Cannabis in the Medicine Cabinet

by: Scott Barker

In the past 100 years, marijuana has gone from being a recognized treatment for a variety of medical conditions, to a banned substance that’s used to get high, to the object of hope for many who struggle with physical or emotional disorders. But how much do we really know about marijuana as medicine?

George, the small town lawyer, needs some convincing.

Seated around a nighttime campfire with his two traveling companions — Wyatt and Billy — he eyes the marijuana cigarette that’s offered to him and says uneasily, “I couldn’t do that. I’ve got enough problems, with the booze and all. I mean, I can’t afford to get hooked.”

Nonchalantly, Wyatt reassures him, “You won’t get hooked.”

Almost stuttering, George responds, “Yeah, well I know, but it leads to harder stuff.”

Met with just an enigmatic smile from Wyatt, George responds, “You say it’s all right? Well all right, then … how do I do it?”

That scene from the 1969 cult classic Easy Rider perfectly captures the first cannabis experience of many people who came of age in the 1960s and ’70s. They were hanging out in the boonies with friends, or at a Grateful Dead concert, maybe crashed in their dorm room, possibly relaxing in the bed of a friend’s truck when they first lit up. Provided that the experience didn’t terminate with the police (or their parents) showing up, people who smoked pot 50 years ago probably have nostalgic memories of that first toke, as warm and comforting as a freshbaked brownie.

But here we are in 2020, clearly not in the 1960s anymore. Peter Fonda and Dennis Hopper, two of the shining stars in that campfire scene, are sadly gone for good, and Jack Nicholson has retired from acting. The Age of Aquarius is such a distant memory that a 50th anniversary celebration of Woodstock fizzled like a wet doobie.

More surprisingly, cannabis, which once got people arrested on a regular basis, is legal for recreational use in 11 states, Guam and Washington, D.C., and there are medical programs in 33 states, Puerto Rico, and the U.S. Virgin Islands.

If Nicholson’s character from Easy Rider had survived the beating (sorry, spoiler alert) he receives in the film and woken up now, like some sort of Trip Van Winkle, he would probably be saying, “Medical marijuana … what?”

He could certainly be excused for wondering if that was even a thing. It has been many years since cannabis has been regarded as anything but an enemy combatant in the federal government’s War on Drugs.

But if you pay attention to the headlines, you’ll notice that legislation regarding cannabis, and two of its key compounds, is wafting through the courts, steady as drifting smoke.

It’s impossible for any magazine article to tackle all the issues regarding cannabis as medicine. The best we can hope to do over the next few pages is lay out a few of the major questions and present the opinions of some experts.

Because, with all due respect to George and his biker buddies, the first thing to ask isn’t, “How do I do it?” but “What will happen if I do?”

The Cannabis Chronicles

Arthur C. Clarke penned a famous short story about “The Nine Billion Names of God.” There may not be quite as many epithets for cannabis, but if it were a horse race between names for the Almighty and those for marijuana, we’d need to review the videotape to pick the winner. Weed, pot, dope, reefer, Mary Jane … the list from just the 1960s would go on for pages.

But what is it, exactly?

Cannabis, from the family of flowering plants Cannabaceae, is generally thought to be two species — cannabis sativa and cannabis indica. Sativa — the taller-growing, narrow-leaf variety — is what we think of as the hemp plant, grown by such famous and revered individuals as George Washington for its many fiber uses.

Indica, on the other hand, is broader-leaf and has a heavier concentration of the compound that scientists first identified in 1964 to be psychoactive.

Michael Backes, author of the book Cannabis Pharmacy, sums up the difference between hemp and marijuana very succinctly: “Hemp is cannabis used principally for fiber, food and seed oil, typically with less than .5 percent THC in the female flowers. Hemp typically produces CBD at around 2 percent in its female flowers.

“Marijuana is used for drug content, whether THC, CBD or a combination of cannabinoids. In recent years, hemp varieties have been crossed with marijuana varieties to produce hemp varieties with high-CBD content that can exceed 20 percent, but typically are closer to 10 percent.”

Though there are more than 500 compounds in the cannabis plant, there are only two that are household names: delta-9 tetrahydrocannabinol (THC), and cannabidiol (CBD). In a nutshell, THC is the stuff that produces a high for users, and CBD is the non-psychoactive substance that could have anti-inflammatory and other medicinal properties (more on that later).

Though you might be tempted to think that all this is a new phenomenon, humans have had a relationship to cannabis that dates back thousands of years. There is evidence that the hemp variety was being used for oil and fiber around 4000 B.C. And a recent excavation of a 2,500-year-old tomb in western China uncovered burnt cannabis, suggesting that its implementation as a mind-altering component in rituals has been with us for a very long time.

Ritual isn’t really medicine, however, so the question remains — at what point did humans decide that cannabis could treat any ailments? Since cannabis is indigenous to Asia, it’s no surprise that we first read of it as a treatment for disease in writings that originate in China around 2800 B.C. Though the actual author of these works, such as Shennong Bencaojing, is heavily disputed, we know that Chinese physicians were using cannabis for a variety of things — including as an anesthetic — several thousand years ago. Murky, too, is the origin of the word “marijuana,” which some etymologists suggest could date back to ancient China as the term ma ren hua, which means hemp seed flower.

Cannabis, as hemp, landed in the New World in the 16th century, thanks to Spanish sailors, and as mentioned before, it went on to be well known as a fiber source for everything from rope making to clothing by our founding fathers. It may have been utilized in folk remedies for many years before there was any serious study of it by western doctors, but eventually it made its way into tinctures and other preparations sold in pharmacies.

The backlash to the use of cannabis built for years in the U.S., finally igniting a firestorm of legislation in the 1930s, when sensationalized newspaper headlines, and movies such as the notorious Reefer Madness convinced Congress to act … tax act, that is. The Marihuana [sic] Tax Act of 1937 banned hemp and cannabis in the then-48 states, and set up a conflict that continues in some form today. Though restrictions were lifted somewhat during WWII, cannabis and hemp were pretty much persona non grata in all parts of America until 1996 when California legalized it for medical use.

The Straight Dope on the Law

Mama says yes
Papa says no
Make up your mind
’Cause I gotta go

Though when Mick Jagger sang “Rip This Joint” he wasn’t railing against the tangled spider web of laws governing cannabis in the U.S., he certainly could have been. What’s permissible in one state is totally illegal next door, and possibly verboten but not criminal just across the next state line.

To complicate things further, the federal government has its say, too.

And here’s the bottom line: marijuana is classified under the U.S. Controlled Substance Act as a Schedule 1 drug, meaning it’s illegal to buy it, sell it, and use it.

“But wait,” you say, “what about states that allow recreational or medical use? How can that be?”

Pima County Public Defender Joel Feinman explains with a hypothetical scenario, “In a very practical sense, an FBI agent can come in any time and arrest me in my home, if they have a search warrant, for smoking marijuana even though I have a medical marijuana card, because it’s a violation of federal law. They choose not to. But they could. So it’s not that Arizona law violates federal law, it’s that Arizona law is different than federal law and the federal government chooses not to go after the people who are benefiting from that difference.”

There are myriad problems that have cropped up because of the federal government’s insistence on keeping cannabis on the Schedule 1 list (along with LSD, heroin and ecstasy, to name a few of the other banned drugs). In many states that authorize recreational or medical marijuana, growers and dispensaries have to operate as a cash business because banks won’t touch proceeds from selling something that the Feds have banned. And there’s another financial problem that people outside the cannabis industry aren’t exposed to.

“Banking is so obvious that everybody knows about it,” comments Moe Asnani, co-founder of the Downtown Dispensary and D2. “But there’s also something called a 280E tax code that says if you’re selling a Schedule 1 substance, you can’t write off any of your expenses. So from the perspective of the IRS, we’re basically not even able to run our businesses. We have to fight for that every day. The 280E code is supposed to be applied to all Schedule 2 substances [i.e., cocaine, oxycodone, fentanyl, etc.] as well, but they’re selectively choosing only the marijuana businesses and not manufacturers of Schedule 2 substances.”

There is legislation in the works — the Secure and Fair Enforcement (SAFE) Banking Act (H.R. 1595) — that would facilitate companies working in the cannabis industry in writing checks, taking credit cards, paying taxes through conventional means, etc. At press time it had been passed in the U.S. House of Representatives, but was waiting on Senate approval.

If you’re following rules and regulations covering cannabis across this land, you need to diagram the changes like you’re keeping the characters straight in a Tolstoy novel. With head-spinning frequency, news agencies trumpet the developments: the 2018 federal Farm Bill legalized hemp (but not anything with more than 0.3 percent THC); New York state recently decriminalized public possession and use of cannabis; Illinois, which just legalized recreational pot, will expunge the criminal records of some 770,000 people who have been convicted of marijuana offenses; the TSA created policies that allow for flying with hemp-derived CBD (but nothing with THC); and so on.

Despite efforts to legalize/ decriminalize it’s still a minefield out there. Until last summer, Arizona dispensaries couldn’t be sure that selling extracts of cannabis complied with state law. Kansas has arrested hemp farmers and charged them with selling marijuana, despite the fact that the Colorado Department of Agriculture had already certified that the shipment they were transporting had no more than 0.3 percent of THC.

Given that there are legal hoops to jump through to obtain and use cannabis products under Arizona’s program, the pertinent question is “Who would enroll in something like this, and why?”

A Need for Weed?

Arizona recognizes more than a dozen diseases and conditions for which a physician may prescribe medical marijuana, ranging from cancer to glaucoma to chronic pain. There also is the provision that the Department of Health Services can approve the use of medical marijuana on a case-by-case basis for other conditions.

Physicians who have been gathering information on the possible benefits of cannabis feel pretty confident that they can check off that time-worn advice to doctors, “First do no harm.”

“I think that marijuana is probably the safest of all medications out there because it’s toxicity is so low,” observes Andrew Weil, M.D., a long-time Tucsonan who is world renowned for his investigations into integrative medicine. “You can’t kill people with it. On a physical level it’s much safer than much of the medication that we use.”

Though researchers don’t know the exact mechanism that allows compounds in cannabis to be effective for various ailments, it was established about 30 years ago that humans (and many other animals) have an endocannabinoid system, that is, receptors throughout the body that react to compounds in cannabis and function in areas ranging from pain sensations to immune system to bone growth.

“I think there are many potential benefits,” Dr. Weil says of cannabis as a medical treatment. “The old uses have been around for a long time, such as being helpful for glaucoma, muscle spasicity, and for nausea, but the new research suggests there might be great potential both as a preventive and treatment for many kinds of cancer, as well as slowing down age-related dementia, reducing inflammation in the body, and controlling appetite. There are a lot of possibilities there. I think the evidence we have for them is not really strong, but it’s pointing in the right direction.”

Dr. Weil actually wrote the forward to Backes’ Cannabis Pharmacy, and he is quick to credit the author for being on top of past and current research on marijuana. Backes, a University of Arizona alumnus, is based in California, and he explains that his book was the result of a personal journey. “I was a patient, and I couldn’t get my questions answered when I went to dispensaries here in California. I saw this education gap, and I had a biology background, but I wasn’t a full-time scientist. I was actually working in Hollywood for Michael Crichton, the guy who wrote Jurassic Park. At the dispensaries, they were selling cannabis as a medical product, but a lot of people behind the counter had no idea what was in it, what those compounds did, or whether they were effective or not. So I really got into it. I got involved with a dispensary and after a couple of years I decided to write a book.”

Backes says that there are many avenues worthy of research regarding cannabis as medicine. “Today you have to point toward the compounds for which there is the most evidence. There’s the most for THC, that compound produced by cannabis that gets you high, but doesn’t get you high at really low doses. It actually may have some medical efficacy at low doses. It also can have medical value at moderate doses. You don’t necessarily get stoned so much as a light buzz along with pain relief. Or you get anti-inflammatory benefits. It also may help control your nausea if you’re undergoing chemotherapy. There’s a kind of nausea that chemo patients get called anticipatory nausea. What that means is they pull into the parking lot of the hospital and they want to throw up before they’ve even had the treatment. It’s definitely not ‘fake,’ and it’s terrible for somebody who is going through it. What’s fascinating is that cannabis is one of the few compounds that can control that anticipatory nausea.”

The FDA has already approved cannabis-derived, or cannabisrelated drugs such as Epidiolex, a treatment for seizure disorders that contains CBD, as well as Marinol and Syndros, both containing synthetic versions of THC, that are being used in patients with AIDS who are losing weight. Another drug, which, like the aforementioned, also is by prescription only, is Cesamet, an anti-nausea treatment for chemo patients that is chemically similar to THC.

Raun Melmed, M.D., co-founder of the Southwest Autism Resource and Research Center (SARRC) in Phoenix, is the medical director for a trial involving a drug containing synthetic CBD as a treatment for some of the symptoms associated with fragile X syndrome and related disorders.

“In all of these disorders there are core symptoms — cognitive issues and special challenges, and it certainly would be wonderful if the needle could be moved in that direction,” says Dr. Melmed, who also is a developmental pediatrician. “Often what changes are not necessarily those core symptoms but co-occurring problems, such as irritability. From my personal experience in the autism arena, the results have been very mixed and a wide variety of improvements have been reported, but that’s in a very anecdotal fashion.”

Dr. Melmed is hopeful, but realistic, about whether or not this cannabis-related medication might be helpful for children with a genetic condition such as fragile X.

“The fact that there was an indication [for CBD] in certain types of rare seizure disorders was a positive thing, but aside from that there are no clinical studies to suggest we’re going to see a positive signal.”

Some of those doing research on the healing benefits of cannabis are on the frontlines of treatment. Elaine Burns, NMD, founder and CEO of Phoenix-based Southwest Medical Marijuana Evaluation Center, comments, “I’m a physician and I’ve been in the clinical cannabis therapeutic part of the industry — seeing patients and recommending clinical cannabis for various medical conditions — since 2011. Because the cannabis industry, even though it’s a medical marijuana program in Arizona, still has a lot of influence from the recreational world, some of the medical products that we would be recommending as clinical physicians were not necessarily available at the dispensaries. A few years back I decided that I could create a very good product that would meet the medical qualifications and be in that lane specifically. And because I have a background in botanical medicine, I decided to create condition-specific formulas. In the cannabis industry that’s unheard of. They just have products that contain THC or CBD. But mine also contain other botanicals.” Her “Releaf” formulations include Migraine, GI Assist (for gastrointestinal problems such as GERD and IBS), Sleep, and Menopause Tonic.

There are many different ways to use cannabis products, including smoking the flower, vaping an extract, ingesting it in candy or a baked good, or applying topical preparations.

Here in Tucson, the Downtown Dispensary and its sister location D2 have been assisting medical marijuana patients since 2013, and though they’ve found that certain products seem to be the most requested, they nonetheless stock a very large array.

“We have about 350 products at any given time, including flower, edibles, topicals, and vape cartridges,” says Asnani. “When we first opened, we probably had about a couple of dozen items. Now we’re growing significantly in what we carry, and I think it’s a function of the market growing and newer technology, which lets us have more sophisticated products, too.”

As for what they sell the most, he doesn’t hesitate to say, “Vape cartridges. That’s our focus. That’s what we’re the best at, and we make them ourselves here in Tucson. It’s discrete, there are many options in terms of the different kinds of vape cartridges you can buy, and it’s not something that requires a lot of effort to use. With flower, you have to grind it up to smoke it using different devices. With the vape system, you just plug it into a battery and it’s good to go.”

If you look around the waiting room of D2, which resembles the antechamber for a dentist or optometrist, you notice a cross-section of the city’s population.

“When we opened, there were only about 38,000 medical marijuana patients in Arizona, and now there are more than 200,000,” says Asnani. “In Pima County alone there are about 27,000. When we look at that landscape, we want to be able to make sure that we’re able to get them in and out as quickly as possible. Online ordering is a big part of it, delivery is something we started doing more recently.”

From A High To A Low

At the conclusion of TV ads for pharmaceuticals, you see a list of possible side effects, detailing every frightening possibility from headaches to weight gain to a fatal stroke. If we based our medication-taking decisions solely on the potential side effects, whom among us would ever chance taking any pharmaceutical?

But we don’t just depend upon the fine print. We solicit the advice of health care professionals, our friends and family members, and we often rely on our previous experience with that drug or similar ones.

Therein lies a major hang-up for critics of medical marijuana programs. If you are basing your decision about using cannabis on the marketing from that industry, or someone at a dispensary, or your own nostalgia for getting high 30 or 40 years ago, you are missing a lot of pertinent information.

“There’s this notion that marijuana is a miracle drug for dozens and dozens of ailments, and that it’s been approved by the FDA or some scientific body,” says Kevin Sabat, Ph.D, president and CEO of Smart Approaches to Marijuana. “There are components of marijuana that have medicinal properties and we’re very much in favor of expediting the research, making sure we know what’s in it, getting those to be FDA approved. But that’s very different from a voter-led initiative basically saying that almost all marijuana use is medical.”

Sabat was an advisor on drug policies to Presidents Bill Clinton, George W. Bush and Barak Obama, and left the political world in 2011 to join with former Congressman Patrick Kennedy to provide an alternative to the narrative they were hearing from the cannabis industry.

“We saw a massive new industry emerging with really zero opposition and no groups that were trying to get the science out, so we decided to do something about that. We assembled a top group of science advisors and researchers from around the country who follow this issue, and who were upset about seeing the commercialization of marijuana.”

The concerns of opponents to current medical marijuana programs include a lack of rigorous testing; few gold standard double-blind studies of its efficacy; and the potential for serious physical and psychological side effects.

If you speak with mental health professionals about the topic of cannabis use, you hear apprehensions based on firsthand experience with treating addiction.

First off, they point out that typically no real screening for addiction or mental health problems is conducted during an evaluation for a patient to get medical cannabis.

Donnie Sansom, DO, the director of the addiction program at Sierra Tucson, elaborates, “There are issues with it being a primary drug of addiction. We also have issues with that sort of lax attitude that people have about, ‘Oh, this is no big deal. It’s so casual, everybody smokes, it’s going to be legalized. It’s medical marijuana in this state.’ Maybe a lot of that is true politically, but from an addiction point of view, the cross-addiction potential is really high.

“Let’s say a person sees themselves primarily as an alcoholic. And they may insist, ‘But I’m not addicted to marijuana, so I can smoke a little bit.’ And the problem is that marijuana does a lot of things in the brain. THC not only works on the endocannabinoid receptors, it also stimulates their reward pathway, which becomes diseased with a person with addiction. It changes the way an addict thinks about their pursuit of that drug.”

Nancy Macklin, a part-time Tucsonan, also is the executive director for Treatment Services Northwest in Oregon. Her organization works with people who have a DUI conviction and have been mandated to addiction counseling. “My experience in treatment has been primarily in Oregon, and first we had medical marijuana, and now its legal for recreational use. That has pretty much put medical marijuana on the back shelf. People can get it easily so there’s no reason to do the medical part.

“The thing that I find interesting about the medical piece in Arizona is that when you look at a chart for sales you see what happens every Friday: sales peak. And this is what we saw in Oregon, too. And look at what happens on April 20th … 4/20… another big peak. All these people on medical marijuana have a whole lot of pain on 4/20?”

Physical problems resulting from marijuana use can run the gamut, but one of the chief ones to emerge in the last several years is cyclical vomiting, also referred to as marijuana hyperemesis syndrome. “There is a complaint where patients come in with prolonged vomiting, not responsive to anti-emetics, which we’ve found is related to marijuana use,” observes Jake Whatley, an emergency department nurse in Sacramento, California. “We’re learning more and more about it, but we’re finding that people who smoke chronically and smoke a lot, either every day, or multiple times a day, are coming in and they’re having this intractable vomiting, so we’ll try things like Zofran, Reglan, Benadryl. We find that with the marijuana use those drugs don’t really work. One thing we’ve found that will is Haldol, which is an antipsychotic medication.”

Within the last few months, vaping has come under increased scrutiny because several thousand vapers across the nation have been hospitalized with severe lung ailments, and dozens of them have died. Some 80 percent of those vapers had used their devices for cannabis products, and there is speculation that “gray market” vitamin E acetate added to THC may be a culprit. At press time, the exact mechanism for the disease was still being sought.

It doesn’t necessarily require chronic use for cannabis to create an unpleasant, and possibly even dangerous effect. Marijuana’s tendency to invoke paranoia, and even a psychotic episode, is well documented. In January 2019, former New York Times investigative reporter Alex Berenson published the book Tell Your Children, an exhaustive analysis of the evidence that marijuana use (especially for people under age 25, or folks with mental health issues), can result in extreme reactions ranging from social withdrawal, to homicidal violence.

Berenson isn’t trying to craft a literary Reefer Madness campaign for modern times. Rather, he’s making the point that pot isn’t just a benign weed that makes people get sleepy, hungry, and abnormally fond of certain rock bands. And he’s warning potential users that today’s pot is a far cry from Woodstock-era weed. “The THC in marijuana in the 1970s was probably .3 to one percent,” concurs Dr. Sansom. “Maybe realistically it could be five percent in the ‘good’ stuff. Now you’re looking at it ranging from 10 to 20 percent THC. That’s significantly stronger.”

Though to some, Berenson’s prose may come off as alarmist, no one can accuse the Arizona Poison Drug Information Center of being anything but cool-headed and unbiased. Their mandate — from the state’s Department of Health — is to advise, not to judge.

Aside from calls from frantic parents whose child has ingested THC, or patients who want to know if marijuana will interfere with their blood pressure medication, the Center provides education to those who are overseeing the sales of the products.

“All Arizona dispensaries are required to have a medical director,” explains Center Director Mazda Shirazi, M.D. “They can be a primary care doctor, a surgeon, or a naturopath. They can have a variety of backgrounds. We were tasked to provide continuous medical education to them. It is not binding to the dispensaries to attend, but many of them send their medical directors or their representatives to our presentations. We try to go over all the findings and concerns, for example about children having exposure to edibles. Many edibles are not clearly marked, and they aren’t in child-proof packaging. Many dispensaries do not even say to the adults who are using them, ‘You need to keep them out of the hands of children.’ Our hope is that the industry will take that up.”

More than that, a lack of FDA oversight has physicians like Shirazi worried. “Most people do not understand that just because there is an industry doesn’t mean there’s purity testing to make sure the products are not contaminated with anything else.”

That will change in Arizona in November 2020, when a mandatory testing program begins. Such laboratory oversight will certainly aid in ensuring that what is being sold at local dispensaries isn’t contaminated with pesticides, mold, or unwanted chemicals, and that the percentage of THC or CBD in a product is correctly stated. Realizing that this regulation is actually good for their customers and their bottom line, some dispensaries aren’t waiting for the law to take effect. “We’ve been testing since early 2016,” says Asnani. “As soon as there was a lab that opened in Tucson that could handle it, I decided we had to start testing everything.”

Can We Talk?

In this brave new weed world, we’ve gone way beyond sitting around the campfire and lighting up to get a buzz. In the past 100 years, marijuana has come full circle: starting as a remedy for various ailments; becoming a banned substance that some people used to get high; and finally morphing into a high-tech-engineered product that’s marketed to treat more than a dozen conditions. But there’s still so much that we don’t know about cannabis, and haven’t really considered as more states (and entire nations, such as Canada), legalize it.

“Our goal as a society should be to have an honest discussion and ongoing research,” comments Dr. Shirazi. “Probably in the next 10 years many other states will allow medical, or adult use, and I think part of those taxes should go toward looking at the medical impact and what to do about it. We do have an agent out there — alcohol — that’s legal and we tax it, even though it causes lots of problems for us.

“We have a chance of dealing with this new agent — cannabis — and deciding how it’s going to be treated in our society much more logically in terms of its true impact, its benefits or risks.”

Opinions differ on whether a full legalization and regulation of cannabis is inevitable. But even some medical professionals who are working with the industry aren’t keen to see marijuana become a legit recreational substance such as alcohol. “I’m conflicted,” admits Dr. Burns. “With the medical marijuana program, we’ve taken two steps forward and we’re getting better, to the point where physicians from very well-known entities like Barrow and Banner are referring patients to us. If a recreational program gets in place, we’ll be taking several steps back again because people will say, ‘Look, that medical marijuana program was just a ruse for recreation.’”

It’s easy to see why there are such extreme camps when you begin to examine marijuana as medicine. You have a profit incentive for some non-medical people in the industry to say that it’s a treatment for nearly everything. And you have folks who have had experience in sweeping up the damage when we’re wrong about a medicine – such as what has happened in the opioid crisis — who are telling us to put the brakes on.

Michael Backes offers a clear-eyed summation of marijuana as medicine that cuts through the hype and fears. “There’s nothing really special about cannabis except that its compounds work throughout the body at a lot of different sites. And the reason is the compounds in cannabis are mimicking those our own body produces on demand. That’s the endocannabinoid system.

“What cannabis medicine can do ideally, if used correctly, is just restore a little balance so that your body can take over and go the rest of the way. That’s how medicine should work.”

Getting Carded

The situation is fairly straightforward for a patient seeking medical marijuana in Arizona, but there are still 50 shades of gray areas. Arizona voters passed the Medical Marijuana Question in 2010, and in 2012, sales began. Basically the state’s medical marijuana program (listed in the Arizona Administrative Code as Title 9, Health Services, Chapter 17), has recently been modified by the passage of SB 1494. The current rules are that you must have a medical marijuana card in order to purchase cannabis products from a licensed dispensary, and to obtain the card you first have to be examined by a physician. The cost of obtaining a medical marijuana card (not including the fee paid to the physician) is $150.

Having a card entitles you to purchase up to 2.5 ounces of cannabis product every 14 days. You are restricted on where you can consume it, however. The key is that it must be consumed in a private space. You can’t walk down the street toking on a joint, or vaping an extract, even with a card. It’s also illegal to smoke cannabis in a vehicle, and regardless of where you have smoked/vaped/ ingested, you can be charged with Driving Under the Influence if you get behind the wheel with THC in your system.

To CBD … Or Not To CBD

One of the remarks that you hear again and again from opponents to medical marijuana is that the way its being promoted to the public is misleading. Marijuana marketing is all over Tucson. You see signs for clinics that will do evaluations so someone can get their card. You glimpse billboards for services such as WeedMaps that will direct patients to dispensaries. Print advertising has popped up in numerous publications. And one cannabis component in particular — CBD — is enjoying the sort of ubiquitous presence in the media that’s usually reserved for winning sports teams and pop stars.

“I can’t believe the attention to CBD,” muses Andrew Weil, M.D. “It’s available on every street corner now, and everybody wants to put it in drinks and use it in all sorts of ways. I’d say the only solid evidence we have for benefits is control of seizures in kids who don’t respond to standard anti-seizure medication. The other claimed benefits, I don’t think we have good evidence for. The products out there, some of them may have traces of THC in them, which can give people a psychoactive effect or show up in drug tests. You have to be careful about the product, and I don’t know how to advise people on that because there’s such a range.”

Who, What, Why

Given that there are more than a dozen conditions for which a physician can prescribe cannabis in Arizona, what sorts of patients do dispensaries tend to see? “I would say the biggest thing is people who have been using opioids and they realize that the side effects of those are significantly harmful, and they’re doing it obviously for pain,” says Downtown Dispensary’s Moe Asnani. “If you look at the statistics, 89 percent of patients use it for pain. The average patient that we see is in their mid-40s. We have a location that’s close to UA, and you might assume we’re going to be getting younger patients, but we actually have a pretty diverse mix and they tend to lean a little bit older.”

Costs depend on the product and the amount, and dispensaries do run specials so patients can save during those discount days. Observes Asnani about his company’s pricing, “Most flower is about $30-50 an eighth of an ounce, or 2.5 grams. For the vape cartridges we make we offer buy-one-get-one deals basically every day and those work out to about $25 a pop for 500 mg, and closer to $45 for the 1000 mg versions.”

Edibles start around $5 and go up depending upon strength and quantity, and a topical with THC and CBD like iLAVA Touch retails for $60 for 2.85 ounces.

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