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MEDICAL CANNABISOverview of State Policies
Samantha Slaughter-Mason, MPH
PhD Student, Health Systems & Policy
Portland State University-Oregon Health & Science UniversityMay 30, 2019
Disclosure
Family member previously a medical cannabis grower,
currently works for a recreational grow in Oregon
Learning Objectives
Understand the
current medical
cannabis policy
landscape & how
we got here
Be able to identify
policy levers to
“medicalize”
cannabis use
Understand how
states are
approaching
medical cannabis
& opioids
US History of
Cannabis Policy
UNREGULATED
1850
Cannabis
included in US
Pharmacopeia
1937
Marihuana Tax
Act
1911
States start to
enact cannabis
prohibitions
1914
Harrison
Narcotics Act
BUREAU OF NARCOTICS
DEPT. OF TREASURY
1956
Narcotic
Control Act
1961
UN Single
Convention on
Narcotic Drugs
1970
Comprehensive
Drug Abuse
Prevention &
Control Act
BUREAU OF NARCOTICS & DANGEROUS DRUGS
DEPT. OF JUSTICEBUREAU OF NARCOTICS
DEPT. OF TREASURY
ERA OF LEGALIZATION &
REGULATION1973 1988
States begin to
decriminalize
cannabis
UN Convention
against Illicit Traffic
in Narcotic Drugs &
Psychotropic
Substances
DRUG ENFORCEMENT ADMINISTRATION
DEPT. OF JUSTICE
1996
States begin to
legalize medical
cannabis use
Expanding Information
1900-29
1930-39
1940-49
1950-59
1960-69
1970-79
1980-89
1990-99
2000-09
2010-18
Shifting Public Perception
States begin to
legalize medical
cannabis use
States begin to
decriminalize
cannabis
Should be legal
Should be illegal
0
25
50
75
100
1969 1973 1977 1981 1985 1996 2001 2005 2009 2013 2017
States begin to
legalize adult use/
recreational
State PoliciesC U R R E N T P O L I C Y A S O F M A Y 2 0 1 9
Federal prohibition has resulted in a patchwork of state
approaches.
Since 1996, 46 states and the District of Columbia have
enacted some form of cannabis medial legislation
State medical cannabis programs serve over 3 million
patientsMedical & Adult Use
Medical
CBD only or limited use
Increasing Patient Populations
0 100000 200000 300000 400000 500000 600000 700000 800000 900000
2009
2010
2011
2012
2013
2014
2015
2016
2017
Boehnke KF, Gangopadhyay S, Clauw DJ, & Haffajee RL. Qualifying conditions of medical cannabis license holders in the United States. Health Affairs; 2019, 2:295-302.
Regulating Use
Testing & Labeling
Manufacturing &
Distribution
TaxationPatient-Provider
Relationship
Provider Training
Modes of
Ingestion
Patient RequirementsStates have varying requirements for patients to be registered in medical cannabis programs
Patient registers with the
state, or obtains a
license to access medical
cannabis
Registration/License
Medical provider
certifies patient has
qualifying medical
condition
Certification
Patient presents with
qualifying medical
condition, as recognized
by state
Qualifying Condition
Patient accesses medical
cannabis/product
through legal sources
Access Legal Product
Qualifying Medical ConditionsStates allow cannabis use for conditions despite a range of evidence
LIMITED EVIDENCE OF INEFFICACY
NONE OR INSUFFICIENT
LIMITED
SUBSTANTIAL
29
31
CONCLUSIVE
31
32
21
Qualifying Conditions by State Policy Type
10%
33%
5%2%6%
27%
1%
3%
3%
3%
7%
Cancer
“Medicalized”
States
Chronic pain
Epilepsy
Glaucoma
IBD
MS
PTSD
Spinal cord injury
Chemo-related nausea
Cachexia
Other
3%
68%
2%
14%
4%
6% 3%
“Non-
Medicalized”
States
Boehnke KF, Gangopadhyay S, Clauw DJ, & Haffajee RL. Qualifying conditions of medical cannabis license holders in the Unit
ed States. Health Affairs; 2019, 2:295-302.
Medical Cannabis Policy & Opioids
MO
A chronic
medical
condition that
Rx drug could
lead to
dependence,
and cannabis
may be a safer
alternative
Opioid Use
Disorder as an
adjunct to
Medication
Assisted
Therapy
NJ NY PA UT WV
Pain that
degrades
health and
functional
capability as
an alternative
to opioid use
Opioid use
disorder for
which
conventional
Tx is
contraindicated
or ineffective
Pain lasting
longer than 2
weeks not
managed by
conventional Tx
other than
opioids or
opiates
Severe, chronic
pain for which
conventional &
opioid Tx
contraindicated
or ineffective
4.1/100K71.8/100 22/100K44.2/100 15.1/100K51.3/100 18.5100K88.6/100 16.4/100K73.1/100 49.6/100K81.3/100
OPIOID RX OPIOID DEATH
NIDA. Opioid summaries by state. https://www.drugabuse.gov/opioid-summaries-by-state
Considerations Related to Opioid UseEvidence on the relationship between medical cannabis policy & opioid use is mixed
Potential
substitution
effect
Potential
no/little effect
Potential
increased risk
of OUD
Samantha Slaughter-MasonP h D S T U D E N T , H E A L T H S Y S T E M S & P O L I C Y
