State board suggests more restrictive medical cannabis limits

Carl Olsen has been a leading advocate for medical cannabis in Iowa for many years and closely follows legislative happenings related to the issue. -promoted by Laura Belin

In a highly unusual move, the Iowa Department of Public Health (IDPH) announced on the afternoon of April 12 that the Medical Cannabidiol Advisory Board had rescheduled its planned meeting. Instead of convening for two and a half hours on May 3, the board would meet for one hour on April 16.

Members called the shorter, rushed meeting in order to discuss recommendations on the tetrahydracannabinol or THC cap and purchase limits in a bill the Iowa House approved last month.

House File 732 cleared the lower chamber by 96 votes to 3 on March 26. Four days later, a member of the advisory board resigned in protest, claiming state lawmakers had misrepresented the board’s input and approved a “dangerously high” allowable dosage for some patients. (Bleeding Heartland discussed that House debate here.)

When the Iowa Senate Judiciary Committee considered this bill on April 4, senators recommended an amendment to keep the current THC cap of 3 percent. At that point, the advisory board decided to weigh in on the matter, according to sources at the IDPH.

HF 732 contains some of the recommendations the advisory board suggested on January 1: removing felony disqualifiers, adding physician assistants and nurse practitioners, employment of pharmacy professionals, and collection of data. However, the House bill also lifted the 3 percent cap on THC. The board had recommended keeping the 3 percent cap in place.

At its April 16 meeting (audio available here), the board generally agreed with lifting the 3 percent cap, but did not concur with the House bill’s new proposed dosage limit of 25 grams of THC per 90 days. In a letter to Governor Kim Reynolds and state lawmakers, the board suggested changing the THC limit to 4.5 grams per 90 days (50 mg per day).

During the board discussion, Dr. Robert Shreck mentioned that the original House Study Bill 244 created a THC cap of 20 grams per 90 days, but would have allowed the department to reduce that cap. During floor debate, House members amended the bill to increase the allowable 90-day dosage from 20 grams to 25 grams, and removed language permitting the department to lower that amount.

The board relied on literature from the governor’s Office of Drug Control Policy and the Minnesota Department of Health showing Minnesota dosages ranging up to 80 mg of THC per day on the high end.  The board decided 50 mg of THC per day was reasonable, reasoning that higher doses on some days could be offset by lower doses on other days.

In contrast, MedPharm Iowa presented a summary of the same data showing an average of 70 mg of THC per day and a high end of 850 mg of THC per day.

Shreck cited his experience as an oncologist with Marinol, a synthetic THC product.  He said each Marinol tablet contains 10 mg of THC and that prescibing more than four of those per day would be so unsual he would have the Board of Medicine and the Board of Pharmacy knocking on his door the next day.  He said 10mg of THC per day was enough to cause psychoactivity in some of his patients.

Shreck also alluded to studies from the MedPharm website showing averages of 30 mg of THC per day, but I’m unable to find them (I’ve asked MedPharm if they can help me with this). In addition, he cited studies involving Sativex, an inhaled product with 1:1 THC to CBD ratio currently under FDA clinical investigation, showing an average of five to eight sprays per day–which Shreck said is not even 30 mg of THC per day.

Dr. Lonny Miller, a family medicine practitioner, reasoned that going higher than 50 mg per day would discourage more doctors from certifying patients’ diagnosis–a necessary step for Iowans wishing to participate in the state’s medical cannabis program. In Miller’s opinion, a higher allowable dosage would be viewed as authorizing abuse.

Then things began to get really strange.  Miller said the Iowa program was intended to be CBD only.  The advisory board began to discuss topics that were not on the meeting agenda. No one in attendance was prepared to adequately address those items. Furthermore, the board usually allows public comments, but not at its April 16 meeting.

Miller suggested recommending a maximum THC to CBD ratio of 1:1.  Shreck responded that MedPharm produces and distributes a 20:1 THC to CBD product.  MedPharm could not manufacture that product if the board hadn’t approved it.  After Shreck said it would be disruptive to change that limit, Miller withdrew his suggestion.

Miller then proposed that patients under age 18 be limited to 20:1 CBD to THC ratio products and no more than 10 mg of CBD per kg of body weight per day.  He cited pages 78-79 of the Minnesota Department of Health report, showing 10 mg of CBD per kg per day and 20:1 CBD to THC ratio being used in a study on pediatric autism.  Miller offered this idea as a motion, which passed without objection.  No one spoke up for the children who now receive higher THC ratio products.

My sources at the IDPH tell me the legislature did not request further advice from the advisory board.  The board had already submitted its advice on January 1.

State law permits this board to meet only four times per year, so members cancelled a quarterly meeting in May to hold this irregular meeting.  While I’m extemely displeased by what took place, I would say the House leadershp didn’t give this matter enough time and thought. Instead, the House bill got rammed through in a hurry, two days before the legislature’s “funnel” deadline. The obvious intent was to kill Senate File 501, which was moving through the upper chamber. HF 732 appeared on the same day the Senate Judiciary Committee had passed SF 501.

The Senate bill went beyond the advisory board’s suggestions but kept the 3 percent cap on THC.  The House version mostly stuck within parameters recommended by the advisory board, other than lifting the 3 percent cap on THC.

The advisory board’s intervention last week was another link in the chain of last-minute moves that hadn’t been thoroughly considered.

All of this follows a now too familiar pattern of abuse and neglect of suffering Iowans.  The Medical Cannabidiol Act, Iowa Code Chapter 124E, was introduced on a Saturday morning at 3:00 a.m., voted out of the House that same morning at 5:00 a.m., and out of the Senate that same morning at 6:00 a.m., on the last day of the legislature’s 2017 session.  The common thread here is lack of proper vetting and lack of preparation.

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