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The Medical Marijuana Issue

A primer on the terminology and current legality of medical marijuana.

The Terminology

The chemical complexity of cannabis has been difficult to track. Cannabis is the genus name for a disputed number of plant species. Hemp and marijuana are two different species of the Cannabis genus of plants. The two species differ not only in appearance but also in levels of tetrahydrocannabinol (THC) and cannabidiol (CBD).1 Hemp, which is primarily used for industrial purposes (eg, fiber products), is considered to be the Cannabis sativa species, while marijuana is used for medicinal and recreational purposes and considered to be the Cannabis indica species. Medicinal cannabis comes in herbal (marijuana), tincture, oil, and edible forms. It can be smoked, vaporized, ingested in edible or other oral forms, taken sublingually, or applied topically.

To date, 568 unique molecules have been identified in cannabis.2 Of these, more than 60 are considered to be cannabinoids – that is, compounds that act on receptors in the body’s endocannabinoid system, a system which plays a key role in endogenous pain control. Two specific cannabinoids are found in cannabis that are thought to exhibit the synergistic effects that often promote pain relief:3,4

  • THC – the most psychoactive cannabinoid found in cannabis, THC is primarily responsible for the “high” associated with marijuana and may reduce nausea while also increasing appetite.
  • CBD – does not provide the euphoria associated with THC but has been associated more with reducing pain and inflammation.

The form/route of administration may also play a role in the pain effects of cannabis. Commercial cannabis strains fall into three broad chemotypes (ie, chemically distinct plants that otherwise appear indistinguishable) that are defined by their THC:CBD ratio:5

  • C. sativa, associated with higher levels of THC
  • C. indica, associated with higher levels of CBD
  • C. ruderalis,6 a very low THC variant that is rarely grown by itself and often used in “hybrids.”

Dispensaries are stores, much like pharmacies, that are designed to give patients a secure location to procure information, ask questions, and ultimately obtain medical cannabis. Many dispensaries require a doctor’s recommendation, medical cannabis certification, and/or proper documentation, which varies from state to state (see below). Some also distribute recreational marijuana products, depending on the state.

While at the dispensary, patients are advised by a budtender, a dispensary worker who, much like a pharmacist, is knowledgeable about different cannabis strains, what they do, and how they interact with the body. The role of a budtender is to make recommendations on the ideal strain to purchase and in what quantity. He or she is usually certified but not medically trained, understands the practical aspects of compliance, and is primed on different methods of ingestion.

A primer on the terminology and current legality of medical marijuana. (Source: 123RF)

The Legality

As of April 2019, medical cannabis was legal in 34 states. At the federal level, however, marijuana has been classified as a Schedule I substance under the “Controlled Substances Act” since 1970 and there are no recognized medical indications.

Many states that have legalized medical cannabis require patient registry or identification cards for the purchase and use of the substance for specific diagnosed conditions. Testing of sold substances varies by state and may be limited to contamination tests or may include quantification of CBD and THC levels. These protocols continue to evolve.

The following 34 states have passed legislation for a “comprehensive medical marijuana program,” according to the National Conference of State Legislatures, which also includes the District of Columbia, Guam, Puerto Rico and the US Virgin Islands: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington, and West Virginia.

To date, 12 states have enacted legislation allowing for limited use of medical marijuana (low CBD:THC ratio programs): Alabama, Georgia, Indiana, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, Wisconsin, and Wyoming. Minnesota added chronic pain and age-related macular degeneration to its list of qualifying conditions for medical cannabis - to take effect in August 2020.

In addition, the District of Columbia and these states allow for adult recreational marijuana use: Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington.

Last updated on: December 3, 2019
Continue Reading:
Talking to Patients about Medical Cannabis
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