Marijuana Law, Policy & Reform

"Did Michigan’s Legalization of Recreational Marijuana and Ohio’s Legalization of Medical Marijuana Increase Marijuana OVI Arrests in Ohio?"

The question in the title of this post is the title of this new paper authored by Peter Leasure and Dexter Ridgway ay Ohio State's Drug Enforcement and Policy Center (which I help direct).  Here is its abstract:

The current study used Ohio State Highway Patrol data to explore whether Michigan’s legalization of recreational marijuana and Ohio’s legalization of medical marijuana increased arrests for operating a vehicle while impaired (OVI) by marijuana in Ohio.  Overall, a conservative examination of the results did not support the hypothesis that Michigan’s legalization of recreational marijuana and Ohio’s legalization of medical marijuana increased marijuana OVI arrests in Ohio.  However, strong conclusions should not be drawn from this study as the results must be replicated using data from other Ohio law enforcement agencies and perhaps extended time periods.  Additionally, our results may not be generalizable to other outcomes such as OVI-related crashes.

"Putting Patients First: Medical Cannabis Use Patterns and Policy Protections"

The title of this post is the title of this notable new R Street policy study authored by Chelsea Boyd.  Here is  its executive summary:

Historically, cannabis has been used for medical purposes for millennia. Cannabis was introduced into western medicine in the mid-1800s but began to decline in use by the early 1900s.  It was made a Schedule I substance under the Controlled Substances Act of 1970, which effectively prevented research on its potential medical uses and benefits. Nevertheless, since 1996, more than three-quarters of states have legalized the medical use of cannabis in some form. This policy study explores what is known about medical cannabis patients’ use patterns and preferences; describes marketplace trends and medical relevance of cannabinoid content; and suggests policies that promote the availability of safe, effective and accessible medical cannabis products for patients.

Because there is limited research on cannabis as a therapeutic treatment, it is hard to make conclusive statements about effective dosing and use patterns for specific conditions or patient populations. Nevertheless, compared to non-medical users, medical cannabis patients tend to use daily, via multiple routes of administration, and do not report a desire to experience cannabis’ psychotropic effects. Medical patients also seem to prefer different cannabinoid profiles than non-medical users. Keeping in mind that, for many patients, finding the most effective use pattern is a process of trial and error, ensuring a wide variety of products with different cannabinoid ratios is one policy that can enable patients to find the most beneficial product combinations for their conditions. Similarly, because medical patient preferences are different from non-medical users, insulating medical markets from the potential pressures of the adult-use market can ensure that patients have access to products they prefer, even after a state legalizes adult use.

Additionally, when states legalize medical cannabis, they have a duty to ensure that any markets that emerge are safe. Because cannabis is regulated at the state level, there is notable variability in cannabis markets and product standards. Ensuring that each state has accurate, comprehensive and (when possible) evidence-based labeling standards can help patients make informed decisions about the products they use. States can also protect patients by regulating contaminants appropriately. Practical medical cannabis policies are necessary to ensure patient safety and allow the greatest accessibility.

Student presentation examines autism as a potential qualifying considition for medical marijuana in Ohio

Among the many virtures of a class on marijuana law and policy, and one reason I have students do presentation on topics of their choice, is the opporutnity to look at some issue with a broad landscape approach and then at related issues with a more refined focus.  During what I can hardly believe is the final week of my class, the first student presentation will be exploring medical marijuana programs around the nation.  Then, in what is scheduled to be the fourth presentation, a different student will look specificaly at autism as a potential qualifying considition for medical marijuana in the Buckeye State.  Here is how the topic is described by my student (along with background readings):

Medical Marijuana has been legalized in Ohio since 2016, however, Autism Spectrum Disorder (ASD) remains off of the list of qualifying conditions.  ASD is a neurodevelopmental disability which effects three major domains: social interaction, communication, and behavior patterns.  As of January 2022, ASD affected 1 in 44 children.  House Bill 60 and House Bill 261 aim to expand what conditions qualify for the use of medical marijuana and, specifically, look to add ASD as one of those qualifying conditions. 

Currently, 23 states list autism as a qualifying condition for medical marijuana use — Ohio is hopeful to be the 24th state. While there are many barriers to the recommendation of medical marijuana for autism, much of the evidence today is anecdotal.  Other countries such as Turkey analyzed the relationship between medical marijuana and Autism — the study was described to be a miracle for those with Autism.

Background materials:

Ohio House Bill 60

Ohio Senate Bill 261

Lihi Bar-Lev Schleider et al., "Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy" (2019)

Autisim Science Foundation, "Use of Medical Marijuana"

Peter Hess, "Cannabis and autism, explained"

Serap Bilge & Barış Ekici, "CBD-enriched cannabis for autism spectrum disorder: an experience of a single center in Turkey and reviews of the literature" (2021)

Student presentation exploring "Medical Marijuana and the Mental Health Crisis"

When students in my Marijuana Law, Policy & Reform seminar "take over" the second half of my class by giving presentations, they always cover a diverse array of cutting-edge topics.   So, this very first week of  presentations, a look at tax issues will be followed by a presentations focused on "Medical Marijuana and the Mental Health Crisis."   Here is how my student has described her topic along with background readings she has provided:

The mental health crisis in the United States is growing.  The stigmas surrounding mental health, as well as the barriers surrounding treatment, lead many individuals to self-soothe.  Drug use may be one method of choice. Medical marijuana could be an effective form of treatment, particularly for anxiety and panic disorders, but the lack of research and education about its efficacy and use make it an unrealistic option for many.

Though medical marijuana is growing in popularity as an alternative treatment method, it remains taboo throughout the world of practicing physicians.  Medical marijuana is not prescribed by a doctor – though it can be recommended (see Conant v. Walters, 309 F.3d 629 (9th Cir. 2002)) – and medical education does not present marijuana as a viable treatment option.  These limitations pose significant obstacles to both research and effective use, perpetuating a growing crisis with a limited number of answers.  This presentation will discuss the role of medical marijuana in treating mental illness, focusing on the systematic barriers that leave prescribers without authority and patients without aid.

Suggested Reading:

National Alliance on Mental Illness, "Mental Health By the Numbers"

Susan A. Stoner, Alcohol and Drug Abuse Institute, "Effects of Marijuana on Mental Health: Anxiety Disorders"

Anastasia Evanoff et. al, "Physicians-in-training are not prepared to prescribe medical marijuana," 180 Drug and Alcohol Dependence Volume 151 (Nov. 2017).

Americans for Safe Access releases "2022 State of the States Report: An Analysis of Medical Cannabis Access in the United States"

My wonderful marijuana seminar is about to turn to a close examination of the laws, policies and practices around medical marijuana reforms, and I am incredible grateful that the folks at Americans for Safe Access (ASA) unveiled their latest comprehensive annual report on medical marijuana reform just in time for our collective review. This new 150+ page report, titled "2022 State of the States Report: An Analysis of Medical Cannabis Access in the United States," provides both a national and state-by-state perspective on medical marijuana reforms.  This ASA press release about the report provides a bit of an overview:

The report evaluates the effectiveness of each state cannabis program from a patient perspective and assigns a grade using a rubric that reflects the key issues affecting patient access, broken down into more than 100 categories, including: barriers to access, civil protections, affordability, health and social equity, and product safety. The report also assigns penalties for harmful policies. ASA distributes the report to state legislators and regulators in every state, as well as hundreds of health and patient organization across the country.

Despite an increase in registered patient numbers and states with medical cannabis programs, the report highlights the fact that states are still falling short in creating programs that fulfill the needs of all patients-- the average grade among states was only 46.16% with Maryland earning the highest score of 75.71%. The report also highlights new issues facing patients including a decline in legislative improvements to state medical cannabis programs and the negative impacts recreational adult-use laws are having on medical cannabis access.

The report also offers solutions to improve state programs including legislative and regulatory language. Since the first edition in 2014, advocates and state legislators have utilized ASA’ report to pass new legislation and regulations to improve medical cannabis access. This year’s report offers policymakers a Medical Cannabis Equity Checklist with legislative improvements for states with recreational adult-use programs or those considering adopting such programs, to ensure patient access is not harmed.... ASA recognizes that state policymakers and regulators have been tasked with creating the infrastructure for a supply chain that remains illegal at the federal level and are now addressing a new health concern of the seemingly federally legal, unregulated cannabinoid market. In 2022 alone, 99 pieces of legislation were introduced regarding the unregulated cannabinoid market. The State of the States report calls on state legislatures to join patient advocates in calling on Congress to pass comprehensive federal legislation, and offers steps to do so in the “State's Government's Role in Ending Federal Prohibition” section.

"Changes in Prescribed Opioid Dosages Among Patients Receiving Medical Cannabis for Chronic Pain, New York State, 2017-2019"

The title of this post is the title of this new study published in JAMA Network Open. Here are the publication's "Key Points" and "Abstract":

Key Points

Question Is receiving medical cannabis for a longer duration associated with reducing prescription opioid dosages among patients receiving long-term opioid therapy?

Findings In this cohort study among 8165 patients with chronic pain receiving long-term opioid therapy, receiving medical cannabis for a longer duration was associated with prescription opioid dosage reduction. Higher opioid dosages were associated with larger reductions.

Meaning These findings contribute evidence toward potential clinical benefits of medical cannabis in reducing prescription opioid intake, which may decrease patients’ risk of opioid overdose.

Abstract

Importance Patients with chronic pain often receive long-term opioid therapy (LOT), which places them at risk of opioid use disorder and overdose. This presents the need for alternative or companion treatments; however, few studies on the association of medical cannabis (MC) with reducing opioid dosages exist.

Objective To assess changes in opioid dosages among patients receiving MC for longer duration compared with shorter duration.

Design, Setting, and Participants This cohort study of New York State Prescription Monitoring Program data from 2017 to 2019 included patients receiving MC for chronic pain while also receiving opioid treatment. Of these, patients receiving LOT prior to receiving MC were selected. Individuals were studied for 8 months after starting MC. Data were analyzed from November 2021 to February 2022.

Exposures Selected patients were divided into 2 groups based on the duration of receiving MC: the nonexposure group received MC for 30 days or fewer, and the exposure group received MC for more than 30 days.

Main Outcomes and Measures The main outcome was opioid dosage, measured by mean daily morphine milligram equivalent (MME). Analyses were conducted for 3 strata by opioid dosage prior to receiving MC: MME less than 50, MME of 50 to less than 90, and MME of 90 or greater.

Results A total of 8165 patients were included, with 4041 (median [IQR] age, 57 [47-65] years; 2376 [58.8%] female) in the exposure group and 4124 (median [IQR] age, 54 (44-62) years; 2370 [57.5%] female) in the nonexposure group. Median (IQR) baseline MMEs for the exposure vs nonexposure groups were 30.0 (20.0-40.0) vs 30.0 (20.0-40.0) in the lowest stratum, 60.0 (60.0-70.0) vs 60.0 (60.0-90.0) in the middle stratum, and 150.0 (100.0-216.2) vs 135.0 (100.0-218.0) in the highest stratum. During follow-up, significantly greater reductions in opioid dosage were observed among the exposure group. A dose-response association of patients’ opioid dosage at baseline was observed with the differences in the monthly MME reductions between exposure and nonexposure groups, with a difference of −1.52 (95% CI, −1.67 to −1.37) MME for the lowest stratum, −3.24 (95% CI, −3.61 to −2.87) MME for the middle stratum, and −9.33 (95% CI, −9.89 to −8.77) MME for the highest stratum. The daily MME for the last month of the follow-up period among patients receiving longer MC was reduced by 48% in the lowest stratum, 47% in the middle stratum, and 51% in the highest stratum compared with the baseline dosages. Among individuals in the nonexposure group, daily MME was reduced by only 4% in the lowest stratum, 9% in the middle stratum, and 14% in the highest stratum.

Conclusions and Relevance In this cohort study of patients receiving LOT, receiving MC for a longer duration was associated with reductions in opioid dosages, which may lower their risk of opioid-related morbidity and mortality.

"Solving a Drug Epidemic with More Drugs: A Discussion on the Expansion of Medical Marijuana in Ohio and its Impact on the Opioid Crisis"

As I have recently mentioned, during a very busy semester, I have fallen a bit behind posting some recently produced papers that are part of the on-going series of student papers supported by the Drug Enforcement and Policy Center.  As I try to catch up in the days ahead, as I continue to relish the he chance to highlight great work by OSU law students and recent graduates.  The title of this post is the title of this new paper authored by Brianna Sweeney who is in the midst of her 3L year at The Ohio State University Moritz College of Law.  Here is its abstract of this paper: 

Ohio has suffered greatly at the hands of the opioid epidemic, but a new form of treatment could be on the rise for those who struggle with opioid use disorder (OUD).  As Ohio Senate Bill 261 has proposed “opioid use disorder” as a new qualifying condition for the recommendation of medical marijuana, the possibility emerges of medical marijuana’s positive impact on the opioid crisis.  This paper will explore the relationship between medical marijuana and the opioid epidemic, including the policy debate of medical marijuana’s advantages and disadvantages, particularly in comparison to prescribing opioids, and its ability to assist in opioid use disorder treatment.  Next, it will turn to the research on how medical marijuana laws have potentially affected opioid related death rates across the country.  Narrowing in on the pertinent issue, the research discussion will also cover how medical marijuana impacts OUD and OUD treatment.  Finally, the paper discusses the lack of conclusive research available, the need for further research, and a possible route for Ohio to take as this topic and the understanding of it evolves.  It is this paper’s hope that Ohio can provide another opportunity to prevent lives lost to opioids, contribute to the end of the epidemic, and promote future work and conversations on this topic.

Prez Biden formally signs into law new "Medical Marijuana and Cannabidiol Research Expansion Act"

As reported in this Marijuana Moment piece, "President Joe Biden has officially signed a marijuana research bill into law, making history by enacting the first piece of standalone federal cannabis reform legislation in U.S. history." Here is more:

The bill cleared the House in April and the Senate last month, and a White House spokesperson confirmed to Marijuana Moment that the president intended to sign it. On Friday, he did just that.

The law gives the U.S. attorney general 60 days to either approve a given application or request supplemental information from the marijuana research applicant. It also creates a more efficient pathway for researchers who request larger quantities of cannabis....

Reps. Earl Blumenauer (D-OR) and Andy Harris (R-MD) sponsored the House version of the research legislation, which is substantively identical to a Senate bill from Sens. Dianne Feinstein (D-CA), Brian Schatz (D-HI) and Chuck Grassley (R-IA) that previously cleared that chamber....

The four co-chairs of the Congressional Cannabis Caucus — Blumenauer and Reps. Barbara Lee (D-CA), Dave Joyce (R-OH) and Brian Mast (R-FL) — released a joint statement following the president’s signing.

“For decades, the federal government has stood in the way of science and progress—peddling a misguided and discriminatory approach to cannabis. Today marks a monumental step in remedying our federal cannabis laws,” they said. “The Medical Marijuana and Cannabidiol Research Expansion Act will make it easier to study the impacts and potential of cannabis.”...

In a press release, Schatz said that “the medical community agrees that we need more research to learn about marijuana’s potential health benefits.” “Our new law will remove excessive barriers that make it difficult for researchers to study the effectiveness and safety of marijuana, and hopefully, give patients more treatment options,” he said.

Blumenauer and Harris previously championed a separate cannabis research bill that advanced through their chamber in April. Unlike that legislation, however, the newly approved bill notably does not include a provision that scientists had welcomed that would have allowed researchers to access cannabis from state-legal dispensaries to study.

The research legislation further encourages the Food and Drug Administration (FDA) to develop cannabis-derived medicines. One way it proposes doing so is by allowing accredited medical and osteopathic schools, practitioners, research institutions, and manufacturers with a Schedule I registration to cultivate their own cannabis for research purposes.

The Drug Enforcement Administration (DEA) is now mandated to approve applications to be manufacturers of marijuana-derived, FDA-approved drugs under the bill. Manufacturers will also be allowed to import cannabis materials to facilitate research into the plant’s therapeutic potential.

Another section requires the Department of Health and Human Services (HHS) to look at the health benefits and risks of marijuana as well as policies that are inhibiting research into cannabis that’s grown in legal states and provide recommendations on overcoming those barriers.

The bill further states that it “shall not be a violation of the Controlled Substances Act (CSA) for a State-licensed physician to discuss” the risk and benefits of marijuana and cannabis-derived products with patients.

DEPC releases "Ohio Medical Marijuana Control Program at Four Years: Evaluating Satisfaction and Perception"

I am happy to highligth the release of a terrific new report, titled ""Ohio Medical Marijuana Control Program at Four Years: Evaluating Satisfaction and Perception," authored by Jana Hrdinova of the Drug Enforcement and Policy Center (DEPC) at The Ohio State University Moritz College of Law.  This DEPC webpage provides this overview:

This report, a fourth in the annual series from the Drug Enforcement and Policy Center (DEPC), traces the evolution of the Ohio Medical Marijuana Control Program (OMMCP) over the last four years in terms of its growth and OMMCP patients’ and prospective patients’ satisfaction levels with the functioning and design of the program. For the first time, our survey finds respondents reporting being more satisfied with OMMCP than dissatisfied, an important milestone in OMMCP’s development. Nevertheless, the survey respondents continue to report dissatisfaction with some elements of the program, with the price of marijuana product being the most pressing concern, followed by lack of legal protections for patients and the cost and difficulty of obtaining OMMCP patient card. The final section of this report includes recommendations for policy and regulatory changes that could have a positive impact on patients’ satisfaction with OMMCP.

Here are a few of many notable findings from the report:

• 56.1% of respondents reported some level of satisfaction with OMMCP, with 15.3 % reporting being “extremely satisfied” and 40.8% being “somewhat satisfied.” Only 35.5% of respondents expressed some degree of dissatisfaction with OMMCP, a significant change from last year when 55.1% of people reported being dissatisfied.
• If averaged over the 13 months, an Ohio patient paid $4.08 more per gram of plant product in an Ohio dispensary than a Michigan resident in a Michigan dispensary, and $3.57 less per gram than a marijuana medical patient in Pennsylvania.
• The OMMCP recorded a 44% increase in the number of patients with active recommendation and active registration growing over the past 12 months. But the number of physicians with a certificate to recommend has declined over the same time period to 641 from 651 a year earlier. The patient to doctor ratio in Ohio now represents the lowest among states with a similarly aged program.
• The top three policy changes that would most positively affect patients’ satisfaction with OMMCP would be the adoption of legal protections for patients, followed by state allowance for self-cultivation, and provision of home delivery under OMMCP.
• Since January 2019, the state of Ohio collected over $132 million in revenue, with the state tax and local tax accounting for approximately $64 million, medical marijuana businesses application and licensing fees accounting for another $46 million and patient and caregiver fees making up the remaining $22 million.
• 84% of respondents reported having trust in the safety of products sold in Ohio dispensaries. Only 7.2% reported not trusting the safety of dispensary products.

DEPC's 2022–23 Marijuana and Drug Policy Research Grant Call for Proposals

I am very excited that Ohio State's Drug Enforcement and Policy Center (DEPC) is continuing its regular research grant program to fund work specifically in the marijuana and drug policy research/policy space. Here is the link to the DEPC grants page along with an overview of the call for proposals this year:  

The Drug Enforcement and Policy Center (DEPC) invites researchers and policy experts from universities, government agencies and independent research centers in the United States to submit proposals for funded research or policy analysis focused on implementation and policy impacts of marijuana legalization and other emerging topics in drug enforcement and policy.  We are specifically interested in research addressing questions related to criminal justice administration, public health, and public safety, as well as their various intersections.

This year’s call for proposals encompasses two different tracks: traditional research projects (maximum award of $25,000) and policy analysis/model policy creation (maximum award of $10,000).  In selection for funding, we are likely to prioritize shorter-term research projects (e.g., completed before end of 2023) that can help inform the work of lawmakers, regulators and advocates eager to promote evidence-based best practices and policies in emerging and future reforms efforts.  Topics may include, but are not limited to, the following:

• Impacts of marijuana reform and other drug decriminalization efforts on criminal case processing and law enforcement work including resource allocation, changes to existing arrest/charging/sentencing practices, use of fines and fees for enforcement, and broader effects on crime, clearance rates and community relations.
• Study and evaluation of present expungement and record relief efforts focusing particularly on marijuana offenses and other drug crimes and the impact of new laws and practices on affected populations.
• Impacts and attitudes toward various drug reform efforts in specific neighborhoods/communities defined by geography, political affiliation, social-economic status, and/or other demographics.
• Cost-benefit analyses of marijuana legalization/decriminalization policies, with a focus on economic development and budgetary impacts resulting from reforms such as tax revenues, law enforcement expenditures, treatment costs and regulatory expenses.

A fuller overview is available in this detailed document and the deadline for submissions is January 15, 2023, but proposals will be considered on a rolling basis.  Submit complete proposals to Jana Hrdinová at hrdinova.1  @  osu.edu.

"Association of cannabis potency with mental ill health and addiction: a systematic review"

The title of this post is the title of this notable new article published this week online at The Lancet Psychiatry authored by multiple researchers. Here is its summary:

Cannabis potency, defined as the concentration of Δ9-tetrahydrocannabinol (THC), has increased internationally, which could increase the risk of adverse health outcomes for cannabis users.  We present, to our knowledge, the first systematic review of the association of cannabis potency with mental health and addiction (PROSPERO, CRD42021226447).  We searched Embase, PsycINFO, and MEDLINE (from database inception to Jan 14, 2021). Included studies were observational studies of human participants comparing the association of high-potency cannabis (products with a higher concentration of THC) and low-potency cannabis (products with a lower concentration of THC), as defined by the studies included, with depression, anxiety, psychosis, or cannabis use disorder (CUD).

Of 4171 articles screened, 20 met the eligibility criteria: eight studies focused on psychosis, eight on anxiety, seven on depression, and six on CUD.  Overall, use of higher potency cannabis, relative to lower potency cannabis, was associated with an increased risk of psychosis and CUD.  Evidence varied for depression and anxiety.  The association of cannabis potency with CUD and psychosis highlights its relevance in health-care settings, and for public health guidelines and policies on cannabis sales.  Standardisation of exposure measures and longitudinal designs are needed to strengthen the evidence of this association.

"Maximizing social equity as a pillar of public administration: An examination of cannabis dispensary licensing in Pennsylvania"

The title of this post is the title of this notable new paper authored by Alfred Lee Hannah, Daniel J. Mallinson and Lauren Azevedo published in the Public Administration Review. (For the record, this research was supported by funding from the Drug Enforcement and Policy Center.)   Here is the paper's abstract:

Public administration upholds four pillars of an administrative practice: economy, efficiency, effectiveness, and social equity.  The question arises, however, how do administrators balance effectiveness and social equity when implementing policy?  Can the values contributing to administrative decisions be measured?

This study leverages the expansion of medical cannabis programs in the states to interrogate these questions.  The awarding of dispensary licenses in Pennsylvania affords the ability to determine the effect of social equity scoring on license award decisions, relative to criteria that represent the other pillars.  The results show that safety and business acumen were the most important determining factors in the awarding of licenses, both effectiveness concerns.  Social equity does not emerge as a significant determinant until the second round of licensing.  This study then discusses the future of social equity provisions for cannabis policy, as well as what the findings mean for social equity in public administration.

"The Right Prescription: High Cost Savings and Other Benefits from Medicare and Medicaid Coverage of Medical Marijuana"

As I continue to catch up on posting a lot of recently produced papers that are part of the on-going series of student papers supported by the Drug Enforcement and Policy Center, I continue to have the chance to highlight great work by OSU law students and recent graduates.  The title of this post is the title of this paper authored by Nathan Ecker who recently graduated from The Ohio State University Moritz College of Law.  Here is its abstract:

As medical marijuana usage continues to grow, coverage options under federal and private health insurance schemes have wilted away.  Despite the expanding list of qualifying conditions for medical marijuana, patients seeking coverage under Medicare, Medicaid, or other governmental health insurance programs are consistently denied funding under these plans.  Instead, patients are forced to either rely on “traditional pharmaceuticals” or incur the out-of-pocket expenses for medical marijuana.  However, by expanding health insurance coverage to include medical marijuana, medical treatment options would expand, and the government would experience significant cost savings.  This Paper examines the benefits to expanding Medicare and Medicaid coverage to encompass medical marijuana and suggests possible solutions for implementation.

Reviewing the need for, and barriers to, additional medical marijuana research

Students in my Marijuana Law, Policy & Reform seminar are continuing to "take over" my class through presentations on the research topics of their choice, and are continuing to provide in this space some background on their topic and links to some readings or relevant materials. The second of our presentations taking place this week will focus on medical marijuana research, and here is how my student has described his topic along with background readings:

Medical Marijuana and the federal government have a long, complicated history.  By complicated, I mean not complicated at all.  Marijuana has been illegal at the federal level ever since the Controlled Substances Act was signed into law.  Medical marijuana research in the U.S. has so far been limited, although two FDA approved, marijuana-derived drugs have been on the market since the 1980’s.  The overwhelming consensus is that the research space is not nearly as large as it could be, given the large user base, and that potential therapeutic effects of marijuana are largely unknown.

Even though its medicinal use goes back millennia.  Even today, many users self-report more managed symptoms from a variety of diseases and ailments; nausea and vomiting, chronic pain, and spasticity.  Researchers in the United States would like to further study some of these self-reported medicinal benefits of marijuana, but they claim that the federal government makes marijuana research too hard to be worth the effort.

This paper and my accompanying presentation begin by discussing the brightest research areas for medical marijuana consumption, and why those are not enough.  Then I will explore why marijuana has not received as much attention as the scientific community would like to give it.  Finally, I will discuss potential legislative fixes.

Sources and Background Reading

N.I.D.A., What is the scope of cannabis (marijuana) use in the United States? (2022).

Nat’l Academies of Sciences, Eng’g, and Med., Health and Med. Div., The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (2017)

U. of Mississippi, Marijuana Research (2022)

21 U.S.C. § 811

Michael H. Andreae et al., An Ethical Exploration of Barriers to Research on Controlled Drugs, 16 Am. J. Bioeth. 36 (2016).

Caleb Hellerman, Scientists Say the Government’s Only Pot Farm Has Moldy Samples – and no Federal Testing Standards (2017)

New Leafly report concludes "legal cannabis now supports 321,000 full-time American jobs"

The folks at Leafly have this notable new report seeking to address this basic question: "How many jobs are in America’s legal cannabis industry?" Here is part of the answer:

The 2022 Leafly Jobs Report found 428,059 full-time equivalent jobs supported by legal cannabis as of January 2022.  In the second year of the Covid-19 pandemic, America’s cannabis industry sold nearly $25 billion in products and created more than 107,000 new jobs — enough to fill the Rose Bowl and then some.

That’s a 33% increase in jobs in a single year.  And it marks the fifth year in a row of annual job growth greater than 27%. No other industry in America can match that.  Last year, America’s legal cannabis industry created more than 280 new jobs every day.  In 2021, someone was hired for a cannabis-supported job about every 2 minutes of the work day....

Those 428,059 jobs include direct cannabis jobs like cultivation and retail sales — what are often called “plant-touching jobs” — as well as indirect ancillary jobs that serve licensed companies or depend on legal cannabis sales. Ancillary jobs include work in accounting, human resources, legal affairs, regulatory compliance, security, maintenance, and construction.  Also included are indirect jobs in cannabis media, technology platforms, public relations, lobbying, non-cannabis product suppliers, and industry associations....

America now has three times as many cannabis workers as dentists.  Cannabis workers outnumber insurance salespeople. There are more people employed in the cannabis industry than there are hair stylists, barbers, and cosmetologists—combined....

While legal cannabis now supports 428,059 jobs, the total employment potential in a mature US legal cannabis market is approximately 1.5 million to 1.75 million workers.  The economic and employment potential for legal cannabis remains quite bright for many years to come.

"Societal Costs and Outcomes of Medical and Recreational Marijuana Policies in the United States: A Systematic Review"

The title of this post is the title of this notable new research in the journal Medical Care Research and Review authored by Michael French, Julia Zukerberg, Tara Lewandowski, Katrina Piccolo and Karoline Mortensen.  Here is its abstract:

Significant support exists in the United States for legalization of marijuana/cannabis.  As of 2021, 36 states and four territories approved the legalization of medical cannabis via medical marijuana laws (MMLs), and 15 states and District of Columbia (DC) have adopted recreational marijuana laws (RMLs).  We performed structured and systematic searches of articles published from 2010 through September 2021.  We assess the literature pertaining to adolescent marijuana use; opioid use and opioid-related outcomes; alcohol use; tobacco use; illicit and other drug use; marijuana growing and cultivation; employment, earnings, and other workplace outcomes; academic achievement and performance; criminal activity; perceived harmfulness; traffic and road safety; and suicide and sexual activity.  Overall, 113 articles satisfied our inclusion criteria.  Except for opioids, studies on use of other substances (illicit drugs, tobacco, and alcohol) were inconclusive. MMLs and RMLs do not generate negative outcomes in the labor market, lead to greater criminal activity, or reduce traffic and road safety.

"Maximizing Social Equity as a Pillar of Public Administration: An Examination of Dispensary Licensing in Pennsylvania"

The title of this post is the title of this notable new preprint authored by Lee Hannah, Daniel Mallinson and Lauren Azevedo. (Note: This research received supported from the Drug Enforcement and Policy Center, which I help direct.)   Here is the paper's abstract:

Public administration upholds four key pillars for administrative practice: economy, efficiency, effectiveness, and social equity.  The question arises, however, how do administrators balance these often-competing priorities when implementing policy?  Can the values which contributed to administrative decisions be measured? 

This study leverages the expansion of medical cannabis programs in the states to interrogate these questions.  Focusing on the awarding of dispensary licenses in Pennsylvania affords the ability to determine the effect of social equity scoring on license award decision, relative to criteria that represent the other pillars of public administration.  The results show that safety and business acumen were the most important determining factors in the awarding of licenses, both effectiveness and efficiency concerns. Social equity does not emerge as a significant determinant.

"The Impact of Medical Marijuana Legalization on Opioid Prescriptions"

The title of this post is the title of this notable new paper recently posted to SSRN authored by Hayoung Cheon, Tong Guo, Puneet Manchanda and S. Sriram.  Here is its abstract:

Since the late 1990s, opioids have been increasingly prescribed for pain treatment in the U.S as a result of aggressive marketing by pharmaceutical companies.  This has resulted in more than 450,000 opioid overdose deaths since then.  In the same time period, several U.S. states have legalized medical marijuana, a drug that can also be used for pain relief.  As a result, medical marijuana can be used as a substitute for opioids, leading to a reduction in opioid prescriptions.  On the other hand, marijuana use can lead to increased substance abuse, leading to a potential increase in opioid prescriptions.  The lack of scientific and medical knowledge along with the uncertain regulatory environment vis-a-vis medical marijuana use also makes it possible that its legalization has no impact on opioid prescriptions. 

With claims data from a large health insurance company in the U.S. between 2006 and 2016, we study the effect of medical marijuana legalization on opioid prescriptions, leveraging the temporal variation in state-wise legalization.  We find that, on average, opioid prescriptions decreased after medical marijuana legalization for all three outcome metrics that we consider (number of prescriptions, total days of supply, and total dosage in MME).  We also find that the role of physicians in reducing opioid prescriptions after legalization is more prominent than their corresponding role in increasing opioid prescriptions. 

"Smoke and Fears: The Effects of Marijuana Prohibition on Crime"

The title of this post is the title of this notable new working paper authored by Scott Callahan, David M. Bruner and Chris Giguere. Here is its abstract:

U.S. drug policy presumes prohibition reduces crime.  Recently states have enacted medical marijuana laws creating a natural experiment to test this hypothesis but is impeded by severe measurement error with available data.  We develop a novel imputation procedure to reduce measurement error bias and estimate significant reductions in violent and property crime rates, with heterogeneous effects across and within states and types of crime, contradicting drug prohibition policy.  We demonstrate uncorrected measurement error or assuming homogeneous policy effects leads to underestimation of crime reduction from ending marijuana prohibition.

And here is a key paragraph from the paper's introduction:

Our results indicate that MMLs result in significant reductions in both violent and property crime rates, with larger effects in Mexican border states.  While these results for violent crime rates are consistent with previously reported evidence (Gavrilova et al., 2017), we are the first paper to report such an effect on property crime as well.  Moreover, the estimated effects of MMLs on property crime rates are substantially larger, which is not surprising given property crimes are more prevalent.  We also find novel evidence consistent with our hypothesis that MMLs reduce violent crime rates more in urban counties compared to rural counties, contrary to previous estimates (Chu and Townsend, 2019).  We attribute this result to greater conflict between producers in urban counties under prohibition.  Overall, our results are consistent with the need for market participants to create de facto property rights under prohibition, often through the use of violence.  Our results are also consistent with prohibition causing a diversion of scarce policing resources, which when reallocated have the greatest impact on more pervasive types of crime and in locations where crime rates are higher.  These findings demonstrate both the importance of accounting for heterogeneous policy effects on crime and the necessity to correct for measurement error in crime data when conducting policy analysis.

"Ohio Medical Marijuana Control Program at Three Years: Evaluating Satisfaction and Perception"

The title of this post is the title of this terrific new report authored by Jana Hrdinova of the Drug Enforcement and Policy Center (DEPC) at The Ohio State University Moritz College of Law.  This DEPC webpage provides this overview:

Summary

H.B 523, enacted by the Ohio General Assembly, became effective in September 2016 and made Ohio the 25th state to adopt a comprehensive medical marijuana program.  A new report from the Drug Enforcement and Policy Center (DEPC) traces the development of the Ohio Medical Marijuana Control Program (OMMCP) since the start of legal sales in January 2019 and documents continued dissatisfaction among patients and prospective patients.

By gathering key program data and reporting on a new patient survey, this research fills gaps in our understanding of the OMMCP five years after becoming law.  With multiple new marijuana reforms under discussion in Ohio, the perceived effectiveness and success of the current system among patients and potential patients may shape the long-term prospects and future of the program.

Selected Findings

• 55% of respondents reported some level of dissatisfaction with OMMCP, with 25.4% reporting being “extremely dissatisfied” and nearly 30% being “somewhat dissatisfied.”  However, when compared to previous years the overall dissatisfaction levels are declining (67% in 2019 reported being dissatisfied, compared to 62% in 2020 and 55% this year).  Additionally, the intensity of dissatisfaction has lessened.

• 72% of survey respondents with a qualifying medical condition reported that Ohio dispensaries were their primary source of medical marijuana.  For people who indicated that they purchased marijuana from other sources, the primary reason for doing so was the cost of product in Ohio dispensaries and the cost and difficulty associated with becoming a registered patient.

• High price of marijuana in Ohio dispensaries was the top reason cited by participants for their continued dissatisfaction, for not using licensed dispensaries, and for opting out of using medical marijuana.  Price of marijuana in Ohio continues to be considerably higher than in Michigan and significantly lower than in Pennsylvania.  The second and third top-cited reasons were lack of home grow and lack of employment protections, respectively.

• 81% of respondents reported having trust in the safety of products sold in Ohio dispensaries. Only 8% reported not trusting the safety of dispensary products.

• COVID-19 inspired changes, including telemedicine, online ordering and curbside pick-up have had a positive impact on patients’ satisfaction levels.

• Despite growth in sales and in the number of patients and caregivers, the number of physicians with a Certificate to Recommend has actually decreased over the last 12 months.  Ohio is now second to last in the number of physicians per 100,000 residents able to recommend medical marijuana.