Regulatory and legislative disparities with cannabis present challenges to P&T committees and health care providers ​

In Summary

​An article has recently been published that gives a summary of current federal and state cannabis laws and highlights the arising regulatory and legislative challenges. Cannabis is still considered a Schedule I drug at the federal level under the Controlled Substances Act but the FDA approval of Edioplex, a cannabidiol (CBD)-based epilepsy medication, has caused CBD to be ruled as a Schedule V drug by the Drug Enforcement Agency. The piece explains the implications of CBD approval, including the Farm Bill passed in 2018 and discusses the intricacies of maneuvering between federal and state drug regulations. Current laws, even at the federal level, show a shift towards the approval of cannabis products but there is still a long way to go. 
The article also highlights and attempts to explain the difficulties that physicians, budtenders,  and pharmacists in prescribing, licensing, and providing cannabis. Some states, not including Massachusetts, require that pharmacists provide cannabis so that they can properly advise patients about the risks and benefits of cannabis use. Massachusetts (MA), like many other states who have legalized medical cannabis, do not require budtenders at dispensaries to possess any prior medical knowledge, meaning that their advice on which strain or product a patient should try can be extremely under-informed and subjective. Patients in states like MA should take care to speak with their licensing physician or nurse practitioner about which cannabinoids or products would likely be best for them. 

View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan 

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In Summary

As the medical cannabis industry grows and local governments continue to legalize medical cannabis use state programs are forced to set standards without the aid of the federal government. State governments are now facing the challenge of attempting to regulate medical cannabis while maintaining the safety of patients and the general public. States now have to regulate labeling with universal warning symbols, child-resistant packaging, advertising restrictions, and pesticide use while also addressing members of the public's concern about the safety of medical cannabis. If cannabis is ever rescheduled in the future so that the federal government can standardize the regulation of cannabis practices across the nation it will be interesting to see how local practices change in accordance. 
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Despite multiple petitions and new research, the federal government has refused to reschedule cannabis. Cannabis used to be an accepted medication before a few politicians, namely Harry Anslinger began a propaganda campaign, highlighted by the film Reefer Madness (1936), turning the public opinion away from medical cannabis. This was largely thought to be a move to further ostracize minorities, further segregating races as Anslinger connected marijuana to violence to immigrants from Mexico. Cannabis never became medically dangerous in the early 1900s, merely a tool used by politicians to induce public fear and reinforce racist tendencies. In the featured article it was stated that 9 out of 10 Americans support the use of medical marijuana yet cannabis still has yet to be rescheduled and the reasons behind it are unclear but may lead back to the original push to have cannabis outlawed in the first place.

In Summary

 Earlier this July a letter was published providing evidence that adolescent cannabis use may actually decrease post-legalization of medical and recreational cannabis. An analysis of Youth Risk Behavioral Surveys from the past two decades revealed that legalizing medical cannabis had little to no effect on cannabis use among adolescents in 8th and 10th grade but that legalization of recreational cannabis actually led to an overall decrease of adolescent cannabis use across the states. The authors hypothesize that the rate of adolescent use may decrease as illegal drug dealers are replaced by legal, regulated dispensaries. This evidence may prove compelling for the possible rescheduling of cannabis under the federal Controlled Substances Act. 
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Adolescent substance use, like that of alcohol, has been found to be detrimental to brain development. There have been varying results regarding the effects of adolescent cannabis use on brain development yet some caretakers are given special permission to administer cannabis-based products to children experiencing rare forms of epilepsy or other seizure disorders. Cannabis-based medications may be a more ethical and far less dangerous substance to administer to children so that they aren’t set up for a substance use disorder at a young age.  The research focussed on adolescent cannabis use needs to be conducted for better regulations and to better advise the parents and pediatricians of adolescents who have accidentally consumed cannabis or need a cannabis-based medical intervention.