Reforming cannabis policy on a state and federal level in the USA

Reforming cannabis policy on a state and federal level in the USA
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The US-based Marijuana Policy Project aims to ease the burden on patients by campaigning for effective, workable policy reform.

The Marijuana Policy Project (MPP), founded in 1995, is the USA’s leading organisation focused solely on cannabis policy reform; with accomplishments including spearheading most of the major state level cannabis policy reforms enacted in the past 15 years.

MPP played the leading role in eight of the 11 adult use legalisation laws, starting with drafting, funding and staffing the historic 2012 Amendment 64 initiative in Colorado — which made the state the first place in history to legalise cannabis for adults and regulate it like alcohol.

MPP also led the coalitions which passed initiatives to legalise and regulate cannabis in Alaska, Maine, Massachusetts, Michigan and Nevada in 2014, 2016 and 2018. In terms of state legislation, MPP successfully spearheaded the advocacy campaign which led to Vermont becoming the first state to legalise cannabis for adults legislatively in early 2018. MPP also played a crucial role in crafting and lobbying for Illinois’ legalisation and regulation measure, which was signed into law on 25 June 2019.

Part of MPP’s mission is to change federal law to allow states to determine their own cannabis policies without federal interference. MPP believes that the best way to accomplish this is through changing state policy, which in turn applies pressure at the federal level through achieving a majority of federal lawmakers who represent legal states.

MPP is also actively lobbying on Capitol Hill, pushing for reform measures such as the SAFE Banking Act, which would allow for cannabis businesses to access financial services; the STATES Act, which would protect states’ rights to enact their own cannabis policies without federal interference; and the MORE Act, which would remove cannabis from the Controlled Substances Act and includes social equity and expungement provisions.

MPP is determined to pass policies which allow for the medical use of cannabis in all 50 states and the US territories. Initially, MPP focused almost entirely on medical cannabis laws; and along with MPP-backed campaign committees, played a leading role in efforts to successfully pass thirteen recent state medical cannabis laws in Arizona, Delaware, Illinois, Maryland, Michigan, Minnesota, Montana, New Hampshire, Ohio, Pennsylvania, Rhode Island, Utah and Vermont.

Medical cannabis laws

Currently, 33 states and Washington, DC have workable medical cannabis laws on the books. MPP defines a ‘workable medical cannabis law’ as one which allows qualifying patients to possess and use cannabis without breaking the law; provides realistic means for patients to access cannabis in-state without relying on federal cooperation; and allows patients to use a variety of strains or extracts of cannabis, including strains with both higher and lower amounts of THC.

Sixteen additional states have laws on the books which acknowledge the medical value of cannabis but fall short of being defined as ‘workable.’ Generally, these laws only include strains of cannabis that include very little or no THC; and often fail to provide an in-state way to access those medical cannabis preparations. In total, 49 states acknowledge the medical benefits of cannabis. Idaho is the only state in the USA with no laws acknowledging the benefits of cannabis or cannabinoids.

Not all medical cannabis laws are created equally, including the laws which MPP defines as ‘workable.’ There are states which have effective and comprehensive policies in place, while other states’ policies are in need of improvement. The discrepancies between state-level policies play a direct role in patients’ ability to access medical cannabis, sometimes making it substantially more difficult. It is important to recognise what provisions are necessary to best address patients’ needs and mitigate their burdens.

Home cultivation provisions are one way in which state-level medical cannabis policies differ. In some states such as Washington and California, patients are permitted to grow their own cannabis for medical purposes. Allowing home cultivation benefits patients who are unable to leave their home due to their conditions. Patients may also struggle with paying for cannabis products from licensed dispensaries considering the fact that, unlike other prescribed medications, insurance does not cover these costs. Allowing for home cultivation helps reduce this financial burden.

Conditions which enable patients to qualify for medical cannabis programmes vary from state to state. Qualifying conditions range from multiple sclerosis to PTSD, with chronic pain being the most common qualifying condition across the United States. In lieu of an official list of approved qualifying conditions, some states, including Oklahoma and Maine, permit a patient’s physician to recommend medical cannabis for any medical condition if they have reasonable cause to believe that it will be beneficial. In states with a limited number of qualifying conditions, patients who may benefit from the use of medical cannabis can be left out, making their access to legal medical cannabis impossible.

Encouragingly, the number of states which include opioid use disorder or opioid replacement as a qualifying condition, either explicitly or within the bounds of significant medical conditions, continues to grow. Illinois’ medical cannabis policy goes as far as permitting patients to trade in their opioid prescriptions for a medical cannabis card on the same day. Allowing medical cannabis as an alternative to opioids is significant considering that on average, over 100 Americans die each day as a result of opioid overdoses. On average, states with medical cannabis laws in place see 25% fewer opioid mortalities than states without them.

The vast majority of medical cannabis laws allow patients to administer medical cannabis through whatever method works for them — be it whole plant cannabis, ointments, tinctures, oils, or edibles. Allowing patients an array of options ensures that they are able to access the modes of administration that will suit their conditions most effectively.

Unfortunately, not all states have adopted this comprehensive approach. In North Dakota, edibles and concentrates are not permitted; while in Pennsylvania smoking is prohibited along with whole plant cannabis. Medical cannabis laws which prohibit certain modes of administration, such as the ones mentioned, have the potential to limit patients’ ability to access what will work best for them. Prohibiting whole plant cannabis is especially problematic, considering the dozens of studies which have demonstrated the medical benefits of whole plant cannabis in its natural form. There is no good reason to deny an incredibly sick individual access to a product which has been extensively studied and proven to alleviate a variety of medical conditions.

Medical cannabis policies can also differ in terms of possession limits, caregiver provisions, recognition of out-of-state licences, taxation and licensing limits. These differences, as well as the those highlighted above, play a direct role in patients’ ability to access medical cannabis. Limiting licences can create obstacles by resulting in qualifying patients having to travel for hours in order to access medical cannabis, which for some is an unrealistic option. Placing excessive taxes on medical cannabis adds to the financial burden patients too often face; and in turn can prevent them from accessing medical cannabis.

As states continue to pass effective and workable medical cannabis policies, it will be crucial for policymakers to examine what is working in the states which have previously passed similar legislation. Likewise, legal states should acknowledge the burdens associated with patients’ access to medical cannabis and implement policy changes to address them.

Looking to 2020, MPP is focused on working with patient advocates to advance medical cannabis-related bills in several states, including Kentucky and South Carolina, along with a 2020 medical cannabis initiative in Nebraska.

Violet Cavendish
Marijuana Policy Project
+1 202 462 5747
Tweet @MarijuanaPolicy

Please note, this article appeared in issue 11 of Health Europa Quarterly, which is available to read now.

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