Legal Cannabis: Party Hearty or By Prescription Only?
by SAVANNAH SMITH
Today, in the United States, it is no longer a question of whether or not marijuana should be legalized—but rather, when and how. What sort of regulation and oversight will it have? Should we treat it like a medicine or a party favor? And if we treat it like a medicine, would availability be over-the-counter, like Tylenol, or should it only be available via prescription like Amoxicillin or Vicodin? Conversely, if we treat it like a party favor, do we regulate it like alcohol, or is it accepted as more innocuous, with health benefits like green tea? The answers to such questions rest in part with the people moving the pieces in legalization: no longer the long-haired hippies and social justice activists of yore, but men in suits and ties, discussing profit margins and negotiating production tiers. The primary driving factor behind legalization is, problematically, no longer access to a useful medicine, but access to tax revenue and market shares.
Useful as a case study, Washington State has been on the forefront of the marijuana reform movement for the past two decades—being the second state to legalize medical marijuana in 1998 and one of the first to legalize recreational marijuana, along with Colorado, in 2012. The newest evolution of Washington’s cannabis policy however, reveals another trend: in 2015, the state became the first to completely collapse their medical program in favor of a solely recreational marketplace. Disconcertingly, this change indicates an increased focus of the industry’s focus on commercial profitability, rather than the plant’s utility and accessibility as a medicine and raw industrial material.
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A Canna-Tourist’s Tale
Daryian is an Ohio resident who currently uses black market cannabis to cope with fibromyalgia, IBS, chronic nausea, and lack of appetite. She visited Washington for a week-long vacation in March 2016, and agreed to answer some questions about her typical use in Ohio and how her experiences changed while she had access to legal recreational buds in Washington. Unsurprisingly, the first thing she mentioned was that the use during her visit was “more recreational.” She proclaims candidly, “I was high from the moment I got into my friend’s car at the airport until the moment I got out of the car to fly home.”
At home in Ohio, Daryian consumes cannabis the old-fashioned way—lighting it on fire and inhaling the smoke through a glass pipe—but simple dry herb is the least exciting of the offerings within a recreational marketplace. Edibles, extracts, and concentrates afford a cannabis consumer the ability to eat a candy, swallow a capsule, or vaporize wax or oil: sparing them the harmful carcinogens introduced by traditional combustion. Still, Daryian says she stuck to combusting dry herb during her brief stay but admits that if she lived in Washington, she would definitely try other ways of ingesting, “because smoking regularly [if there were other options] just wouldn’t make sense for my lungs!"
When asked about the shops themselves, Daryian shrugs as she describes a clean, well-lit place full of glass cases and helpful staff. Employees are not permitted to give advice about medical treatment, but can inquire about the customer’s desired effects and advise accordingly. She told the clerk she preferred a relaxing body high, and paid $45 for 3.5 grams of an indica strain called, “Cookies.” In Ohio, Daryian would pay between $40-$50 for the same amount of product, but receives a small price-per-unit discount if she buys in bulk. Washington law, however, dictates that each 3.5g unit be purchased as a separate individual product. Or, for purposes of comparison, it is the marijuana equivalent of Washington State outlawing the sale of six-packs, cases, and kegs, then requiring stores to sell each beer individually at a mark-up.
Despite this price differential, Daryian felt very positively about her experiences. What she enjoyed most about her visit overall, she says, was ultimately not having to worry about getting in trouble for using something that grants her relief from chronic pain, disruptive digestive issues, and crippling nausea.
Insight from an Industry Insider
Patrick, whose name has been changed to maintain his privacy, is an Ohio resident who relocated to Washington in search of a career in legal cannabis. Through friends already involved in the industry, he was able to secure a position at a top production and processing company based out of Seattle. He watched the company continue to grow and evolve throughout his year-long employment, but ultimately left as the roll out of Washington’s recreational-only market left him feeling uneasy. He has requested his former employer’s name be withheld for legal purposes.
Patrick started his position towards the end of 2014 as a “processor” in one of the company’s large indoor grow facilities. “I basically trimmed [plant] product and packed ‘pre-rolls’ or joints,” he explains. His former company offers just four types of products: smokable dry herb, pre-rolled joints, extracts such as oil and wax, and activated extracts in pill form. Industry commentators in 2014 praised the company’s limited product offerings as “more reminiscent of a natural food brand than a traditional, THC-heavy recreational cannabis company” and their “clear understanding of cannabis as a wellness (not recreational) product”. Indeed, two years later and comfortably positioned at the top of a completely new marketplace, the official website still detailed its founders’ commitment to safe, high-quality cannabis products. However, Patrick claims that after the rec-only laws went into effect in July 2015, “almost everything started changing overnight.”
As a processor who worked hands-on with the plants before and after the switch, he noted a few key differences between the two markets: while recreational products were held to a higher safety standard than their medical counterparts, their mass production ultimately yielded lower quality, less potent products; and yet the prices of recreational products were much higher than those of comparable medical products had been previously.
Product packaging and marketing morphed from simple, clean, and medicinal to fun, playful, and recreational. “The capsules of extract that were once very pharmaceutical in appearance... switched to a pressed powder pill that almost resembled an ecstasy tablet,” he laments. Additionally, his well-established employer began to expand through absorbing smaller producers unable to survive the recreational transition, purchasing their inventory and processing it as their own. Patrick explains, "there [had never been any] licenses available for medical producers so there was no way for them to be legit. When [the state] made the switch [in 2015], companies had to prove they had been following all of the rules to a T before being eligible for a recreational license. A lot of companies didn't make it and ended up having to find ways to get rid of everything they had since they were going to have to close down."
In the wake of these changes, Patrick felt he and other employees went from being family members to being “a disposable aspect” of a company increasingly focused on “production quotas and analyzing numbers.” As a processor who worked hands-on with the plants before and after the switch, he noted a few key differences between the two markets: while recreational products were held to a higher safety standard than their medical counterparts, their mass production ultimately yielded lower quality, less potent products; and yet the prices of recreational products were much higher than those of comparable medical products had been previously. This is partially a result of stricter regulations on permissible activity during commercial exchanges: consumers in recreational shops are not permitted to open, smell, or really visually inspect a product before they purchase it. Shop staff cannot answer questions, or make recommendations about treating specific medical symptoms, and instead approach transactions similarly to a bartender differentiating among craft beers.
Patrick concludes, “I think cannabis should be more respected for the truly amazing benefits it can provide. I left [the Washington industry]...because I saw the market shifting in support of more established businesses and not so much in favor of the smaller ‘boutique’ producers taking time and effort to produce beautiful, potent, and unique products. I think it would be a shame for all of the high quality stuff to be only available on the black or grey market but we will see if it can all balance out in a year or two, like they say.”
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These two accounts from both sides of Washington’s legal marketplace give a unique picture of the cannabis industry’s ever-changing nature. But what could Washington’s example mean for the future of legalization in a country where over half the states have yet to take any action on the issue? The answer likely lies in revenue.
State by State or Country-wide?
Thus far, no state has successfully moved from prohibition to full recreational access with a single vote, despite a handful of attempts, most notably Ohio’s Issue 3 in 2015. In the coming years, we will see some form of national action concerning cannabis, likely in the form of a change in drug classification—rescheduling—from Schedule I to Schedule II or III. This action will be monumental in terms of easing restrictions on medical cannabis and industrial hemp research, and in reducing criminal penalties for cannabis-related offenses. Specific laws and regulations governing the issuance of grow, processing, and commercial licenses, whether just medical and/or recreational access is granted, and even which conditions qualify for medical access would not be encompassed in this national change. Each state will still have to confront the ‘nitty gritty’ of legalization on an individual basis, and their decision to launch medical and/or recreational markets concurrently will affect interstate commerce and thus the potential for regional and national canna-business growth.
Sam Kamin, a law professor at Denver University, told The Economist that, “federal legalization, which would make interstate trade legal, could well see cannabis cultivation become something like the business of growing hops, virtually all of which come from Washington, Oregon and Idaho. Big farms supplying a national market would be much cheaper than the current local-warehouse model, driving local suppliers out of the market, or at least into a niche." Indeed, the picture of the growth of the alcohol industry after its re-legalization is a sobering one: three states bear the brunt of growing hops, and a single corporation—AB InBev Brands—controls many of the domestic and international brands sold in North America, including Budweiser, Corona, Stella Artois, Beck’s, Hoegaarden, Busch, Michelob, Landshark, Breckenridge Brewery, Natural Ice, and Rolling Rock.
There are, in fact, many lessons the green industry could learn from the alcohol industry’s recovery from its stint under Prohibition. Believe it or not, alcohol was once used medicinally, though there is markedly less empirical research to support its therapeutic benefits compared with medical cannabis. But through limiting supply during Prohibition, the American government made it quite profitable to bootleg illegal alcohol, giving rise to dangerous factions of organized crime while fueling the public’s wild consumption. With Prohibition’s repeal, booze began to permeate mainstream culture anew, in part thanks to ingenious marketing techniques. Advertisers tasked with silencing the still-sizeable temperance crowd worked to compensate by utilizing new television technology to reach audiences nationwide. Anheuser-Busch, for instance, specifically tied their Busch Bavarian brand to baseball, America’s national pastime, and even sponsored a network television show on CBS, “The Ken Murray Show” in the 1950s. Today with the internet and social media, advertising campaigns have the potential to reach hundreds of thousands of consumers daily to become nearly as iconic as the product itself.
And thus far, the broad topic of cannabis legalization has enjoyed robust support from left-leaning politicians. However Kamin worries, “that could change with the growth of a business lobby that, although understanding that an explosion in demand would trigger a backlash, may have little long-term interest in restraint.” The picture of influential lobbyists representing an industry bent on massive recreational consumption, completely stripped of its medical origins is unsettling, to say the least. But the impending growth of such a lobby could also motivate states to take on legalization via state-enacted legislation, which would afford lawmakers more control over the law than a citizen-initiated constitutional amendment—the current legalization method de rigueur.
Plants vs Pills: What’s the big deal?
The healing potential of medical cannabis is so great that our modern medical industry is clearly struggling to harness it within its traditional model. The therapeutic properties of Cannabis sativa can be attributed to a combination of cannabinoids, terpenes, flavonoids, and a handful of other phytochemicals working in concert to balance the effects of one another. This chemical synergy is known as the “entourage effect,” a term coined by Israeli researchers Shimon Ben-Shabat and Raphael Mechoulam in a 1998 study.
In recent years, German scientists Hildebert Wagner and Gudrun Ulrich-Merzenich have expanded upon this theory by describing the four primary mechanisms of the entourage effect, including the ability to affect multiple targets within the body, improve absorption of active ingredients, and minimize adverse side effects from any one chemical component. This means that cannabis could produce meaningful relief from multiple unrelated symptoms with a single treatment, eliminating the need for patients to juggle a cocktail of prescriptions each day to manage various aspects of their illness. For instance, recall that Daryian, the Ohio resident turned Washington canna-tourist, smokes for relief from pain related to fibromyalgia, intestinal inflammation related to IBS, chronic nausea, and lack of appetite.
The Human Body Cued for Cannabis
It is a little known fact that humans naturally possess an entire body system in which cannabinoids are the sole chemical currency. Known as the human endocannabinoid system (ECS), this system—first discovered in the mid-1990s—plays a role in regulating almost all of our body systems, and sheds light on why cannabinoid treatment is effective in treating such a vast array of seemingly unrelated pathologies. Throughout our body are two main types of cannabinoid receptors, CB1 and CB2, that regulate things such as our appetite, mood, memory, and sensation of pain. Endocannabinoids produced by our own bodies mimic effects from phytocannabinoids from natural plants, similar to how endorphins have narcotic-like effects.
While there are 66 known phytocannabinoids, two have risen to the forefront of popular medical research and treatment, delta-9 tetrahyrdocannibinol (THC), and cannabidiol (CBD). THC acts on receptors within the nervous, immune, and gastrointestinal systems to reduce inflammation and help minimize the negative effects of stress on the brain. CBD works on receptors in the nervous, circulatory, and skeleto-muscular systems to relieve pain, reduce seizures/convulsions, and suppress muscle spasms, among many other things. Unsurprisingly, phytocannabinoids each have their specific endocannabinoid doppelganger: anandamide for THC, and 2-AG for CBD.
I can’t believe it’s not pot!
There are currently three pharmaceutical cannabinoid products on the international market but only two are currently approved for use and marketed in the United States. Dronabinol and nabilone (marketed in the US as Marinol and Cesamet, respectively) are, interestingly, both synthetic chemicals rather than plant derivatives. The FDA-approved synthetic cannabinoids are both approximations of THC and commonly prescribed to treat chemotherapy-induced chronic vomiting and lack of appetite due to HIV / AIDS. Nabiximols, marketed as Sativex in the UK and 28 other countries throughout Europe and Asia, is the third pharmaceutical cannabinoid. An oral spray meant to treat neuropathic pain, muscle spasticity, and other symptoms related to multiple sclerosis, Sativex is the sole pharmaceutical product on the market that is derived from the actual cannabis plant. More surprising still is that the product contains active doses of both THC and CBD in a fixed ratio.
Yet, like attempting to recreate a recipe without including all the necessary ingredients, THC administered without its natural entourage of terpenes, amino acids, proteins, enzymes, and other cannabinoids is just not quite the same.
By creating synthetic chemicals to mimic naturally-occurring compounds in cannabis, pharmaceutical companies are able to subvert would-be cannabis consumers back through traditional pharmaceutical channels to obtain cannabinoid treatment. Unfortunately, these new compounds boast limited efficacy in comparison to plant-based treatments. However, the trend of evaluating synergistic properties of cannabinoids in the development of pharmaceuticals indicates that the scientific community’s acceptance of the entourage effect is growing over time: single-cannabinoid Marinol hit the market in 1986 and Cesamet in 2006, while dual-action Sativex made its introduction in the UK in 2010. Yet, like attempting to recreate a recipe without including all the necessary ingredients, THC administered without its natural entourage of terpenes, amino acids, proteins, enzymes, and other cannabinoids is just not quite the same.
Many doctors have been outspoken from the beginning about their patients’ open preference for whole plant therapy over pharmaceutical offerings. In a 1998 interview, Dr. Robert Gorter of UC-San Francisco told AIDS Treatment News, “my patients who had experience with both cannabis and Marinol almost always preferred cannabis, because Marinol had more side effects, including headaches and a hung-over feeling." Dr. Lester Grinspoon, a professor of Psychiatry at Harvard University, stated unequivocally in the 2001 International Journal of Drug Policy, “I have yet to examine a patient who has used both smoked marijuana and Marinol who finds the latter more useful; the most common reason for using Marinol is the illegality of marijuana, and many patients choose to ignore the law when they believe that the difference between the two puts their health, comfort or economic well-being at risk. If patients were legally allowed to use marijuana, relatively few would choose Marinol." Other doctors cite things such as an hour-plus wait between administering Marinol treatment and patients’ relief of symptoms; chronic nausea patients being unable to swallow a pill; as well as increased levels of intoxication.
There is a great deal of irony in the FDA legalizing synthetic approximations of naturally-occurring phytochemicals, while simultaneously claiming there is not sufficient research to support the safety and efficacy of natural chemicals. Clearly THC holds some medicinal value, otherwise pharmaceutical companies would not have successfully produced and marketed Marinol and Cesamet for over three decades. In fact, scientists know even less about the long-term adverse effects of synthetic cannabinoid use than they do whole-plant use, simply because their lab-created chemicals are mere decades old while Cannabis sativa has been used therapeutically for millennia.
Truly, though, the harm of pharmaceuticalizing cannabinoid therapy is as much an economic as it is a potentially physical danger. The cost of maintaining prescriptions and specialist appointments throughout chronic illness is exorbitant. Indeed, one of the most popular TV series in modern history, Breaking Bad, centers around the impossible financial predicament faced by a blue-collar cancer patient seeking treatment. By offering relief from multiple unrelated symptoms, whole plant cannabinoid therapy could mean a single treatment instead of a cocktail of five or six different pills throughout the day. Full-plant medical use also offers the potential for a patient or group of patients to grow their own product at-cost instead of paying for prescriptions monthly, thereby alleviating a great deal of the financial burden of chronic illness.
Business Up Front, Party in the Back
Ever the gold standard, Colorado managed to pull off the opposite of what has happened in Washington State. After building a well-regulated commercial medical industry in 2009, only medical operations were permitted to apply for recreational licenses once those became available in 2013. This ensured business owners were familiar with the licensing process, had the financial wherewithal to participate competitively in a new industry, and were experienced in commercial processing and safety regulations. Like Colorado slowly moving from legal medical in 2000 to commercial medical in 2009, then finally to recreational in 2013, States must learn to walk before they run—in this instance, that means perfecting the smaller medical industry before unveiling a more widely-accessible recreational industry. Simply put, it is easier to manage and troubleshoot fewer commercial entities catering to a fraction of the customer base, and allow the industry to evolve naturally. This is important to avoid the potential pitfalls that come when an under-regulated medical market is subsumed by a highly-regulated recreational market..
There is a great deal of irony in the FDA legalizing synthetic approximations of naturally-occurring phytochemicals, while simultaneously claiming there is not sufficient research to support the safety and efficacy of natural chemicals.
Washington should have instituted a more regulated medical program from the beginning. Because the state merely amended its constitution to allow for the cultivation, use, and possession of cannabis in 1998, the industry cobbled itself together in the subsequent years without regard to licensing protocol, health and safety standards, or tax revenue and reinvestment. Despite attempted medical reform in 2010, the state did not enact any meaningful commercial regulations until the advent of their recreational industry in 2013, leaving established medical businesses to be swallowed up by industry titans such as Patrick’s former employer.
Party Hardy or By Prescription Only?
Within just three years of recreational legalization, the industry has already seen media moguls such as Snoop Dogg, Wiz Khalifa, and the Bob Marley Estate erect multi-million dollar brands to promote cannabis products. Cult film director Kevin Smith even created two custom strains of cannabis to accompany the release of one of his films. Reality TV star Bethenny Frankel (of SkinnyGirl Cocktails fame) is purportedly sponsoring the development of a strain that does not give its user “the munchies.” Pause to recall that chronic nausea, vomiting, and lack of appetite are the conditions currently approved for FDA-approved cannabinoid treatment in the US. Yet here, a recreational brand already seeks to uncouple the plant from this exact therapeutic property in the name of intoxication and dieting.
With single-cannabinoid extracts and single-cannabinoid synthetics, a company, be it pharmaceutical or recreational, can ensure that a product treats only a limited number of symptoms of any given disorder or gives only specific desired effects. In paring down the therapeutic properties of cannabinoid treatments, pharmaceutical companies have effectively created an entirely new family of drugs to study, synthesize, patent, and market. When patients, cures, and compassionate care are no longer the driving forces behind industry growth, interest in meaningful research stalls. And if the plant itself begins to be cultivated solely for adult recreational purposes, product quality suffers while helpful medical strains may even fall out of production in favor of strains with more commercial appeal. Without access to the appropriate plant-based treatments, patients would be forced to turn to pharmaceutical extracts and synthetics for effective cannabinoid treatment.
Pause to recall that chronic nausea, vomiting, and lack of appetite are the conditions currently approved for FDA-approved cannabinoid treatment in the US. Yet here, a recreational brand already seeks to uncouple the plant from this exact therapeutic property in the name of intoxication and dieting.
If there is an answer, it rests neither in withholding a harmless plant from recreational users, nor in further criminalization. It is not necessary to keep marijuana strictly medical through discouraging recreational usage; it is possible and beneficial for medical and recreational programs to coexist quite peacefully (as evidenced in Colorado and Oregon). But, we need to allow whole-plant cannabis to retain its medical validity by ensuring patients have a robust medical market and are always granted the respect, consideration, affordability, and ease of access they deserve as medical patients.
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Savannah Smith can be reached at firstname.lastname@example.org.