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West Virginia Governor Jim Justice signed a bill that makes his state the 29th to allow medical use of marijuana. West Virginia is the sixth state to legalize medical marijuana in the last year and the third (along with Ohio and Pennsylvania) to do so through the legislature. In the other three states: Arkansas, Florida, and North Dakota, voters approved ballot initiatives authorizing medical marijuana last November.

West Virginia’s new law recognizes marijuana as a treatment for patients with terminal illnesses or any of 14 specified conditions, including cancer, HIV/AIDS, epilepsy, multiple sclerosis, Crohn’s disease, post-traumatic stress disorder, and intractable pain. Patients whose doctors recommend marijuana will be able to obtain it in the form of pills, oils, gels, creams, ointments, tinctures, liquids, and vaporizable extracts from state-regulated dispensaries. The dispensaries will not sell buds for smoking or marijuana edibles, although patients can prepare their own at home. The law does not allow home cultivation, and patients can legally possess no more than a month’s supply at a time.

Matt Simon of the Marijuana Policy Project (MPP) stated, “This legislation is going to benefit countless West Virginia patients and families for years to come. Medical marijuana can be effective in treating a variety of debilitating conditions and symptoms. It is a proven pain reliever, and it is far less toxic and less addictive than a lot of prescription drugs. Providing patients with a safer alternative to opioids could turn out to be a godsend for this state.”

One downside to West Virginia’s law is a new standard for driving under the influence of marijuana that erroneously equates impairment with a blood THC level of three nanograms per milliliter. That’s even lower than the unfair and unscientific five-nanogram cutoff that Colorado and Washington adopted when they legalized marijuana for recreational use. As MPP notes, West Virginia’s DUID standard “could make it illegal for some patients to ever drive, since many patients have THC levels at this amount or greater many hours or days after last administering cannabis.”

West Virginia’s rules put it on the less liberal end of a medical marijuana spectrum that ranges from highly permissive (e.g., California) to highly restrictive (e.g., New York). Eight of the 29 medical marijuana states also allow recreational use. Medical use was approved by ballot initiative in 14 of those states, beginning with California in 1996. In the rest, as in West Virginia, medical marijuana laws originated in the state legislature.

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There are dozens of medical marijuana dispensaries in cities across Michigan, and Detroit has 61 marijuana shops open for business. However, by this time next year, the landscape for marijuana around the state could be completely different. That’s when the state will start officially handing out licenses to cultivators, testing facilities, transporters, and dispensaries.

The state Department of Licensing and Regulatory Affairs (LARA) is beginning to gear up for the task of regulating a new, and potentially very lucrative, business in the state. The medical marijuana business is projected to generate revenues of more than $700 million, and if a ballot proposal goes to voters in 2018 and the market is opened for recreational use, too, those revenues will easily surpass $1 billion. Shelly Edgerton, director of LARA stated, “Most states have had two years to get this going. For us, this is a huge endeavor.”

Andrew Brisbo, who has served as LARA’s licensing division director, has been named as the director of the newly created Bureau of Medical Marijuana Regulation. He will be in charge of the department that could grow to nearly 100 employees who investigate all license applicants and ultimately regulate the medical marijuana business and administer the system that tracks medical marijuana from seed to sale.

LARA approved a $447,625 contract with a Florida based company to provide the monitoring system. They also provides a similar service to Colorado, which was the first state to legalize recreational marijuana. Right now, there are 240,000 people who have gotten medical marijuana cards that allow them to use weed legally to treat a variety of conditions. They are served by 40,000 state-approved caregivers, who can grow up to 12 plants for each patient and who are allowed up to five patients each.

The new law keeps that system in place but also creates five categories of medical marijuana licenses for cultivators of up to 1,500 plants, testing facilities, transporters, dispensaries and the seed-to-sale tracking. The dispensaries will be taxed 3 percent on their gross receipts, and that money will go back to the state and local communities. The state is still coming up with an application and licensing fee schedule, which will cover the cost of regulating the industry, an estimated $18.6 million, according to Governor Rick Snyder’s budget proposal for the department.

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A recent proposal aims to legalize medical marijuana in North Carolina. The bill lays out the development of a medical marijuana supply system and aims to create a program administered by the UNC system called the North Carolina Cannabis Research Program. The program would conduct studies to determine the safety and efficacy of cannabis as medical treatment and then develop guidelines for the appropriate physician administration and patient use of medical cannabis.

The political director of the marijuana advocacy group NORML, Justin Strekal, said the proposal is comprehensive and includes a long list of conditions that doctors could prescribe marijuana to treat. He stated, “Some other states have gone a much more conservative approach in terms of what they will consider marijuana to be a treatment for.” Strekal said there are states that only legalize cannabidiol, or CBD (oil derived from a strain of marijuana without psychoactive effects).

Strekal said, “The CBD-only is really great at treating the kids with refractory epilepsy, but as far as the much more holistic approach that can be used to treat a whole host of ailments, it’s important to have access to the whole plant. So, as far as medical marijuana bills go, we’re very happy with what’s being introduced in North Carolina.” But the federal administration and U.S. Attorney General Jeff Sessions have been increasingly critical of states legalizing marijuana in recent months.

He recently said, “I, as you know, am dubious about marijuana. States can pass whatever laws they choose, but I’m not sure we’re going to be a better, healthier nation if we have marijuana being sold on every corner grocery store.” Whether Sessions and the new administration will actually enforce the federal status of marijuana remains unclear. Strekal said data suggests legalization of medical marijuana could reduce opioid dependency in the state.

Research from the Johns Hopkins Bloomberg School of Public Health and the Philadelphia Veterans Affairs Medical Center found the annual number of deaths from prescription drug overdose is 25% lower in states that have legalized medical marijuana. Strekal said, “The data is very conclusive that marijuana can be a pathway out of addiction rather a gateway in.”

Executive director of Drug Free America Foundation Inc., Calvina Fay, said she doesn’t think the proliferation of marijuana reduces drug-related deaths and overdoses. “Is there a state that has reduced their opioid problem and legalized marijuana? Yeah, I’m sure there is,” she said. “But there’s no proof that marijuana is the cause of that.”

In a speech to Virginia law enforcement in March, Sessions said marijuana proliferation will not staunch the effects of the opioid crisis. Sessions stated, “I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana; so people can trade one life-wrecking dependency for another that’s only slightly less awful.”

However, criticisms of medical marijuana are outdated and not based on scientific fact, Strekal said. He stated, “To maintain the same classification of marijuana in the realm of heroin is absolutely absurd. It’s unfounded, and it’s unfathomable to deny patients access to a substance that will alleviate their suffering.”

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NFL players are banned from using the marijuana for any purposes under the existing collective bargaining agreement, even in states where it is legal. Under that agreement, players who test positive for marijuana must enter a substance abuse program. Multiple violations lead to fines, game suspensions, and banishment from the league.

Former NFL players have been increasingly vocal in their criticism of the ban in recent years, saying that medical marijuana is a safe alternative to the powerful prescription opiates routinely prescribed to NFL players for pain. Documents obtained by The Post earlier this year show that NFL teams are heavy users of prescription pain medications, averaging about “six to seven pain pills or injections a week per player over the course of a typical NFL season.”

There’s little evidence that opiates work for the chronic aches and pains often suffered by football players. But there’s strong evidence that anyone, NFL pro or otherwise, who uses opiates on a long-term basis is putting themselves at serious risk for drug dependency, overdose, and death. A 2014 review of 39 studies investigating the efficacy of opiate painkillers for chronic pain found that “evidence on long-term opioid therapy for chronic pain is very limited but suggests an increased risk of serious harms that appear to be dose-dependent.” In other words, there’s little evidence of benefit for treating chronic pain with opioids, but a there is a real risk of harm.

The implications of this finding shouldn’t be understated, for either NFL players or the public. Opiate painkillers, like the ones prescribed in bulk by the NFL, kill over 15,000 people a year via overdose. No death from a marijuana overdose has been reported, according to the DEA. On the other hand, chronic pain is one of the conditions that marijuana has been shown to be effective at treating. Earlier this year the National Academies of Sciences, Engineering and Medicine published an expansive literature review, spanning decades of research, showing “substantial evidence that cannabis is an effective treatment for chronic pain in adults.”

The NFL, in other words, is pumping its players full of highly addictive and deadly substances that are of dubious use for treating the long-term, chronic pain suffered by so many players, and fining and suspending players who choose instead to self-medicate with a less-addictive and non lethal substance. The disproportionality of the league’s substance abuse policy was put into stark relief in 2015, when the Browns’ Josh Gordon received a year-long suspension for multiple violations of the league’s marijuana ban. When Ravens running back Ray Rice was charged with aggravated assault for beating his then-fiancee, his initial suspension from the league was only two games.

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South Carolina Representative Eric Bedingfield used to oppose all marijuana use until his son lost a battle with opioid addiction and died from overdose. The conservative Republican co-sponsored marijuana legislation. Bedingfield recently stated, “My mindset has changed from somebody who looked down on it as a negative substance to saying, this has benefits.”

Bedingfield now believes marijuana may successfully help addicts wean themselves from a dependence on opioids. He also believes marijuana may be an alternative to prescription medications like OxyContin.

Almost twenty years after California became the first state to legalize medical marijuana, efforts to let patients legally access marijuana are slowly taking root in the South. Out of 28 states that allow medical marijuana, only two of those states are in the south. Arkansas and Florida voters approved theirs through November’s ballot. A law signed in Louisiana last year, also not yet in effect, does not allow the vaping or smoking of marijuana.

This year’s renewed push in South Carolina is supported by some of the state’s most conservative legislators, such as Bedingfield, whose opinions have shifted due to personal losses or the pleadings of parents and pastors in their districts. Three years ago, state legislators passed a very narrow law permitting patients with severe epilepsy, or their caregivers, to legally possess cannabidiol (CBD), a non-psychoactive oil derived from marijuana. Bedingfield voted against that idea.

Bill Davis, a Christian author who leads a Bible study for people fighting drug addiction, said he was bedridden before trying marijuana. Diagnosed two years ago with idiopathic pulmonary fibrosis, a lung disease with no cure, he was put on an experimental drug with “horrible side effects.” Davis said, “I had to decide whether I wanted to die of lung disease or kidney or liver failure.” Then he started vaping marijuana, which he says allows him to control the amount of CBD and THC he receives. He said, “I’m praying this state will allow me to be treated legally for me to live” using “a plant that God made.”

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Biomedical research is teaming up with the University of Oxford to set up a lab to research the effects of medical marijuana on various health conditions. The school’s Cannabis Research Plan will study the use of cannabinoids to treat cancer, inflammatory diseases, neurological disorders, and pain.

Doctor Ahmed Ahmed, professor of gynecological oncology at Oxford recently stated, “Cannabinoid research has started to produce exciting biological discoveries, and this research program is a timely opportunity to increase our understanding of the role of cannabinoids in health and disease. This field holds great promise for developing novel therapeutic opportunities for cancer patients.”

The school will be paired with Oxford Cannabinoid Technologies (OCT), a bio-med startup funded by venture capital firm Kingsley Capital Partners. Neil Mahapatra, a managing partner at Kingsley, explained the strategy behind the company’s initial funding of $12.5 million to the lab. He stated, “Medical cannabis and cannabinoid medicine is already helping patients with some of the most distressing conditions across the world. However, research into the specific pathways and mechanisms that create this benefit is limited and long overdue. Through OCT, we hope our strategic partnership with Oxford will support the development of innovative new therapies to help millions of people around the world. The partnership gives the UK a global leadership role in this fast-growing field.”

Even though the use of medical marijuana is still not legal in the UK, a drug containing cannabinoids THC and CBD, Sativex, is legal to treat multiple sclerosis. The Green Party and Liberal Democrats support the legalization of medical marijuana. Members of the Labor and Conservative parties, and even Sir Patrick Stewart show their support, as well. The actor stated, “Two years ago, in Los Angeles I was examined by a doctor and given a note which gave me legal permission to purchase, from a registered outlet, cannabis-based products, which I was advised might help the osteoarthritis in both my hands.” He continued, “As a result of this experience, I enthusiastically support the Oxford University Cannabis Research Plan.”

Oxford Cannabinoid Technologies currently plans to bring in investors for the next round of funding to the lab, and recruiting volunteers, both patients and healthy subjects, to participate in clinical trials. The group will also be hosting the International Cannabinoid Biomedicine Conference later this year.

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Private Medical Marijuana labs are restricted from testing properties on the plant for one year, according to Ohio’s new law. During that time, public universities would test medical cannabis produced within the state to make sure it is safe for consumers. The problem is that no other state tests medical marijuana like this. That’s because many university officials are wary of losing money from a federal government that still labels cannabis as among the most dangerous, illegal drugs, at the same level as heroin.

Rob Ryan, executive director of the Ohio Patient Network and a Blue Ash councilman stated, “If there is no testing, then there is no program. We are very concerned.” Even if Ohio’s universities want to test medical cannabis, the cost is $2,000 for an application fee and an $18,000 fee to operate a testing lab. Those numbers could change before the rules are finalized by September. Buying testing equipment, cameras, and other tools would cost at least $1 million, depending on what the university already had in place, said Jeffrey Raber, CEO of The Werc Shop, which tests cannabis in California, Oregon, and Washington. And to buy equipment or finance lab work, professors often rely on grants, many of which come from government entities.

Other concerns include whether universities would have the capacity to handle all medical cannabis grown in Ohio or whether they can safely secure the plant to prevent theft. “There are too many unknowns to rely exclusively on learning institutions,” said Chris Lindsey, senior legislative counsel for the Marijuana Policy Project, which pursued a ballot initiative to legalize medical marijuana in Ohio in 2016 but dropped the idea after lawmakers passed their plan. “Private labs are in better positions to respond.” It is unclear whether any in-state, public universities are interested in laboratory testing. At this point, officials at University of Cincinnati, Ohio State University, Cleveland State University, and Kent State University are not planning to provide laboratory testing of medical cannabis, spokespeople told The Enquirer. That could change, but universities in other states have avoided medical cannabis.

In Maryland, for example, only universities with academic medical programs were permitted to dole out cannabis. But none were interested so legislators reworked the program. University of Illinois’ Chicago campus announced in 2015 that they would start testing medical marijuana but shortly after, officials changed their minds. Kerry Francis, Ohio Department of Commerce spokeswoman stated, “We can’t speculate as to which universities will apply.” The Ohio Department of Commerce has not yet set a deadline for applications.

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Florida Marijuana

A proposal that would award $2.5 million for UF to study medical marijuana recently moved forward in the Florida House of Representatives. The proposal states that money from the General Revenue Fund will be used to fund UF’s study on the safety and efficiency of medical cannabis. The bill, which passed through the Health Care Appropriations Subcommittee, moved into the Appropriations Committee on Friday.

If the bill is passed in the committee, it will go to a full House vote for final approval. If it passes through the House, the proposal states the one time fund will be finalized in July. House member Dane Eagle, a republican who represents District 77, sponsored the proposal, which was first submitted February 7. Janine Sikes, spokesperson for UF, wrote in an email that the money would fund UF’s proposed Cannabis and Safety Outcomes Surveillance System, a program which would monitor the safety and effectiveness of medical cannabis on 25,000 enrolled patients throughout the state.

Florida’s Amendment 2, a constitutional amendment that allows stronger cannabis to be used for a broader list of conditions, took effect in January. Of the six medical cannabis dispensaries licensed in Florida, two are in Alachua County, according to the Florida Department of Health’s Office of Compassionate Use. Sikes said the UF program would monitor treatments that haven’t been approved by the FDA. UF would create a secure Data Warehouse to track patient data as part of the program.

She said the $2.5 million would be for costs such as faculty salaries and data processing. She stated, “Evidence is lacking to evaluate risk/benefit of medical marijuana. It is pivotal that the state establishes a system to monitor emerging safety concerns, especially for use in children.” She said the proposal is related to the Compassionate Medical Cannabis Act of 2014, which requires physicians to submit a quarterly patient treatment plan to the UF’s College of Pharmacy for research on the safety and effectiveness of low-THC cannabis on patients. The details of the proposal state that it would offer funding to implement research provisions in the 2014 act.

A UF nursing senior, Alicia Ciliezar, said she supports the use and research of medical cannabis. The substance helps improve pain levels for individuals with issues such as neurologic conditions and digestive disorders. She said, “I’m very eager to see the aims of the study, the objectives and the outcomes. I’m sure it will be fascinating and shape our perception on the substance.”

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Research published in the International Journal of Drug Policy has discovered that people taking psychoactive medications and drugs for conditions such as chronic pain seem to prefer medical cannabis to other drugs, including sedatives, opioids, and antidepressants.

Many analysts have expressed worry about the use of opioids to treat chronic pain. More than 183,000 people died of prescription opioid overdoses between 1999 and 2015 in the U.S. Some research, such as a recent study that looked at states with medical cannabis laws, suggests access to medical marijuana could reduce opioid abuse. The research used survey data from 271 people registered to purchase medical cannabis. Participants answered 107 questions covering demographic data, use of cannabis, reliance on other drugs, and health history.

Survey respondents had been prescribed drugs for a range of reasons, including chronic pain, mental health conditions, and gastrointestinal issues. Overall, 63% reported using marijuana instead of prescription drugs. The most common drug class for which participants substituted cannabis was opioids, accounting for 30% of the total. Sixteen percent of participants used marijuana to replace benzodiazepines, and 12% used marijuana instead of antidepressants.

Cannabis was also a popular replacement for potentially addictive nonmedical drugs. Twenty-five percent of respondents used cannabis instead of drinking alcohol, 12% used it instead of cigarettes or tobacco, and 3% replaced illicit drugs with cannabis. The study’s authors suggest side effects, concerns about addiction, and level of safety figure prominently among the decision to use cannabis instead of other medications. Some medical marijuana users report cannabis works better than more traditional prescription medications.

The study found individuals often faced challenges to accessing medical cannabis. More than half were charged for their marijuana prescription, with 25% paying more than $300 for the prescription. Some participants still purchased marijuana from unregulated sources in spite of having a prescription.

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Kimberly Cargile opened A Therapeutic Alternative Shop in 2009. She says her store serves more than 40,000 patients throughout California. In addition to buying marijuana products, patients can also take advantage of free services like massage therapy and yoga. Cargile stated, “I believe that a patient has a right to heal themselves by all means necessary. So we really are on the cutting edge.” There are 30 dispensaries in Sacramento that serve individuals with a doctor’s prescription for medical cannabis.

That number will soon increase as thousands of applications are expected for dispensaries that will sell cannabis to recreational users. A doctor’s prescription for cannabis is no longer necessary under the state’s Adult Use of Marijuana Act, but until 2018 there is no store where a person can legally buy marijuana without a prescription. The question is whether existing shops will open their businesses to recreational users next year. Cargile said, “We will stay medical. There are plenty of legit patients who come to us who really need our services. We believe that we’ll be able to stay sustainable in the face of quite a bit of competition from recreational stores.”

Nate Bradley, executive director of the California Cannabis Industry Association, says he’s spoken to dispensary owners who want to stay medical. But Bradley says many of them have changed their minds. He stated, “It’s just expanding your market. If you’re a business owner, why would you not want to expand your market?” Bradley says Prop 64 was written to complement California’s existing legal framework for medical cannabis. He says the goal is to have one system with two sets of retail licenses, one for medical cannabis and another for recreational marijuana. Bradley said, “But that is what we’d like to see for the long run instead of creating the bureaucracy of two separate systems with two separate sets of rules you have to be in compliance with.”

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