Wellness Corner - Medical Marijuana - by Dr. Gary Pace M.D. - January 2018

With the new cannabis laws starting January 1, and with Santa Rosa positioned to be a hub in the industry, it seems worthwhile to revisit the role of medical marijuana in this new legal climate.

In 1996, California voters passed Proposition 215, which legalized medical cannabis. Cultivation and possession of small quantities for personal medicinal use was allowed with a recommendation.

The dispensary infrastructure expanded over time. Growers now produce regulated product, patients get cards through their physician or ‘cannabis docs’ (including on-line, usually going for $50), and a myriad of edible and smokable products are now available. Our understanding of the biochemical components, mainly THC, CBD, and terpenes, and their relevance for certain health conditions has progressed. Now, people can get cannabis strains that address specific symptoms, i.e., improved sleep, decreased anxiety, targeting inflammation.

In 2017, California became one of 8 states to approve recreational marijuana use, or “adult use.” Possession has been legal for several months now, but until January 1, 2018, it had not been possible for businesses to sell it for non-medical use. In November, California approved regulations to license businesses for retail, cultivation, distribution, and processing. Currently, city and county governments are debating local guidelines. Some locales will have regulations in place for licensing application by January 1, others will take more time.

Medicine? What will be the role of the medical cannabis market in the coming years? Certainly in the last 20 years, many people came for 215 cards who mainly wanted to escape the legal ramifications for growing and recreational use. Now that need has been eliminated.

Cannabis was considered a standard herbal medicine found in regular pharmacies until made illegal in 1937. Later, as part of Nixon’s “War on Drugs,” marijuana was listed as Schedule 1 (with heroin and LSD), meaning there was considered a high potential for abuse and no apparent medical usefulness. Research ground to a trickle in the US.

In the 1990s, an Israeli researcher made an astonishing discovery. He found endo-cannabanoid receptors throughout the human body, particularly in the nervous system, immune system, and GI tract. This meant that we produce our own cannabis-like substances as a part of our hormonal/neurotransmitter-mediated homeostasis, and these messengers serve an important role in our health. Now there was a mechanism for understanding how cannabis could be used as a medicine.

Getting valid information can be a bit challenging, but not impossible. Americans for Safe Access has a good site (www.safeaccessnow.org) and UCSD, a world-class medical research facility, houses the Center for Medicinal Cannabis Research (www.cmcr.ucsd.edu). Promising areas for treatment include inflammation, sleep disorders, anxiety, intractable seizures, and pain. More research will help us understand how and when to most effectively use cannabis as a medical treatment.

Potential Problems with Legalization Dr. Larry Wolk, Chief Medical Officer of Colorado. Says that there have been no significant overall problems noted since legalization in Colorado, but certain questions do to continue to frequently arise. From the experience after legalization in Colorado and Washington we can learn(from Business Insider, Nov 9, 2016):

Youth consumption? No increases noted. Traffic fatalities? No increase in fatal accidents, but more drivers did test positive. Opioid addiction and overdose? A clear decrease in states with MJ legalization. ER visits? Increases noted due to accidental consumption, but the overall number was still small. Increases tended to be seen in children, pets, tourists. Incarceration? Clearly will go down. There were 8000 felony arrests and 6000 misdemeanors for cannabis in California in 2016. Communities of color carried an inordinate share of this burden.

How the medical cannabis industry will unfold now that recreational use has become legal is an open question The huge market for recreational use will undoubtedly consume most of the attention of the growers and retailers.

A few obvious differences with medical vs. recreational are apparent. At a minimum, recreational use will have an additional 5% sales tax. In addition, it is unclear if the recreational industry will continue to provide the higher CBD strains that are preferred by many of the medical patients. Thus, the laws and the market are currently a moving target.