Recently a lot has come out claiming that the US Government is going to “make marijuana legal”. People are raving that all Americans will have access to medical cannabis and our opiate addictions will be solved. While there is no confirmed decision on cannabis (the government only said they would make an announcement about medical marijuana), there are some pieces of the puzzle that are in place that suggest something may be coming. However, it doesn’t look like the US will be any closer to a compassionate medical marijuana program any time soon.
In the last 8 years, several new things have happened including: GW Pharmaceuticals completing human trials and garnering patents, half the states have some form of medical marijuana law and more are set to join in, multitudes of patient stories have hit the mainstream creating a fervor from patients, CDC recommended that doctors no longer test for THC when dispensing opiates, and a resurgence of the heroin epidemic has hit the US. All of these together indicate that something may be coming from the Feds, but it is still all speculation. If the government does decide to make some decision, it will probably be to move marijuana and cannabinoids to Schedule II (Marinol is Schedule III FYI). There are a couple ways a Schedule II ruling could go. One is that every state’s medical marijuana program remains intact and research begins, but the more realistic version isn’t so pretty. Moving cannabis to Schedule II does have some good points, and we know we cannot expect the government to do the right thing immediately. Change is always baby steps. In Schedule II, a doctor could actually prescribe FDA approved cannabis if they have the DEA registration, similar to how doctors prescribe oxyorphone. Arguably, the best thing about Schedule II is that some forms of research will open up for cannabinoid therapy. Cannabis and cannabinoids are incredibly complex and are excellent multi-performers. Then add in terpenes, and the end result changes again. Everything about cannabis has a shared, symbiotic relationship. There isn’t one function per chemical, which makes studying cannabis tricky. Definitive science is decades away, and the quicker we can start – the better.
If the Feds choose to ignore states rights, or if the states use the Federal piece as an excuse – a Schedule II classification could actually harm medical marijuana as we know it. Schedule II would allow for a doctor to prescribe an FDA approved product to their patients. GW Pharmaceuticals has 2 products (Epidiolex and Sativex) that are in the last staged of the FDA approval process. This would mean the only 2 medical cannabis products that a doctor could prescribe would be these two. No others. A Schedule II ruling does not allow for the current system of medical marijuana, and leaves patients vulnerable to DEA raids and prosecution. You can be prescribed morphine, but it is a felony to be caught with opium poppies. The same would apply here.
Having a product like Epidiolex or Sativex will definitely be a convenient solution for some, but roughly 2/3 won’t get the benefit needed from those 2 products. Epidiolex is specifically CBD which works amazingly in Dravet Syndrome, but doesn’t show the same track record with other seizure disorders. In Colorado, most of the non-Dravet epilepsy patients use some form of full spectrum cannabis. This means that they have to find the ratios of each cannabinoid needed to stop their seizures. There are children in Colorado who use THC as a rescue medicine when having seizure issues, and others needing CBG or CBN (other cannabinoids). Sativex does include THC and CBD, but the terpene variety and other cannabinoids are absent. The Entourage Effect is part of the reason cannabinoids are so difficult to study. Each reaction from cannabis, depends on the chemical make up of both the plant material and your body. Having a strain higher in CBD is going to have a different effect than one higher in THC, as is a plant that has a higher ratio of CBN. All of these plus the terpene make up (terpenes are just as important) will dictate how the cannabinoids work in the body. Without the option for strain variety and to experiment with full spectrum cannabinoids, the pharmaceutical products will fall short of what patients need.
Cost will definitely increase. A Schedule II prescription doesn’t last all year like a cannabis recommendation. According to the DEA’s Office of Diversion Control, “Prescriptions for Schedule II controlled substances cannot be refilled. A new prescription must be issued.”. Every month, you will have to go see a doctor to get the prescription. This new expense has to be added. In addition, the Schedule II ruling will actually increase the value of plant material. With the government admitting medical value yet restricting access to the plant, more and more are going to be seeking black market cannabis. This could cause a resurgence in cannabis trafficking by violent cartels and an uptick in exactly the type of organized crime we are trying to prevent through descheduling.
Most disturbing is the ability of the DEA to start prosecuting patients again. Should the government actually decide to do something about the erroneous scheduling of cannabis, they could choose to ignore states rights and refund the persecution of patients. This would allow them to stamp out home grows (some states allow this, and in my opinion growing is the only sustainable way to treat any illness with cannabinoids), place felony trafficking charges on cancer patients, and would allow government intervention in patient’s lives.
Patients are tired of having to fight like this. For a non-toxic substance (albeit intoxicating), too many lives are lost waiting for access that often comes too late. Do not make the mistake of thinking a Schedule II ruling makes cannabis legal or accessible to the average patient. Be sure you stay up to date on what your local, state, and country governments are doing and how that plays into the existing circumstances in your area. Several states have started to push out their medical dispensaries in favor of the more profitable recreational markets, and those same states have basically banned home grows. Without the ability to experiment with the entirety that is cannabis, many are looking at an unsure future. Stay educated and up to date!