On May 17, 2021, Alabama Gov. Kay Ivey signed medical marijuana legislation into law, making the Heart of Dixie the 37th state to adopt a medical cannabis program. But while the Alabama Medical Cannabis Commission (AMCC) is up and running, it’s estimated that medical marijuana won’t be available to Alabama patients until 2023.
There are several reasons for the long timeline, including:
- The AMCC must draft regulations and create a database to track patients.
- Alabama’s various medical associations must develop education and certification guidelines for physicians who want to prescribe medical marijuana.
- The AMCC won’t begin accepting applications to grow and distribute medical cannabis until Sept. 1, 2022.
- It takes time to review and approve applications and for growers and distributors to set up operations.
That extended timeline doesn’t bother Peter Lane, MD, medical director of the UAB Medicine Addiction Recovery Program.
“I’ve thought a lot about it, and I’m not a fan of medical marijuana,” he says. “But I appreciate that the law doesn’t allow for smokable cannabis.”
Indeed, Alabama’s new law approves tablets, capsules, tinctures, patches, and suppositories, but it prohibits any raw plant material, so called “edibles”, and products that can be smoked or vaped.
In states that have legalized smokable medical marijuana, the amount of THC – the substance that produces the cannabis high – isn’t controlled, Dr. Lane says.
“The patient goes to a medical marijuana dispensary, where a non-medical person selects the product,” he says. “It makes more sense that a patient must see a physician, obtain a prescription, and then receive a medication made by a pharmaceutical company.”
Eligibility for Medical Marijuana
Under Alabama’s new law, the use of medical marijuana is restricted to patients with certain diseases and medical conditions, such as:
- Certain cancer side effects, such as wasting syndrome, nausea, weight loss, and chronic pain
- Crohn’s disease
- Epilepsy or other conditions that cause seizures
- Nausea or weight loss related to HIV/AIDS
- Panic disorder
- Parkinson’s disease
- Nausea that doesn’t respond to typical treatments
- Post-traumatic stress disorder
- Sickle cell anemia
- Muscle tightness from motor nerve diseases like ALS or multiple sclerosis
- Terminal illness
- Tourette’s syndrome
- Chronic pain that doesn’t respond to other treatments
According to Dr. Lane, dronabinol – a manufactured form of THC – already is used to treat nausea from cancer chemotherapy and to stimulate the appetites of some HIV patients. His standard for using cannabis to treat medical conditions is no different than his standard for any other drug: Do the research first.
“If I have a new medicine to treat cancer, I have to go through a rigorous Food & Drug Administration protocol to get my drug approved,” Dr. Lane says. “Nobody had to do that with cannabis.”
Medical marijuana research has been scarce in part because the federal government lists cannabis as a Schedule I drug, defining it as having no accepted medical use and a high potential for abuse. According to the U.S. Drug Enforcement Administration (DEA), historically there has been only one approved supplier of marijuana for research purposes, and research could be conducted only by the National Institute on Drug Abuse. But that is changing. In May 2021, the DEA announced that it had drafted agreements with other manufacturers to supply a broader range of researchers across the United States.
Marijuana and Addiction
Bronwyn McInturff, LICSW, manager of the UAB Medicine Addiction Recovery Program, agrees with Dr. Lane’s perspective about separating smokable marijuana from medicinal cannabis.
“We see people who are experiencing negative consequences from smoking marijuana,” McInturff says. “In our patients who have a vulnerability to psychosis, it can start a psychotic break.”
McInturff says recreational marijuana usage can have a range of negative impacts, such as impairing long- and short-term memory.
“As with any addiction, we also see the compulsive side of marijuana use,” she says, adding that patients seeking medical cannabis should be aware that marijuana, like many other drugs, has addictive potential. “We had one patient who had to refrain from smoking marijuana while being monitored by the legal system, and she couldn’t do it.”
Dr. Lane also has concerns about the concentration of THC in today’s smokable cannabis.
“In the 1960s or 1970s, marijuana contained about 3-4% THC, which is a potent psychoactive chemical,” he says. “Data from 10 years ago found that the amount of THC was 13.8%, and a Canadian study found that the cannabis tested was over 20% THC.”
The rise in THC concentration makes Dr. Lane doubly glad that Alabama had the wisdom to prohibit smokable medical marijuana.
“Smokable marijuana doesn’t have any place in treating anything,” Dr. Lane says, adding that he’s a strong advocate for more research into cannabis pharmaceuticals. “There are 77 different cannabinoids from marijuana that we know nothing about. And cannabidiol – the non-psychoactive part of marijuana – may be effective in treating conditions like pediatric seizures. We just need to do the research before calling marijuana ‘medicinal.’”