Advocacy

Cannabis Position Statement

PreventEd’s top legislative priority for 2020 is ensuring that Amendment 2, Missouri’s medical marijuana program, is implemented in a way that promotes transparency, legitimacy, and the public health. The General Assembly should, at the least, pass legislation regulating marketing, tracking of sales, dispensary staff training, and limits on edibles.

Read our agency position statements on cannabis below.

Medical

In 2013, Illinois enacted statute that allowed for people to access cannabis for a narrow range of conditions. In the intervening 6 years, 55 medical dispensaries opened across the state of 12.7M people. In 2019, Illinois expanded its medical program to allow for the substitution of cannabis for opioids, and shortly thereafter statute was passed to allow for recreational use of the drug.

In November 2018, Missouri amended the state constitution to create a medical cannabis program. This program is broad both as it relates to patient access and as to the limits it places on the state’s ability to regulate the industry. 

Ensuring safety and efficacy of cannabis for responsible medicinal applications form the guiding principles for PreventEd’s policy in this area.

PreventEd supports federal rescheduling of cannabis for the purpose of facilitating research and allowing science to lead the discussion concerning medical uses. This change should permit pharmaceutical professionals to engage in: isolation of therapeutic chemical compounds; double blind testing; refinement into medications of known potency, duration of effect, side effects, and purity; and ultimately, pursuit of FDA approval.

As with any medication, the potential benefit of cannabis as medicine should be weighed against risk factors including, but not limited to: side effects, addiction potential, and lack of efficacy.

PreventEd is advising state and local governments regarding the following issues:

Advertising

Cannabis products should not be advertised in a manner that explicitly or implicitly makes unsubstantiated health claims. This includes messages that either subvert discussion of harms associated with cannabis use or implies that it addresses conditions for which no evidence exists. Nor should medical cannabis be marketed in a manner designed to promote non-medical use.

Tracking of sales

The Department of Health and Senior Services should track individual purchases of cannabis to ensure patients do not exceed regulatory limits in any given time period.

Dispensary staff training

Dispensary staff should be trained regarding side effects of cannabis use as well as potential interaction with other medications. Training should include how various methods of administration impact these effects. Dispensary staff should communicate these potential harms to patients at the point of sale. Staff also should be trained on HIPAA protocols and procedures.

Labeling

Every medical cannabis product sold should contain factual statements warning against the potential for misuse and addiction, potential side effects, and noting that the product is not regulated or approved by the FDA for the prevention, treatment, or cure of any medical condition. Such labeling also should include dosage, potency, and administration instructions.

Limits on edibles

Edibles should be limited to products that do not appeal to children, including but not limited to: a prohibition on baked goods (cookies, brownies, cakes), candies (gummies, chocolates, etc), flavors, and others.

Distances from schools/places of worship

Medical dispensaries should be treated similar to pharmacies, assuming that the recommended restrictions on advertising and signage are enacted.

Penalties

Penalties should exist to deter consumers from possessing more than their medically necessary allotment. However, penalties should be focused primarily on retailers, manufacturers, and cultivators that violate regulations and statutes governing the industry.

Patient certification

Patients should be required to be recertified on at least an annual basis, and the recertification should include screening for substance use disorder.

Physician legitimacy

The physician recommendation process should be one of integrity. The presumption of a recommendation should not exist prior to patient examination and consultation. Physician recommendations must be based on evidence, not profit.

Resources

Dispensary staff and medical providers who engage with those who use medical cannabis should be able to provide resources on demand for those who may have developed a cannabis use disorder.

Recreational

Eleven (11) states, including Illinois, have legalized recreational cannabis. In Illinois, cannabis became available for recreational use beginning January 1, 2020. It is anticipated that Missouri will confront legalization in the near future.

PreventEd believes substance misuse should be addressed as a public health concern. Responding through the criminal justice system does not provide equitable opportunities for evidence- based treatments and recovery in a behavioral health setting. Additionally, PreventEd objects to the commercialization of cannabis because, as seen with alcohol and nicotine, commercially profiting from addictive substances provides powerful incentives for industry to expand markets to vulnerable populations, including young children, with messages and images designed to encourage experimentation and the development of substance use disorders.

Below are our policy positions for Illinois as they look to implement recreational use and Missouri if the issue comes to the forefront.

Age

Recreational cannabis should not be available under the age of 21. Penalties for selling to an underage individual should be calibrated to deter violations of laws.

Product limits

Products should be designed in ways not to appeal to the underage population, including, but not limited to restrictions on edibles, flavoring, creative artwork, and similar tactics. Additionally, limits should exist on product potency for recreational purposes as well as the amount of product an individual can possess at a given time, in order to limit diversion to the grey market. “Home grow” cannabis should not be permitted.

Inspections

State and local health officials should be required to inspect all aspects of the supply chain from cultivation to sale to ensure compliance with state and local regulations, including: sanitation, product testing, purity, and compliance with point of sale and other restrictions.

Advertising

Advertising should be restricted in a manner consistent with constitutional protections. Every product sold should contain factual statements warning against the potential for misuse and addiction, potential side effects, and potency.

Revenues

A material portion of tax revenues garnered from recreational cannabis sales should be dedicated to address the health impacts of increased cannabis use.

CBD (Cannabidiol)

Cannabidiol (CBD) is an active ingredient derived from both high THC and low THC strains of hemp. Those plant varieties with THC levels above a certain point are referred to as cannabis. At the federal level CBD derived from hemp is legal, whereas CBD derived from cannabis is legal in the form of certain FDA approved medications.

CBD is infused into foods, drinks, pet treats, lotions, and almost any consumable product one can find. Claims regarding CBD include alleged anti-inflammatory properties, anxiety reduction, skin/hair/nail health, pain relief, eliminating nausea, addressing neurological problems, heart health, diabetes prevention, tumor reduction, and treatment for substance use disorders. Many of those who sell this product would allege other healthful properties as well. The data behind CBD is far less conclusive.

PreventEd’s position with regard to unregulated CBD is nuanced, but can best be summed up as “you’re on your own” and “buyer beware.” While there is evidence that CBD can be helpful to patients experiencing certain seizure conditions, Dr. Nora Volkow with the National Institutes for Drug Abuse (NIDA) states, “While the existing data show promise, it is still too soon to tell whether and for whom CBD will be effective.”

Epidiolex

One pharmaceutical-grade CBD product has been approved by FDA: GW Pharmaceutical’s Epidiolex. Epidiolex is a prescription medicine used to treat seizures in people with Lennox-Gastaut syndrome or Dravet syndrome.

PreventEd supports the availability of FDA approved medications. If a physician and patient feel that Epidiolex may provide benefit, we support their ability to access and use this medication.

FDA Regulation

With the exception of Epidiolex, The FDA has not approved unregulated CBD products. According to the FDA,

Unlike drug products approved by the FDA, unapproved CBD drug products have not been subject to FDA review as part of the drug approval process, and there has been no FDA evaluation regarding whether they are safe and effective to treat a particular disease, what the proper dosage is, how they could interact with other drugs or foods, or whether they have dangerous side effects or other safety concerns.

Misleading and false claims associated with CBD products may lead consumers to put off getting important medical care, such as proper diagnosis, treatment, and supportive care. For that reason, it’s important to talk to your doctor about the best way to treat diseases or conditions with existing, approved treatment options.

PreventEd recommends that the FDA regulate CBD as a dietary supplement and ensure accuracy of potency, legitimacy of medical claims, and monitor for side effects. The FDA is currently examining its options to do just that.

Department of Agriculture Regulation

According to the US Department of Agriculture (USDA), industrial hemp cannot have a THC concentration more than 0.3 percent on a dry weight basis.

Efforts to ensure commercially available CBD products are tested for the minimum allowable THC content should be encouraged. Additionally, products should be tested to verify the accuracy of product labeling and ingredient listing.

Advertising/Labeling

Until there is federal regulation, PreventEd believes that consumer education is critical. Adults should have access to medically accurate information with regard to what they are putting into their bodies.

Commercially available CBD products should not be advertised in a manner that explicitly or implicitly makes unsubstantiated health claims. This includes messages that either subvert discussion of harms associated with CBD use or implies that it addresses conditions for which no evidence exists.

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