Healthcare to Improve for Cannabis Patients – part 2
In 2014 Congressmen Dana Rohrabacher (R-CA) and Sam Farr (D-CA) offered an amendment to a spending bill prohibiting the Justice Department from spending any money in 2015 to prevent states “from implementing their own State laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” Congress passed the amendment as part of the final omnibus spending bill signed by President Obama. Under the provision, medical cannabis states would no longer need to worry about federal drug agents raiding dispensaries. The Obama administration has largely left state programs alone, but the measure approved as part of the spending bill will codify it as a matter of law. Additionally, Senators Rand Paul (R-KY), Cory Booker (D-NJ), Kirsten Gillibrand (D-NY) and Dean Heller (R-NV) introduced bipartisan legislation to legalize cannabis for medical use. The Compassionate Access, Research Expansion and Respect States – CARERS – Act is the first-ever bill in the U.S. Senate to legalize cannabis for medical use and the most comprehensive medical cannabis bill ever introduced in Congress. Rep. Steve Cohen (D-TN) and Rep. Don Young (R-AK) introduced a House version of the bill last week.
There are a total of 39 states and the District of Columbia with some form of medical cannabis program (MCP); 16 are CBD only. The full-fledged programs fall into two groups corresponding to the first and second decades of medical cannabis. 10 were established between 1996-2005 and 14 between 2006-2015. The programs established during the first decade are summarized below:
Medical Cannabis Market Development: 1996-2005
MCPs established in the first decade have grown and stabilized at 15-20 cannabis patients per 1,000 residents. Today’s largest MCPs were established in the first decade, and there is a strong relationship between program age and development. However, first-decade MCPs did not develop strong therapeutic infrastructures similar to those that exist for FDA-approved pharmaceuticals. Physicians are allowed to recommend cannabis as treatment for approved conditions, but they are not allowed to prescribe specific strains, methods of consumption, or treatment regimens.
In California – where both patient registration and physician reporting of cannabis recommendations are voluntary, and the list of qualifying conditions is comprehensive – the medical and recreational cannabis markets developed side-by-side, casting doubt on the legitimacy of the former. Washington’s MCP required physician reporting but allowed voluntary patient registration, and did not explicitly authorize dispensaries (like California). Oregon and Colorado have mandatory registration and physician reporting, and explicit dispensary regulations. None of the four largest first-decade MCPs has developed disease-specific treatment protocols, medical school courses and CME curricula, and a longitudinal data set of cannabis patients, their medical conditions, and use of cannabis to treat their conditions.
It is important to note that the four largest first decade MCPs have either legislatively (Oregon, Washington and Colorado) or unintentionally (California) established recreational marijuana markets. Each of the four states is considering or has passed legislation to more sharply distinguish the medical and recreational markets, but none is focused on creating a legitimate therapeutic infrastructure, the core of which should be patient and physician education.