Cannabis: Crisis or Cure?

The Two-Year Battle for Medical Marijuana in the State of Ohio

By Breanna Beers

With the passing of House Bill 523 in 2016, Ohio joined 30 other states that have now legalized marijuana for medical use. Over two years later, however, there are still no facilities approved to process the drug, no physicians permitted to prescribe it, and no pharmacists authorized to dispense  it. So what does this law entail, and what has it actually accomplished?

On Sept. 14, Cresco Labs received its certificate of operation from the state of Ohio, allowing the facility to cultivate marijuana for medical purposes. The next day, Cresco gardeners planted more than 30 strains of cannabis in their newly built facility in Yellow Springs, Ohio.

Former Yellow Springs Village Council President Karen Wintrow, who approved the sale of undeveloped Yellow Springs property to Cresco in June 2017, was thrilled to see the facility finally up and running.

“It’s an innovative, growing business with a lot of potential in this state,” said Wintrow. “They’re concerned with wellness and taking care of patients … with what I would say is a less harmful solution than opioids for pain.”

In an area seriously affected by the current opioid crisis — Dayton, Ohio, just a few miles away, has been labeled the ‘overdose capital of the nation’ — the concern for patients was a key factor in the passing of this bill. However, will medical marijuana really help? Pharmacy professor Dr. Dennis Sullivan has some doubts.

“I have grave misgivings about opening up the use of medical marijuana in Ohio, for three reasons,” said Sullivan. “One, I don’t feel like the medical evidence is as strong as it should be. Two, I am concerned about possibilities for abuse. Three, I’m worried that it could possibly be a gateway for the abuse of illegal drugs.”

First, Sullivan said, the evidence for the medical benefits of marijuana is minimal, mixed, and mostly anecdotal. Due to the long-time illegality of the substance, controlled clinical studies have been limited until very recently. Varying forms of the product and concentrations of active chemicals further complicate the data.

According to one study published by the American Medical Association, patients in states with legal medical marijuana filed fewer Medicare claims for prescription opioids than patients in states where medical marijuana is still illegal. Another study published in an International Cannabinoid Research Society (ICRS) journal found that patients reported that cannabis provided relief “on par with other medications,” such as opioids, but without the unwanted side effects often associated with these substances. However, both these studies are based on patient responses, not actual medical observations, and the ICRS study concluded only that further research should track clinical outcomes for patients who switch to cannabis for pain.

Yet while the full implications of switching from opioids to marijuana for the treatment of pain has not been extensively studied, some limited studies do suggest that the risk of addiction may be slightly lower for marijuana than for opioids. Additionally, while marijuana overdose can have serious consequences, it is unlikely to be lethal, a serious advantage compared to opioids.

Sullivan’s second concern, that there may be a high risk of cannabis abuse, is based on the complicated legal status of the drug. Ohio House Bill 523 categorizes marijuana as a Schedule II substance — one with some legitimate medical use, but a “high potential for abuse” and serious risk of “severe psychological or physical dependence.” Federally, however, the Drug Enforcement Agency considers marijuana a Schedule I drug — one with “no currently accepted medical use” and serious potential for abuse.

This gap between federal and state classifications of the drug, Sullivan said, is a significant problem for all states with medical or recreational marijuana. First, it means that any cannabis legalization laws are technically unconstitutional and could be removed at any time if the attorney general should choose to enforce the federal classification .

Second, it means that under federal law, no physicians can legally prescribe marijuana, nor can pharmacists dispense it. Instead, Ohio grants licenses to doctors to recommend cannabis as a medical treatment. Patients themselves then take this recommendation to approved marijuana dispensaries to obtain their medication, rather than to a licensed pharmacy.

This protocol leaves a lot of gray areas, giving Sullivan serious concerns about the potential for abuse, especially considering that possession of up to 100 grams of marijuana — even without a physician’s recommendation — was largely decriminalized in 1975.

Additionally, while the state has selected physicians, dispensaries, testing labs, and cultivators such as Cresco Labs, Ohio has yet to approve any facilities for processing raw plant matter into the five forms approved for medical use: oils, tinctures, extract, edibles, and patches. According to Wintrow, the connection between growers and processors is critical. The Cresco Labs facility was built as both a greenhouse for cultivation and a lab for processing, and she hopes that state licenses to make the site fully operational are coming soon.

“The idea of the connection between the plant material and the final product is so critical because as cultivators they can really cultivate the plant to address particular afflictions with particular strains and particular characteristics,” said Wintrow. “So if they’re cultivating the plant and the end product they can provide a product that has much greater efficacy for patients.”

The state has no clear timeline on when these licenses will be given, having pushed the deadline back several times (the entire system was supposed to be fully operational with product ready to dispense by Sept. 8 of this year), which means that for now, the plants currently in the ground have nowhere to be processed once mature.

Sullivan’s third concern is that marijuana may serve as a “gateway drug,” leading to further substance abuse, legal or illegal. One study analyzing data from the National Epidemiological Survey on Alcohol and Related Conditions found that cannabis use is associated with “increased risk of alcohol use disorder onset and persistence.”

Another study using data from the same organization found that nearly 50 percent of participants who used cannabis before any other drug later progressed to other illicit drug use at some point in their lives. The authors of the study also acknowledged that sociodemographic factors such as psychiatric disorders and economic status likely also played a role.

The lack of clinical evidence to support the use of marijuana as a medical treatment combined with the known risks lead Sullivan to doubt the wisdom of the legislative decision.

“I’ve been involved in a lot of discussions about the ethics of opening up laws for permitting marijuana in Ohio for medical reasons,” Sullivan said. “I am very concerned about the potential risks of this new legislation.

However, while full implementation is yet to come, the legislation has already been passed. Sullivan’s hope is that regulation will be carefully implemented, physicians will be wise in their recommendations, and patient care will remain a priority. In time, legal bumps may be smoothed, and further clinical studies may provide more reliable conclusions.

Wintrow expressed confidence that Cresco Labs will ultimately be a positive addition to the village of Yellow Springs through its innovative process, environmental consciousness, and community impact, as well as providing an economic boost to the area.

“They did the installation of the infrastructure, and that opened up the rest of the park for additional development,” Wintrow said. “We’ve taken a piece of ground that was basically getting just a few hundred dollars a year as agriculture, and turned it into tens of thousands a year in property tax revenue to the village, most of which will go to the schools.”

According to Wintrow, Cresco Labs is known for its energy efficiency, local philanthropy, and community support. She is hopeful that marijuana may ultimately prove to be a safer and more effective treatment for chronic pain and other ailments than the current alternatives, despite the risks.

Note: The views expressed in this article represent the opinions of the individuals interviewed, and in no way reflect on the perspective, values, or standards of Cedarville University as an institution.

Breanna Beers is a sophomore molecular and cellular biology major and the interim off-campus news editor for Cedars. She loves exercising curiosity, hiking new trails, and quoting The Princess Bride whether it’s relevant or not.