24 things that won't happen under Iowa's new medical cannabis law

In one of his final official acts before he departs for China, Governor Terry Branstad signed into law the last bill approved during the 2017 legislative session.

House File 524 has been portrayed as a major expansion of medical cannabis in Iowa. Whereas the 2014 law permitted the use of only one cannabis derivative (CBD oil) to treat certain seizure disorders, the new law allows the same product (cannabidiol with no more than 3 percent THC) to be used for nine medical conditions: cancer, multiple sclerosis, epilepsy, AIDS or HIV, Crohn’s disease, amyotrophic lateral sclerosis (Lou Gehrig’s disease), Parkinson's disease, untreatable pain, or "any terminal illness with a life expectancy under one year associated with severe or chronic pain, nausea or severe vomiting, cachexia or severe wasting." Threase Harms, who lobbied for the bill, described it as a "great next step in the process of making medical cannabis available for many folks here in Iowa who need access to it as a medical treatment."

A more comprehensive bill, which had gained broad bipartisan support in the Iowa Senate, had the potential to improve the quality of life for thousands.

I see little evidence anything "great" will come out of legislation finalized during an all-nighter by House Republican lawmakers who refused to take up that Senate bill.

As Iowa implements the new law, the following outcomes are predictable.

1. Iowa cancer patients won't get relief from symptoms of their disease or side effects from treatment.

For decades, oncologists have quietly recommended marijuana to some of their patients suffering from nausea or weight loss. Cancer is the first condition listed in House File 524. Yet experts in the field of medical cannabis agree that CBD oil containing 3 percent THC or less will not help treat cancer.

Shelly Servadio is a registered nurse, member of the American Cannabis Nurses Association, and co-founder and director of the Iowa Hemp Association. She appeared on Chance Dorland's Des Moines FM podcast last month to talk about the bill lawmakers approved before adjourning for the year. Servadio noted that industrial hemp has less than 3 percent THC, the compound that makes marijuana users high. Medicinal cannabis has higher levels of THC, Servadio said. "What the legislators passed was not a medicinal cannabis bill, or a medical marijuana bill. They passed an industrial hemp bill, which is really what the [Iowa] GOP platform states that they'll do. And what they passed wasn't based in science or medicine. It was based in the party platform. [...] You can't help HIV or cancer with only 3 percent THC. It's not going to be a therapeutic benefit."

Senator Joe Bolkcom, the legislature's leading advocate for medical cannabis for many years, voted against House File 524, saying it offered only "false hope” to Iowans “who have begged us to help.”

We know from pharmacologists and people in the medical cannabis field that you actually need cannabis medicines with more than 3 percent THC to treat things like cancer pain, MS, Crohn’s disease, HIV/AIDS, and a host of other conditions.

Speaking later to the Des Moines Register's Kathie Obradovich, Bolkcom said, "It’s kind of like, you can have a baby aspirin for that, you know it won’t work, but that’s what we’re going to allow you to have."

2. Iowans with multiple sclerosis won't get relief from symptoms of their disease or side effects from treatment.

See point 1.

3. Not all Iowans with epilepsy will benefit from the only allowable cannabis treatment.

Many people with seizure disorders have found relief from using CBD oil, including Erin Miller's son Abram, who inspired her tireless activism to make medical cannabis more available in Iowa.

But although Harms welcomed news that Branstad had signed House File 524, she told the Des Moines Register's Jason Noble, “There’s still a lot of work to do. Even with epilepsy, not everybody can be treated with a medicine that has 3 percent THC.” Harms would know, since she advocated for this bill on behalf of the Epilepsy Foundation and the Upper Midwest Chapter of the National Multiple Sclerosis Society.

4. Iowans with AIDS or HIV won't get relief from symptoms of their disease or side effects from treatment.

See point 1.

5. Iowans with Crohn's disease won't get relief from symptoms of their disease or side effects from treatment.

See point 1.

6. Iowans with amyotrophic lateral sclerosis (Lou Gehrig’s disease) won't get relief from symptoms of their disease or side effects from treatment.

See point 1.

7. Iowans with Parkinson's disease won't get relief from symptoms of their disease or side effects from treatment.

See point 1.

8. Iowans with untreatable pain won't get relief from their symptoms.

See point 1.

9. Iowans with terminal illnesses won't get relief from "chronic pain, nausea or severe vomiting, cachexia or severe wasting."

See point 1.

10. Iowans with glaucoma won't have legal access to any form of medical cannabis.

House Republicans removed about half of the medical conditions that would have been covered under the bill 45 state senators had approved a few days earlier.

Just like when GOP lawmakers in the lower chamber scaled back a different cannabis bill during the 2016 legislative session, the shorter list of qualifying conditions wasn't grounded in any scientific research or advice from specialists. Rather, a few Republicans arbitrarily decided that Iowans with certain illnesses should be able to obtain cannabis, while others would be excluded. Glaucoma patients are one of the groups without any new treatment options.

Servadio's frustration was palpable as she told Dorland, "We shouldn't be picking and choosing and basing it on politics instead of medicine. [...] Too many people are left out."

11. Iowans with hepatitis C won't have legal access to any form of medical cannabis.

See point 10.

12. Iowans with ulcerative colitis won't have legal access to any form of medical cannabis.

See point 10.

13. Iowans with Ehlers-danlos syndrome (a connective tissue disorder) won't have legal access to any form of medical cannabis.

See point 10.

14. Iowans with post-traumatic stress disorder won't have legal access to any form of medical cannabis.

See point 10.

Servadio chairs the Iowa Democratic Party's Veterans Caucus and told Dorland, "it was really quite heartbreaking to me for my veterans, my precious veterans," to have PTSD "arbitrarily erased" from the bill. She added that many people who are not veterans suffer from PTSD as well.

15. Iowans with Tourette’s syndrome won't have legal access to any form of medical cannabis.

See point 10.

16. Iowans with muscular dystrophy won't have legal access to any form of medical cannabis.

See point 10.

17. Iowans with Huntington’s disease won't have legal access to any form of medical cannabis.

See point 10.

18. Iowans with Alzheimer’s disease won't have legal access to any form of medical cannabis.

See point 10.

19. Iowans with complex regional pain syndrome, type I and II won't have legal access to any form of medical cannabis.

See point 10.

20. Iowans with rheumatoid arthritis won't have legal access to any form of medical cannabis.

See point 10.

21. Iowans with polyarteritis nodosa (a disease that can affect many organs) won't have legal access to any form of medical cannabis.

See point 10.

A few more points are worth noting:

22. Opioid use probably won't drop in Iowa as a result of the new law.

A peer-reviewed study covering eighteen states over more than a decade determined that "States that allow medical marijuana to be used to treat pain show a decline in the use of opioids." A different study published this year found,

Hospitalization rates for opioid painkiller dependence and abuse dropped on average 23 percent in states after marijuana was permitted for medicinal purposes, the analysis found. Hospitalization rates for opioid overdoses dropped 13 percent on average.

At the same time, fears that legalization of medical marijuana would lead to an uptick in cannabis-related hospitalizations proved unfounded, according to the report in Drug and Alcohol Dependence.

Since many severe or chronic conditions are excluded from the new law, and CBD oil won't effectively treat eight of the nine conditions that are ostensibly covered, we are unlikely to see any significant reduction in the number of Iowans using or abusing opioid painkillers.

23. The growers and dispensaries envisioned in the law may never materialize.

House File 524 lays out a process for manufacturers and dispensaries to be licensed to produce and sell cannabidiol in Iowa by December 2018.

But given how few patients would benefit from the new law, and the fact that CBD oil can already be purchased over the internet, Servadio and some other medical cannabis advocates question whether any businesses will apply for Iowa licenses.

Our neighbor to the north's experience is not encouraging. Kyle Potter and Linley Sanders reported for the Associated Press on May 12 about language that allows Iowa patients to access CBD oil from Minnesota while waiting for in-state sources to become available.

A provision of the bill specifically references that state as a potential source of medication and directs Iowa regulators to contract with Minnesota's two manufacturers of medical marijuana.

It's the first half of an arrangement being worked out between Iowa House Speaker Linda Upmeyer and Minnesota House Speaker Kurt Daudt, friends who first explored the idea last year until the push to expand Iowa's medical marijuana law fizzled out. Both lawmakers confirmed their discussions to The Associated Press this week.

Upmeyer said Minnesota could offer immediate relief to sick Iowans while the state works to set up its program over the next 18 months. Minnesota may even serve as a permanent back-up in case the state can't secure its own manufacturer, a prospect she and others have feared. [...]

It's unclear how many Iowa patients might take advantage of being able to buy their supply in Minnesota, but Daudt said any patients from Iowa could help manufacturers in Minnesota, where the tight restrictions have led to lackluster patient enrollment, high medication costs and huge financial losses for both companies. [...]

"One of the problems that we have had here is that the manufacturers ... have a limited number of customers, and it may become difficult to sustain their business," Daudt said Thursday. "It may be helpful to our manufactures and ultimately to our jobs and economy here in Minnesota. I think it could be a mutually beneficial thing."

You have to wonder what Upmeyer was thinking when she rejected the Senate's broader medical cannabis bill. If you were concerned that Iowa may not be able to secure a manufacturer, why would you change the bill to exclude thousands of potential patients and all but one form of cannabis?

24. Expanding the new law will be more difficult than many advocates believe.

Some readers disagreed with my take on House File 524. Though they acknowledge the bill's flaws, they believe it establishes a critically important framework for growing and dispensing cannabis in Iowa. As public support for medical marijuana grows, and patients continue to plead their case, they believe state lawmakers will inevitably add to the list of qualifying medical conditions and allow the use of a wider range of cannabis derivatives.

They point to section 8 of the law, which creates a Medical Cannabidiol Advisory Board. That board will be able to make recommendations, such as including new medical conditions, which the Department of Public Health could implement through administrative rule-making. However, the board cannot recommend legalizing other forms of cannabis, and if it recommends permitting the use of CBD oil with higher THC levels, administrative rules will not suffice. The law reserves for the legislature "the sole authority to revise the definition of medical cannabidiol" in Iowa.

In addition, the board will include "eight practitioners representing the fields of neurology, pain management, gastroenterology, oncology, psychiatry, pediatrics, family medicine, and pharmacy, and one representative from law enforcement"--but zero patients and zero representatives of advocacy groups for Iowans with conditions that could be treated with cannabis.

In his signing statement on House File 524, Branstad urged legislators to amend the law during the 2018 session. He does not want to expand its scope, though. He wants to tighten up language on background checks and disqualifying felony offenses for people involved in growing or dispensing CBD oil.

Surely many committed Iowans will continue to lobby for a bill at least as broad as what the Senate approved this year. Unfortunately, they won't have the same kind of leverage in 2018, because the new law has no sunset provision. The previous medical cannabis law was due to expire on July 1, putting pressure on GOP leaders to do something before adjournment or leave patients with seizure conditions hanging.

Nothing gets through the state House without Upmeyer's blessing, and she is not inclined to make cannabis more widely available to Iowans. I can't imagine what would compel her to allow further progress when she and other House Republicans now have a perfect excuse: the new law hasn't been fully implemented yet, let's give it time to work.

Any relevant comments are welcome in this thread, especially if you can make a convincing case that this law will not be as useless as I anticipate.

UPDATE: The Des Moines Register's editorial board weighed in on the deal between Iowa and Minnesota legislative leaders.

In theory, Iowa will give Minnesota the customers it needs, and Minnesota will give Iowa the product it needs. [...]

Of course, this partnership will do nothing to address the shortcomings in the laws of either state. It also will force ailing Iowans to travel out-of-state for medical assistance, and will squander an obvious economic development opportunity in Iowa.

Then there’s the federal government. Several of the 29 states that have legalized medical marijuana allow purchases by out-of-state patients, but Iowa’s law takes things a step further because it fully anticipates the state’s own residents traveling across the border to buy their medication elsewhere. [...]

Even if the feds agree not to interfere with the Iowa-Minnesota arrangement, Iowa will still be saddled with a poorly crafted law that relies on a Minnesota law to minimize some of its deficiencies.

  • It is what it is

    Regardless of whether HF 524 makes it easier or more difficult to move forward, it's a little late now. I asked the governor to send this bill back to the legislature and Threase Harms explained in detail all the problems with it in her request for a line item veto. My comments are in my blog post from April 30, 2017, and my legislator sent me Threase Harms' comments which were apparently sent to the governor and all of the legislators.

    Medical Cannabis and the 2017 Iowa Legislative Session


    Let's keep working on this. We don't have any other options.

  • One thing that will continue to happen

    There will be, for medical and non-medical reasons, continued trips by some Iowans to Colorado to bring back marijuana products, whether the Iowa Legislature likes it or not. In February, it was reported that marijuana tax revenues in Colorado in 2016 reached $200 million.

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