Marijuana Law, Policy & Reform

"Land of the Free, Home of the (Disgruntled) Brave: The Case for Allowing Veterans Access to Medical Marijuana"

The title of this post is the title of this new paper recently posted to SSRN authored by David Haba, a recent graduate of The Ohio State University Moritz College of Law.  This paper is the ninth in an on-going series of student papers supported by Drug Enforcement and Policy Center.  (The eight prior papers in this series are linked below.)  Here is this latest paper's abstract:

Approximately 30 percent of post-9/11 veterans have been diagnosed with Post-traumatic Stress Disorder (PTSD).  Over half of U.S. veterans struggle with chronic pain, and approximately 22 veterans commit suicide every day in America.  For veterans currently seeking medical treatment through Veteran Affairs (VA), 50 percent of PTSD patients cannot tolerate or do not adequately respond to existing treatments of opioids, anti-anxiety, and anti-depressant medications.  While an overwhelming majority of veterans, about 83%, support the use medical marijuana, they remain unable to obtain their preferred course of treatment (or financial assistance for it) through the VA because the federal government prohibits VA health care providers from recommending MMJ.

This paper argues that veterans, especially those with PTSD, should be able to obtain a recommendation, and financial assistance, for medical marijuana from the VA. This is especially true in states with legal medical marijuana programs.  Veterans have recently been calling on lawmakers to help them in their time of need as they battle hosts of ailments such as PTSD, chronic pain, and opioid addiction.   The government's current policy, which has allowed thirty-three states to enact legal medical marijuana programs, yet does not allow veterans to obtain a MMJ recommendation from the VA, nor obtain financial assistance for this medication, is unacceptable.  This paper calls on researchers to continue to enhance our understanding of MMJ's effects on PTSD, and for lawmakers to step up and do the right thing — to give the veterans the medicinal treatment that they want, need, and deserve for laying it all out on the line for our freedoms.

Prior student papers in this series:

• "The Canna(business) of Higher Education"
• "Marijuana Banking in New York and Around the US: 'Swim at Your Own Risk'"
• "Intellectual Property Survey: Cannabis Plant Types, Methods of Extraction, IP Protection, and One Patent That Could Ruin It All"
• "Marijuana in the Workplace: Distinguishing Between On-Duty and Off-Duty Consumption"
• "An Argument Against Regulating Cannabis Like Alcohol"
• "The State of Marijuana in The Buckeye State and Fiscal Policy Considerations of Legalized Recreational Marijuana"
• "Race Based Statutes at Play with Cannabis: Cultivating a Process for Weeding Out the Competition"
• "Tribal Cannabis: Balancing Tribal Sovereignty and Cooperative Enforcement"

"State Of The States Report: An Analysis Of Medical Cannabis Access In The United States"

The title of this post is the title of this huge new version of an annual report produced by Americans for Safe Access. Here is part of the introductory letter from Steph Sherer, the President and Founder of ASA, at the start of the 178-page report:

Each year, Americans for Safe Access (ASA) analyzes, summarizes, and critiques legislation and regulations as they become law and develops this report to assess how these programs are serving the needs of patients.  In 2014, when we first started writing this report, only 22 states were analyzed and graded.  Now, six years later, we are analyzing 47 states in over 50 categories surrounding Patient Rights and Civil Protection from Discrimination, Access to Medicine, Ease of Navigation, Functionality of the Program, and Consumer Safety and Provider Requirements.

Through this report, ASA also recommends how states can improve programs, and we take great pride in knowing that these recommendations are frequently followed and incorporated by regulators and policymakers.  While we are excited to see the number of states with medical cannabis programs increase, we know this patchwork of laws is not working to provide access to everyone who needs this medicine.  Patients can still not travel to other states with their medicine, and some states only offer protections that cover a small subset of patients using a certain type of medicine.  The types of medicine available, method of administration, purchase limits, training requirements for staff, labeling requirements, etc. are different depending on the state that you are lucky, or unlucky, enough to live in.

Two very different tales of state medical marijuana reform in Oklahoma and West Virginia

Way back in April 2017, as spotlighted in this post, West Virginia become first new medical marijuana state of the Trump era when Gov. Jim Justice signed a comprehensive medical marijuana bill into law.  But, as highlighted by this new Marijuana Business Daily article, headlined "West Virginia medical marijuana sales start delayed until 2021 or 2022," two years later the state is still nowhere near an operational medical marijuana program:

Allison Adler, director of communications for the West Virginia Department of Health, wrote in an email to MJBizDaily that the “primary cause” behind the projected two- to three-year delay is concern about the ability of MMJ companies to secure banking services. The banking issue was addressed in recent legislation. The state treasurer, Adler noted, recently issued a request for proposals from financial institutions interested in providing banking services to the industry. However, the proposals will “require time to evaluate and implement.”

Adler continued that “it is important to note that after a solution to the current banking issue is found, it will take time for multiple stages of the medical cannabis permitting process to be implemented.” The whole process, she added, also requires program staffing and development, rules implementation and registration of medical providers and patients.

Meanwhile, a thousand miles away, a different route to medical marijuana reform has helped produce a very difference experience in Oklahoma. One year ago, as noted in this post, Oklahoma voters passed a medical marijuana initiative’s passage by the wide margin of 57 percent to 43 percent.  And this recent article, headlined "One year after SQ 788 vote, Oklahoma near No. 1 for patients among medical marijuana states," details how quickly the state has become record setting:

When Oklahomans voted one year ago in favor of State Question 788, officials thought about 80,000 patients, or about 2% of the state’s estimated population, would register in the first year of a legal medical marijuana program.

As of June 24, the Oklahoma Medical Marijuana Authority has already registered more than 3.5% of the population as patients, with little sign of applications slowing. That participation rate puts Oklahoma near No. 1 among the 33 states that have some form of medical cannabis legislation in place as of May.

Comparatively low financial barriers, combined with a lack of restrictions on qualifying conditions, brought patients out in droves to apply for licenses, OMMA Executive Director Adrienne Rollins said last week.

Oklahoma’s medical cannabis law, unlike the laws of most other states, does not have a list of qualifying medical conditions patients must prove to enroll. “I think everyone took the language of the state question to heart by not adding medical condition qualifiers,” Rollins said of lawmakers who worked the past legislative session to expand Oklahoma’s medical marijuana regulations....

U.S. Census data indicates Oklahoma has a projected 3.943 million residents as of 2018. With nearly 140,000 patients on record as of June 17, Oklahoma’s registration rate is about 35 per 1,000 people.

Maine, the closest comparison, removed qualifying conditions from its law last year after medical marijuana became legal in 1999 and does not require patients to register with the state. The Office of Marijuana Policy in Maine released statistics showing a printed patient certification card rate of about 34.3 per 1,000 residents in 2018.

California, a state with both medical and recreational cannabis laws, also does not require patients to obtain an identification card to take advantage of its medical law, Proposition 215, which took effect in 1996. However, organizations such as the Marijuana Policy Project estimate California has a registration rate of about 31 patients per 1,000 residents.

“The numbers are already at least roughly tied with the highest participation rate in the country,” said Karen O’Keefe, the director of state policies for the MPP, a pro-cannabis nonprofit that advocates for legal reforms and also tracks cannabis use by state. “In a lot of ways I think Oklahoma has among the best medical marijuana programs in the country in terms of patients having relief quickly without a bunch of hurdles they and their physicians have to jump through.”...

The OMMA as of June 17 has approved 3,211 grower, 1,548 dispensary and 859 processor licenses. Arkansas, which legalized medical cannabis in 2016, had only its third dispensary statewide open earlier this summer after lengthy legal battles over limitations on commercial licenses. “I think it helped there was a noncompetitive application process,” O’Keefe said of SQ 788, adding that “You don’t have the government deciding how many pharmacies can operate. For the most part, we let the free market decide.”...

Rollins said neither the OMMA nor the state Legislature anticipate making attempts to reduce the size of Oklahoma’s program. The Oklahoma State Board of Health last July voted to enact emergency rules that would have banned consumption by smoking and require the involvement of pharmacists in dispensaries. However, public outrage — including, in some cases, from lawmakers — and a letter from the state’s attorney general led to a reversal of those changes.

Gov. Kevin Stitt signed House Bill 2612, a lengthier framework for the medical cannabis industry, into law earlier this year. It will take effect in late August, without restrictions likely to limit patient participation, and includes state-level protections for patients who own firearms.  “I think everyone has tried to make it easier for patients to have access to the system as far as applying and how they can get recommendations,” Rollins said. “The demand is obviously there, so I think it will be interesting once we get to renewal season (this fall) on the business side to see how many have been able to sustain and become operational.”

Just another stark reminder that just how a big new law gets implemented so often is so much more important than when and how it is passes.

"The State of Marijuana in The Buckeye State and Fiscal Policy Considerations of Legalized Recreational Marijuana"

The title of this post is the title of this new paper recently posted to SSRN authored by Finley Newman-James, who is a student at The Ohio State University Moritz College of Law.  This paper is the sixth of an on-going series of student papers supported by Drug Enforcement and Policy Center.  (The first five papers in this series are linked below.)  Here is this latest paper's abstract:

In 1975, Ohio’s 63rd Governor James A. Rhodes joined the growing trend of marijuana decriminalization by signing a bill passed by the legislature that supported amending the Ohio Revised Code to remove criminal penalties for use of marijuana.  This was the first big change to marijuana laws in Ohio.  Despite Ohio being one of the most conservative states in the country at the time, Rhodes brought Ohio to become the 6th state to relax punishments on marijuana use.  Since that time, a lot has changed regarding the status of cannabis in the Buckeye State.

This paper will first describe the past legal framework for marijuana along with current developments and proposed changes in the future, including a citizen’s ballot initiative that will appear on the November 2019 ballot that could potentially make sweeping changes to Ohio’s Constitution and marijuana law in Ohio.   This is then followed by an analysis of the potential benefits that recreational marijuana could have in respect to key fiscal budgetary issues facing the state of Ohio. 

Prior student papers in this series:

• "The Canna(business) of Higher Education"
• "Marijuana Banking in New York and Around the US: 'Swim at Your Own Risk'"
• "Intellectual Property Survey: Cannabis Plant Types, Methods of Extraction, IP Protection, and One Patent That Could Ruin It All"
• "Marijuana in the Workplace: Distinguishing Between On-Duty and Off-Duty Consumption"
• "An Argument Against Regulating Cannabis Like Alcohol"

Americans For Safe Access releases detailed "Patient's Guide To CBD"

The leading medical marijuana advocacy group, Americans for Safe Access, has this terrific new resource titled "Patient's Guide To CBD."  Though the title of this nearly 50-page report is simple, the contents provide an intricate road-map to the complicated law and science surrounding the status and import of the cannabis-plant compound known as CBD. Here is a section of the publication's introduction:

The Patient’s Guide to CBD was created by Americans for Safe Access (ASA) for the benefit of patients, prospective patients, healthcare providers, consumers, and anyone interested in learning more about CBD.  The goal of this guide is to be an informative and useful reference document that will be shared with others so that patients, doctors, and regulators can make informed decisions regarding CBD....

Patients and consumers should also be aware of the legal and regulatory status of CBD products.  As of May 2019, 47 U.S. states have passed some type of legislation permitting the use of cannabis or cannabinoids such as CBD; nevertheless, cannabis with THC in excess of 0.3% by dry weight is a Schedule I controlled substance under U.S. Federal law.  Therefore, CBD-containing products that were produced from cannabis plants that exceed the federal threshold on THC may be legal at the state level, but are federally illegal.  Additionally, even CBD products that are derived from plants containing not more than 0.3% THC by dry weight may violate laws such as the Food, Drug and Cosmetics Act and create further legal challenges for patients and consumers.

The passage of the Agriculture Improvement Act of 2018 (also known as the 2018 Farm Bill) will make industrial hemp (i.e., cannabis with no more than 0.3% THC by dry weight), including CBD-rich industrial hemp, an agricultural commodity in the United States, but the U.S. Department of Agriculture has yet to promulgate federal regulations or approve state regulations regarding the cultivation and processing of industrial hemp. Further, the U.S. Food & Drug Administration has yet to provide a pathway for the introduction of hemp-derived CBD products into the marketplace.  Therefore, it is not yet federally legal to market hemp-derived CBD as a drug, dietary supplement, food product, or cosmetic.  Patients and consumers are encouraged to stay up to date on these changing regulations to ensure that they, and their products, are in compliance with applicable laws.

Globally, the use of products containing CBD has risen dramatically as more and more people seek alternative ways to improve their health and their lives.  The data has shown an increase in the sales of products containing CBD every year, and sales are expected to continue to rise in the coming years.

Arizona Supreme Court clarifies that state medical marijuana law includes resins and hashish

Last year, an intermediate appellate court in Arizona ruled that a medical marijuana patient could still be criminal prosecuted for possession of hashish because, in the court's view, the Arizona Medical Marijuana Act retained a distinction between cannabis and marijuana and preserved the criminality of the former.  But yesterday, in Arizona v. Jones, No. CR-18-0370-PR (Ariz. May 28, 2019) (available here), the Arizona Supreme Court ruled unanimously that "AMMA’s definition of marijuana includes both its dried-leaf/flower form and extracted resin, including hashish."  Here is an excerpt from the tail end of the opinion:

AMMA appeared on the 2010 ballot as Proposition 203.  The accompanying ballot materials stated Proposition 203’s purpose was to “protect patients with debilitating medical conditions . . . from arrest and prosecution” for their “medical use of marijuana.” Ariz. Sec’y of State, 2010 Publicity Pamphlet 73 (2010).  Proposition 203 was intended to allow the use of marijuana in connection with a wide array of debilitating medical conditions, including “cancer, glaucoma, . . . amyotrophic lateral sclerosis, Crohn’s disease, [and] agitation of Alzheimer’s disease,” including “relief [from] nausea, vomiting and other side effects of drugs” used to treat debilitating conditions.  Id. It is implausible that voters intended to allow patients with these conditions to use marijuana only if they could consume it in dried-leaf/flower form.  Such an interpretation would preclude the use of marijuana as an option for those for whom smoking or consuming those parts of the marijuana plants would be ineffective or impossible. Consistent with voter intent, our interpretation enables patients to use medical marijuana to treat their debilitating medical conditions, in whatever form best suits them, so long as they do not possess more than the allowable amount....

We hold that the definition of marijuana in § 36-2801(8) includes resin, and by extension hashish, and that § 36-2811(B)(1) immunizes the use of such marijuana consistent with AMMA.  We reverse the trial court’s ruling denying Jones’s motion to dismiss, vacate the court of appeals’ opinion, and vacate Jones’s convictions and sentences.

Noting diverse employment law realities for medical marijuana users in diverse states

Governing has this effective new piece on employment law's intersection with marijuana reforms under the headline "Can Medical Marijuana Get You Fired? Depends on the State." The subheadline highlights a theme of the piece: "Less than half of the states where the drug treatment is legal protect patients from employment discrimination. Courts have generally sided with employers -- until recently." Here are excerpts:

In most states, you can use medical marijuana without getting arrested -- but it could still get you fired.  While 33 states have legalized cannabis for medicinal purposes, fewer than half of them protect patients from being fired or rejected for a job because of a positive cannabis test or simply because they're registered on a medical marijuana database.  This legal haziness has sparked lawsuits across the country.

Courts have generally sided with employers, says Peter Meyers, a law professor at George Washington University.  This was the case in 2006 in Oregon and in 2009 in Montana.  More recently, however, judges have shifted their verdicts in favor of employees.  In New Jersey last month, an appeals court ruled that medical marijuana use is covered under the state's ban on disability-based employment discrimination.  This case follows similar rulings in Connecticut, Massachusetts and Rhode Island. As more states legalize the drug treatment, the battle will continue in the workplace.

“The big problem is [marijuana] remains illegal federally except for narrow exceptions,” says Meyers, who has written about the constitutionality of drug testing. “There’s this conflict, and a lot of the court rulings have deferred to federal law. It’s a very confusing situation.”  The legal contradiction has left a lot of employers, and employees, uncertain about what rules to follow.

Bipartisan legislation to protect medical marijuana patients from employment discrimination has been introduced in Congress, but it only applies to federal workers and has yet to gain traction. With the federal government unlikely to change its marijuana policy any time soon, states are left to make their own rules.  In 14 of them, medical marijuana patients have explicit employment protections either through legislation or court rulings, according to the Marijuana Policy Project.

That leaves 19 states where people may have to choose between this treatment option and a job.  One of them is California, which was the first state to legalize medical marijuana, in 1996, but doesn't have explicit workplace protections.  The state Supreme Court ruled in 2008 that an employer could reject a job candidate with a positive cannabis test -- even if they had a prescription.  Bills seeking to override that decision have been tossed around without success.

Even where employment protections exist, they have limitations.  Arkansas law, for example, says an employer can't discriminate based on a person’s past or present status as a marijuana patient.  But companies can still ban employees from taking it at work.  In Oklahoma, employers can't penalize employees or applicants for a positive drug test -- unless failing to penalize someone would cause the employer to “imminently lose a monetary- or licensing-related benefit under federal law or regulation.”...

Despite the widespread legalization of medical cannabis, there are a number of reasons employers pause when it comes to having people who use it on their staff.  Some aren't fully aware of their state's protections, and others might fear losing out on federal funding.  “A lot of people are concerned about whether marijuana users will be less productive [at] work or if there will be more workplace accidents,” says Karen O’Keefe, state policies director for the Marijuana Policy Project.

But unlike many other drugs, THC, the active ingredient in marijuana, can be detected for 30 days or longer after use, so workplace drug tests don't necessarily portray a person’s current level of impairment.  As medical marijuana becomes less taboo, more employers will likely change their drug policies.  Already, fewer employers -- particularly those facing staff shortages -- are requesting preemployment tests for marijuana.

Medical marijuana proving very popular in Oklahoma

This local article spotlights the (surprising?) popularity of medical marijuana in the Sooner State under the headline "Oklahoma Medical Marijuana Authority estimated licensing 80,000 patients in year one. It's on track for 150,000."  Here are excerpts:

The Oklahoma Medical Marijuana Authority last year projected licensing 40,000 to 80,000 patients in its first year of operations. But in a surprise to OMMA personnel, the agency surpassed the 80,000-patient mark last week and could reach 150,000 by its first anniversary if the current pace of applications remains steady.

"We're probably averaging just over 5,000 a week," OMMA Director Adrienne Rollins said Thursday, which represents an increase of about 1,000 applications per week since early February, when OMMA shuttered its call center to free up time for application reviews. "We thought we would really be hammered in the very beginning and then it would start to level out. But as the number of physicians who are getting on board as far as recommending has increased, we've seen our numbers drastically increase," Rollins said. "I think at this point we're on track to have potentially 150,000."...

OMMA Communications Director Melissa Miller provided documentation to the Tulsa World showing the number of licensed patients in Oklahoma this week is more than 20 percent higher than it was the week of March 18. Miller said about 150 business license requests are submitted each week on average in recent weeks. Rollins said five OMMA employees specialize in reviewing those types of applications....

Rollins, who became the OMMA's director in October, said her department received about 3,500 patient applications between Aug. 26 and the first week of September. The number of submissions remained manageable until the winter holiday season, which is when Rollins said she noticed a "big jump" ahead of the expected widespread opening of dispensaries across the state.

By February, the OMMA closed its customer service call center, reassigning those five employees to review applications at least on a temporary basis. The move, Rollins said, means the OMMA can make decisions on up to 500 more patient applications per weekday. Of continuing to keep the call center shuttered, she said it was a "drastic change" from the OMMA's desires but maintained it was necessary to ensure applications are reviewed within the 14-day limit provided in State Question 788.

The House Rules Committee on Thursday passed a heavily amended version of Senate Bill 1030, which has a clause that if signed into law would expand the business applicant decision time to 90 days.

Spotlighting racial and regional differences in modern marijuana reform dynamics

I am very sad that presentations in my my Marijuana Law, Policy & Reform seminar have wrapped up, but that reality gives me a bit more time and space here to catch up on the marijuana law, policy and reform stories that most catch my eye.  One such important story that I missed a few weeks ago comes here from Stateline under the headline "African-Americans Missing Out on Southern Push for Legal Pot."  I recommend the extended article in full, and here are some excerpts:

Medical cannabis laws typically lay out the conditions for which the drug may be prescribed. But the laws in Arkansas and Florida — the only Southern states that have legalized medical cannabis — don’t cover sickle cell disease, which causes acute pain and disproportionately affects African-Americans. The bills advancing in Tennessee and Kentucky also exclude that condition. Three states that have legalized medical but not recreational cannabis — Connecticut, Ohio and Pennsylvania — allow sickle cell disease patients to use it....

Black legalization advocates also fear that even if medical cannabis becomes legal, white politicians won’t regulate licensing and permitting in a way that ensures equitable opportunities for people of color. “Without that, it’ll be more of the same,” said Dr. Felecia Dawson, a board-certified physician who closed her Georgia-based OB-GYN practice to focus on advocating for medical cannabis. “Legislators will keep people of color ... from the benefits of cannabis.”

Nationally, research suggests that medical marijuana use is more common among whites with high incomes, perhaps in part because of the long history of racial disparity in drug enforcement....

Every Southern state by 2016 had legalized the treatment of a limited number of conditions using CBD oil. As public support increased, so did lawmakers’ willingness to expand the list of eligible conditions. But some conditions that affect minority populations at higher rates than white ones — such as sickle cell disease, which affects 73 in 1,000 African-Americans at birth compared with 3 whites, according to federal estimates — are not included in proposals currently making their way through several Southern statehouses.

In a 2017 hearing co-hosted by the Arkansas Medical Marijuana Commission, following a ballot initiative that had legalized medical cannabis, advocates wore “Diversity for All” T-shirts to emphasize the drug’s importance to minority residents. “We know that such diseases as hypertension, sickle cell, neuropathy and so on are more predominant in blacks,” Casey Caldwell, a black cannabis advocate, said at the hearing.

“It is safe to say that African-American communities would benefit the most,” she added. “In the past, pharmaceutical drugs have been priced so high that [we] have to make a decision whether or not they should eat or whether they should purchase medication.”

Those concerns echoed what Dee Dawkins-Haigler, a former Democratic Georgia representative who headed the state’s Black Caucus, said in 2015 about the initial absence of black people among the state’s 17 appointees to the Commission on Medical Cannabis. The Black Caucus eventually fought to get sickle cell disease added to the list of conditions eligible for CBD oil....

In Florida, black farmers initially cried foul at being shut out of the state’s multibillion-dollar cannabis trade over policies that required license holders to have operated for 30 straight years. According to Roz McCarthy, founder of the Florida-based advocacy group Minorities for Medical Marijuana, the state’s law lacked the teeth needed to ensure that medical cannabis license holders adhered to requirements to ensure diversity in hiring. A spokesperson for the Florida Department of Health said that state law “does not require medical marijuana treatment centers to report the race or ethnicity of its owners.”

McCarthy said, “We’re trying to push lawmakers to understand that they have the ability and the power to ensure exclusionary practices don’t happen. Barriers are there. But the opportunity to reduce barriers is also there.”

Examining state medical marijuana programs and historic links to alcohol prohibition

A set of students in my Marijuana Law, Policy & Reform seminar are taking a deep dive into state medical marijuana programs this coming week.  Here is how they explain their planned presentation and links to some background reading:

For our presentation, we analyzed each state’s medical marijuana programs to determine ease of accessibility for patients.  We studied each state’s medical marijuana program and compared variables such as cost of registration, reciprocity, approved conditions, and many others.  Through our research, we discovered that there is wide spectrum of accessibility among the states which have legalized medical marijuana.  More specifically, we concluded that the top 5 easiest states to obtain a medical marijuana card are California, Hawaii, Illinois, Michigan, and Nevada.  Additionally, we concluded that the hardest states (among those which have legalized it) to access medical marijuana are Florida, Louisiana, Missouri, and Utah.

Next, we sought to determine if there was any correlation between the states that had easier/hardest accessibility with when those states ratified and abolished prohibition.  Our hypothesis was that the states with the laxer medical marijuana laws would be the ones that repealed prohibition sooner than those with the harsher medical marijuana laws.  Generally, we found that that states that ratified the 21st Amendment sooner seemed to have laxer medical marijuana laws and the states with the harsher laws repealed prohibition later on.  Also, side note, Oklahoma didn’t even repeal prohibition until 1959!

Background Sources

• ProCon list of 33 Legal Medical Marijuana States and DC

• 2018 Annual Report on Medical Marijuana Programs prepared by Americans for Safe Access

• Americans for Safe Access list of Legal Information By State & Federal Law

• NORML resources on state medical marijuana laws

• High Times article "How Many Dispensaries Are In Each State?"

"The Effect of Marijuana Use on American Veterans with PTSD, and How the U.S. Department of Veterans Affairs Ought to Respond"

The title of this post is the title of a presentation to be made by one of my students in my Marijuana Law, Policy & Reform seminar this coming week.  Here is part of his explanation of his topic and links to some background reading:

Because the U.S. Department of Veterans Affairs (VA) is required to follow all federal laws, the VA is prohibited from prescribing, recommending, or assisting veterans in obtaining marijuana.  While veterans may discuss marijuana use with VA providers, VA doctors cannot help their patients participate in a state medical marijuana program and veterans cannot obtain reimbursement funding through the VA when they seek medical marijuana from state programs.

The inability of the VA to prescribe or recommend marijuana to American veterans with PTSD denies former service members an opportunity to receive treatment that many veterans not only want, but which also has the potential to be safer than the VA’s history of doling out addictive prescription drugs such as opioids, antidepressants, and anti-anxiety pills.  PTSD is a serious disease that is relatively common among combat veterans — it causes varying symptoms such as flashbacks, nightmares, severe anxiety, and uncontrollable thought about a triggering event.

The medical research in this arena has reached mixed findings.  While some researchers have found that the use of medical marijuana by veterans with PTSD has positive results, other studies suggest that marijuana use by those with PTSD may actually make symptoms worse.  There simply has not been enough controlled studies to conclusively state whether marijuana is beneficial for those with PTSD.  Nonetheless, there is plenty of anecdotal evidence by veterans suggesting that their use of marijuana has improved, or in some cases eliminated, symptoms associated with their PTSD.  Fortunately, the first clinical trial of marijuana for American veterans with PTSD is currently underway in Colorado.  My presentation will suggest that we need more controlled clinical trials such as this to further identify whether marijuana could (or should) truly be used as a remedy for veterans with PTSD.

* Medical journal article, "Post-Traumatic Stress Disorder" (discussing what PTSD is and various treatment options, including cannabis).

* Medical journal article, "Use and effects of cannabinoids in military veterans with posttraumatic stress disorder"(reviewing several studies and noting that while there is a need for more randomized and controlled studies, some PTSD patients report benefits in terms of reduced anxiety and insomnia and improved coping ability).

* Medical journal article, "Posttraumatic Stress Disorder and Cannabis Use Characteristics among Military Veterans with Cannabis Dependence" (exploring the negative effects of treating PTSD with marijuana and finding that individuals with PTSD may have a particularly difficult experience when attempting to quit marijuana).

* Medical journal article, "Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review" (explaining that conclusions cannot yet be drawn about the therapeutic effects of marijuana and related cannabinoids for PTSD; suggesting that rapidly changing legal landscape will permit promising clinical research).

* Medical journal article, "A review of medical marijuana for the treatment of posttraumatic stress disorder: Real symptom re-leaf or just high hopes?" (finding some positive data for use of marijuana for PTSD but also noting conflicting findings and limits of studies conducted thus far).

* Report on study, "Marijuana for Symptoms of PTSD in U.S. Veterans" (first clinical trial of marijuana for PTSD in American veterans underway).

* Recent Weedmaps article, "Marijuana Study Findings Could Hold Promise for Veterans With PTSD" (noting that MAPS study mentioned above could pave the way toward an FDA-approved prescription medicine; anecdotal evidence of veteran using black market rather than expensive medical marijuana program in CA)

Two interesting new articles about the early operation of Ohio's medical marijuana program

Two Ohio papers had two interesting new article about early developments in the operation of Ohio's still-new medical marijuana program.  Here are headlines, links and excerpts:

From the Akron Beacon Journal, "Ohio medical marijuana recommendations coming from clinics, not family doctors"

If you know someone who has received a recommendation to use medical marijuana, odds are the recommendation didn’t come from a family doctor or primary-care physician. The vast majority of recommendations in Ohio come from clinics that employ doctors solely to evaluate patients for medical marijuana, say people familiar with the industry....

“Marijuana-specific clinics fill a huge need,” said Dr. Joel Simmons, who runs the Ohio Herbal Clinic, a Near East Side cannabis clinic. While the clinics, many of which have out-of-state owners, have some critics, patient advocates say primary-care doctors are the ideal source for marijuana recommendations.

Those doctors better understand a patient’s needs and medical history, said Mary Jane Borden, co-founder of the Ohio Rights Group, which advocates for users of medicinal cannabis. When Ohio lawmakers wrote the state’s medical-marijuana law, they hoped that family physicians would be writing most recommendations, Borden said....

Clinics charge between $125 and $200 for an evaluation, which insurance won’t cover.  Because the clinics don’t negotiate with insurance companies, they clinics can charge whatever they want, said Emilie Ramach, founder and CEO of Compassionate Alternatives, a Columbus-based nonprofit agency that helps patients pay for medicinal cannabis.  Several clinic doctors, including Simmons, said they do their best to keep their prices reasonable.

From the Columbus Dispatch, "High prices keep many Ohioans out of legal cannabis market"

As Ohio’s medical marijuana industry finally takes off, some patients and advocates are griping about costs that put it out of reach for many people.  A steep price tag stems partly from the lack of competition, as Ohio only has seven dispensaries spread throughout the state, mostly in rural areas, experts said.  Costs are expected to drop as more dispensaries open and the industry finds its footing.

In the meantime, patients openly acknowledge buying the drug on the black market while they wait for prices to come down.  And without insurance to cover the expense, some worry that low-income people might never be able to afford medical cannabis....

Several local patients said using marijuana has improved their quality of life, but they must stretch their budgets to pay for it or buy it on the street.  “I’m not using as much as I probably need to be using,” said Mary Alleger, 31, of Reynoldsburg, who said she uses cannabis to treat post-traumatic stress disorder (PTSD) and ongoing pain from a botched medical procedure.

Katherin Cottrill, 33, of Newark, has worked with the patient advocacy organization Ohio Rights Group to acquire a medical marijuana card, but said current costs keep her from even getting started.  “I would have to pay $200 to $250 (just to get a recommendation),” Cottrill said.  “And then I have to drive to a dispensary and pay $50. It’s unreasonable for me to even try.”...

Just under 3 grams of medical marijuana costs about $50. Cannabis clinics charge between $125 and $200, and the state charges $50 in fees.  Marijuana is cheaper on the street, patients said.

“On the black market you can buy an ounce for $200,” said Robert Doyle, 61, of Newark, who has a medical marijuana card but still buys the drug on the street due to the cost.  There are about 28 grams in an ounce.  Doyle said he’s visited dispensaries in Michigan with prices comparable to the black market, making him confident that Ohio’s costs will eventually fall....

But even if prices drop, clinic costs and fees will remain a barrier for some, Cottrill said.  “What about low-income people who are desperately seeking medication?” she said. “They can’t even afford to pay $50 to get their card registered.”

Federal judge finds Walmart unlawfully discriminated under state law against Arizona medical marijuana patient

As reported in this local article, headlined "Judge Rebukes Arizona Walmart for Firing Employee With Medical-Marijuana Card," a federal court last week issued a notable ruling on behalf of a medical marijuana patient in Arizona. Here are the basics:

An Arizona Walmart location terminated an employee in 2016 who held a valid medical-marijuana card after a drug test came back positive. But now a federal judge has ruled that because Walmart could not prove the employee was impaired at work, the company violated the nondiscrimination provision in the Arizona Medical Marijuana Act.

In a significant decision that recognized a private right of action for employment discrimination under the AMMA, Arizona U.S. District Judge James A. Teilborg said last week that Walmart was not justified in firing the worker based on the company's idea that marijuana metabolites in her urine meant she must have been impaired at work.

Whitmire's attorney Joshua Carden, who runs a Scottsdale-based law firm, said Teilborg's decision is "the first of its kind in Arizona."

"No court has officially decided whether a private right-of-action exists under the Arizona Medical Marijuana Act, so that was a big part of the decision," Carden told Phoenix New Times on Tuesday.

Before she was fired, Carol Whitmire had worked at Walmart stores in Show Low and Taylor for about eight years. On May 21, 2016, while working as a customer service supervisor at the Taylor Walmart, a bag of ice fell on Whitmire's wrist while she was leveling the bags, according to the lawsuit. The injury led to an urgent care visit and a drug test, pursuant to Walmart policy. Whitmire’s urine tested positive for marijuana metabolites.

A medical-marijuana cardholder for approximately the last five years, Whitmire smokes marijuana before bed to treat her shoulder pain and arthritis, and as a sleep aid, according to court records. She says she never brought marijuana to work or reported to the job impaired.

After the wrist injury, Whitmire informed the Walmart human resources department and the urgent care clinic that she holds a medical-marijuana card. She continued working until July 4, when she was suspended as a result of the urine sample. Her manager fired Whitmire on July 22 because of the positive result of the drug test, the complaint says.

In March 2017, Whitmire filed a discrimination charge with the Equal Employment Opportunity Commission and the civil rights division of the Arizona Attorney General’s Office. Three months later, she sued Walmart in federal court in Phoenix, alleging wrongful termination and discrimination in violation of the AMMA, the Arizona Civil Rights Act, and Arizona worker's compensation law.

In his decision last week, first reported by Law360, Teilborg granted partial summary judgment to Whitmire for her claim of discrimination under the AMMA. The judge, however, denied Whitmire’s claims alleging discrimination under the Arizona Civil Rights Act and retaliatory termination under Arizona employment protection and worker’s compensation laws.

The court will make a decision regarding damages or Whitmire's potential reinstatement in May, her attorney said. Under the AMMA, it is illegal for an employer to discriminate in hiring or firing based on a patient's "positive drug test for marijuana components or metabolites, unless the patient used, possessed or was impaired by marijuana on the premises of the place of employment or during the hours of employment."

In court, Walmart denied wrongfully terminating or discriminating against Whitmire, and said the company's drug testing policy is lawful and protected under Arizona's Drug Testing of Employees Act (DTEA). But Teilborg wrote that in the absence of expert testimony establishing that Whitmire's drug test shows she was impaired at work because of marijuana she smoked the night before, Walmart "is unable to prove that Plaintiff’s drug screen gave it a ‘good faith basis’ to believe Plaintiff was impaired at work."

Walmart could not meet the burden of proving that the urine sample after the accident “sufficiently establishes the presence of metabolites or components of marijuana in a scientifically sufficient concentration to cause impairment,” the judge wrote.

The full 50+ page ruling in Whitmire v. Walmart is available at this link. As the press report notes, the key to the ruling is the patient protective language in the the Arizona Medical Marijuana Act. Consequently, this ruling does not provide protection to medical marijuana patients outside the state. But the ruling is still notable and another recent example of lower courts growing more comfortable recognizing and enforcing rights under state law on behalf of some marijuana users in some settings.

Interesting early data about the early operations of Ohio's medical marijuana program

Though Ohio enacted its medical marijuana law, HB 523, way back in June 2016, the state took quite some time getting its rules and regulations and licenses in place to make the program operational.  But starting about a month ago, a few medical marijuana dispensaries were open for business and a system for registering doctors and patients in the program has been operational for a few months.

This past week, the Ohio Medical Marijuana Control Program Advisory Committee had a meeting at which this powerpoint presentation was shared showing all sorts of interesting data about how this program is now operating. Though I do not think the data is all too dissimilar to what we see in other states recently bringing a medical marijuana programs on-line, I still found these early facts from these PPT slides notable:

• Medical Marijuana Sales Figures (from January 16 – February 3, 2019) had total sales of $502,961, with total volume of 68.22 pounds

• Total Patient Recommendations were 17,077, along with 472 Total Caregivers

• Patients with Veteran Status were 1,284, with Indigent Status were 405, and with a Terminal Diagnosis were 83

• 10% of Registered patients are aged 18-29, 21% are aged 30-39, 22% are aged 40-49, 22% are aged 50-59, 19% are aged 60-69, and 6% are over 70

• Registered patients have twenty-one different conditions, with the top five being Spinal cord disease or injury (998 patients), Cancer (1,082), Fibromyalgia (1,973), Post-traumatic stress disorder (2,622), and Pain that is either chronic and severe or intractable (10,910)

• There are 374 active Certificates To Recommend (CTRs) among physicians, but only 177 physicians have so far issued recommendations for patients

"Should Physicians Recommend Replacing Opioids With Cannabis?"

The title of this post is the title of this short new "Viewpoint" piece authored by Keith Humphreys and Richard Saitz and published in the Journal of the American Medical Association.  I recommend the full piece, and here are excerpts:

Recent state regulations (eg, in New York, Illinois) allow medical cannabis as a substitute for opioids for chronic pain and for addiction.  Yet the evidence regarding safety, efficacy, and comparative effectiveness is at best equivocal for the former recommendation and strongly suggests the latter — substituting cannabis for opioid addiction treatments is potentially harmful.  Neither recommendation meets the standards of rigor desirable for medical treatment decisions.

Recent systematic reviews identified low-strength evidence that plant-based cannabis preparations alleviate neuropathic pain and insufficient evidence for other types of pain.  Studies tend to be of low methodological quality, involve small samples and short-follow-up periods, and do not address the most common causes of pain (eg, back pain).  This description of evidence for efficacy of cannabis for chronic pain is similar to how efficacy studies of opioids for chronic pain have been described (except that the volume of evidence is greater for opioids with 96 trials identified in a recent systematic review).

The evidence that cannabis is an efficacious treatment for opioid use disorder is even weaker.  To date, no prospective evidence, either from clinical trials or observational studies, has demonstrated any benefit of treating patients who have opioid addiction with cannabis.

Substituting cannabis for opioids is not the same as initiating opioid therapy.  There are no randomized clinical trials of substituting cannabis for opioids in patients taking or misusing opioids for treatment of pain, or in patients with opioid addiction treated with methadone or buprenorphine.  In addition to surveys of patients who use medical cannabis, the other types of studies prompting a move to cannabis to replace opioids are population-level reports stating that laws allowing medical cannabis use are followed by fewer opioid overdose deaths than expected.  The methodological concern with such studies is that correlation is not causation.  Many factors other than cannabis use may affect opioid overdose deaths, such as prescribing guidelines, opioid rescheduling, Good Samaritan laws, incarceration practices, and availability of evidence-based opioid use disorder treatment and naloxone....

For opioid use disorder, there is concern that the New York State Health Commissioner has defined opioid addiction to include people being treated with US Food and Drug Administration – approved, efficacious, opioid agonist medications, as a qualifying condition for medical cannabis.  Methadone and buprenorphine treatment reduces illicit opioid use, blood-borne disease transmission, criminal activity, adverse birth outcomes, and mortality.  Discontinuing such medications increases the risk of return to illicit opioid use, overdose, and death.  The suggestion that patients should self-substitute a drug (ie, cannabis) that has not been subjected to a single clinical trial for opioid addiction is irresponsible and should be reconsidered....

Cannabis and cannabis-derived medications merit further research, and such scientific work will likely yield useful results.  This does not mean that medical cannabis recommendations should be made without the evidence base demanded for other treatments. Evidence-based therapies are available.  For chronic pain, there are numerous alternatives to opioids aside from cannabis.  Nonopioid medications appear to have similar efficacy, and behavioral, voluntary, slow-tapering interventions can improve function and well-being while reducing pain.

For the opioid addiction crisis, clearly efficacious medications such as methadone and buprenorphine are underprescribed.  Without convincing evidence of efficacy of cannabis for this indication, it would be irresponsible for medicine to exacerbate this problem by encouraging patients with opioid addiction to stop taking these medications and to rely instead on unproven cannabis treatment.

Reviewing the now "mainstream" and "trendy" (and still uncertain) new world of CBD products

NBC News has this new article, headlined "CBD goes mainstream as bars and coffee shops add weed-related drinks to menus," that is worth a read, and I especially liked its closing paragraph. Here are excerpts:

Coffee. Cocktails. Lotion. Dog treats. You name it, CBD is probably in it.

CBD, short for cannabidiol, is a compound found in the cannabis plant.  It promises to deliver the calming benefits of marijuana without the high that comes from THC.  Companies are adding CBD to just about everything — a trend set to accelerate as regulations ease and consumer interest grows.

Most CBD is now federally legal thanks to the farm bill President Donald Trump signed in December. Companies still aren't supposed to add CBD to food, drinks and dietary supplements, but many are doing it anyway.  The Food and Drug Administration has said it plans to continue enforcing this ban but will also look into creating a pathway for such products to legally enter the market.

Some users swear by it, saying it relieves their anxiety, helps them sleep and eases their pain.  And forget stoner stereotypes when thinking about CBD. Moms and even pets are experimenting with it.  One research firm, Brightfield Group, expects the CBD market to reach $22 billion by 2022.

However, most of our current understanding of CBD is anecdotal — not proven through scientific studies.  And because CBD products aren't yet regulated, the quality can vary widely. "There's a lot of interest and excitement, for good reason, but I think people are pushing it too hard, too fast and are overgeneralizing things," said Ryan Vandrey, a professor at Johns Hopkins who studies the behavioral pharmacology of cannabis.

We don't know what exactly CBD interacts with in the brain or the body, but researchers do know that CBD tends to turn down abnormal signaling in the brain, said Ken Mackie, a psychological and brain sciences professor at Indiana University.  That's why CBD may help with epilepsy, anxiety and sleep. CBD and other cannabis compounds tweak systems in the body, a process he compares to lowering the volume. Other compounds, like opioids, ketamine and nicotine, simply turn them on and off.

There isn't much clinical research on the safety and efficacy of CBD. Studying cannabis has been challenging because it's technically illegal under federal law, meaning researchers must overcome a number of hurdles in order to study it.  We don't know anything about indications like sleep, anxiety or pain, Vandrey said.

We do know it's safe and effective in treating seizures in children with Lennox-Gastaut syndrome or Dravet syndrome. GW Pharma studied its CBD-derived drug, Epidiolex, in numerous clinical trials.  After reviewing the company's science, the Food and Drug Administration approved Epidiolex in June.

The lack of clinical evidence hasn't stopped consumers from trying it — and raving about it.  "It's always nice to have strong proof in placebo controlled trials, but if someone's taking a drug and feeling any benefit, more power to them," Mackie said....

The farm bill signed in December legalized hemp. Most CBD hitting shelves is derived from the hemp plant, which contains less than 0.3 percent THC, the psychoactive chemical in weed. Hemp's close cousin, marijuana, can contain upwards of 10 percent THC. So you can't get high from CBD products if the proper dosage is followed, but the industry isn't regulated on a federal level so the amount of THC can vary.

Doses can vary, too. Some shops recommend six milligrams of CBD when taken as a tincture or added to food. Others recommend at least 30. Again, since there isn't much clinical research on CBD, most of the recommendations are based on trial and error.

As more people dabble with CBD, more people are following the money, worrying some that bad products will enter the market and taint CBD's allure. Or worse, harm consumers. "There does need to be some sort of regulatory framework for overall product safety and to protect the customer from purchasing products that contain false advertisements or make unsubstantiated claims," said Pamela Hadfield, co-founder of HelloMD, a medical cannabis company, while cautioning against strict regulations that would be "too difficult for most manufacturers to comply."

Joe Masse, beverage director at The Woodstock bar, added a CBD cocktail to the menu in September. Called The White Rabbit, the drink is made with Bombay Dry Gin, sage simple syrup, honey, fresh lemon juice and 1 milligram of CBD oil.... "It's trendy right now, so I don't know how it will be in six months when we redo the menu," Masse said. "A year ago, activated charcoal was popular and now you can't find it anywhere."

Because I am not hip enough to know that "sctivated charcoal" was once, and now is no longer, a big deal, I am not the right person to be predicting the trend lines on the CBD trend.  But I do know how important and likely unpredictable it will be to see the FDA and/or state regulatory players take on CBD products and marketing in the wake of the new Farm Bill.  Just another important front to watch in the coming months and years and marijuana products and industry players continue to emerge from prohibition's shadow.

Speculating about impact on the opioid crisis as Ohio finally sees its first legal medical marijuana sale

Here is a silly trivia question:  How did some people in Ohio celebrate the 100-year anniversary of the ratification of the alcohol prohibition amendment? 

Answer: By finally being able to purchase medical marijuana in the state legally. 

Remarkably, it has taken more than 30 months form the Buckeye State to go from the passage of a medical marijuana law to the opening up of the first legal dispensaries.  And, not surprisingly, this new NBC News piece is already asking whether this development will help with the state's opioid problems.  Here are excerpts:

Leaning on her cane, Joan Caleodis stepped gingerly into history on Wednesday as one of the first people to legally purchase medical marijuana in the state of Ohio.

Caleodis, who is 55 and suffers from multiple sclerosis, paid $150 for three containers, each holding 2.83 grams of dried cannabis flowers, at the CY + Dispensary in the town of Wintersville.

“I’m feeling ecstatic,” Caleodis told reporters as other pain sufferers waiting in line applauded. “The patients no longer have to wait for relief. We can get rid of this opioid issue we have in this country.” Caleodis said she felt even better when she got home and tried out her purchase. “I was curious and I am very happy with the quality,” she told NBC News. “Some days are worse than others, but I am pretty much in constant pain and right now I am not.”

A former state worker who went on disability after 27 years on the job, Caleodis said she was prescribed opioids for pain after she was diagnosed with multiple sclerosis more than eight years ago. “I found myself taking double the amount prescribed and told myself, ‘I’m not going that route’,” she said. “This is definitely better.”

While medical marijuana is now available in the Buckeye State, it is unclear if the change will put a dent into the state's opioid epidemic. Ohio is one of “the top five states with the highest rates for opioid-related overdose deaths,” according to the National Institute on Drug Abuse.

Medical marijuana dispensaries are regulated in Ohio by the state Board of Pharmacy. When asked if the state views legal pot as a potential weapon in the battle against the deadly opioid epidemic, a Board spokesman replied, “The state has no official policy on this.”

The same question was posed to newly-installed Gov. Mike DeWine, who as attorney general sued the pharmaceutical companies for flooding his state with prescription painkillers. His team referred a reporter to the state Board of Pharmacy....

“There’s some suggestive evidence that marijuana may help to reduce opioid use,” Dr. Caleb Alexander, co-founder of the Center for Drug Safety and Effectivenesss at the Bloomberg School posted. “There’s also some evidence to the contrary.”

Rosalie Liccardo Pacula, co-director of the Drug Policy Research Center at the RAND Corporation said in the same forum that she was in favor of expanding medical marijuana programs, but added, “I do not believe that doing so will substantially impact the opioid epidemic. “

“Most people substituting cannabis for opioids are not using either drug medicinally,” she wrote. “Moreover, research does not suggest that cannabis is a substitute for heroin or fentanyl, the major drivers of the epidemic today.”

Mark Parrino of the American Association for the Treatment of Opioid Dependence said, “It is counterintuitive to advocate for the legalization of marijuana while our nation is struggling with an opioid use disorder epidemic.” “While medical use of marijuana may be beneficial in some cases, I do not think that it is reasonable to promote marijuana as a positive medical treatment,” he wrote.

Caleodis said anyone who thinks marijuana doesn’t help should take a walk in her shoes. She said she has used other “black market” cannabis products to easy her anguish over the years. “My symptoms are always there, I feel a burning in my feet just about all the time,” she said. “And at night it is way worse. Sometimes I just can’t sleep. But tonight I think I will.”

"Life, Liberty, (and the Pursuit of Happiness): Medical Marijuana Regulation in Historical Context"

The title of this post is the title of this great new book chapter authored by Lewis Grossman now available via SSRN.  Here is its abstract:

The struggle for access to medical marijuana differs from most other battles for therapeutic freedom in American history because marijuana also has a popular, though controversial, nontherapeutic use — delivery of a recreational high.  After considering struggles over the medical use of alcohol during prohibition as a precedent, this chapter relates the history of medical marijuana use and regulation in the United States.  The bulk of the chapter focuses on the medical marijuana movement from the 1970s to present.  This campaign has been one of the prime examples of a successful extrajudicial social movement for freedom of therapeutic choice.  With the exception of a single promising decision in 1975, courts have uniformly rejected arguments for medical marijuana access.  But the 1996 passage of Proposition 215 in California triggered a tremendous wave of state measures legalizing medical cannabis, as well as a dramatic change in American attitudes about the issue. 

The chapter recounts this history in light of the special legal, political, and rhetorical challenges medical cannabis advocates have faced.  First, many officials have opposed the legalization of medical marijuana, regardless of whether it offers therapeutic benefits, because of the public health harms and moral degradation they associate with the use of pot.  Second, marijuana’s designation as a Schedule I substance under the Controlled Substances Act of 1970, and the DEA’s rejection of multiple citizen petitions to reclassify it, has placed extremely high obstacles in the way of researchers interested in scientifically assessing marijuana’s therapeutic efficacy.  Third, federal government policies have lagged behind public preference and state law.  Finally, medical marijuana supporters have had to negotiate an invaluable but fraught relationship with advocates for comprehensive marijuana legalization.  The perspectives and goals of these two groups have overlapped and conflicted in fascinating and unexpected ways.

Maryland Medical Cannabis Commission report explores treatment of opioid use disorder by using medical cannabis

The debate over the relationship between the opioid crisis and marijuana reforms is so very interesting and, of course, so very important.  Advocates for and against marijuana reform seem ever eager to leverage the opioid crisis (and everything else) to support their prior conclusions about the virtues or vices of marijuana reform.  Against this backdrop, I think  information from non-partisans is especially valuable, and thus I was pleased to see this notable new report from the Maryland Medical Cannabis Commission titled "Treatment of Opioid Use Disorder with Medical Cannabis."  I recommend the full report, which mostly just reports on the state of the law in many jurisdictions and research on these topics.  Here are excerpts:

Since 2016, at least nine states have considered legislation or regulations to allow medical cannabis as an opioid replacement therapy to help ease withdrawal symptoms and aid in relapse prevention....  In 2018, Pennsylvania, New Jersey, and New York became the first states to expressly allow medical cannabis for the treatment of OUD. Each state permits the use of medical cannabis to treat OUD, but with significant restrictions....

From 2016-2018, at least seven state legislatures considered bills that would expressly add OUD to the list of medical cannabis qualifying conditions.  Of these, the majority rejected the legislation seeking to add OUD to the list of qualifying conditions.  [T]hree states – Hawaii, Maine, and New Mexico – passed legislation authorizing the use of medical cannabis to treat OUD; however, the State’s Governor vetoed the legislation in each instance following significant pressure from health care providers, health care organizations, and addiction specialists....

Data suggest that cannabis legalization reduces prescription opioid use by serving as an alternative pain treatment. Medical cannabis laws may also have downstream policy effects on reducing opioid-related hospitalizations, overdose deaths, and traffic fatalities. The following section examines existing literature on the association between medical cannabis and opioid use, including as a treatment for opioid use disorder....

[But] a study was published in the “To the Editor” section of JAMA Internal Medicine in September 2018, which found that the opioid-related overdose death rate was accelerating in states where medical and/or adult use cannabis laws had been implemented. Moreover, the death rate surpassed that of nonlegalizing states. The study reviewed opioid-related overdose death data from 2010 to 2016, and determined that the age-adjusted death rate was higher in states with cannabis legalization and that the age-adjusted death rate was increasing at a faster rate than in non-legalizing states. While several researchers have challenged the methodology of this study – including the inaccurate assessment of states that have legalized medical and adultuse cannabis – the results call attention to the need for further investigation of the association between cannabis legalization and opioid-related overdose deaths....

In December 2018, the Commission received two petitions requesting the addition of OUD to the list of medical cannabis qualifying conditions. If the Commission determines that either or both of these petitions are “facially substantial” then it must conduct a public hearing within the next 12 months to evaluate whether the medical condition or disease should be included in the list of qualifying conditions.  The Commission’s Research Committee, which includes two physicians, a scientist, addiction specialist, and horticulturist, is currently evaluating the petitions to determine whether they are facially substantial and require a public hearing. The Commission will provide the General Assembly with updates on the status of the OUD petitions, including information on any public hearings to consider adding OUD as a qualifying medical condition.

Holiday-season, marijuana-reform headline round-up

The holiday last week and busy times at the end of a semester (and lots of sentencing reform activity) has put a crimp in my blogging lately.  But this slow down on the blog does not reflect a slow down in marijuana reform news, and so I will try to catch up here with a few headlines and links to stories that highlight, yet again, that it is always a busy season in the arena of marijuana reform:

• From the Baltimore Sun, "Medical marijuana sales in Maryland set to blow through one expert forecast, reach $100 million"

• From the Boston Globe, "Customers spent more than $2 million in first week of Mass. recreational marijuana sales"

• From CNN, "Louisiana is trying to keep medical marijuana medical. It's harder than it sounds

• From the New York Times, "How a Push to Legalize Pot in N.J. Became a Debate on Race and Fairness"

• From Politico, "Bankers' pot push gets boost from blue wave, Sessions ouster"

• From Rolling Stone, "Weed and Pregnancy: How Cannabis Laws Are Hurting Mothers"

• From Salem Statesman Journal, "Medical marijuana sales in Maryland set to blow through one expert forecast, reach $100 million"