Medical cannabis has been legal in Washington since 1998, but the passage of the Cannabis Patient Protection Act in 2015 has thrown a curve ball of sorts to patients.
On the heels of The Beachcomber’s recent story about a Vashon Senior Center trip to a retail cannabis shop, follow up with those that participated suggested that there was a need for more clarity regarding medical cannabis in Washington State.
A little history: The cannabis plant has been used by humans for thousands of years, both for hemp — the fiber that comes from the stalk of the plant — as well as medicinal cannabis, which is made from the flowers and leaves. It was a part of mainstream medicine in the U.S. for nearly 100 years before it was criminalized in 1937. PBS’ Frontline offers a quick picture and timeline of the legal history of cannabis in the U.S. until the mid ’90s, when individual states began legalizing it for medicinal use here.
What’s in a word? Quite a lot, when it comes to “marijuana,” actually. This piece that appeared in The Stranger last spring offers some eye-opening insight into the word’s history and use, and why some are choosing to stick with the scientific term (cannabis) instead.
In the works: The first FDA approval of a plant-derived cannabinoid drug may well be on the near horizon. Currently the U.S. has only approved drugs (two of them) made with synthetic cannabinoid compounds. While this type of medicine should not be confused with medical cannabis, if approved, it could force some legal changes at the federal level.
Now, for the questions.
Is there a difference between “medical” cannabis and non-medical?
This is a tricky question because there are several answers.
The chemical component in cannabis that is most frequently talked about and referenced is called THC, which stands for tetrahydrocannabinol. This is a psychoactive compound which means it can cause you to feel “high.” Most recreational cannabis products are made with a focus on THC content or concentration. But there are other compounds in cannabis that can offer relief to patients with certain medical conditions, and do not have the psychoactive effects of THC, including cannabidiol or CBD, as it’s commonly known, and terpenes. The prevailing school of thought for medicinal cannabis treatment is that a combination of these works best, like a team or an “entourage” of chemical compounds and components that act together.
Currently, there is no mandatory regulation of products sold to medical patients, meaning that a shop that has a medical cannabis endorsement won’t necessarily have these types of products available, though medical patients can still use THC-focused products.
Is there any regulation or quality control of medical cannabis in Washington?
There are no mandatory quality or safety regulations regarding cannabis products in Washington at the moment, whether sold as medical or recreational. However, the Cannabis Patient Protection Act does offer a voluntary compliance program for producers who can choose to participate or not. The program applies standards for safer and healthier products, including labeling that provides THC and CBD concentrations and ratios, testing for molds, pesticides, fungus and solvents, and safe handling and employee training requirements. Products that have gone through the program will be labeled specifically to identify them as being compliant.
Dr. Ethan Russo, islander, board-certified neurologist and psychopharmacology researcher, noted in a paper published in the Sept. 16, 2016, issue of Frontiers in Pharmacology, that random testing of legal cannabis products purchased in Washington showed an 84.6 percent pesticide residue contamination rate, which included potentially neurotoxic and carcinogenic agents. In an interview with The Beachcomber, he stated that quality control is absolutely imperative for the medical cannabis market for patients to be safe.
Why are there no medical dispensaries any more?
With the passage of Initiative 502 in 2012, a regulated market was created for recreational cannabis. Medical cannabis, however, was to that point unregulated. Instead of trying to work with two separate markets with the potential for highly taxed and regulated recreational retailers hiding under the guise of a medical dispensary, the state passed the Cannabis Patient Protection Act in 2015 and determined that medical cannabis should be sold and dispensed at licensed and regulated recreational shops.
“What the legislature did is inexplicable, scientifically,” Dr. Russo said of the integration, that has proven to be confusing and disruptive to both patients and suppliers. “The medical system was working well, in terms of consistency and accessibility.”
Vashon’s lone dispensary was shut down last summer as the owner was not interested in the expense and many requirements that would have been involved to become a recreational shop with a medical endorsement — which would have included moving to a different location, among other things. See The Beachcomber story about the shop’s closure here for more information.
What qualifies a cannabis shop as “medically endorsed?”
To be medically endorsed, a retail cannabis shop must have a certified medical cannabis consultant on staff. A certified consultant is not a medical provider. Seattle Central College offers a medical cannabis consultant training program, and there are 161 active medically endorsed stores in Washington.
Consultants can assist customers with product selection, describe risks and benefits of methods for using various products, advise customers regarding proper storage and safekeeping, proper methods for using various products and answer questions regarding the law. They cannot offer medical advice, diagnose conditions, recommend changes to current treatment or open/use actual products while demonstrating use.
Do any providers on Vashon write medical cannabis authorizations?
Neighborcare Health’s Chief Medical Officer, Marcus Rempel, stated that Neighborcare’s policy is that it is up to the individual providers whether they will write authorizations or not. At press time, The Beachcomber was able to reach Neighborcare Vashon’s Medical Dirtector, Jessica Wesch, who stated that she will write authorizations for her established, qualifying patients. The best answer is to ask your provider.
The types of providers who may write an authorization for medical cannabis are limited to:
- Medical doctors
- Physician assistants
- Osteopathic physicians
- Osteopathic physician assistants
- Naturopathic physicians
- Advanced registered nurse practitioners
Veterinarians, dentists and chiropractors are not allowed to write authorizations.
The healthcare practitioner must be licensed to practice in Washington State.
Currently, conditions that would qualify for an authorization under the law include:
- Cancer, human immunodeficiency virus (HIV), multiple sclerosis, epilepsy or other seizure disorder, or spasticity disorders.
- Intractable pain, meaning pain unrelieved by standard medical treatments and medications.
- Glaucoma, either acute or chronic, unrelieved by standard treatments and medications.
- Crohn’s disease with debilitating symptoms, unrelieved by standard treatments or medications.
- Hepatitis C with debilitating nausea or intractable pain, unrelieved by standard treatments or medications.
- Diseases, including anorexia, which result in nausea, vomiting, wasting, appetite loss, cramping, seizures, muscle spasms, or spasticity, when these symptoms are unrelieved by standard treatments or medications.
- Posttraumatic stress disorder.
- Traumatic brain injury.
Mental health conditions do not currently qualify.
What is the Authorization Database?
The passage of the Cannabis Patient Protection Act led to the creation of a patient authorization database, which is voluntary to participate in for those with medical cannabis authorizations from qualifying health care providers. However, if a patient wants the full benefit of medical authorization, they must submit their authorization information to a certified consultant at a retail shop to be entered into the database and receive a special “recognition” card.
Benefits of being in the database include:
• Purchasing products from medically endorsed shops sales-tax free
• Purchasing up to three times the current recreational limit of cannabis
• Possess six plants and eight ounces of useable cannabis (from the plants), with the potential for a health care provider to authorize a maximum of 15 plants and 16 ounces of useable cannabis (from the plants). Recreational consumers are not legally allowed to grow their own plants.
• Participation in a medical cannabis collective/cooperative
• Arrest protection and an affirmative defense to prosecution
Medically authorized patients who do not participate in the database may only purchase the amounts allowed for recreational consumers, and are allowed to have only four plants for personal medical use and possess up to six ounces of useable cannabis from the plants, even if a higher number of plants is designated on their authorization. There is no arrest protection for medical patients who do not have a recognition card, but there is still an affirmative defense to prosecution.
The recognition card costs $1.
The state Department of Health says that it strictly limits who can access the information in the database and how the information may be used. For example, the state department of revenue has access to obtain sales-tax-free sales reports. When asked about potential federal law enforcement action that could occur with a new administration, the statement from Public Information officer David Johnson was that the state would oppose any attempt to access the database by any person or entity that was not allowed under the law. However, the law as it is currently written, allows federal or other law enforcement officials to access the database in instances of “verifying that a card is valid.” Currently there are over 16,000 patients or designated providers in the database.
The medical use of cannabis is an extensively documented subject, albeit sometimes controversial, and medical cannabis patients should work closely with their healthcare providers to ensure safety, best practices and treatment.
Information for this piece was obtained from the Washington State Department of Health’s website, which offers extensive and detailed information on medical cannabis here, as well as interviews and email exchanges with: Dr. Russo, Dr. Beatriz Carlini, Senior Research Scientist at the University of Washington’s Alcohol and Drug Abuse Institute, Cheryl Richmond, Vashon Senior Program Director, Shango Los, founder of the Vashon Island Marijuana Enthusiasts Association and host of the Shaping Fire podcast, David Johnson, Public Information Officer for the Washington State Department of Health, Mary Schilder, Director of Marketing and Communications for Neighborcare Health and Dr. Wesch.
