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Professional football players have been asking their bosses for the freedom to use medical marijuana in states where it is legal. But the powers that be, while they are allegedly discussing the possibility, at least here and there, have so far refused this modest request. They just aren’t sure whether medical marijuana has a place on the football field. That’s when player advocates began jabbering about the potential therapeutic uses associated with the use of cannabidiol (CBD). Some former players like two-time Denver Broncos Super Bowl champion Terrell Davis told the press that CBD “worked for me” to help ease joint and migraine pain. He then encouraged the NFL to take a closer look in an effort to give players more pain relieving options than pills.
The NFL and the NFL Players Association said, “What the hell, we’ll give this non-intoxicating substance some consideration.” And why not? CBD has been mostly legal nationwide for more than a year, ever since the federal government re-legalized industrial hemp production in 2018. It is conceivably one of the most popular non-FDA approved supplements on the American market right now, so why not see what’s what. Well, they finally met on the issue, and the outcome proved somewhat embarrassing for those players pushing CBD as a legitimate pain reliever.
The NFL says it’s still not going to let players use CBD because the science behind it doesn’t jibe with the “hype.”
Earlier this week, a special panel for the NFL gathered to talk about whether CBD should be eliminated from its list of banned substances. More specifically, they were conducting a fact-finding review to see if the CBD compound could be used as an alternative to opioids. Why? Because that’s the spiel the higher-ups have been fed since day one concerning medical marijuana and CBD. All the suits have been hearing is how the product would give players a safer way to combat the bashes and bruises that they incur on the field. It might even save some lives, they said.
But when the Pain Management Committee for the NFLPA took a look at the science behind this popular cannabis derivative, they didn’t find much evidence that suggested it would benefit players trying to tame pain. They respectfully denied it’s abilities. “CBD is a promising compound, but the level of its use in the United States outpaces the level of research at this point,” the panel wrote. “Most of the hype about CBD is based upon results from animal studies.”
Perhaps knowing that their decision might cause an advocacy fart storm asserting the call was due to the NFL being in cahoots with the pharmaceutical trade, the committee attempted to explain that the type of data they need to advise players that any drug or supplement is acceptable to use for its medicinal benefits just wasn’t there. Right now, the committee wrote in a statement, the main setback with CBD is it hasn’t been given a proper assessment in the treatment of pain.
“Clinical trials in large numbers of people are usually needed before millions of Americans use a medication for serious medical problems,” the panel said. “There are two small clinical studies that suggest that CBD may be effective for treating a kind of pain called neuropathic pain that involves a burning feeling usually in a person’s feet.”
The committee is concerned that if it puts its stamp of approval on CBD that players may get themselves into jams when treating pain conditions. Some of the CBD products sold on the market are labeled inaccurately and possibly contain dangerous, foreign substances that can make people sick, some studies have shown. So far, the U.S. Food and Drug Administration has not approved any hemp-derived CBD products for medicinal use. The best the agency has to offer is the approval of a cannabis-based epilepsy drug known as Epidiolex. But that can only be doled out with a prescription and only for a two specific types of epilepsy. The drug hasn’t been given approval for any other health conditions. So, due to the unregulated nature of this beast, CBD is considered unpredictable in the United States. Due to the status of CBD products in the current market, it would be irresponsible for the NFL to support these products as a reliable substitute for drugs that are backed by science. But, also keep in mind that cannabis continues to be categorized as a Schedule I substance in the U.S., meaning scientific tests on human subjects are nearly impossible.
Unfortunately, the NFL’s snubbing of CBD doesn’t give the cannabis advocacy community much hope that marijuana will be met with serious consideration and removed from the banned substances list. The NFL and the NFLPA agreed last year to examine cannabis as a potential alternative to opioids. Many expected the announcement would result in a new bargaining agreement with updated policies surrounding the use of marijuana. After all, it’s a move that is becoming more prevalent in professional sports. Major League Baseball has ended its ban on cannabis as a whole. And the National Hockey League isn’t militant toward players who test positive for it.
Still, the NFL is apparently going to need more than just statewide legalization efforts to side with weed. Because if it’s not willing to get on board with CBD, a legal substance in the U.S., it certainly isn’t going to open up to an herb that is still considered a dangerous drug in the eyes of the federal government. As for now, NFL players will continue to deal with pain as they always have – lots of prescription painkillers. Or they’ll use medical marijuana anyway and risk the consequences.
TELL US, do you think NFL players could benefit from CBD?
Every day, patients around America use cannabis to treat everything from glaucoma to chronic pain to nausea from chemotherapy treatments. Yet even in places like California, which pioneered legal medical marijuana in 1996 and passed adult-use cannabis in 2016, hospital policy has not caught up with the law and cannabis remains officially barred from hospital premises across the country. The reason why should sound familiar: federal prohibition.
Hospitals in the United States are subject to federal regulations, and could stand to lose funding and the ability to serve patients if they break the federal law, even with something like a state-legal medication.
This conflict between state and federal law on cannabis use in hospitals has very real consequences. One woman, Jessica Assaf, wrote on Healthcare in America in January 2018 about the experience of watching her partner’s father die of colon cancer at Memorial Sloan Kettering Cancer Center in New York City.
“After two years of failed chemotherapy and radiation, this prominent New York City lawyer weighed 130 pounds and could no longer talk nor move,” she wrote. “Though this patient had a medical recommendation for cannabis use in New York and vaporized THC and CBD daily to manage his pain, he could not use his medicine while he was stuck in the hospital. Instead, he was administered fentanyl.”
The medical marijuana movement, in fact, has a history of pushing for cannabis use in hospitals. The legendary activist known as Brownie Mary brought the issue into the international spotlight after she was arrested for bringing pot brownies to people dying of HIV/AIDS in San Francisco’s hospitals in the 1980s. Forty years later, it might be legal for millions to purchase medical marijuana — but using it in hospitals remains as prohibited as ever.
California Pioneering the Fight for Cannabis Use in Hospitals
The first sign of progress in allowing cannabis use in hospitals came in September 2016, just north of San Francisco. In a 2-0 vote, with three members abstaining, the board of California’s Marin Healthcare District voted in favor of a resolution to study allowing patient cannabis use at Marin General Hospital, in the town of Greenbrae. A series of public forums were to be held to discuss the proposal.
However, in the three years since, the study has not been conducted and has effectively stalled.
The resolution was originally introduced by retired emergency room physician Dr. Larry Bedard, who had served on the California Medical Association cannabis task force that led to the association recommending legalization in 2011.
“We ought to be on the cutting edge for our patients, allowing them to openly and appropriately use medicinal cannabis,” Bedard told San Francisco’s KPIX at the time of the Marin resolution.
“This is something they know about,” said Shaw. “I think it’s time for Marin General to step up, because this is a revolution for better health… For goodness sake, help the patients! Save lives!”
However, Shaw’s comments apparently didn’t get through. In the three years since the Marin Healthcare District voted to study the issue, little has come of it. Reached for comment in Marin County by Cannabis Now, Bedard says the resolution has seen no progress.
“The hospital administrators basically said ‘C’mon Larry, it’s a Schedule I drug, the Trump administration would take away our Medicare provider number and we’d have to close,” Bedard tells us.
An attempted remedy at the state level in California has also failed. Last year, Senate Bill 305, the “Compassionate Access to Medical Cannabis Act,” unanimously passed both chambers of California’s Legislature. It would have prohibited healthcare facilities from interfering with a terminally ill patient’s use of medical cannabis. It was also dubbed “Ryan’s Law,” after Ryan James Bartell, a San Diego native who had died of pancreatic cancer in April 2018. But in October, it was “begrudgingly” vetoed by Gov. Gavin Newsom.
“This bill would create significant conflicts between federal and state laws that cannot be taken lightly,” Newsom wrote in a veto statement, noting that “health facilities certified to receive payment from the from the federal Center for Medicare and Medicaid Services must comply with all federal laws.”
But his statement also took aim at those federal laws. “It is inconceivable that the federal government continues to regard cannabis as having no medicinal value,” Newsom wrote, adding that this “ludicrous stance puts patients and those who care for them in an unconscionable position.”
Doctors Weigh In
Clearly, the stakes in this question are high due to the illegality of cannabis at the federal level. While 11 states have legalized adult-use cannabis and 33 states have legalized medicinal marijuana, the feds still hold significant sway over hospital policy.
First, as already noted, hospitals must be accredited through the federal Center for Medicare & Medicaid Services and “could be found to be in violation, lose federal funding, and face penalties” if they allow even state-legal cannabis use, according to a 2017 article in the peer-reviewed journal Hospital Pharmacy.
Second, clinicians are also prohibited from prescribing or providing cannabis in a hospital because it is not approved by the U.S. Food and Drug Administration.
“Yet, hospitals in more states are asked to create cannabis policies as voters decriminalize cannabis for medical use,” the authors Laura Borgelt and Kari Franson wrote in that same article. “There is no recognized supplier of medicinal cannabis, so hospitals are often asked to allow patients to bring in their own supply for their own use.”
But in a Kafkaesque twist, hospitals then risk running afoul of a guideline established by the Joint Commission, the national body that sets standards for medical facilities. Joint Commission Standard MM.03.01.05 states: “The hospital informs the prescriber and patient if the medication brought into the hospital by patients, their families, or licensed independent practitioners is not permitted.”
Borgelt and Franson note that some hospitals have considered that “cannabis policies that could adequately address this standard” and allow cannabis on its premises if it informs everyone involved that the cannabis is “not permitted.”
“But several questions remain,” the authors write. “For example, how is the product identified, how does the institution verify its integrity, and how is a federally illegal drug ‘permitted’?”
However, some doctors have taken a more laissez-faire approach to the issue of allowing cannabis in hospitals.
“I think there’s a legal question and an ethical question,” Dr. Benjamin Caplan, founder of the CED Clinic and a representative of the group Doctors for Cannabis Regulation, told Patient Safety Monitor Journal in 2019. “In order for doctors to best manage illnesses carefully, and to the best of our abilities, we must know as much as we can [about] what a patient is taking. But it’s very common for patients to sneak cannabis in back rooms or under the radar, which is really unfortunate for everyone. I think the hospital perspective should be embracing what patients find helpful.”
Emphasizing the ethical dimension, Caplan added: “To have cases where patients are having seizures in a hospital and they can’t get the medicine that they want (and find helpful) as an outpatient is a real cultural disconnect for the medical establishment. I think the solution is for people to not sneak around; the solution is for hospitals to open their arms to patients who find a medication helpful.”
Veterans Lack Access to Cannabis in VA Hospitals
The question of whether or not it’s allowed to use cannabis in a hospital is a particular concern for military veterans — many of whom use cannabis to treat PTSD, yet are more directly dependent on the federal government for their healthcare. The U.S. Department of Veterans Affairs has remained largely intransigent on the question of medical cannabis, despite growing pressure.
“Moving to make cannabis available through VA hospitals or other go-to sources of care is difficult,” the VA website notes. “Doctors at VA facilities aren’t just prohibited from prescribing marijuana: The drug is still listed as ‘Schedule I,’ so these health care professionals can’t even speak about it with their patients.”
Needless to say, if the VA won’t allow its doctors to prescribe cannabis, it’s certainly not allowing its patients to use cannabis on the premises of VA hospitals.
The Mayo Clinic & the Potential for Change
The most significant opening for allowing cannabis in hospitals appears to come from the Mayo Clinic, the national network of medical treatment and research facilities. The Mayo Clinic website recognizes that “medical cannabis has possible benefit for several conditions.”
It notes that three states — Arizona, Florida and Minnesota — have adopted some form of the “Right to Try Act,” allowing access to “investigational” treatments, potentially including cannabis, for people with life-threatening conditions who have exhausted approved treatment options.
In one of those states, the Mayo Clinic allows on-premises use: “Minnesota residents with a supply of medical cannabis from the Minnesota Medical Cannabis program may continue use during their Mayo Clinic visit or hospital admission.”
However, the Mayo Clinic is in a unique position as a not-for-profit organization with national renown and standing as a top research institute. While the Mayo Clinic receives a significant amount of federal funding and has a Medicare number, it appears willing to take the risk with the federal government. If other hospitals will follow remains to be seen.
TELL US, do you think patients should be allowed to use cannabis in the hospital?
This morning, on Jan. 15, the House Subcommittee on Health of the Committee on Energy and Commerce held a hearing covering six different marijuana-related pieces of legislation currently on Capitol Hill.
The hearing, titled “Cannabis Policies for the New Decade,” featured a panel of speakers who testified before the House of Representatives committee about the federal government’s potential to study, allow, and regulate the use of cannabis. It was the committee’s first-ever hearing on cannabis, despite it being the oldest committee in Congress.
“After years of working to advance cannabis reform in Congress, this critical hearing is an important milestone where another major congressional committee focused time and attention on our movement,” said Cannabis Caucus Co-Chair Representative Earl Blumenauer, a Democrat from Oregon, in a statement. “It was important to hear a number of senior members of Congress affirming the change that is taking place at the state level and affirming the contradictions that are created by the federal government being out of step and out of touch. It’s past time for Congress to catch up with the American people.”
The panel included Matthew J. Strait, senior policy advisor in the Drug Enforcement Administration’s Diversion Control Division, which is focused on preventing, detecting and investigating the diversion of controlled pharmaceuticals. It also included Dr. Douglas Throckmorton, deputy director for regulatory programs at the Food and Drug Administration’s Center for Drug Evaluation and Research, and the National Institute on Drug Abuse Director Nora D. Volkow, who will be a familiar face for those who have watched past congressional hearings on cannabis.
The bills covered by the Jan. 15 committee meeting included:
Advocates from all aspects of the cannabis industry had been keeping an eye on the calendar for the hearing, which ended up lasting over three hours. However, many of them were disappointed with what they heard.
“At a time when nearly 70 percent of all Americans want to end our failed federal policy of blanket cannabis criminalization, it is unfortunate to see so many participants at this hearing advocating largely for business as usual,” said NORML Executive Director Erik Altieri.
Altieri pointed out that most Americans now have to access legal cannabis, so they should now be reasonably questioning why federal regulators continued to use dated talking points.
“The fact of the matter is that legalization and regulation work,” Altieri said. “Eleven states regulate the adult use of marijuana and 33 states provide for medical cannabis access. The time for federal policy to reflect this political and cultural reality is now, Congress should promptly approve the MORE Act and put the failed legacy of marijuana criminalization behind us.”
We asked Altieri what it felt like to watch the three federal agencies that currently play a big role in the cannabis research bottleneck talk about the need for more research.
“It was borderline painful to watch a multi-hour hearing where the very people in control of greenlighting further marijuana research bemoaned the lack of marijuana research,” Altieri replied. “Not only is there generally not a lack of research available, with around 32,000 peer-reviewed studies available on PubMed, but if the witnesses testifying truly wanted more information they could begin opening the doors to further study tomorrow.”
Prior to the hearing, the National Cannabis Roundtable, Global Alliance for Cannabis Commerce, Cannabis Trade Federation, Minority Cannabis Business Association and National Cannabis Industry Association sent the committee a letter.
The letter outlined a series of policies the groups are in favor of, including federal oversight, the descheduling of cannabis, the removal of barriers to cannabis research, limiting minor access to cannabis, social equity in the cannabis industry, and more.
MCBA’s Policy Committee Chair, Khurshid Khoja, further explained why today’s hearing was so important.
“MCBA members represent small businesses from those communities most disenfranchised by discriminatory enforcement of past state laws prohibiting cannabis,” Khoja said. “MCBA’s proposed model policies and laws have served as frameworks for effective implementation of social equity at the state and local level, and we invite members of Congress to evaluate these proposals in tandem with efforts to deschedule cannabis.”
A Few Positive Moments from the Hearing
Yes, the hearing certainly featured three federal agencies parroting the talking points they’ve been using for years around the research they’re holding up, but some members of the committee had their moments.
The formerly anti-pot Congressman Joe Kennedy setup this fascinating line of questioning around descheduling. First, he asked Volklow if descheduling marijuana would make it easier to research. She tried to talk in circles, but he kept questioning her until she relented and admitted moving cannabis to Schedule II would in fact make it easier to research. Generally, it was a surprising day from a guy whose family has funded the national effort to keep marijuana criminalized.
“Will the DEA move expeditiously on getting people permits?” Griffin asked.
Strait claimed the agency has been working expeditiously, it just didn’t seem like it to the committee. He also noted the people who applied in 2017 got refunded their money if they applied again in 2019.
Finally, Rep. Debbie Dingell of Michigan had one of the funnier takes.
“I was the keynote speaker at Hash Bash this past year. Yes, you should laugh. My staff told me I couldn’t,” she told the panel of feds admitting she didn’t know how it got scheduled. But she said she learned a lot from scientists she ran into.
She went on to explain the reason why she and her colleagues kept asking the same questions about why we can’t have more cannabis research, if everyone is saying we need more cannabis research: “Because we don’t understand what the answers are.”
Dingell added, “Every one of us has a story from our district that somehow someway there is a problem and we’re in the biggest catch-22 that you can ever see or imagine. So you’ve gotta help us figure out how we’re going to get out of this.”
TELL US, why do you think the federal government hasn’t made pot legal yet?
This is how quick the modern cannabis experience is changing — and nobody knows this better than the consumers who are witnessing this rapid growth firsthand. From dispensary shelves filled with products you’ve never seen before to the increasingly serious push for legal cannabis nationwide, to cannabis consumption lounges opening up in a few lucky locations, we are living through the cannabis renaissance. And yet, more expansive change is still on the horizon.
That said, I feel confident in anticipating other 2020 trends because cannabis is growing into its commodity crop designation and, increasingly, the marijuana industry is beginning to mimic more traditional industries as normalization and commercialization continue to take root. Here’s what to expect in the new year.
1) An Even Stronger Emphasis on Quality & Accountability
Legal cannabis products started with a relatively low bar: grow marijuana flower or develop an infused product that meets the state’s exacting standards, and then sell it to the masses, who were thrilled to purchase any THC-containing product in a legal store.
And much of these first-generation products were just that: a starting point, with safe and efficacious products that did the job.
But in 2020, we’ll see a drastic increase in product quality and accountability.
Our source material is already getting consistently better, with cannabis growers recognizing the need to cultivate better flower to differentiate their gardens from competitors’ grows. We see this happening with the flower brands and small-batch cultivators who are selling their products at a premium, and we’ll surely see lots more of this in 2020.
Edibles and topicals will also follow suit, with brands starting to invest in better, healthier, more sustainable and increasingly luxurious ingredients, from cacao in edibles to cocoa butter in topicals. And of course, particularly after the vaping illness incidents in 2019, the fast-growing concentrates and extracts categories will also see an elevation in product quality in their never-ending quest for purity, tasty terpenes and efficacious formulations.
2) More Changes at the Federal Level
Many marijuana aficionados don’t feel the sting of federal cannabis policy in their day-to-day lives. Sure, weed remains federally illegal, but state-legal cannabis is currently available to a clear majority of Americans.
Even so, all consumers shopping in regulated markets feel the pinch of federal illegality — even if they aren’t aware of it.
Every plant-touching business in the U.S., including dispensaries, cultivation facilities and manufacturers, pays a premium on almost everything it does. Real estate is often more expensive, because of restrictive zoning requirements and lingering stigma. Effective tax rates are off the charts, because of IRS tax code 280E. And nearly everything involving capital is more difficult (read: expensive) because of these licensed businesses’ inability to access traditional banking services.
But some of this will change in 2020, and this will affect consumers.
The U.S. Congress has taken its sweet time in passing legislation that would allow cannabis businesses to operate like literally any other business. But political insiders and high-ranking financial stakeholders are showing signs that real change is on the way — and we can assume that once cannabis businesses are taxed and banked like any other company, some of those savings will get passed down to the end consumer.
3) An Explosion of Cannabis Tech Innovation
The collision of cannabis and technology has only just begun.
Already we’ve seen some impressive innovation in the canna-tech space. We’ve also seen some snake oil tech that fails to deliver on its promises.
But we will see more canna-tech innovation in 2020 than the last five years combined — because of the market’s confidence, because of the availability of capital, because of the dwindling stigma and because we the consumers are demanding more from our cannabis experiences.
And this revolution of innovation won’t be limited to the kind of technology we most often think of, though we’ll also see plenty of game-changing extraction machinery and vaporizing devices. Think about the technology of traditional agriculture and its potential impact on marijuana breeding and farming programs. And what about the technology of humidity control and decontamination and what this could mean for an industry that is starting to consider shipping large amounts of legal cannabis around the world?
And what about the new delivery methods that have yet to be created? Yes, medical technologies such as sublinguals and suppositories are scientifically proven methods of administration. And yes, while dabbing once seemed intensely taboo, well-designed technology has replaced the butane torch, and now it all seems so normal.
2020 is just beginning and I can’t wait to see where the new year takes us.
TELL US, what are your cannabis predictions for 2020?
Originally published in Issue 40 of Cannabis Now. LEARN MORE