Ohio is now one of 26 states to legalize medical marijuana, and a committee appointed by the governor will begin drafting implementation rules this month. Members say one priority is to ensure the state protects the community and the patients who will ultimately use the marijuana products.
“We don't want this to turn in to another Big Tobacco, and we don't want this to be a 'green rush,' where people are looking to make money,” says Tony Coder, who sits on the committee and is assistant director of Ohio's Drug Free Action Alliance, a prevention agency. “We have to remember this is medical marijuana.”
While industry advocates warn of the downhill slide toward legalizing harder-to-regulate recreational marijuana, Coder says there is evidence in the literature that medicinal properties in the cannabis plant are helpful in treating seizures and cancer pain, for example, so the medical community might consider giving marijuana a second look. He believes useful medicine should be available when it's supported by evidence. (Ohio voters already have rejected broader legalization of marijuana for recreational use at the ballot box.)
In fact, a pharmaceutical company in the United Kingdom has created two cannabinoid drugs: Sativex (nabiximols), which is available by prescription for multiple sclerosis patients in 11 countries; and Epidiolex (cannabidiol), an investigational medicine that now has an Orphan Drug Designation from the U.S. Food and Drug Administration.
“There is some evidence, but there needs to be so much more research to get it where it needs to be,” says Marcie Seidel, executive director of the alliance, who is also on the Ohio committee. “It needs to be done through the proper systems and not through legal action or ballot initiatives. But having said that, medical marijuana is now legal in Ohio, so we need to make sure the patient is protected.”
Rules to protect
Seidel says there are three priorities the alliance will emphasize:
Plants used to create the medical marijuana products will need to be free of pesticides;
Plants must also be free of mold and mildew, which can be common because of the amount of water required to grow the plant; and
Products must balance concentrations of the THC and cannabinoid components for safety.
Coder says the THC is the key issue when examining harmful properties of marijuana products. In Colorado, some of the recreational edible products that are legally sold under the state's recreational marijuana law might contain as much as 14% THC, which is quite strong. Addiction is a potential issue, as is psychosis, according to a number of studies in Lancet, he says.
“We are prevention specialists of substance use disorders, and we need to look at medical marijuana to make sure it stays in the hands of the patient,” says Seidel. “What the patient is deemed by a physician to use, must not leave their hands and get out to the general public. Other states have seen that.”
She says some other states have profiled patients with medical marijuana access cards and found them to be 32-year-olds without a history of indicated chronic diseases who also have some substance misuse history.
“It's the most abused public policy in the United States from my perspective,” Seidel says. “That's why we need rules to protect the intent of the law.”
Other rules will include definitions on who can grow and dispense the products; prescriber training; mandatory checking of the prescription drug database; and registration for patients and caregivers. Seidel says other state models will help inform Ohio. She is especially concerned that the medical dispensaries must not look like “party stores.”
“For the patients who are prescribed medical marijuana, it shouldn't look like they've been trick-or-treating,” she says. “Those products must be securely packaged and identified as medicine—not candy or sweets.”
In Ohio, a maximum 90-day supply of medicinal product in the form of oils, tinctures, plant material, edibles and patches is permitted. The law prohibits the use of medical marijuana by smoking or combustion but does allow for vaporization. Additionally, Ohio prohibits any product that is attractive to children.