Most of us were caught off-guard by the rush of states this year that approved the limited use of CBD-only marijuana extracts because these traditionally conservative states had heretofore rejected the medical use of marijuana. So it seems worth a moment to consider how this occurred, and what it means on a grander scale.
But first, a little recent history.
Throughout this year’s state legislative season, a total of 10 states enacted laws seeking to provide limited access to medical marijuana products that contain high levels of CBD and virtually no THC for qualified, typically pediatric patients suffering from severe and disabling seizures: Alabama, Florida, Iowa, Kentucky, Mississippi, Missouri, South Carolina, Tennessee, Utah and Wisconsin.
On one level, this unexpected embrace of the medicinal qualities of marijuana by states that previously rejected the concept must be seen as a favorable development. These serendipitous adoptions reflect a degree of compassion not obvious in the previous legislative debates in those states.
But it is far from certain that these laws will actually help the young patients they are intended to help.
First, such products are primarily only available in a handful of states like California and Colorado and none of these new state laws create a viable in-state supply source for such products. Further, even if a patient from out-of-state could find these products in California or Colorado, it would be a violation of federal law (and also likely state law) to take the medicine back to their home state.
And while some of these laws attempt to establish CBD research projects at their major universities or research hospitals, recent experience demonstrates that few universities or research hospitals are willing to enter this confusing field while marijuana remains a federal crime, and those that may be willing to take the bait will face a steep and long learning curve before the first patient will have high-CBD extracts available.
This legislative rush to CBD-only extracts also suggests (1) the degree to which elected officials are influenced by popular media, (2) their willingness to pick and choose the science they like (while ignoring the science they do not), and (3) the strong puritanical impulse that remains a factor with many elected officials.
And it all relates to the “Gupta Effect”. When CNN’s Dr. Sanjay Gupta’s report highlighting how high-CBD marijuana products control debilitating seizures among children suffering from Dravet’s syndrome (the most severe form of childhood epilepsy) went public, few Americans had even heard of cannabidiol. Most people were familiar with THC (tetrahydrocannabinol), the primary psychoactive ingredient in marijuana that principally accounts for the “high” that marijuana smokers enjoy, but had zero idea that CBD even existed.
Dr. Gupta, who had previously uncritically accepted the federal government’s consistent claim that marijuana had no legitimate medical use, when confronted with actual children whose lives had been transformed following their use of high-CBD marijuana extracts, understandably felt misled by the government’s anti-marijuana propaganda, and went public with two special programs introducing the importance of high-CBD extracts in reducing or eliminating seizures in these children.
In the second program Dr. Gupta made it clear that while CBD appeared to be the primary therapeutic ingredient for this class of patients, he also made the point that some level of THC was also required, because of what he termed the “entourage effect.” Without the THC, the CBD would either be less effective, or in some instances ineffective.
It’s embarrassing that so many of our elected officials would get their scientific understanding of the medical properties of marijuana from a popular television doctor, instead of conducting their own research into the available science, before moving legislation forward. But better they be motivated by a celebrity doctor than continue to ignore the benefits of medical marijuana altogether.
Of which there are a myriad.
The marijuana plant is one of the most studied biologically active substances of modern times. A search on PubMed, the repository for all peer-reviewed scientific papers, using the term “marijuana” yields nearly 20,000 scientific papers referencing the plant and/or its constituents, nearly half of which have been published just within the past decade. In addition, more than 100 controlled trials, involving thousands of subjects, have evaluated the safety and efficacy of cannabis and/or individual cannabinoids.
Most recently, a review of FDA-approved marijuana plant trials conducted by various California universities concluded, “Based on evidence currently available the Schedule I classification (for cannabis) is not tenable; it is not accurate that cannabis has no medical value, or that information on safety is lacking.” The best summary of this research can be found in the publication Emerging Clinical Applications for Cannabis and Cannabinoids, available on the NORML website. So the basic research is available for all who care to learn.
But few elected officials appear to be aware of this considerable body of science. Rather, the common refrain is to claim they cannot support the medical use of marijuana because the only evidence is “anecdotal”. These officials prefer to remain ignorant because it reinforces their preconceived notion that medical marijuana is a hoax perpetuated by those who simply wish to get “high”.
So what this latest rush to approve CBD-only marijuana products demonstrates, more than anything else, is the degree to which our public policy can frequently be influenced by a strong strain of puritanism that remains alive among our elected officials. If it feels good, it must be bad!
These many state legislators were willing to show some compassion by allowing the medical use of marijuana by these poor children suffering from multiple, disabling seizures, so long as the marijuana did not make them feel “high” (i.e., feel better!). These legislators are against pleasure, and if the use medical marijuana includes the feeling of pleasure, then it cannot be approved.
Excuse me, but is that not the purpose of using medicine when one is ill – to feel better?
Admittedly, for some of these puritans, the association of the word “high” with the use of marijuana may lie at the heart of the problem for them. Marijuana has long been demonized by conservatives, law enforcement, and many in the medical community, and that has spilled-over to the marijuana “high”.
If they understood that the marijuana “high” makes the user feel better, and that seriously ill patients almost always want (and need) to feel better, perhaps they could overcome their fear of medical marijuana. But for now at least, it is clear that in their view the marijuana “high”, like marijuana itself, is something to be avoided by responsible Americans, even if that precludes the use of medical marijuana by seriously ill patients.
It is time we moved beyond the notion that pleasure is bad, and stopped treating the marijuana “high” as something to be avoided, when it makes patient feel better. For them, feeling better and feeling high is often the same.