Accurate Education – Marijuana (Cannabis): Legislative Update

Marijuana (Cannabis)

 

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.

 

Legislative Update

The use of marijuana for recreational or medical purposes remains highly controversial. While Louisiana has recently passed new legislation legalizing marijuana (cannabis) for medical use, it is likely to not be fully implemented until late 2018 or later.

 

Terminology

Prescription Cannabinoids

The term “prescription cannabinoid” refers to products containing one or more marijuana plant-derived or synthetically manufactured cannabinoids that are available by prescription only. Currently in the U.S. only three prescription cannabinoids are FDA-approved and legal to be prescribed in all states. These include:

  1. Cesamet (nabilone, a synthetic cannabinoid similar to THC) – Available in the U.S.
  2. Epidiolex (a plant-derived CBD) – Available in the U.S.
  3. Marinol (dronabinol, a synthetic THC) – Available in the U.S.

 

Sativex (a combination of THC and CBD in a 1:1 ratio) is a prescription cannabinoid available in Canada and Europe but not yet FDA-approved or available in the U.S.  Some of the most informative research into medical uses of marijuana has come from studies evaluating Sativex because it is plant-base and contains both THC and CBD as well as other pharmacologicaly significant cannabis plant constituents including some terpenes.

 

Medical Marijuana:

This term is in popular use but it is imprecise.  It generally refers broadly to dried cannabis dispensed or otherwise obtained and used either for supervised medical purposes or for self-medication. In a more accurate context, the term “cannabis” or “dried cannabis” is preferred when describing the plant form.

 

Cannabis/Dried Cannabis:

The terms “cannabis” or “dried cannabis” refer to the marijuana in its plant form.

 

Pharmaceutical Cannabinoids:

The term “pharmaceutical cannabinoid” refers to cannabinoids that may be available without a prescription that  are generally derived from the marijuana plant and manufactured under controlled commercial conditions. Which of these products are available without a prescription varies state by state and the quality of manufacturing may also vary significantly from one product to another, with little to no regulatory oversight over the manufacturing process.

 

In Louisiana, the only pharmaceutical cannabinoid currently legal and available is cannabidiol if it is 100% pure and manufactured from cannabis stems or seeds, not leaves or flowers. Louisiama has now legalized other cannabinoids including THC, likely in the forms of capsules and tinctures only, expected to become available in the fall of 2018.

 

Tinctures

Tinctures are produced by steeping cannabis flowers in alcohol while applying low heat which allows the active compounds in cannabis to infuse into the alcohol. This infusion is then concentrated, resulting is a potent liquid that contains various cannabinoids and other constituents. Manufacturers often add carrier oils and other complementary ingredients, such as an orange oil to improve the taste of a tincture. Tinctures can be taken orally or sublingually (under the tongue).

 

 

 

See below for more information about Medical Marijuana in LA

 

The guidelines previously establishd by the LA State Board of Medical Examiners dictated that the use of illicit marijuana could not be allowed in my opioid pain management program. Due to recent legislation, the growing knowledge regarding the combined use of opioids and medical marijuana, and changing attitutudes to the use of marijauan, it may be possible in the near future that it would not be necessary to forbid the use of illicit marijuana in patients who are prescribed opioids. Nevertheless, the legal ramifications remain unclear and until these are resolved, patients in the Accurate Clinic opioid pain management program are  still advised they must discontinue use of illicit cannabis or be terminated from opioid management. Discontinuing chronic use of cannabis products may be difficult and may be associated with withdrawal symptoms (see Marijuana – Discontinuing Use).

 

See:

Marijuana – Legislative Update for Louisiana

Marijuana – Medical Use Overview

Marijuana – Prescription Cannabinoids

Marijuana – Cannabidiol (CBD)

Marijuana – Edibles (coming soon)

Marijuana – Inhaled (Smoked and Vaporized)

Marijuana – Cannabinoids and Opioids (coming soon)

Marijuana – Pharmacokinetics

Marijuana – The Endocannabinoid System (coming soon)

    

See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder (CUD)

 

 

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

 

Medical Marijuana (Cannabis) in Louisiana

While Louisiana has recently passed new legislation legalizing medical marijuana (cannabis), it is likely to not be fully implemented until late 2018. Amongst other hurdles,  the state boards of pharmacy annd medical examiners must determine the specific products to be made available, including quantities and strengths and the combination ratios of different constituent components including THC and cannabadiol (CBD) . Furthermore, they must determine what constitutes a month’s supply for prescribing purposes. Contrary to the previous stance by the LA Board of Medical Examiners, it appears that medical marijuana will be allowed to be prescribed in conjunction with opioids.

 

The most recent legislation, House Bills 579 & 672, were signed by the governor and became law on 8/1/18.  The current form of legislation dictates that medical marijuana may be used for treatment of the following conditions, although this list may change in the future:

 

  1. Intractable Pain
  2. Severe muscle spasm
  3. PTSD
  4. Crohns
  5. Spasticity such as Spastic Quadriplegia
  6. Chemotherapy in the treatment of cancer
  7. Certain seizure disorders
  8. HIV/AIDS complications such as cachexia or wasting syndrome
  9. Debilitating medical conditions such as Parkinsons and Muscular Dystrophy
  10. Multiple Sclerosis
  11. Autism

 

Caveats to the above include the definition of intractable pain which legislation defines as “A pain state in which the cause of pain cannot be removed or otherwise treated with the consent of the patient and which in the generally accepted course of medical practice , no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts. It is pain so chronic and severe as to warrant an opioid prscritpion.”

 

Similar to the prescribing of opioids, medical marijuana is not the first “go-to” treatment for the above conditions. A patient must first trial and fail conventional, conservative therapy. While not specified, it is likely that medical marijuana may be prescribed without first establishing a failed course of opioid therapy.

 

Cannabidiol (CBD)

CBD – Legal Status

There exists a great deal of confusion for researchers, practitioners and patients with regard to CBD products. This confusion arised from conflict between federal and state laws on the medical use of cannabis products, the lack of consistency among state laws and the availability of many artisanal cannabis and CBD products.

 

Federal Law

The DEA’s most recent denial of two marijuana rescheduling petitions means that marijuana and its constituent cannabinoids, including CBD from any source (including hemp), will remain Schedule I.  Based on federal law, all Schedule I drugs are illegal in all states. This conclusion is based on a recent legal review article published in 2017.  However, while the DEA maintains that CBD is definitely still illegal, in November 2017 a spokesperson for the agency stated that while those who violate federal drug laws could run the “risk of arrest and prosecution,”  the DEA is not “going after” individuals who benefit from CBD oil.

 

Louisiana Law

Currently, cannabidiol products are legal in Louisiana but only if derived from industrial hemp seeds and/stalks but not flowers or leaves, not synthetic, and they must be 100% free of THC (See: House Bill 225 – 2017). 

 

Availability of Medical Marijuana Products

There are only two medical marijuana growers licensed in LA, Southern University and LSU. Each of these growers are using different resources to produce the products that will be available to LA residents who qualify for prescriptions. Reportedly, LSU will have products available by October, or November.  Southern University will reportedly have products available in February, 2019.  However, these predictions do not appear reliable.

 

Currently, there will only be nine licensed pharmacies allowed to dispense medical marijuana. The exact products to be made available are unknown but the law allows medical marijuana to only be in the form of a pill or tincture. Dried plant is not to be included and no product that is intended to be smoked or vaped will be legal.

 

The Nine Pharmacies:

New Orleans Region

H&W Drug Store will be located at 4718 Paris Ave. in Gentilly. 

Central Louisiana – Alexandria

The Medicine Cabinet Pharmacy will be located at 403 Bolton Ave.

Southeastern Louisiana – Madisonville

 It will be located at 1519 W. Highway 22 in Madisonville.

Shreveport Region – Shreveport

Hope Pharmacy will be located at 1410 E. Kings Highway in Shreveport.

Monroe Region – West Monroe

Delta Medmar will be located at 111 McMillan Road in West Monroe.

Acadiana – Lafayette

The Apothecary Shoppe will be located at 620 Guilbeau Road in Lafayette.

Capitol Region – Baton Rouge

Capitol Wellness Solutions will be located at 7941 Picardy Ave in Baton Rouge.

Teche Region – Houma

Green Leaf Dispensary will be located 6048 W. Park Ave. in Houma. 

Southwestern Louisiana Region – Lake Charles

Medicis will be located at 1727 Imperial Blvd. in Lake Charles.

 

Resources:

www.Healer.com

This website appears to be good resource for exploring medical marijuana.

 

References:

Medical Marijuana – Federal

  1. The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. law – 2017

 

Medical Marijuana – Louisiana

  1. louisiana-medical-marijuana-expansion-bill-signed-into-law-may-20-2016
  2. louisiana-2016-sb180-chaptered
  3. medical-marijuana-in-louisiana-who-will-get-access-june-2015
  4. now-in-effect-louisiana-medical-marijuana-law-shields-patients-and-caregivers-from-prosecution-aug-5-2016
  5. La house committee passes bill to allow medical marijuana prescription 4-5 2018
  6. HOUSE BILL NO. 225 – 2017 Regular Session

 

Medical Marijuana – Colorado

  1. The Clinical Conundrum of Medical Marijuana – 2017

Medical Marijuana –Pain

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients

 

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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