Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Saturday, October 6, 2018

"Marijuana skeptics fear 'de facto legalization' in states"

Download (22)The title of this post is the headline of this lengthy Politico article discussing the politics and practicalities surrounding the relationships between medical marijuana reform and marijuana industry developments.  I recommend the piece in full, and here are excerpts:

With nine states, and the District of Columbia, now allowing the recreational use of cannabis — and more in the pipeline — advocates on both sides of the issue say that medical cannabis programs are increasingly functioning as a Trojan horse for de facto legalization in the 40 states where the politics of legalization aren’t quite ripe yet. And that’s rapidly changing the political and policy dynamics surrounding the emerging industry....

Medicinal marijuana has, indeed, been a driving force for legalization in other states. California’s decision 20 years ago to become the first state to approve the sale of legal medicinal marijuana paved the way for the Golden State to become, as of this year, the world’s largest legal recreational cannabis market. Now, with polls showing public support for medical cannabis in the U.S. at around 90 percent, medical marijuana proponents have shifted their gaze to more conservative states like Kentucky, West Virginia, Oklahoma and Louisiana, or towards enlarging existing medical marijuana programs in places like New Jersey or Pennsylvania.

And while medicinal advocates insist their efforts are simply meant to help patients, opponents say that’s laughable. “There’s a marijuana industry making all sorts of medical claims that, if they were pharma companies, they’d probably be jailed,” said Kevin Sabet, the president and CEO of Smart Approaches to Marijuana, which opposes recreational use policies. “It’s not this bright line between medical and recreational. And there should be a bright line.”...

“This doesn’t have anything to do with cancer patients, or folks with epilepsy, this is about the expansion of the marijuana industry,” he said. “The worst kept secret about most medical marijuana programs is that they often act as de facto legalization. With the expansion of programs in New Jersey or other states, this is often tied to the marijuana industry’s interest to expand the user pool and make money.”

Marijuana proponents don’t necessarily disagree. The growing acceptance of medical cannabis has helped eliminate the stigma around recreational use, multiple sources told POLITICO. We’re far from the days of “Reefer Madness.” “When you have a situation in a state like California, where there are cannabis stores in your neighborhood; when you can see what that looks like, and how much it’s different from the unregulated criminal market; when you can see the effects of businesses moving into storefronts that generate jobs and tax revenue,” then it’s far easier to change the minds of fearful or skeptical consumers — and political leaders — about legalization, says Tom Angell, publisher of Marijuana Moment, one of the nation’s leading trackers of developments and news in the cannabis industry....

California, which legalized the sale of recreational marijuana this past Jan. 1, essentially wrote the blueprint for moving from medicinal marijuana to full-scale legalization. The state’s cannabis market is expected to reach $5.1 billion in the next year — and $25 billion by 2026. That booming business potential on both the medical and recreational side has made it an attractive investment for Canadian companies like CannaRoyalty Corporation, which this year acquired a crowd of California-based cannabis firms that include FloraCal Farms, an “ultra-premium cannabis producer,” Oakland-based Alta Supply, a medical cannabis firm; Kaya Management, a vaporizer manufacturer, as well as RVR, a “large-scale distributor” of both medical and recreational cannabis....

Already, the immediate challenges of transitioning from legal medical to recreational markets have resulted in a flood of legislation aimed at addressing concerns and regulations in the U.S. Angell says that his publication, Marijuana Moment, tracked a whopping 863 bills in Congress related to cannabis this year alone. And along with that legislation has come a parade of “stakeholders invested in keeping legalization in effect — and eroding prohibition on the state and federal level.” That includes lobbyists, industry representatives, attorneys and innovators. What their growing numbers show is that “it will be increasingly hard for opponents to push back on the green wave,” he said.

With tens of thousands of Americans now employed in both the medical and recreational segments of the industry, and billions of dollars being generated in tax dollars for local and state governments, it’s no wonder that “so many ambitious politicians jumping in front of this issue,’’ Angell said. They’re not going back, he predicts: “There are too many people invested in legalization now.”

October 6, 2018 in Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Wednesday, September 26, 2018

"Does CBD Really Do Anything?"

CbdThe title of this post is the title of this interesting new FiveThirtyEight piece by Christie Aschwanden. Here is how it gets started: 

As marijuana is legalized in more and more states, the wellness world has whipped itself into a frenzy over a non-intoxicating cannabis derivative called cannabidiol. CBD products can be found on the internet and in health-food stores, wellness catalogs and even bookstores. (A bookstore in downtown Boulder, Colorado, displays a case of CBD products between the cash register and the stacks of new releases.) Celebrities like Gwyneth Paltrow, disgraced cyclist Floyd Landis and former Denver Broncos quarterback Jake Plummer are all touting CBD products, and according to Bon Appétit, CBD-infused lattes have become “the wellness world’s new favorite drink.”

But, uh, what is it that CBD is supposed to do? I visited a cannabis dispensary in Boulder to find out what the hype was all about.  After passing an ID check, I was introduced to a “budtender” who pointed me to an impressive array of CBD products — tinctures, skin patches, drink powders, candies, salves, massage oil, lotions, “sexy time personal intimacy oil” and even vaginal suppositories to treat menstrual cramps.

Most of these products promised to relieve pain or otherwise enhance well-being, and none of it was cheap.  (Prices started at about $30.) But I wanted to know: Does any of this stuff really work? After a deep dive into the scientific research, I learned that the answer was a big fat maybe.

Although there’s enticing evidence that good ol’ cannabis can ease chronic pain and possibly treat some medical conditions, whether CBD alone can deliver the same benefits remains an open question.  What is clear, at this point, is that the marketing has gotten way ahead of the science.

September 26, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Science | Permalink | Comments (0)

Tuesday, September 18, 2018

Come see great panel on "Marijuana Policy in America" at "Laboratories of Democracy: Drug Policy In The United States"

The second part of the title of this post is the title of this exciting event taking place in Washington DC next week that I have had the honor of helping to plan.   The event will include a panel discussion on the opioid crisis and a panel discussion on marijuana reform, and here is the event's full description:

Drug use and substance abuse are circumstances that no longer impact only a small percentage of our population. In 2016, over 20 million Americans dealt with a substance use disorder, and the CDC estimates that more than 10 percent of the American population use some form of illegal drug each month. The Bureau of Justice Statistics estimates that 58 percent of those in state prisons and 63 percent of those sentenced to state jails meet the medical criteria for drug dependence or abuse.

The Ohio State University’s newly established Drug Enforcement and Policy Center (DEPC), with support from the Charles Koch Foundation, will host Laboratories of Democracy: Drug Policy in the United States. This important event will bring together leading academics, members of law enforcement, policymakers, think tank scholars, community advocates, media figures, and other influencers from different spheres and perspectives to discuss the diverse and challenging policy questions that have emerged in the drug policy area.

The event will be held at The Willard InterContinental in Washington, DC on September 25, 2018 from 9:00 am until 3:00 pm. The experts speaking at this event have used their knowledge to propose positive drug policy solutions to tackle the difficult problems faced by our country, and the program will engage attendees in an action-oriented discussion on how our country can move forward with positive solutions to addiction and substance abuse.

More details about and registration for this event are available here and here.   I will be one of the speakers on the marijuana panel, and all the other participants are even more interesting.

September 18, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (2)

Wednesday, September 12, 2018

Latest issue of International Review of Psychiatry focused on cannabis science

Download (4)The latest issue of the International Review of Psychiatry has a collection of interesting looking articles with titles like "Marijuana matters: reviewing the impact of marijuana on cognition, brain structure and function, & exploring policy implications and barriers to research" and "Sweet flowers are slow, and weeds make haste: leveraging methodology from research on tobacco, alcohol, and opioid analgesics to make rapid and policy-relevant advances in cannabis science." There are too many interesting looking pieces to cite them all here, but I can quote the start of the editorial introduction:

The allowance of cannabis to be used as a medicine in the absence of adequate data to inform basic clinical decision-making is rooted in compassion for individuals with life-threatening illness, or substantially debilitating illness, and no other course for treatment. However, this relatively simple tenet has now morphed into a large-scale for-profit industry that is fraught with public health concerns.  Access to cannabis has been expanded to include treatment for a multitude of health conditions, many of which are neither life-threatening nor debilitating, and for which effective alternative treatments exist. Data from which to determine the risk-benefit for an individual considering the use of cannabis is sparse at best.  Quality control issues abound in this industry as there are no established standards for cultivating, processing, testing, or labeling cannabis products.  There is also concern over advertisements and product labeling that include misleading or unsubstantiated health claims, as these products have not been vetted by traditional drug development methods.  The speed in which cannabis policies are changing is rapid, and the fact that these are happening as a direct result of legislation or by voter referendum is reckless given the absence of consensus standards and, in many cases, appropriate regulatory oversight. The impact of revised cannabis laws, both with respect to medicinal use for a variety of health conditions, and for non-medicinal (aka ‘recreational’) use of cannabis by adults, will likely have a substantial impact on psychiatry.

This special issue of the International Review of Psychiatry is focused on cannabis science, but with a very targeted theme of cannabis regulatory science.  Recently in the US, the Food and Drug Administration (FDA) was granted regulatory authority over all nicotine and tobacco products.  This was a landmark event, and has engendered a bolus of thoughtful, policy-oriented research that has already resulted in tobacco regulations which are likely to positively impact public health in the US and abroad.  Studies have included careful scientific evaluation of the impact of nicotine on cigarette reinforcement and self-administration, packaging and flavoring on youth initiation, the harm reduction effects associated with nicotine delivery devices other than cigarettes, and other important topics.  The parallel need for a cannabis regulatory science is urgent.  Novel products and cannabis delivery devices are rolling onto the shelves of dispensaries at a rapid rate, product development appears to be geared towards high potency/high dose products, and it is all being carefully marketed to increase consumption.  Contributions in this issue highlight lessons learned from tobacco, alcohol, and opioid regulatory science that are relevant to cannabis, detail important factors surrounding tobacco and cannabis co-use, and detail the potential impacts of regulatory changes on cannabis use in the workplace.

September 12, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research | Permalink | Comments (0)

Tuesday, September 11, 2018

"Medical marijuana users are being shut out of public housing"

Section8-2The title of this post is the title of this new Vice News piece telling yet another tale at the intersection of state marijuana reforms and federal prohibitions.  Here are excerpts:

Cancer patients and other people with debilitating conditions are being forced to choose between medical marijuana and federal public housing assistance. Even though some of the most conservative states are passing laws legalizing medical weed, marijuana is still a Schedule I controlled substance on a federal level, along with heroin and ecstasy, which can make users ineligible for programs like rental assistance or public housing....

“From a civil rights perspective, you’re denying a whole class of people housing that have already been denied other aspects of living their life to the fullest potential because of the federal prohibition on cannabis,” said David Mangone, director of governmental affairs and counsel for the advocacy group Americans for Safe Access. “No one should have to choose between staying off opioids and a roof over their head”

The majority of states now allow some form of medicinal marijuana. Americans overwhelmingly favor legalizing the drug for medical use. And in New York State — which hosts North America’s largest public housing population — medical marijuana is permitted to treat debilitating conditions such as cancer, chronic pain and Amyotrophic Lateral Sclerosis (ALS).

The U.S. Department of Housing and Urban Development released a memorandum in 2011 saying new admission applications revealing legal marijuana use would be denied, no matter the circumstance. However, the memorandum gave local landlords and public housing authorities the right to determine whether they should evict existing residents for medical marijuana use.

It’s not clear how many public housing authorities have sided with tenants on the local level, nor how many applicants have been rejected due to federal marijuana laws. But as more states normalize marijuana locally, it can make users ineligible for federal programs, like housing assistance.

When the 2011 memorandum was issued, 14 states had legalized medical marijuana. Now, 31 states and the District of Columbia have legalized cannabis for medicinal purposes, and the drug is becoming a viable alternative for patients that don’t want to use opioid drugs, many of whom are elderly or disabled. “There’s a much larger population now that’s affected by this guidance,” Mangone said....

A spokesman for HUD noted that their policies haven’t changed since the 2011 memorandum; they’re unable to reconsider their policy until federal laws regarding marijuana change. As long as marijuana remains a controlled substance, the rules “still apply, even where state law allows for its use,” Brian Sullivan, HUD spokesman, said in an email.

In June, Rep. Eleanor Holmes Norton, a non-voting Democrat representing the District of Columbia, introduced legislation that would allow residents in federally subsidized housing to use legal medical or recreational marijuana in their homes. “Individuals who live in states where medical and/or recreational marijuana is legal, but live in federally-assisted housing, should have the same access to treatment as their neighbors,” Norton said at the time.

September 11, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (1)

Monday, September 10, 2018

"Legitimate Medicine in the Age of Consumerism"

The title of this post is the the of this new paper recently posted to SSRN and authored by Matt Lamkin.  Here is its abstract:

From the opioid epidemic and medical marijuana to abortion restrictions and physician-assisted suicide, disputes over the proper uses of medicine loom large in American life.  Nowhere is this conflict more apparent than in federal drug control policy, which is premised on a clear distinction between legitimate “medical” uses and illicit “abuse.”  Yet the Controlled Substances Act defines neither of these foundational concepts . While it is tempting to imagine medicine’s scope is limited to treating or preventing disease – rendering nontherapeutic drug use “abuse” – in fact medical practice has always included interventions that are not aimed at healing.  This trend has only accelerated as medical practice has become increasingly consumer-oriented.  From Adderall to Xanax, patients now routinely seek prescriptions not to treat diagnosable illnesses, but to relieve stress, improve productivity, and otherwise enhance quality of life.

As physicians increasingly prescribe psychoactive drugs to help healthy people obtain desirable mental states, distinguishing legitimate drug use from recreational abuse becomes ever more difficult.  Having failed to acknowledge this challenge, the DEA, courts, and scholars have not offered a principled way to make this distinction, rendering drug control policy increasingly incoherent.  As a result, doctors face criminal prosecution without clear standards governing prescribing, potentially valuable interventions are arbitrarily barred from the market, and millions seek the benefits of drugs without professional medical guidance to mitigate their risks.

Rather than being limited to therapeutic aims, medicine is better understood as the application of a loosely-defined set of knowledge and interventions that the law entrusts to specific professionals, with accompanying duties to use these tools to benefit patients.  Medical practice includes treating and preventing illnesses, but can also include enhancing social and cognitive functioning and promoting the well-being of people whose challenges do not rise to the level of disorders.  Discarding a narrow conception of medicine does not require abandoning the enforcement of drug laws or the policing of doctors. But acknowledging the expansiveness of medicine’s domain does argue for clarifying the scope of physicians’ criminal liability and pursuing new strategies for harnessing drugs’ benefits while mitigating their risks.

September 10, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Friday, September 7, 2018

In Ohio, "cannabis is basically regulated like plutonium"

I could not resist spotlighting this new local article about the slow roll-out of Ohio's medical marijuana program due to its use of a great quote in its headline, "'Cannabis regulated like plutonium': Security measures causing delays in marijuana launch date." Here is some context for the quote:

Ohio's Medical Marijuana program was originally supposed to launch on Sept. 8. For months, it's been clear that delays with licensing and construction for the new facilities meant patients wouldn't be able to get medical products produced in Ohio until months after the initial start date, potentially as late as early 2019.

For an industry that's planning to be the business of the future, required security measures sound like they're from an old-fashioned action movie. Some of the basic procedures medical marijuana companies will have to follow include "unmarked cars, travel point A to point B, randomized routes, manifests before and after delivery," explained Frantz Ward LLP Attorney Tom Haren....

"I think that cannabis is basically regulated like plutonium," said Cleveland School of Cannabis Dean of Instruction and Student Success Jacob Wagner.  He says plants are tracked "from seed to sale," making sure nothing gets diverted to the black market.  When his school's students graduate and become medical marijuana industry employees, they'll wear state-required badges, and their facilities will be watched around the clock through redundant security systems, accessible to regulators in Columbus.

"It's designed to also make sure that every product is tested, every product is properly packaged and properly labeled before it reaches the end consumer, the patient," said Wagner. 

"The worst thing for the program would be some type of criminal activity of some kind of adulterated product making its way into the market and into the hands of the patient," said Haren.

September 7, 2018 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Tuesday, August 28, 2018

Has anyone tracked how many times and how many ways state medical marijuana programs have been expanded after inception?

The question in the title of this post was my first reaction to the latest reports on the latest states to expand access to medical marijuana.  This piece from Connecticut on this front is headlined "State Approves Use Of Medical Marijuana For Stubborn Headaches, 7 Other Conditions," and here are the basics:

Medical marijuana may now be prescribed in Connecticut to treat medication-resistant headaches, severe rheumatoid arthritis and several other new conditions, the Department of Consumer Protection announced Tuesday.

The state legislature’s Regulation Review Committee has updated the state’s medical marijuana program regulations to include eight new conditions for adults and two new conditions for patients under 18.

Today, also brings this similar news from Illinois, under the headline "Rauner signs medical marijuana expansion bill allowing drug as painkiller alternative," starting this way:

A measure that could dramatically expand access to medical marijuana in Illinois — making it available as an opioid painkiller replacement and easing the application process for all who qualify — was signed into law by Gov. Bruce Rauner on Tuesday....

No longer will any applicants have to be fingerprinted and undergo criminal background checks.  And those who complete an online application with a doctor’s authorization will get a provisional registration to buy medical cannabis while they wait for state officials to make a final review of their request.

My sense is that this is a common reality that has found expression perhaps multiple time in multiple states: over time, states add qualifying conditions or reduce restriction on access to medical marijuana. I suspect someone somewhere is tracking these developments nationwide, and I think the pace and scope of amendments to state medical marijuana regimes would tell an interesting and significant modern reform story.

August 28, 2018 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Tuesday, July 31, 2018

Noting the enduring challenges for sports leagues with state marijuana reforms in tension with federal prohibition

Download (3)Regular readers know that I find fascinating the intersections between sports and marijuana reform, but I have not blogged on the subject much lately.  This new article, headlined "Leagues being pushed to allow medical marijuana use for pain management," gives me an excuse to return to this topic. Here are excerpts:

Between legalization in states with multiple professional sports franchises (like California), and increasing numbers of studies showing marijuana to be largely benign (and perhaps even beneficial) in comparison to opiates, the tide of public opinion continues to turn.  And for now, certain pro sports leagues are getting around the federal prohibition by essentially embracing a wink-and-nod policy.

The National Hockey League doesn’t list cannabis as a banned substance and doesn’t appear to care much about positive cannabis tests. Major League Baseball lists cannabis as a “drug of abuse,” but only tests if there is reasonable cause (and page 40 of the league’s drug policy specifically states that they don’t issue suspensions for a positive test for marijuana) — though, oddly enough, Minor League Baseball does still test and suspend athletes for marijuana use. In addition, the World Anti-Doping Agency, which oversees Olympic policy, has also loosened its standards on what constitutes a positive test, allowing up to 150 nanograms per milliliter (ng/ml) of blood—which essentially means you’d need to be actively high in order to test positive.

But in the NBA and NFL — two leagues in which former players have estimated that more than 80 percent of their peers used marijuana during their careers—there remains a punitive cost. The NFL’s threshold for a positive test is 35 ng/ml; the NBA’s is 15 ng/ml. Repeated infractions, in both leagues, can result in a suspension.

In large part, the NBA’s policy is based on perception: Former commissioner David Stern, in an interview with ex-NBA player and marijuana advocate Al Harrington, said that the league tightened its rules, in part, because “some of our players came to us and said some of these guys are high coming into the game,” and because of the long-held theory (now largely debunked) that marijuana is a gateway drug to harder substances.  Stern now believes the league’s collective bargaining agreement should be altered so that players should be allowed to do whatever is legal in their individual state.  His successor as commissioner, Adam Silver, has embraced some of the most progressive policies of any major sports league, and has said that he’s open to legalizing medical marijuana (though how that would work in states where marijuana remains illegal is unclear).

And that leaves the NFL, whose players — given the inherently violent nature of their sport — may have the best case of all for embracing medical marijuana.  Yet while the NFL has said it’s open to working with its players association on a study of marijuana, it has continued to suspend a number of players for positive drug tests.  In a 2017 radio interview, NFL commissioner Roger Goodell expressed concerns that marijuana use “can be negative to the health of our players.” In a way, this isn’t surprising, given the NFL’s overarching cautiousness when it comes to both political and social issues.  But that policy will face continued challenges from ex-NFL players like [Eugene] Monroe, who point to mounting evidence that cannabis is a safer alternative to the opiates they took regularly in order to sustain their careers.

July 31, 2018 in Medical Marijuana Commentary and Debate, Sports, Who decides | Permalink | Comments (0)

Monday, July 30, 2018

Notable review of Florida’s "booming" medicial marijuana industry

Florida-medical-marijuana-program-rules

This local Florida article, headlined "Marijuana booming as state nears 2-year mark," reports on (unsurprising?) medical marijuana realities in the Sunshine State.  Here are highlights from the lengthy piece:

More than 100,000 Floridians now can legally take marijuana for medicinal purposes.  This milestone, reached in April, is one of many signs that Florida’s young marijuana industry is booming as the state approaches the two-year anniversary of voters legalizing medical pot.

But issues remain: Some patients complain that the Florida Department of Health’s rules create unfair barriers for patients. They can’t smoke their marijuana or grow their own, for example.  They also gripe about the patient approval process and the cost of medication.  Companies eager to jump into the marijuana business are waiting for the state to issue additional licenses required by law upon passing the 100,000-patient mark....

In November 2016, 71 percent of Florida’s voters gave the green light to medical marijuana.  The state still is issuing guidelines and battling lawsuits over how that should be done.  But the direction is clear.  Already, analysts are projecting a $1 billion medical marijuana market in Florida by 2020. 

Fourteen companies have received licenses from the state.  They’ve opened 43 dispensaries statewide, including offices in Summerfield and Lady Lake, to serve the growing number of approved patients, which has more than doubled since the start of the year.  The coveted licenses are drawing attention from established marijuana businesses.  In June, California-based MedMen paid $53 million to acquire the cultivation and distribution rights from Treadwell Nursery in Eustis....

[T]he process to become a qualifying doctor [initially meant] doctors were required to pay $1,000 for an eight-hour course. That requirement has since decreased to a two-hour course costing $250. More than 1,500 physicians now are able to recommend marijuana to patients, including more than 40 in Sumter, Lake and Marion counties.

Miami-Dade and Palm Beach counties have the most registered physicians, with more than 200 each.  Demand for doctors persists, with 1,500 to 3,500 patients joining the registry every week....

Even as more and more people line up for treatment, criticism of the program continues.  Companies and advocates of Amendment 2, which authorized medical marijuana, are challenging some of the rules laid out by the Department of Health.  Attorney John Morgan sued the department over its rule banning smokeable cannabis, arguing it goes against the will of the voters who approved the amendment.  Vaping is allowed.  Tallahassee Circuit Judge Karen Gievers sided with Morgan, saying the restriction was unconstitutional.  The state immediately appealed the decision, and Morgan tried to get the Florida Supreme Court to consider the case.  He now is focusing on legalizing recreational use.

Morgan criticized Gov. Rick Scott, who had opposed the broad legalization of medical marijuana, for allowing the smoking ban. Scott defended following the law as it is written. He is not alone in voicing smoking opposition. The American Society of Addiction Medicine rejects smoking as a means of drug delivery for medical purposes. The American Cancer Society Cancer Action Network, the ACS’s advocacy group, has not taken a position on legalization of marijuana for medical purposes, citing a need for more scientific research on marijuana’s potential benefits and harms.

July 30, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (1)

Wednesday, July 25, 2018

Disconcerting disconnect between Trumpian rhetoric and health care realities for veterans when medical marijuana involved

Cover.vetsandmarijuana3.12-22Prez Donald Trump yesterday gave a big speech to the VFW, Veterans of Foreign Wars, and he extolled his commitment to ensuring veterans receive first-rate health care: "We’re also committed to ensuring that when our warriors return home as veterans, they receive the best care anywhere on Earth." Unfortunately, as this new New York Times highlights, this rhetoric does not meet reality in at least one notable setting. The lengthy article is headlined "V.A. Shuns Medical Marijuana, Leaving Vets to Improvise," and here are excerpts:

Some of the local growers along the [California] coast here see it as an act of medical compassion: Donating part of their crop of high-potency medical marijuana to ailing veterans, who line up by the dozens each month in the echoing auditorium of the city’s old veterans’ hall to get a ticket they can exchange for a free bag.

One Vietnam veteran in the line said he was using marijuana-infused oil to treat pancreatic cancer. Another said that smoking cannabis eased the pain from a recent hip replacement better than prescription pills did. Several said that a few puffs temper the anxiety and nightmares of post-traumatic stress disorder. “I never touched the stuff in Vietnam,” said William Horne, 76, a retired firefighter. “It was only a few years ago I realized how useful it could be.”

The monthly giveaway bags often contain marijuana lotions, pills, candies and hemp oils, as well as potent strains of smokable flower with names like Combat Cookies and Kosher Kush.  But the veterans do not get any medical guidance on which product might help with which ailment, how much to use, or how marijuana might interact with other medications.

Ordinarily, their first stop for advice like that would be the Department of Veterans Affairs health system, with its thousands of doctors and hundreds of hospitals and clinics across the country dedicated to caring for veterans.  But the department has largely said no to medical marijuana, citing federal law.  It won’t recommend cannabis products for patients, and for the most part it has declined even to study their potential benefits. That puts the department out of step with most of the country, where at least 30 states now have laws that allow the use of medical marijuana in some form.

A department survey suggests that nearly a million veterans may be using medical marijuana anyway. But doctors in the veterans’ health system say the department’s lack of research has left them without much good advice to give veterans.  “We have a disconnect in care,” said Marcel Bonn-Miller, a psychologist who worked for years at the veterans’ hospital in Palo Alto, Calif., and now teaches at the University of Pennsylvania medical school.  “The V.A. has funded lots of marijuana studies, but not of therapeutic potential. All the work has been related to problems of use.”...

A bipartisan bill introduced in the House of Representatives this spring would order the department to study the safety and efficacy of marijuana for treating chronic pain and PTSD. If the bill passes, the department could not only develop expertise about a drug that many veterans have turned to on their own — it may also start down the road toward eventually allowing its doctors and clinics to prescribe cannabis.

“I talk to so many vets who claim they get benefits, but we need research,” said Representative Tim Walz, Democrat of Minnesota, who introduced the bill along with Phil Roe, Republican of Tennessee, who is a physician. “You may be a big advocate of medical marijuana, you may feel it has no value,” Mr. Walz said. “Either way, you should want the evidence to prove it, and there is no better system to do that research than the V.A.”

A spokesman for the Department of Veterans Affairs said Congress would need to do more than pass the current House bill. The spokesman, Curt Cashour, said that because cannabis is classified as a Schedule 1 drug under federal law, researchers would need to secure approval from five separate agencies to conduct studies. “The opportunities for V.A. to conduct marijuana research are limited because of the restrictions imposed by federal law,” Mr. Cashour said. “If Congress wants to facilitate more federal research into Schedule 1 controlled substances such as marijuana, it can always choose to eliminate these restrictions.”

The department does have two small studies in their early stages. One, in San Diego, looks at whether cannabidiol, a nonintoxicating component of cannabis, can help patients during PTSD therapy; it is scheduled to continue through 2023. The other, planned for South Carolina, would examine the palliative effects of cannabis in hospice patients. “In a system as big as ours, that’s not much, certainly not enough,” said Dr. David J. Shulkin, who was President Trump’s first secretary of veterans affairs before being fired in March.

During his tenure as secretary, Dr. Shulkin eased some rules, allowing the department’s doctors to start talking to veterans about medical marijuana. But many veterans faulted him for not going further. Dr. Shulkin said that the tangle of red tape surrounding Schedule 1 drug studies should no longer be an excuse not to conduct them. “We have an opioid crisis, a mental health crisis, and we have limited options with how to address them, so we should be looking at everything possible,” he said.

The push for more research and for access to medical marijuana in the veterans’ health system is not coming just from liberal areas of California. The generally conservative American Legion and Veterans of Foreign Wars both favor expanded research. And some of the most vocal advocates are products of the nation’s strict military academies. “Cannabis is the safe, responsible choice,” said Nick Etten, an Annapolis graduate and former Navy SEAL who runs an advocacy group called the Veterans Cannabis Project. “It helps with the Big Three we struggle with after combat — pain, sleep and anxiety — and it is safer than many medications.”

Lots of recent prior related posts:

July 25, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Monday, July 23, 2018

Prominent US Representative for Ohio now advocating that "marijuana should be legal in all 50 states"

220px-Rep._Tim_Ryan_Congressional_Head_Shot_2010CNN recently published this recent commentary advocating federal marijuana reform that is particularly notable because of its author: Tim Ryan, a Democrat representing Ohio's 13th congressional district who is co-chair of the House Addiction, Treatment, and Recovery Caucus (and who at least once had aspirations to be a party leader in the House). Here are excerpts from the commentary:

The year Donald Trump was elected President, more Americans were arrested for marijuana possession than for all violent crimes combined.  Moreover, the ACLU found that even though African-Americans use marijuana at similar rates to white Americans, they are almost four times more likely to be arrested for marijuana possession....

As co-chair of the House Addiction, Treatment, and Recovery Caucus, I've been hesitant to support legalizing marijuana in the past.  But after meeting with countless Ohio families and youth whose lives have been irreparably harmed by a marijuana arrest, I find the social and economic injustices of our marijuana policy too big to ignore.  I firmly believe no person should be sentenced to a lifetime of hardship because of a marijuana arrest. It is morally wrong and economically nonsensical.  That is why I am calling for an end to marijuana being used as an excuse to lock up our fellow Americans.

Marijuana should be legal in all 50 states. Across the country, nine states and the District of Columbia have passed laws legalizing marijuana.  Voters in Michigan and Oklahoma will be voting on marijuana initiatives this November, and efforts are underway in Missouri, Arizona, Nebraska and Utah to get legalization initiatives on the ballot. While I support these states for leading by example, this is an issue that affects every corner of our nation.  You should not be able to legally buy a product in one state, just to be arrested for the very same act in another.

Studies have shown that marijuana legalization could save $7.7 billion in averted enforcement costs and add $6 billion in additional tax revenue -- a $13.7 billion net savings.  Not to mention the reported 782,000 jobs it could create on day one.  Think of what our country could do with that money: rebuild our highways, bridges, and railroads; provide our communities with the resources they need to respond effectively to substance abuse and the opioid epidemic; and create jobs....

Congress can change this by passing the Marijuana Justice Act.  This legislation would remove marijuana's designation as a Schedule I drug -- those classified as having no accepted medical use and a high potential for abuse.  It would also eliminate all criminal penalties for an individual who imports, exports, manufacturers, distributes, or processes with intent to distribute marijuana.  To create economic opportunity in communities devastated by mass incarceration, the bill creates a $500 million community reinvestment fund to provide job training for the nascent legal cannabis industry.

The War on Drugs failed the American people. It is time for us to take the necessary steps to right our nation's wrongs.  We cannot afford to leave people behind and money on the table. If we are truly a nation that believes in second chances, our federal marijuana laws must change.  America is speaking. Congress must act.

July 23, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (3)

Thursday, July 19, 2018

Effective explanation of why it is so hard to explain the exact number of "medical marijuana states"

MarijuanamapOver at Marijuana Moment, Kyle Jaeger has this nice new piece on a bit of head-counting (or should I say state-counting) that always sticks in my craw. His piece is headlined "How Many Medical Marijuana States Are There? Advocates Disagree On The Number," and here are excerpts:

Is it 30? 31? How about 45 or 49?

With marijuana legalization efforts moving forward at full steam in states across the country, it can be understandably difficult to keep track of the total number of states that have legalized cannabis in some form, especially when it comes to counting differing medical programs.

In some cases, even national advocacy groups disagree over the actual tally.  For example, the Marijuana Policy Project (MPP) lists 30 legal medical marijuana states, while NORML says the number is 31.  Americans for Safe Access, meanwhile, has an interactive map that provides information about existing cannabis laws in 45 states. So what is the number, really?

If you ask NORML, it’s a plain and clear 31. Paul Armentano, the organization’s deputy director, told Marijuana Moment that it’s based on simple reasoning: there are currently 31 states in the U.S. that have legalized marijuana for medical or recreational purposes (not including more limited, CBD-focused laws in other states, but we’ll get to those in a minute)....

Unlike NORML, MPP determines what constitutes a legal medical marijuana state based on the fact the state passed a law aimed at medical cannabis in addition to an independent analysis of the efficacy of those laws.  That’s why the organization doesn’t include Louisiana in its list of legal states, for instance, even though NORML and others count it.

“Forty-nine states have adopted some form of medical marijuana law, and we feel that the easiest distinction to draw is between those that are effective and relatively comprehensive and those that are ineffective or highly restrictive,” Mason Tvert, MPP’s media relations director, told Marijuana Moment.  “There are some states, such as Louisiana, that could arguably fall into both categories, but our policy experts currently still consider it to be too limited to be considered one of the states that has adopted an effective and comprehensive medical marijuana law.”...

When you hear numbers in the upper 40s, those generally take into account states that allow certain patients to use CBD extracts with low-THC composition, but licensed programs providing those products are few and far between. Generally speaking, legalization advocates don’t consider CBD-only states “legal,” per se, but it’s another factor that can muddle the math.

What consequence, if any, these varying tallies have on public policy is uncertain. Advocates believe, however, that including the CBD-only states is one key factor that led to the passage in 2014, and subsequent extension, of a congressionally approved rider preventing Justice Department interference in medical marijuana states.  Since the text of the measure itself meticulously lists out all of the affected states — including ones like Texas and Virginia, which only have CBD laws — it is that much harder for lawmakers from those states to vote no....

One thing advocates do agree on is the number of states that allow recreational, or adult-use marijuana. That’s nine, plus Washington, D.C.

July 19, 2018 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Friday, July 13, 2018

"Behind Schedule — Reconciling Federal and State Marijuana Policy"

Nejmp1804408_f1The title of this post is the title of this new Perspectives piece appearing in the The New England Journal of Medicine and authored by Rebecca Haffajee, Robert MacCoun and Michelle Mello. I recommend the piece highly in part because of its terrific graphic under the heading "U.S. Marijuana Policy Milestones, 1970–2018." Here is part of its text:

The present state of conflicting laws seems unstable and suboptimal for rational drug control. Federal regulation that accommodates and reinforces state medical marijuana regulatory regimes would result in a safer, more reliable, more accessible supply of marijuana products. Congress, because it answers to the people and represents the states, appears the most likely branch to move on marijuana policy; it could even be encouraged to act by Canada’s recent legalization of recreational marijuana.  Federal courts are increasingly hearing challenges to marijuana’s Schedule I status but have so far been unwilling to deem Congress’s scheduling determination irrational and therefore unconstitutional.

In Congress, rescheduling marijuana by amending the CSA is one attractive option.  The executive branch, too, can reschedule CSA substances, but the mechanisms are time consuming and unlikely to attract interest within the current administration.  Because considerable evidence now supports marijuana’s therapeutic benefits in reducing chronic pain, nausea, and vomiting in patients with cancer, as well as multiple sclerosis–related muscle spasms, there is a compelling argument that marijuana is more appropriately designated as a Schedule II or Schedule III drug.  Rescheduling would facilitate further study of products for FDA approval, but would not automatically change the severity of penalties for marijuana crimes or alter international treaty obligations, enshrined in the CSA, to ensure that all psychoactive substances are used only for legitimate medical and scientific purposes.

Congress could also remove marijuana from the CSA schedules altogether. This dramatic action could be coupled with legislation authorizing FDA oversight of marijuana products. Whether marijuana’s psychoactive effects preclude this move away from regulation as a controlled substance would provoke considerable debate. Subjecting marijuana products to FDA approval would hinder access initially but ultimately foster a robust system for regulation and research. FDA oversight of marketing would also improve product safety and consistent promotion across states.

The [proposed] legislation [sponsored by Senators Gardner and Warren] represents a third option designed to respect states’ rights — codifying the approach articulated in the Cole Memorandum by amending the CSA to exempt marijuana activities that are lawful in the jurisdiction where they occur. This solution would be more permanent than attorney-general guidance or agreements between states and the attorney general regarding enforcement, which shift with the political winds, and would therefore promote stability for medical users and suppliers. But it would not facilitate research into marijuana harms and benefits, bring products within the FDA’s purview to ensure safety and efficacy, alleviate interstate health risks, or address potential conflicts with international treaty obligations.

We think this third option, which addresses some pressing conflict-of-law concerns such as unpredictable criminal enforcement, is preferable to the current blurred vision of the future of marijuana policy.  Ultimately, a more comprehensive federal regime that perhaps resembles Canada’s recent legalization of recreational marijuana could affirmatively promote health and safety through research and regulation.

July 13, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (2)

Wednesday, July 11, 2018

"Guns N’ Ganja: How Federalism Criminalizes the Lawful Use of Marijuana"

Guns-and-mmjThe title of this post is the title of this notable new article authored by Ira Robbins now available via SSRN.  Here is its abstract:

Federalism is a vital tenet of our Republic.  Although federal law is the supreme law of the land, our Constitution recognizes the integral role that state law plays in the national scheme.  Like any pharmaceutical drug that withstands rounds of clinical testing, state law functions as a laboratory in which Congress can evaluate and potentially adopt novel policies on a nation-wide basis.  Most of the time, federal and state law exist harmoniously, complementing one another; other times, however, the two systems clash, striking a dissonant chord.

In the United States, state marijuana laws are currently on a crash course with federal marijuana law, exemplifying the discordant consequences our dual-system of laws sometimes generates.  Eight states and the District of Columbia have legalized recreational marijuana use, yet under the Controlled Substances Act (“CSA”) marijuana remains illegal in the eyes of federal law. Mere confusion concerning the legality of marijuana is not the only consequence, however.  One notable casualty ensuing from the battle of the mutually exclusive federal and state marijuana laws is the deprivation of rights belonging to the unsuspecting, average citizen.

The CSA establishes a schedule of drugs, and various federal regimes — such as entitlement programs and welfare benefits — impose compliance with the CSA as a necessary antecedent for conferral of those benefits.  For example, although possessing a firearm is a fundamental right under the Second Amendment, citizens who wish to lawfully smoke marijuana can no longer avail themselves of this fundamental right. Section 922(g)(3) of the Gun Control Act prevents users of Schedule I drugs pursuant to the CSA — irrespective of state law — from possessing or owning a firearm. Marijuana, despite its lack of potential for addiction, plethora of medical benefits, and disconnect from violence, has always been a Schedule I drug — essentially deemed more addictive and dangerous than methamphetamine, a Schedule II drug. Unknowing, ordinary citizens are consequently caught in this legal black hole, contemplating how conduct can be both lawful and unlawful.

This Article proposes a simple solution to a complex problem: deschedule marijuana.  The Article first surveys the past, observing that the Nixon Administration’s placement of marijuana in Schedule I rang of racial undertones, and then examines the present, noting the majority of states that have legalized medicinal marijuana and the numerous anecdotal reports of its alleviating properties.  Further, enforcing § 922(g)(3) against individuals who consume marijuana lawfully pursuant to state law simultaneously overreaches and under-reaches, failing to target the violent criminals that Congress initially sought to apprehend.  Thus, the federal government’s insistence on maintaining marijuana in Schedule I undermines principles of federalism and prevents law-abiding citizens from fully exercising their constitutional right to own a firearm.

July 11, 2018 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Saturday, July 7, 2018

"Defying Congress, Jeff Sessions Keeps Blocking Medical Marijuana Research"

The title of this post is the headline of this recent Reason piece by Mike Riggs, which gets started this way:

It's been almost two years since the Drug Enforcement Administration (DEA) began accepting applications for new growers of research cannabis, and two dozen applicants are still in regulatory limbo.

Since the DEA announced in August 2016 that it would end the federal monopoly on producing cannabis for scientific research in the United States, growers, investors, researchers, applicants, and even members of Congress have sought to understand why a relatively simple licensing review process has stretched on for nearly two years. The answer is pretty straightforward: Attorney General Jeff Sessions, for reasons he has not publicly disclosed, decided to intervene in a process that has historically not involved the attorney general in order to stop the DEA from issuing licenses to growers.

While the Controlled Substances Act gives the attorney general regulatory authority over scheduled drugs, that authority has historically been delegated to the DEA, which is part of the Justice Department. The DEA has a whole division, in fact, dedicated to "investigat[ing] the diversion of controlled pharmaceuticals and listed chemicals from legitimate sources while ensuring an adequate and uninterrupted supply for legitimate medical, commercial, and scientific needs."

Members of Congress are not happy with Sessions' obstruction of the licensing process.  In April, Sens. Orrin Hatch (R–Utah) and Kamala Harris (D–Calif.) sent the attorney general a letter in which they asked him to provide the Senate with a timeline for processing applications from potential manufacturers of research marijuana. They also asked the DOJ to update applicants on the review process.  Both actions, Hatch and Harris suggested, should be completed by May 15, 2018.  Not only did the DOJ miss that deadline, but it doesn't seem interested in playing catch-up.

Four license applicants I interviewed in late June told me they've received no official updates from either the DEA or the DOJ in months.  Applicants who have spoken to congressional offices working on this issue say their contacts are equally frustrated by Sessions' obstruction of the DEA's licensing process.

July 7, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Thursday, June 28, 2018

Highlighting how extraordinary the approval of medical marijuana was in Oklahoma

OK-Yes-788Over at Marijuana Moment, Kyle Jaeger has this terrific new piece reflecting on the extraordinary dynamics surrounding the vote on Tuesday in Oklahoma approving a medical marijuana initiative. I recommend the piece in full, and here are excerpts:

Voters in one of the reddest states in the nation approved one of the most far-reaching marijuana ballot measures on Tuesday, making Oklahoma the 30th state to legalize medical cannabis.

And while advocates and pro-legalization organizers in the state will tell you they weren’t necessarily surprised by the results — with polls consistently showing majority support in the lead-up to Tuesday’s vote, for example — the initiative’s passage by a wide margin (57 percent to 43 percent) is still extraordinary.

In part, that’s because of the political landscape of Oklahoma. The state hasn’t voted for a Democratic presidential candidate since 1964, and its marijuana laws have historically reflected a staunch, prohibitionist mindset. Just four years ago, getting caught consuming cannabis in public twice could land you in prison for up to a decade.

But perhaps even more impressively, the initiative was decisively approved—during a midterm primary election—in spite of the fact that committees in support of State Question 788 were outspent by committees opposed to the measure six-to-one. According to the latest campaign finance records, Oklahomans for Health, which played a leading role in support of the initiative, and Yes On 788 spent a total of about $155,000 during their campaigns based on the latest campaign finance disclosure statements submitted June 26.

Committees opposed to the initiative, Oklahomans Against 788 and SQ Is NOT Medical spent a total of about $920,500 on their anti-legalization campaigns, some of which was used for television advertising against the measure. Supporters, on the other hand, did not have enough funds to go on the air with their message.

Chip Paul, chairman of Oklahomans for Health, told Marijuana Moment that the group’s minimal spending “speaks volume for liberty, freedom, unity… because Oklahoma united around this and made it happen.”...

Unlike pro-legalization campaign committees advancing reform bids in many past state-level elections, Oklahomans for Health did not receive financial contributions from national advocacy groups such as Marijuana Policy Project or the Drug Policy Alliance. Paul said it was better that way because “it means more if we do this for $0 or $10,000.”

Another element of the group’s campaign efforts involved strategically avoiding divisive, partisan politics. While the initiative itself has been characterized as “liberal” because it doesn’t include a list of limited medical conditions that qualify individuals for cannabis, the issue at hand is increasingly bipartisan. A recent survey from the progressive think tank Center for American Progress found a record 68 percent of Americans favor recreational legalization, including 57 percent of Republicans. Support for medical marijuana legalization is even higher, with 93 percent of Americans in agreement that patients should be able to legally access the plant. “For the most, we’ve managed to rise above things that would divide us,” Paul said.

June 28, 2018 in Campaigns, elections and public officials concerning reforms, History of Marijuana Laws in the United States, Initiative reforms in states, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Tuesday, June 26, 2018

SCOTUS provides a good new First Amendment precedent for doctors interested in recommending marijuana

Supreme-court-marijuanaThe modern state medical marijuana laws owe part of their structure to critical lower federal court rulings about the First Amendment's protection of doctors who wish to discuss marijuana use with patients.  In the late 1990s after California voters passed the nation's first medical marijuana law, the federal government threatened physicians who recommended or prescribed a Schedule I drug with possible revocation of DEA registration and exclusion from Medicare and Medicaid reimbursements.   But this threat was thwarted through litigation which culminated in a ruling by the U.S. Court of Appeals for the Ninth Circuit holding that physicians’ First Amendment freedom of speech rights under the privileged doctor-patient relationship permitted them to issue medical marijuana recommendations.  The Ninth Circuit's ruling in Conant v. Walters, 309 F.3d 629 (9th Cir. 2002), has provided a key foundation for modern medical marijuana regimes, but the firmness of that foundation could be questioned because the US Supreme Court has never addressed this issue directly.

As of this morning, the Supreme Court still has not addressed this issue directly, but it has now ruled in National Institute of Family and Life Advocates v. Becerra, available here, that the First Amendment limits what states can tell doctors and other health professional to say or not say.  Here is part of a fascinating passage (which even mentions medical marijuana, with my emphasis added) extolling the importance of broad constitutional protections in this realm:

As with other kinds of speech, regulating the content of professionals’ speech “pose[s] the inherent risk that the Government seeks not to advance a legitimate regulatory goal, but to suppress unpopular ideas or information.” Turner Broadcasting, 512 U. S., at 641.  Take medicine, for example. “Doctors help patients make deeply personal decisions, and their candor is crucial.” Wollschlaeger v. Governor of Florida, 848 F.3d 1293, 1328 (CA11 2017) (en banc) (W. Pryor, J. concurring).  Throughout history, governments have “manipulat[ed] the content of doctor-patient discourse” to increase state power and suppress minorities:

“For example, during the Cultural Revolution, Chinese physicians were dispatched to the countryside to convince peasants to use contraception. In the 1930s, the Soviet government expedited completion of a construction project on the Siberian railroad by ordering doctors to both reject requests for medical leave from work and conceal this government order from their patients.  In Nazi Germany, the Third Reich systematically violated the separation between state ideology and medical discourse. German physicians were taught that they owed a higher duty to the ‘health of the Volk’ than to the health of individual patients.  Recently, Nicolae Ceausescu’s strategy to increase the Romanian birth rate included prohibitions against giving advice to patients about the use of birth control devices and disseminating information about the use of condoms as a means of preventing the transmission of AIDS.” Berg, Toward a First Amendment Theory of Doctor-Patient Discourse and the Right To Receive Unbiased Medical Advice, 74 B. U. L. Rev. 201, 201– 202 (1994) (footnotes omitted).

Further, when the government polices the content of professional speech, it can fail to “‘preserve an uninhibited marketplace of ideas in which truth will ultimately prevail.’” McCullen v. Coakley, 573 U. S. ___, ___–___ (2014) (slip op., at 8–9).  Professionals might have a host of good-faith disagreements, both with each other and with the government, on many topics in their respective fields.  Doctors and nurses might disagree about the ethics of assisted suicide or the benefits of medical marijuana; lawyers and marriage counselors might disagree about the prudence of prenuptial agreements or the wisdom of divorce; bankers and accountants might disagree about the amount of money that should be devoted to savings or the benefits of tax reform.  “[T]he best test of truth is the power of the thought to get itself accepted in the competition of the market,” Abrams v. United States, 250 U. S. 616, 630 (1919) (Holmes, J., dissenting), and the people lose when the government is the one deciding which ideas should prevail.

Given the modern politics of marijuana reform, I was not that worried that the Ninth Circuit's work in Conant v. Walters would be undermined anytime soon. But it would not be too hard to imagine Attorney General Jeff Sessions or other state or federal officials resistant to marijuana reform trying to heavily regulate how medical professionals can talk to patients about marijuana. This new SCOTUS precedent would seem to limit such efforts.

June 26, 2018 in Court Rulings, History of Marijuana Laws in the United States, Medical community perspectives, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Monday, June 25, 2018

Formal FDA approval for Epidiolex means some part of the federal government finds some part of cannabis plant has "accepted medical use"

Download (1)This new CNN piece, headlined "FDA approves first cannabis-based drug," reports on the big news from the federal government concerning a very specific form of medical marijuana. Here are the details:

The US Food and Drug Administration approved a cannabis-based drug for the first time, the agency said Monday. Epidiolex was recommended for approval by an advisory committee in April, and the agency had until this week to make a decision.

The twice-daily oral solution is approved for use in patients 2 and older to treat two types of epileptic syndromes: Dravet syndrome, a rare genetic dysfunction of the brain that begins in the first year of life, and Lennox-Gastaut syndrome, a form of epilepsy with multiple types of seizures that begin in early childhood, usually between 3 and 5.

"This is an important medical advance," FDA Commissioner Dr. Scott Gottlieb said in a statement Monday. "Because of the adequate and well-controlled clinical studies that supported this approval, prescribers can have confidence in the drug's uniform strength and consistent delivery."

The drug is the "first pharmaceutical formulation of highly-purified, plant-based cannabidiol (CBD), a cannabinoid lacking the high associated with marijuana, and the first in a new category of anti-epileptic drugs," according to a statement Monday from GW Pharmaceuticals, the UK-based biopharmaceutical company that makes Epidiolex....

The FDA has approved synthetic versions of some cannabinoid chemicals found in the marijuana plant for other purposes, including cancer pain relief. Justin Gover, chief executive officer of GW Pharmaceuticals, described the approval in the statement as "a historic milestone." He added that the drug offers families "the first and only FDA-approved cannabidiol medicine to treat two severe, childhood-onset epilepsies."

"These patients deserve and will soon have access to a cannabinoid medicine that has been thoroughly studied in clinical trials, manufactured to assure quality and consistency, and available by prescription under a physician's care," Gover said. Epidiolex will become available in the fall, Gover told CNN.  He would not give any information on cost, saying only that it will be discussed with insurance companies and announced later....

It's an option for those patients who have not responded to other treatments to control seizures.  According to the Epilepsy Foundation, up to one-third of Americans who have epilepsy have found no therapies that will control their seizures. Shauna Garris, a pharmacist, pharmacy clinical specialist and adjunct assistant professor at the University of North Carolina's Eshelman School of Pharmacy, said the drug is effective and works somewhere between "fairly" and "very well." She has not used Epidiolex in her own clinical practice and was not involved in the development of the drug but said she's not sure it will live up to "all of the hype" that has surrounded it....

As part of the FDA's review of the medication, the potential for abuse was assessed and found to be low to negative, according to Gover. Still, this approval comes as the White House is said to be reconsidering federal prohibition of marijuana and as more and more states approve it for recreational and medicinal use. Gover said the approval signals "validation of the science of cannabinoid medication."

As the title of this post highlights, this news serves as still further proof of the misguided placement of marijuana as a Schedule I drug under the Controlled Substances Act defined as having "no currently accepted medical use in treatment in the United States." But, it should also be realize that this news serves as proof that the federal government, even without any reform to the CSA, can and will approve a cannabis-based medicine which has been "thoroughly studied in clinical trials [and] manufactured to assure quality and consistency."  Thus, the catch-22 comes from the fact that marijuana's placement on Schedule I precludes US-based companies from doing the types of clinical trials that the FDA demands.  (If we had a well-functioning federal government, marijuana surely would have been at least re-scheduled to Schedule II or III under the CSA many years ago.  But I digress....)

June 25, 2018 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical community perspectives, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Thursday, June 14, 2018

"The Politics of Passing and Implementing Medical Marijuana in Ohio"

The title of this post is the title of this notable new paper just posted to SSRN authored by A. Lee Hannah.  Here is its abstract:

Why did the state of Ohio adopt a medical marijuana policy? And why did it do so in 2016?  This article addresses these questions by examining the diffusion of medical cannabis policy across the U.S., by describing the evolution of images related to the policy, and by exploring the content of the law.

Using evidence from legislators’ remarks on the floor of the Ohio General Assembly and interviews with activists and analysts, I show that the direct initiative helped push members of the Ohio General Assembly to write and adopt a medical marijuana law (MML) when they were unlikely to do so. Next, I analyze trends in media coverage of medical marijuana to demonstrate that the spread of the policy has also been aided by shifting images related to the beneficiaries of medical cannabis programs.  Turning to the content of the law, I find that Ohio’s MML is written similarly to later adopters in the Midwest – where laws are more restrictive and medicalized. Finally, I assess how the characteristics of the law and looming elections will affect the implementation of Ohio’s Medical Marijuana Control Program.

June 14, 2018 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)