What's wrong with medical marijuana?

Carl Olsen is the founder of Iowans for Medical Marijuana.

Therapeutic use of marijuana stretches back centuries, but the popularity of its modern use appears to have begun with the discovery of the THC molecule. Tetrahydrocannabinol (THC) is the principal psychoactive constituent of cannabis and one of at least 113 total cannabinoids identified on the plant. THC was first discovered and isolated by Bulgarian-born chemist Raphael Mechoulam in Israel in 1964. 

On May 13, 1986, the Drug Enforcement Administration (DEA) transferred the synthetic form of THC from schedule I to schedule II of the Controlled Substances Act (CSA). On July 1, 1999, the DEA transferred this synthetic form of THC from schedule II to schedule III of the CSA.  Federal Register: Vol. 64, No. 127, Friday, July 2, 1999.

States began legalizing the use of marijuana for therapeutic purposes in 1996. This initial approach had very little state regulation and mostly authorized personal cultivation of the plant. The more recent trend of licensing large scale manufacturing and distribution is based on a 2013 memo from the U.S. Department of Justice suggesting the federal government would prefer and tolerate large scale operations if these operations were carefully controlled by state regulations.

Iowans for Medical Marijuana

On February 17, 2010, after considering a request from Iowans for Medical Marijuana, the Iowa Board of Pharmacy recommended the Iowa legislature transfer marijuana from schedule I to schedule II of the Iowa Uniform Controlled Substances Act and create a study committee to consider a program for medical use of marijuana in Iowa.  Democrat Majority Leader in the Iowa House, Kevin McCarthy, shot down the idea saying the board already had the authority to create a medical marijuana program in Iowa.  Medical marijuana backer plans to petition Board of Pharmacy, Radio Iowa, June 15, 2010.

Cannabidiol for Seizure Disorders

While there are records on the use of marijuana in the treatment of seizure disorders going back centuries, the use of cannabidiol (CBD) for treating seizure disorders was widely reported in 2013 in three CNN specials (“Weed”).  Dr. Sanjay Gupta on medical marijuana: We are in an age of wisdom, but also an age of foolishness.

On March 17, 2014, the Des Moines Register reported that an Iowa poll by Selzer & Co showed 81 percent support for medical marijuana. Respondents were asked whether they would support “allowing adults in Iowa to legally use marijuana for medical purposes if their doctor prescribes it.” One would have to assume that voters understood that to mean the whole marijuana plant, as was typically used in states that had already accepted it for medical use.

While medical marijuana laws have existed since 1996, beginning around 2014 (and, coincidentally, following the three CNN documentaries on “Weed”), “14 states passed laws allowing the use of cannabidiol (CBD) extract, usually in oil form, with minimal or no tetrahydrocannabinol (THC), and often for the treatment of epilepsy or seizures in seriously ill children.  CBD, one of the 400+ ingredients found in marijuana, is not psychoactive.”  States with Legal Cannabidiol (CBD), Britannica, ProCon.org (updated December 3, 2020).

State Medical Marijuana Laws National Conference of State Legislatures (updated February 3, 2022).  Iowa is listed as one of ten states with CBD/Low THC programs.

Iowa Slowly Increases THC in CBD

2014 Iowa Act 1125, Senate File 2360, May 30, 2014 (Medical Cannabidiol Act).  124D.2 Definitions.  As used in this chapter:  1.  “Cannabidiol” means a nonpsychoactive cannabinoid found in the plant Cannabis sativa L. or Cannabis indica or any other preparation thereof that is essentially free from plant material, and has a tetrahydrocannabinol level of no more than three percent.

2017 Iowa Act 162, House File 524, May 12, 2017 (Medical Cannabidiol Act).  124E.2 Definitions.  As used in this chapter:  6.  “Medical cannabidiol” means any pharmaceutical grade cannabinoid found in the plant Cannabis sativa L. or Cannabis indica or any other preparation thereof that has a tetrahydrocannabinol level of no more than three percent and that is delivered in a form recommended by the medical cannabidiol board, approved by the board of medicine, and adopted by the department pursuant to rule.

2020 Iowa Act 1116, House File 2589, July 1, 2020 (Medical Cannabidiol Act).  124E.2 Definitions.  As used in this chapter:  6.  “Medical cannabidiol” means any pharmaceutical grade cannabinoid found in the plant Cannabis sativa L. or Cannabis indica or any other preparation thereof that is delivered in a form recommended by the medical cannabidiol board, approved by the board of medicine, and adopted by the department pursuant to rule.

On March 27, 2021, the Des Moines Register reported: Public opinion polling in Iowa shows 54 percent of Iowans would legalize marijuana and 78 percent for expanding medical use. While that number is not quite as high as it was in 2014 (81 percent) before Iowa created a CBD/Low THC program, it shows the Iowa legisature hasn’t moved the needle very far. Iowans were expecting more.

Listen to the Doctors

The 2017 act created a board of medical experts to oversee the implementation of Iowa’s program.

The board’s 2019 Annual Report to the Iowa General Assembly filed on January 1, 2020, recommended: removing the 3 percent THC limit and replacing it with “4.5 gram THC per 90 days”; removing felony disqualifiers for patients and caregivers; adding mid-level providers to the list of healthcare practitioners; requiring pharmacy-trained staff in dispensaries, allowing physician access to the patient registry, developing language to protect schools, long-term care facilities, and acute care facilities; requiring department research (observational study); a “Total THC” calculation for determination of product potency; removal of the Department of Transportation (DOT) from the registration card process; renaming of the program to reflect the comprehensive nature of the program; and more flexibility in board meeting frequency.

The legislature approved most of these changes in 2020, aside from renaming the program. Specifically, “The Board recommends renaming Chapter 124E to be the ‘Iowa Medical Cannabis Act’ to reflect that products containing THC are also authorized to be sold and manufactured by the law.”

The board’s 2021 Annual Report to the Iowa General Assembly filed on January 1, 2022, recommended: amending the name to “The Medical Cannabis Act”; adding medical cannabidiol dispensaries; removing sales tax from patient purchases at a dispensary; inclusion of PAs and/or ARNPs in the Medical Cannabidiol Board; and veteran eligibility for the reduced application fee option. The board gave additional rationale for changing the name from “cannabidiol” to “cannabis”:

The Board recommends renaming Chapter 124E to be the “Iowa Medical Cannabis Act” to reflect that products containing THC are also authorized to be sold and manufactured by the law, reflect scientific reality via inclusion of all cannabinoids, mitigate confusion with program stakeholders, and improve program education.

The term “medical cannabidiol” was relevant prior to HF2589 and Iowa using a 3 percent THC limit on products.  As Iowa now allows product formulations similar or the same to those allowed in other medical cannabis programs, it is congruent with the rest of the country to update the name. Since the passage of HF2589, the maintenance of the term “medical cannabidiol” has progressively created a knowledge and communication barrier, and caused confusion with law enforcement, DHS investigation personnel, and healthcare stakeholders who are otherwise unaware that high-THC products are legally available in Iowa. This confusion has also been exacerbated by the recently implemented “consumable hemp” program, which provides OTC hemp-derived CBD and cannabinoid products.

For whatever reason, the Iowa legislature is not going to follow the board’s recommendation to rename the program to reflect scientific accuracy for the third year in a row. This is definitely not what 81 percent of Iowa voters wanted in 2014, and what 78 percent of Iowa voters still wanted in 2021. The Iowa legislature needs to do better than this.

The Most Important Improvement

On September 4, 2020, the Iowa Department of Public Health wrote: “The Department has determined that it will move forward with seeking an exception for cannabis as a schedule I substance in Iowa from the DEA, in attempt to minimize conflict between State and Federal Law.”  Program Update, September 4, 2020

On April 23, 2021, the department wrote a letter to the DEA requesting federal funding guarantees for Iowa schools and long-term healthcare facilities. 

On February 8, 2022, the Iowa Senate Judiciary Committee introduced Senate Concurent Resolution 102, asking the DEA to grant an exception to the classification of cannabis under schedule I of the federal Controlled Substances Act in Iowa. It is not clear whether this resolution will advance to the floor of the Iowa Senate or House during this year's session. Federal authorization of our program would resolve a huge host of issues resulting from Iowa’s non-compliance with federal drug laws.

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