Medical and Recreational Marijuana

At the 2013 WSMA annual meeting, the WSMA House of Delegates adopted as amended Resolution B-8 – Informational Guidance Relating to Medical and Recreational Use of Cannabis.

The resolution directed the WSMA to “collect and disseminate appropriate information to its members regarding scientific, regulatory, and public health information on the effects, use, and abuse of cannabis.” To that end, the WSMA has reached out to the Washington Physicians Health Program and has assembled the following resources to help inform physicians so that they can provide better care for patients.

With new legislation and regulations, it is likely that physicians will receive questions from their patients regarding marijuana use. While the WSMA is committed to advocating for a physicians’ perspective as part of the rulemaking and legislative processes, we are simultaneously responding to the changing legal and medical landscape by providing the resources providers need to present balanced and accurate answers to patients’ inquiries. [Note: Some of these links will require additional login information to view the sources in their entirety]

For additional information or questions, contact Denny Maher, MD, JD, at denny@wsma.org or Tierney Edwards, JD, at tee@wsma.org.

General information on marijuana laws in Washington state

Today in Washington, laws regulating the use of marijuana often conflict. Federal law still bans the use, sale or cultivation of marijuana. State law allows for possession and cultivation, but draws distinctions between medical use and recreational use.

Medical marijuana

History of regulation – federal law

Regulations and restrictions on the sale of marijuana began as early as 1916 and increased over the next few decades. By the 1930s, marijuana was regulated as a drug in every state. Some states—such as Washington—have legalized medical marijuana, though this conflicts with federal law.

When federal and state laws conflict, the federal government (specifically, the Drug Enforcement Agency) still actively enforces the Controlled Substances Act. The United States Supreme Court has upheld the CSA and its handling of marijuana. It ruled in United States v. Oakland Cannabis Buyers' Cooperative and Gonzales v. Raich that the federal government may regulate and criminalize cannabis, even for medical purposes.

History of regulation - state law

In 1998, Washington voters approved Initiative 692, otherwise known as Washington State Medical Use of Marijuana Act, thus legalizing the use, possession, sale and cultivation of cannabis patients with certain medical conditions. The law allowed patients with certain conditions to possess limited amounts of cannabis, provided these patients were able to secure a medical authorization certificate signed by a licensed medical professional. The law protects physicians who authorize the use of marijuana, patients and caregivers, but the law does so by providing an affirmative defense for compliant patients, rather than excepting them from Washington’s criminal laws. The law did, however, put limitations on the substance’s use, by restricting the amounts and diagnoses which could merit its authorization. The law also requires patients to carry valid documentation.

To learn more about authorizing marijuana, see the WSMA Web page on medical cannabis authorization. There, physicians can download a form to use when they authorize patients’ possession of marijuana for medical purposes. While the WSMA has not taken action to oppose or support medical marijuana itself, the organization supports the ability of physicians to work with patients to determine which treatment options are appropriate.

Recreational marijuana

History of regulation – state

In 2012, Washington voters approved the recreational use of marijuana through Initiative 502. The initiative legalized possession of marijuana among the general public, while also putting limitations on that by restricting the amount and the age (21 years of age or older) of those who may legally possess it. The law also requires the substance to be heavily taxed and for the revenue generated from its sale to go to health care and substance abuse and prevention education. Growing or selling marijuana otherwise remains illegal under state law.

The Washington State Institute for Public Policy put out a short informational flyer, Access and Regulation in Washington State, in February 2014 explaining state and local medical marijuana laws and how regulation is affecting patient populations, while acknowledging the dearth of information available at this time. WSIPP, as directed by the state legislature, will prepare and publish similar reports on recreational marijuana laws in December 2015.

The Cannabis Defense Coalition has prepared a Washington State Medical Cannabis Legal Guide, which includes comprehensive information on the evolution and application of marijuana laws in Washington, although it neglects some of the cautionary considerations and health-related concerns presented in less detailed publications.

Patient safety concerns and potential adverse effects of marijuana use

The Washington Physicians Health Program and its director, Charles Meredith, MD, have gone to great length to remind the medical community of the potential consequences of marijuana use. In a recent article, Dr. Meredith succinctly compares Washington’s legal landscape to that of California, Colorado, and other locations that have taken steps to legalize marijuana use in one way or another. He then explains why Washington’s unique framework makes over-authorization particularly difficult to track in our state, before succinctly presenting persuasive evidence that indicates marijuana may be more harmful than the casual user believes. The insightful and interesting piece discourages those practicing medicine from using marijuana, and reminds the reader why—despite its recent legalization—marijuana can pose dangers to those who imbibe it.

There are many peer reviewed articles in medical journals that discuss marijuana’s effects, but the recently published Adverse Health Effects of Marijuana Use, featured in a 2014 volume of the New England Journal of Medicine, does an exemplary job of distilling the issue down into an easily digestible and informative read. The NEJM has graciously allowed the WSMA to provide the article in full, and physicians would be well advised to read it.

The University of Washington’s Alcohol and Drug Abuse Institute has many resources for those interested in the health effects and potential dependency issues of marijuana use. Many of these documents are targeted at teens and parents, but the site’s list of marijuana fact sheets are informative, easy to read and understand, and cover a broad array of sub-topics related to marijuana use.

Finally, the American Society of Addiction Medicine has put out a public policy statement raising concerns with physicians’ involvement in authorizing medical marijuana use. The publication concludes with insightful recommendations for physicians and agencies involved in health care.

Emerging research and potential medical benefits

Journal articles discussing emerging research

Aggerwal, S.K. Cannabinergic Pain Medicine: A Concise Clinical Primer and Survey of Randomized-controlled Trial Results. Clinical Journal of Pain. Feb. 29, 2013:162-71.

The research presented in this article indicates that medical marijuana has potential health benefits for pain patients. This is a study partly responsible for the sizable grant the University of Washington recently received to educate Washington state residents on medical marijuana use.

Borgelt, Laura M., et al. The Pharmacologic and Clinical Effects of Medical Cannabis. Pharmacotherapy. Feb. 2013, volume 33, no. 2, pages 195-209.

Resources from the Mayo Clinic

The Riverside Health System website features Marijuana as Medicine: Consider the Pros and Cons, provided by the Mayo Clinic. The information here discuses conditions for which medical marijuana might offer treatment benefits, while explaining some of the negative effects that show that marijuana use is “not without risks.”

The Mayo Clinic also has assessed cannabis sativa as part of their comprehensive library of evaluations for various commonly used drugs and supplements. The clinic’s evaluations include easy to understand A-F grades measuring the drug’s efficacy in treating specific conditions and managing symptoms, which accompany grading rationale. Notably, there is no condition for which the clinic awarded marijuana an “A” grade in treating.