain Treatment: An Overview. Pain Management Nursing. 2019;20(2):107-112.
  2. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008;4(1):245–259.
  3. WHO Expert Committee on Drug Dependence. World Health Organization. Cannabidiol (CBD). https://www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf. Accessed November 16, 2019.

An antidote for cannabis intoxication

The use of “antidotes” or drugs that reverse the action of another drug are very familiar to the public today as the opioid crisis continues to grow.  Naloxone, otherwise known as Narcan, is the most commonly known drug to treat opioid overdoses. Like Narcan for heroin, rimonabant is an antidote for cannabis intoxication. Most people are not familiar with the concept of cannabis intoxication. While there is little to no chance of death, there are symptoms, such as anxiety, that cause numerous number of emergency room visits a year.1 Scientist have worked a treatment for this intoxication, rimonabant, but unfortunately, the mental health side effects have caused it to be unacceptable for patient use.2

              As more and more states and countries are legalizing both medical and recreational cannabis, the instance of intoxication cases have increased as well.  For example, when Colorado legalized recreational cannabis, cases of intoxication increased to almost twice the rate of the rest of the United States, about 6 per 100,000 people.3 The average user may think it is impossible to overdose on cannabis like heroin or other opioids.  While cannabis intoxication is not known to be deadly, it does exist, and emergency room cases are not uncommon.  The most prevalent symptom of the intoxication is severe anxiety.  Other symptoms can range from confusion and paranoia to a rapid heartbeat and hallucinations.3 Currently there is no standardized dosing method for the various strains of cannabis. Without dosing, intoxication is possible, especially in edibles, as the effects take longer to manifest and lasts longer.3  

              Benzodiazepines and sedatives are the usual treatment for cannabis intoxication in the ER.  Unfortunately, these medicines can increase the sedative effects of cannabis.1 An alternative to these treatments exists and actually works very well as an antidote to cannabis intoxication.  Rimonabant, the generic name of Acomplia, is a CB1 endocannabinoid receptor antagonist.2 It was designed to be an anti-obesity drug. In the body, CB1 and CB2 receptors are G-protein linked receptors of the endocannabinoid system.  CB1 is found in the central nervous system while CB2 is found in the immune system.  These receptors normally bind to endocannabinoids found naturally in the body.  When cannabis is ingested, THC binds to the CB1 receptor to cause psychoactive effects.1 Rimonabant is a CB1 antagonist.  This means that it binds to the CB1 receptor, kicking off the bound THC is the process.  Being an antagonist, it deactivates the receptor.1    

              Looking purely at the antagonist activity, rimonbant is an excellent antidote to cannabis intoxication.  It reverses the symptoms without the lethargy of benzodiazepines or sedatives.  Unfortunately, the drug has severe mental health implications.  Suicidal tendencies and depression were rampant among patients taking rimonbant.4 In 2006, Europe approved it for weight reduction.2 In 2007, the FDA recommended against approval due to the serious side effects. The equivalent agency in Europe, the European Medicines Agency, withdrew the drug from production in 2009 for the same reasons.  Today, rimonabant is no longer produced or used in Europe or the US.4         

              Since the legalization of cannabis has started to become widespread, instances of cannabis intoxication have increased as well.  Emergency room doctors commonly use benzodiazepines and sedatives to treat symptoms such as anxiety, paranoia, and hallucinations but these treatments tend to exacerbate the drowsiness associated with cannabis use.  Rimonabant, a CB1 antagonist initially created to fight obesity, can replace THC on the CB1 receptor and counteract the THC psychoactive effects.  While rimonabant was very effective in weight loss and reversing cannabis intoxication, its side effects had significant impacts on mental health in patients including suicidal tendencies and major depression.  Accordingly, the FDA and European equivalent banned its use.  Therefore, while an effective antidote to cannabis intoxication does exist, its side effects prevent it from being used by the medical community.

  1. Cannabis Overconsumption – Current and Future Treatments website. https://profofpot.com/treatment-cannabis-overdose. Accessed on November 10, 2019.

Classifying cannabis strains

The current classifications of cannabis rely on morphologic traits or chemical characteristics.  These classifications can be very confusing, especially in with the vast amount of hybridization that has occurred in the cannabis place over the last century.  A typical user will classify the various strains as “sativa” or “indica” when in fact they could be both C. indica strains.  As well, a plant that appears to be a C. sativa strain, with long thin leaves, may be in fact a hybrid. For these reasons, chemical characteristics are much more valuable to use when classifying the different types of cannabis.

              Morphological classification of cannabis consists of grouping cannabis by their physical traits.  The C. sativa is thought to originate from the spread of plants from Asia and the Himalayas down to northern Africa.2 This strain tends to have lighter green leaves that are longer and thinner in order to adapt to hotter environments.  C. sativa is usually seen to be taller and have a sparse number of flowers.1 It is the primary strain used in industrial hemp. The origins of C. indica are thought to be from the spread of plants near central Africa, Afghanistan, and China.  These were also the plants that eventually spread to Latin America.2 C. indica strains tend to have a bushier appearance. The leaves are shorter and broader than those of the C. sativa strain.3  While classifications based on phenotypes such as these seem straightforward, the dioecious nature of cannabis causes hybridization among strains easily.2 What was once classified as a C. sativa may contain high amounts of THC and find genetic links to C. indica ancestors.  For this reason, classification by chemical characteristics is much more accurate.4

              Hybridization among the different strains of cannabis has been happening ever since it has been used and cultivated by humans.  By crossing male and female plants of different strains, the desirable chemical traits, such as plants high in THC, are easy to create.  In fact, most strains that are found in the medicinal market are a hybrid of C. sativa and C. indica.  These chemical differences make it almost impossible to classify by phenotype alone.4 Instead. The current and most accurate ranking system follows a numeric system.  Type 1 cannabis plants are high in THC and low in CBD.  Type 3 plants are high in CBD and low in THC. Type 3 plants are a combination that show different THC:CBD ratios.4 Using this classification, a pure C. sativa would fall into type 3 while a C. indica would be a type 1.  Hybrids of the two types would be a type 2.4 This is a much more accurate way of classification because the actual chemical constituents show what strain may or may not be dominate in a certain plant based on THC:CBD ratios.

              The original strains of cannabis plants, C. sativa and C. indica, have been so vastly hybridized that classifying a single plant by its physical appearance is nearly impossible.  By looking at its chemical composition, specifically the THC:CBD ratio, the classification can be much more accurate and denote which strain may be dominant. The three types of classifications, type 1, type 2, and type 3, give more insight to the actual composition of the plant than by just comparing such physical features as leaf shape and plant height.

References:

  1. Cervantes, J. The Cannabis Encyclopedia: The Definitive Guide to Cultivation & Consumption of Medical Marijuana. Van Patten Publishing; 2015.
  2. Punja ZK, Rodriguez G, Chen S. Assessing genetic diversity in Cannabis sativa using molecular approaches. In Cannabis sativa L.-Botany and Biotechnology 2017 (pp. 395-418). Springer, Cham.
  3. ElSohly MA, Lata H, Chandra S. Cannabis Sativa L.–Botany and Biotechnology. Springer; 2017.
  4. Cisar J. Genomic and strain diversity. MCST608 Lecture Slides. University of Maryland School of Pharmacy.

Temperature effects on cannabis growth

Growing the cannabis plant is relatively easy and straightforward.  The plant is hardy to a wide range of temperatures.  Growing at an industrial scale, however, is much different, as temperature and humidity can affect the growth rate of the plant as well as flower quality.  For such a multibillion-dollar industry as cannabis, growth temperature is extremely important to help maintain high quality and consistency among the entire cannabis crop.

              The cannabis business is expected to grow exponentially as more states legalize both medicinal and recreational uses for the plant.  With revenue projected at around $20 billion dollars by 2022, growers have an incentive to maximize the quality and quantity of their product.1  While several factors, such as hours of sunlight and soil content, contribute to plant health, temperature plays an important role in growth rate and quality of flower production.  Throughout the four stages of growth, seedling, vegetation, flowering, and late flowering, the cannabis plant prefers certain temperatures to produce at the best levels.1 As well, depending on what the grower is trying to achieve, for instance THC content, temperature is also important.  The strain of cannabis also determines the optimum temperature for production.  There are strains that prefer high temperatures, such as Kaya Gold, because they are originally from warmer climates.1 It appears that African and Hawaiian strains also tend to be more heat resistant, while autoflowering strains originating in Siberia are often heat sensitive.1  While strain type does matter, in general, certain temperature ranges and drops during the night are appropriate for most plant types.

              The best range to grow cannabis is between 22 – 24o C during the day and 2 – 5oC during the night.  The cannabis plant, however, does not react well to changes is temperature of more than 8oC at a time.  More that this can shock the plant and severely affect growth rate.2 In the seedling stage, cannabis prefers temperatures in the 24 – 27oC.3  Clone cuttings also prefer the same temperature range.4 In the vegetation stage, when the plant produces its signature leaves, the best temperature range is 21 – 26oC.  Flowering plants seem to prefer a smaller range of temperatures, around 20 – 24oC.4 Finally, the late flowering period, which is when the plant reaches maturity over six to 12 weeks, temperature between 21 – 27oC seem to produce the best quality flower.3 Colder temperatures tend to affect cannabis much more negatively than warmer temperatures. In warmer temperatures, growth may slow, and flowers tend to be less dense, but the plant can still thrive.  On the other hand, when temperatures are too low, the root system is affected, and nutrient absorption is lowered. This can cause a deficiency in vital minerals such as magnesium.5 Mold and other contaminants also thrive at lower temperatures and may form on the root systems. As well, under 15oC the leaves will start to curl and the plant will eventually die.6  

              There are many factors that influence the cannabis plant during its cultivation.  Temperature is one of the most important of these that can contribute to growth rate and flower quality.  In general, cannabis prefers warmer temperatures because of the warmer climates from which they arise.  While temperature is strain dependent, as a whole, cannabis does not like large temperature swings and cannot survive below 15oC.  Too high temperatures can stunt growth and create sparse flowers.  Industrial scale growers regulate temperature very closely, as it can greatly affect the overall quality and quantity of their product.

References:

  1. Cannabis temperature tutorial. Grow weed easy website. https://www.growweedeasy.com/temperature#why-temperature-matters-to-YOU-as-a-grower. Accessed on June 15, 2020.
  2. Cannabis temperature for indoor grow rooms. Green CulturED website. https://www.greencultured.co/cannabis-temperature-indoor-grow-rooms. Accessed on June 15, 2020.
  3. Temperatures and medical cannabis growing from seedling to harvest. SensoScientific website. https://www.sensoscientific.com/blog-temperatures-and-medical-cannabis. Accessed on June 15, 2020.
  4. What’s the best grow room temperature and humidity level? High Times website. https://hightimes.com/grow/best-grow-room-temperature. Accessed on June 15, 2020.
  5. The effect of cold on cannabis plants. Alchimia website. https://www.alchimiaweb.com/blogen/the-cold-during-a-cannabis-plant-crop. Accessed on June 15, 2020.
  6. The ideal temperature for growing cannabis. Cannaconnection website. https://www.cannaconnection.com/blog/2245-ideal-temperature-growing. Accessed on June 15, 2020.

A Review of all the Cannabis legislation introduced in the Maryland State Legislature

 Bill#Cross File#TitleDescriptionSenate Hearing and VotingHouse Hearing and VotingSenate Lead Sponsor(s)House Lead Sponsor(s)
1HB0217SB0900Income Tax – Subtraction Modification – Expenses of Medical Cannabis Grower, Processor, Dispensary, or Independent Testing LaboratoryThis bill allows what is known as a “subtraction modification” for MD income taxes for any expenses incurred during the year as a medical cannabis grower, processor, dispensary, or testing laboratory.In the Senate – Hearing 3/09 at 1:00 p.m., Budget and TaxationWays and Means 1/21/2021 – 1:30 PM
Health and Government Operations
Senator PetersDelegate Wilkins
2HB0032N/ACannabis – Legalization and Regulation (Inclusion, Restoration, and Rehabilitation Act of 2021)This bill established age limits and defines civil offenses for cannabis.  It also has parts that include civil offenses for unlawful cultivation, licensing requirements for cannabis establishments. It also outlines the ATF’s responsibility for licensing cannabis establishments.N/AIn the House – Hearing 2/16 at 1:30 p.m. (Judiciary)
Health and Government Operations
N/ADelegate Lewis, J.
3HB0453N/AHealth – Medical Cannabis Reauthorization ActThis bill repeals the limit on the number of licenses the MD Cannabis Commission may give to growers and processors. It also stops the Commission from rescinding preapprovals and repeals the requirement to decrease licenses in favor of conducting studies for the future number of licenses.N/AIn the House – hearing 2/16 at 1:30pm, Health and Government OperationsN/ADelegate Barnes, D.
4HB0581SB0486Labor and Employment – Employment Standards During an Emergency (Maryland Essential Workers’ Protection Act)This bill involves essential employees and their rights. It requires essential employers to notify their employees about hazard pay, take safety actions while in emergency situations, and have a non-retaliation policy against those essential workers. It also allows the employee to refuse work in certain situations.In the Senate – Hearing 2/11 at 1:00 p.m.2/05/2021 – 11:00 AM
Appropriations Economic Matters
Sen AugustineDelegate Davis, D.E.
5HB0706N/AMedical Cannabis – Dispensary Grower–Processor LicenseThis bill requires the MD Cannabis Commission to license growers and processers to be able to function if certain requirements are met. The growers and processors must provide and application, must not have any negative disciplinary actions by the committee, and must meet all deadlines. This bill also requires the Commission to establish an application review process.N/AIn the House – Hearing 2/16 at 1:30 p.m., Health and Government OperationsN/ADelegate Ivey
6HB0324SB0143Criminal Law – Marijuana – Possession and Possession With Intent to DistributeThis bill increases the amount of cannabis that defines criminal vs. civil offenses from 10 grams to one ounce.  It also denotes that a person in possession of less than an ounce is not in violation of certain cannabis legislative provisions.In the Senate – Hearing 1/20 at 11:00 a.m. Judicial ProceedingsIn the Senate – First Reading, Judicial Proceedings In the House JudiciarySens Waldstreicher and CarterDelegate Moon
7HB0415N/AFirearms – Right to Purchase, Own, Possess, and Carry – Medical CannabisThis bill guarantees the right of a medical cannabis user to purchase, own, possess, or carry a gun. It also states that medical cannabis is legal and the State should not penalize a user because medical cannabis is legal.N/AIn the house – Hearing 3/10 at 1:30pm, JudiciaryN/ADelegate Grammer
8HB0488N/ACriminal Law – Use or Possession of a Controlled Dangerous Substance – De Minimis QuantityThis bill makes certain violations of certain quantities of controlled substances a civil offense rather than a criminal misdemeanor. It changes the penalties for possession of less than 1- grams from “marijuana” to use or possession of a “de minimis quantity” of specific controlled substances.N/AIn the House – Hearing 2/02 at 1:30 p.m., Judiciary Delegate Moon
9HB0543SB0190Firearms – Right to Purchase, Possess, and Carry – Use of Medical CannabisThis bill states that a person cannot be denied their right to purchase, carry, and possess a gun/firearm because they are a medical cannabis user.In the Senate – Favorable Report by Judicial ProceedingsIn the House – Hearing 3/10 at 1:30 p.m. JudiciarySenator HoughDelegate Hornberger
10HB0683SB0461Workers’ Compensation – Medical Cannabis – Compensation and BenefitsThis bill states that a person can be denied workers’ compensation and benefits if they use medical cannabis without the written certification of a certifying provider or physician.In the Senate – Hearing 2/18 at 1:00 p.m., FinanceIn the House – Hearing 2/09 at 1:30 p.m., Economic Matters, Health and Government OperationsSenator FeldmanDelegate Valderrama
11HB0925N/AWorkgroup on Medical Cannabis Use by Pregnant and Nursing WomenThis bill establishes a Workgroup on Medical Cannabis use by Pregnant and Nursing Women including its composition, chairman, and staffing. The members of the Workgroup are restricted from taking certain compensation but are reimbursed for expenses. It also requires the Workgroup to report its findings to the Governor and General Assembly no later than December 31, 2020.N/AIn the House – Hearing 3/09 at 1:30 p.m., Health and Government OperationsN/ADelegate Arikan
12SB0504N/ADiscrimination in Employment – Use of Medical Cannabis – ProhibitionThis bill provides protection for employees who use medical cannabis. It prohibits an employer from discriminating against a user for a written recommendation for medical cannabis or a positive drug test.  The employer can make policies that prohibit an employee from doing certain duties while under the influence of cannabis.Senate – Hearing 2/09 at 1:00 p.m., Judicial ProceedingsN/ASenator SmithN/A
13SB0708N/ACannabis – Legalization and RegulationThis bill replaces the word “marijuana” with “cannabis” in legislative language. It also changes the amount and age limit for civil offenses involving cannabis. It establishes funds for social equity including the Social Equity Start-Up Fund, the Community Reinvestment and Repair Fund, the Cannabis Regulation Fund, and the Cannabis Education and Training Fund.In the Senate – Hearing 3/04 at 1:00 p.m., Finance, Budget and TaxationN/ASenators Feldman, Ferguson, Guzzone, King, Smith, Waldstreicher, and WashingtonN/A
14SB0884N/AMedical Cannabis – Visiting Qualifying PatientsThis bill prohibits a visiting qualifying medical cannabis patient from being required to have written certification or a medical ID card. This would allow a visiting cannabis patient access to a Cannabis Commission licensed dispensary or agent.In the Senate – Hearing 3/11 at 1:00 p.m., FinanceN/ASenator KlausmeierN/A

What can the cannabis industry do to foster social equity?

Entry into the cannabis market is difficult, especially for the part of the population that has been disproportionally affected by the war on drugs.  While approximately 60% of the US population is white, 81% of the cannabis industry is owned by white people.  Only 4.3% of African Americans, 5.7% have ownership Hispanic, and 2.4% Asian have ownership interests in cannabis companies.1 This is quite a discrepancy between the white population and minorities. There are many reasons for this discrepancy, including such things as starting capital requirements, license applications and fees, as well as general economic disadvantages. Because of this, new cannabis programs need to address the social inequity that seems to plague the cannabis industry.  Two ways of doing this includes offering small plot growing licenses and boutique processor/manufacturing licenses, as well as adding considerations for disadvantaged economic area in the application process.

The first way to ensure economic equity in the licensing process is to offer different sizes of cannabis businesses. For instance, instead of a major growing operation that states require starting capital around $1M, the state can offer small plot licenses with much less capital requirements. These plots can be limited to 25 acres, ensuring that economically disadvantage people can raise enough capital.  Instead of having millions of capital required, small plots can require a much smaller startup cost – more around $50,000 – $100,000. As well, states can offer “boutique” licenses for processers. In this same line of thinking as small agricultural plots, boutique processors can start small, filling a unique niche for customers. Again, a small processor would not need nearly as much capital.  The state, though, would still need a license cap for businesses, as too many can flood the market and cause supply and demand issues.

The next way to help achieve social equity in the licensing process is to offer extra consideration to economically disadvantaged areas. For instance, during the application process, an applicant can gain points for living or working in prior specified disadvantaged locations.  These points would be added to a total score to compete against other applicants. The state should avoid an affirmative action type of applications process, as these can easily be deemed unconstitutional for failing to provide equal consideration under the law.1 A points based system would allow for social equity to be more easily integrated into the process.  Points can also be awarded for planning to locate a cannabis business in an economically disadvantaged area. Other considerations to advance social equity in the cannabis industry can include expedited application process for minorities, application fee waivers, and application grants.

References:

  1. Swinburne, M, Hoke, K. State Efforts to Create an Inclusive Marijuana Industry in the Shadow of the Unjust War on Drugs. Journal of Business & Technology Law. 2020;15(2):235-280.

What issues face medical cannabis in schools?

The ability to use medical cannabis at school is imperative for those students who face disabilities that can be mitigated by it. One of the critical issues that face the legalization of cannabis use in schools is the necessity of secure storage. Allowing cannabis to be administered at school is important not only to the student who needs the medication, but also to parents and caregivers, as having to administer cannabis offsite is time consuming and illogical.  Children who need cannabis products for their health issues must have it available when needed.  As well, allowing cannabis to be administered at school corroborates its effectiveness and place as a serious pharmaceutical.1

A new bill would have to include who may administer cannabis products at school. Although determining a caregiver is important, it is also important to include whether or not cannabis storage onsite will be allowed.  Allowing cannabis storage onsite at school would be beneficial, as a student would have access to their medication when needed. Unfortunately, schools that have “Drug Free” zones are threatened by the Schedule 1 designation of cannabis and the possibility of losing federal funding.  Most likely, this would not happen because of Department of Justice priorities.  Having a suitable secure storage space for medical cannabis can allay some fears that parents, teachers, administration, and the government have about having it on school grounds.

For instance, cannabis products, including CBD, would have to be stored in a secure container out of normal sight of children and the public.  This container must have at least a 4-digit secured lock and provide adequate security as not to be carried away.  Access should be restricted to the caregiver (possibly a school nurse), the principal/vice principle, and one other higher-ranking administration official. This would preclude wide access to the cannabis products from children, staff, and other adults. With standardized storage regulations, lawmakers can be more confident that medical cannabis will be used appropriately on school grounds.

References:

  1. Lekh, K. Testimony in Support (with Amendments) of House Bill 617 (2020), Public Health Law Clinic-University of Maryland Cary School of Law. 

What critical regulatory issues face a state’s new medical cannabis program?

There are many issues that exist when a state considers legalizing medical cannabis.  The regulatory challenges are immense, and the state government must start from the ground up for the unique cannabis industry.  Three major regulatory challenges that lawmakers face include: 1) defining which medical conditions qualify a patient for medical cannabis, 2) what quantity of cannabis products can patient have in their home, and 3) whether there is state reciprocity.

The first issue, defining what medical conditions qualify a patient for cannabis, provides the basis of the entire medical cannabis program. Because there are already 36 states with medical cannabis programs, A state can look at those qualifying conditions that have already been established as standard.1  Most states include such conditions epilepsy, chronic pain, and post-traumatic stress syndrome (PTSD) to qualify for a medical cannabis card.  There are, however, states that have significantly limited the qualifying conditions, such as North Carolina, where the only qualifying condition is intractable epilepsy.1 The legislatures of states must decide whether to be more liberal with their condition list or provide severer restrictions.

The next issue is the quantity of cannabis products that a patient may keep in their private residence.  The states with medical cannabis programs tend to have different quantities of cannabis flower that patients can buy and keep over a certain amount of time.  For instance, in Hawaii, a dispensary can sell no more than 4 ounces to a patient or caregiver over a 15 day period.2 On the other hand, in California, a retailer can sell up to 8 ounces to a patient with exceptions for more based on a recommendation from a doctor.2 The state must not only decide how much flower a patient can have, but also if it will allow the purchase and use of concentrates to their medical patients. Quantities of cannabis flower and concentrates that are allowed are vital to the program because it defines how much a patient can have to manage symptoms.

The third issue is state reciprocity.  This means that a patient who is a member of one state’s medical program can purchase cannabis products in another state under its own medical program.  For instance, Delaware has reciprocity.  A patient from Colorado with a medical cannabis card can obtain medical cannabis in Delaware, as long as they meet one of the qualifying conditions outlined in Delaware’s medical cannabis program.1  Patients are not allowed to cross state lines with medical cannabis, but reciprocity laws help patients obtain the necessary relief provided by cannabis even when they are traveling. For example, it is illegal to drive from Maryland to Delaware with medical cannabis, but if a Maryland patient was to visit Delaware, they could still obtain the cannabis they needed.  Nebraska should consider their own medical cannabis population as well as surrounding states reciprocity laws when deciding whether to honor other states’ medical cannabis cards.

References:

  1. State Medical Marijuana Laws. National Conference of State Legislatures. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Accessed on February 4, 2020.
  2. Purchase Limits for Medical and Recreational Cannabis by State. Blaze. https://support.blaze.me/hc/en-us/articles/360047501473-Retail-Purchase-Limits-for-Medical-and-Recreational-Cannabis-by-State. Accessed on February 4, 2020.

Should Cannabis be de-scheduled or re-scheduled?

Cannabis should be removed completely from Schedules I-IV status of the Controlled Substances Act (CSA). It could remain on Schedule V but removing it completely would make better sense in the long run.  The standards for the different Schedules of the CSA no longer apply to cannabis or its derivatives. Schedule I denotes that cannabis is a drug with no medical use and a high chance of addiction and/or abuse.1 There are numerous clinical and non-clinical studies since the CSA was established in 1970 that show clearly the medicinal value of cannabis. While cannabis use disorder does exist, there is little chance of overdosing or death with cannabis use. Therefore, it could be considered for Schedule V – as it does have some abuse potential.

The biggest issue to avoid is to reschedule cannabis into Schedule II. Not only does the schedule of cannabis need to change, but it must be downgraded to Schedule V or removed completely to avoid the administrative nightmare of bringing all current cannabis industry members allowed by states, such as growers, processors, dispensaries, into compliance with federal registration requirements (which are due in part to the US’s participation in international drug control treaties). As of now, only one grower/processor needs to register – the University of Mississippi and NIDA which is the sole source for federal research cannabis. If cannabis is moved to Schedule II, that means every single person and entity in the cannabis industry throughout all the states that have already legalized medical cannabis will have to be registered at the federal level.

While both Congress and the Drug Enforcement Agency (DEA) have the ability to reschedule or de-schedule cannabis, I believe that Congress should do so in order to have the input from all the states via their senators and representatives. While the DEA specialized in drug enforcement, Congress has the unique ability to bring together many different states’ opinions and viewpoints. The rescheduling of cannabis should be done at the highest level of law making to ensure that the legislation encompasses all states rights.  Congress should be able to make the best decision based on the collective experience of states and their own medical cannabis programs.

References:

  1. The Controlled Substances Act. United States Drug Enforcement Administration. 1970.