Pubdate: Fri, 20 May 2016
Source: Houston Chronicle (TX)
Copyright: 2016 Houston Chronicle Publishing Company Division, Hearst Newspaper
Author: Kenneth E. Leonard
Note: Kenneth E. Leonard is director of, and a senior research 
scientist at, the Research Institute on Addictions, University at 
Buffalo, The State University of New York. A slightly different 
version of this article was originally published on The Conversation


Forty-one states have legislation that permits medical marijuana in 
some form. However, the law in Texas is not considered functional 
because it requires a physician to prescribe marijuana. Since 
marijuana is illegal under federal law, doctors can't prescribe it. 
They can only recommend it to patients.

Louisiana's law had the same flaw, but the state's House of 
Representatives just voted on new legislation that should correct this problem.

In April, Pennsylvania became the latest state to pass medical 
marijuana legislation, which will take effect this month. And 
recently, Ohio's House of Representatives passed a plan to permit 
medical marijuana in the state.

As the director of the Research Institute on Addictions at the 
University at Buffalo and a researcher who studies social factors in 
the development of addictions, I follow many of the emerging trends 
in substance use.

When New York state passed legislation allowing for medical marijuana 
late in 2015, I began to collect information on the ways states were 
approaching this controversial issue.

As medical marijuana laws become more common in the U.S., it's good 
to understand what, exactly, these state laws allow - and what they 
don't. States are trying to strike a balance between access to 
medical marijuana for patients who might benefit while ensuring that 
these laws don't become a back door to full legalization. And, as I 
have found, there is a lot of variation in what states mean by 
"medical marijuana." This can affect whether and how patients can 
access it and what conditions it can be used to treat.

Medicinal properties

Let's start by looking at what medicinal properties marijuana has.

Marijuana consists of several hundred chemical components, but the 
most well known is tetrahydrocannabinol (THC), which causes 
marijuana's "high." It also can be used to treat nausea and vomiting. 
In fact, there are two FDA-approved synthetic versions of THC, 
Dronabinol (also called Marinol) and Cesemet, which are prescribed to 
treat nausea and vomiting for patients undergoing chemotherapy for 
cancer or to stimulate appetite for patients with AIDS. A side effect 
of these drugs is euphoria, which means they can make you high.

At the federal level, only these two medications are legal. THC or 
other extracts, whether synthetic or derived from the marijuana plant, are not.

The other marijuana compound with known medical applications is 
cannabidiol (CBD). Unlike THC, CBD does not produce a high. There are 
no FDA-approved medications based on CBD, although it is being 
studied as promising treatment for severe epilepsy and pain.

Proponents of medical marijuana argue that the combination of the 
chemical components present in the plant itself provides the most 
effective treatment for some medical symptoms. However, the amount of 
the medically important components differs from one plant to the 
next, and other potentially harmful components also may be present in 
the natural product. Research examining this issue is critically needed.

If you can smoke it, is it medical?

The phrase "medical marijuana" might give you the image of people 
buying plants or dried marijuana to smoke. That's the case in some 
states with medical marijuana laws but not all.

As of this writing, people in 21 states and the District of Columbia 
can possess marijuana in plant form for medical purposes. But, of 
course, there is plenty of variation among these states.

For instance, in 15 of the 21 states, laws permit people to cultivate 
marijuana plants for medicinal use. Limits on the number of plants 
vary from state to state, but most allow for six to twelve plants. 
And some of those states limit the number of mature versus immature, 
or seedling, plants people are allowed to have.

Several of these 15 states allow home cultivation only under certain 
circumstances. For example, Massachusetts allows patients to 
cultivate plants if a state dispensary is not nearby or for financial 
reasons. Other states require the cultivation to be in a locked area 
or have other restrictions.

In six other states, medical marijuana laws allow people to possess 
usable marijuana but prohibit them from cultivating the plant.

Still with me? Good. Those are just the states that permit people to 
possess marijuana or to cultivate plants to some degree or another.

In 15 states, medical marijuana laws allow people to possess only one 
specific marijuana extract, CBD, the component that does not produce 
a high. Possessing marijuana itself or cultivating plants isn't allowed.

If you live in Minnesota, New York or Pennsylvania, state laws 
prohibit "smokeable marijuana" but do allow marijuana extracts in 
nonsmokeable forms, such as oils that can be vaporized, oral 
solutions and capsules. These products are manufactured with specific 
amounts of THC and CBD.

Now that we have sorted out the different types of medical marijuana 
states permit, let's move on to the next major variation in medical 
marijuana legislation - what conditions medical marijuana can treat.

What do states say marijuana can help?

Most states that allow people to possess or cultivate marijuana for 
medical purposes allow its use to treat many medical conditions, 
including pain, nausea, HIV/AIDS, seizures and glaucoma. As of now, 
nine states also allow for the use of marijuana for post-traumatic 
stress disorder.

The most liberal of the states, California, goes a step further. Not 
only is medical marijuana permitted to treat all of these conditions, 
but for any other major illness for which marijuana has been "deemed 
appropriate and has been recommended by a physician."

Remember, in some states the only "medical marijuana" permitted is an 
extract, CBD. One of these states, Kentucky, allows CBD only for 
people in a state-sponsored clinical trial.

The other 14 states that allow the use of CBD allow it only for 
"debilitating," "severe" or "intractable" epilepsy. Most of these 
states do not have dispensaries where CBD can be purchased, or they 
have one single source, usually a medical school. So if a physician 
in these states determines that a patient would benefit from CBD, a 
patient would have to travel to another state with a dispensary that sells CBD.

And, of course, it gets even more complicated. Many of the states 
with legal dispensaries of CBD are not permitted to provide it to 
nonresidents. That means that even though CBD is legal in some 
states, it is effectively unavailable for most who might benefit.

Why is there so much variation?

Marijuana is classified as a Schedule 1 Drug, a category reserved for 
substances with "no currently accepted medical use and a high 
potential for abuse." This makes research on its medical applications 

As Nora Volkow, the director of the National Institute on Drug Abuse, 
pointed out, "With research about medical marijuana moving so slowly, 
states, often based on citizen lobbying efforts, have acted, creating 
legislation that might be based more on opinion than on evidence."

Whatever your opinion on the legalization of marijuana for 
recreational purposes, the array of state and federal laws regarding 
the use of medical marijuana is confusing and problematic for those 
who might benefit from such a program. It is vitally important that 
we clear the hurdles to clinical research on marijuana and that we 
accelerate research addressing the potential benefits and harms.
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