2009 was undeniably the "Year of Medical Marijuana" in Colorado as tens of thousands of patients came out of hiding and opted to be added to the state's medical marijuana registry. Thousands of others who had either never tried marijuana, or whose experience with the plant ended decades ago, began to cautiously ask family, friends and their doctors about medical marijuana and what realistic benefits they might expect. Despite a seemingly endless stream of media coverage on the issue, many people are still unclear what "medical" marijuana really means.
Medical Marijuana: The emerging science of applying marijuana's beneficial side effects to an individual patient's needs while minimizing the undesirable side effects on that patient's life.
Despite thousands of years of recorded history of marijuana use, modern science has been slow in studying this plant to better understand its botany, chemistry and the nature of marijuana's interaction with the human body. Although a variety of regulations have hindered modern scientific research on the cannabis sativa plant, researchers around the world have made significant discoveries. In the 1960s, researcher Raphael Mechoulam identified compounds in the plant called "cannabinoids" and then discovered that THC (tetrahydrocannabinol) was the only psychoactive cannabinoid. In the late 1980s, Allyn Howlett discovered that THC activates a previously unknown group of neurotransmitter receptors in the human brain and immune system. This discovery subsequently led researchers to identify "anandamide", a neurotransmitter produced by the body nearly identical to THC. From this starting point, thousands of researchers around the world have studied natural compounds found in marijuana and how those compounds can help treat a variety of medical conditions. In fact, the US Department of Health and Human Services was granted US Patent #6630507 in 2003 for the discovery that these cannabinoids have antioxidant properties that are beneficial for a variety of medical conditions.
Historic cannabis label.
Modern medicine places a high priority on understanding and mitigating detrimental side effects of new pharmaceutical compounds. The thousands of years of reported cannabis use without a single verifiable death provides a strong starting point for testing cannabis' safety, but even such an exceptional lack of reported deaths is not enough to determine whole-plant cannabis' safety. Modern research has indicated that the "Safety Ratio" of marijuana (ratio of a lethal dose to the effective dose) is at least 1,000. This means that the amount of THC required to kill a user is 1,000 times higher than the effective dose needed to feel the effects of a substance. By comparison, alcohol's safety ratio is 10, cocaine's is 15 and heroin's is 6. In plain terms, 2 shots of 80-proof whiskey delivers an "effective dose" of 28g of alcohol while about 20 shots is enough to kill someone. An effective dose of marijuana is reached after injesting a few breaths of cannabis vapor, but for marijuana to be lethal a person would have to consume 1,500 pounds of marijuana in approximately 14 minutes. More recently, researchers studying brain chemistry have discovered that the brain receptors where THC binds are missing from the parts of the brain controlling respiration and cardiac function. This indicates that marijuana is simply unable to bind to the parts of the brain that keep you alive.
While news of the medical benefits of marijuana have been widely reported, discoveries into the botany of the cannabis sativa plant have been much less publicized. We do know that 66 individual cannabinoids have been identified in the cannabis plant. Although THC is the only compound known to bind with receptors in the body, emerging research suggests that the ratio of different cannabinoids to THC is a strong determinant of the physical effects a patients will feel from using marijuana. Cannabis plants also produce over 120 different "terpenes," the essential oils and resins produced by virtually all plants. Plant-derived oils are used in a variety of medical uses from aromatherapy to naturopathic medicine for their ability to affect mood and assist in the delivery of other medicine. In much the same way, the oils in cannabis modify the experience felt by a patient and further expand the range of medical uses for the plant. Since cannabis reproduces sexually, combining two different strains of cannabis creates thousands of unique combinations of these cannabinoids, terpenes and other traits in the resulting seeds. Each of these combinations are called "strains" and offer a slightly different effect on users than other strains even from similar parentage.
Role of the Dispensary
The role of the dispensary is to assist a patient in determining which of the variations will produce the best effects for that patient's needs. This process often includes a discussion of the specific conditions being treated and advice on the strains other patients have had success using for similar conditions. The dispensaries currently serving patients across Colorado are able to stock any of hundreds of different locally-grown strains, plus a full compliment of edibles, extracts, tinctures, medicated oils and countless other products. This market-based system has allowed Colorado to build an entire medical marijuana industry in less than a year while improving the quality and variety of medicine safely and readily available to our patients.
What Does All This Mean?
The combined weight of anecdotal and scientific research into the physical risks of marijuana indicate that the plant is at least safe enough for further testing. As long as our most sophisticated researchers are prohibited from studying cannabis botany and sponsoring human medical trials, formal research into medical marijuana is likely to remain limited. State-based medical marijuana programs have emerged as a mechanism to both focus this research and provide legal protections for patients and caregivers who choose to experiment with medical marijuana on their own. While these programs lack the academic rigor of modern scientific research, adding a controlled market mechanism to a state-based medical marijuana law opens a new avenue for research and development into legitimate medical benefits of marijuana.
Other States' Medical Marijuana Programs
Although 14 states and the District of Columbia have passed laws protecting a patient's right to medical marijuana, only 6 states (California, Colorado, Maine, Montana, New Mexico, and Rhode Island) provide a mechanism for caregivers to work together to provide this medicine. Of those 6 states, 3 require caregivers to be non-profit and the number of licenses available are strictly controlled by their state governments. California is the best-known of the states allowing for medical marijuana dispensaries, but absent clear rules regarding dispensaries early in California's medical marijuana program virtually all regulation of these businesses were shifted to local governments and a patchwork of local regulations hinder current state-level reform and regulation.
How Colorado Can Responsibly Harness Medical Marijuana
The question before Colorado today is, "How should the supply chain of medical marijuana be regulated?" Are patients best served by only being able to work with a single marijuana grower, sheltered from public view? Are patients best served by a small number of state-managed non-profit caregiver entities? Are patients best served by the range of strains and medicated products available today in Colorado's dispensaries? Are there security concerns inherent to marijuana that cannot be addressed through smart regulation?
If Colorado embraces this challenge and openly discusses how we can appropriately regulate medical marijuana, the benefits could be enormous. A well-regulated market system encourages caregivers to develop new strains and marijuana-based products to better address their patients' individual needs. More transparency in the industry allows patients to research a variety of caregivers and choose the one that best meets their needs rather than using the only caregiver they can find. Applying existing sales tax and business regulations placed on other businesses specializing in plant-based medicine allows our local and state governments to reap the financial gain of entrepreneurial growth in this industry. Allowances for research or scientific testing would allow Colorado to take the lead in research into marijuana's botany, biology and chemistry. And most importantly, talking openly about this issue allows our citizens to feel comfortable that we are harnessing the potential of medical marijuana while appropriately containing any risks from such a system.
I'm proud to be a part of this difficult process in Colorado. Our state has taken up the unprecedented task of writing the first modern medical marijuana business regulations to define an appropriate medical marijuana supply chain. If Colorado's citizens let their legislators know we support market-based, reasonable regulations to medical marijuana; then our state can lead the nation in medical marijuana policy and reap the largest gains of new and continuing research into this plant.