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I began researching this story with detached curiosity, more intrigued by the politics than the substance. I remembered the sick-sweet smell and haze of indolence at college parties, the hushed swaps of baggies, the lingo of tokes and bongs and—God!—roach clips. That phrase alone killed any allure.
But when I scan the list of approved medical conditions and see rheumatoid arthritis? Hold on. My mom has rheumatoid arthritis! At night, worn out by the disease but sleepless because the pain sears her joints, she can’t even turn a book’s pages without tears springing to her eyes. Her own immune system is attacking her, leaving her slender, once-graceful hands so stiff it’s like somebody poured concrete over them and let it harden.
She moved to Illinois last year. I start looking for a doctor who could prescribe her some pot.
This is not how it’s supposed to happen; patients are supposed to have a well-established relationship with the prescribing doctor. But by the state’s timeline, the soonest people can sign up is November.
I want her to be ready—if she’s game.
With medical marijuana still illegal under federal law, I expected the new dispensaries to be more like speakeasies than brightly lit supermarkets. But HW Holdings, LLC, already has its first site picked out: a steel building right on the main commercial strip in Bloomington, Ill. There’s even space for a big sign; Erba, which is Italian for grass.
Granted, the company still needs a license. But if HW Holdings makes it through the state’s deliberate obstacle course, it plans to open a second dispensary in Belleville or Edwardsville. “Southern Illinois has two of the most liberal counties in the state, Madison and St. Clair,” explains the company’s staff counsel, Nick Williams. “It’s going to go over far better down there, and competition’s going to be stiffer.”
Williams, like the three guys who started HW Holdings—Harlan Hankins II, Chad Wolenhaupt, and Adam Rosengren—grew up in Illinois. All four are in their thirties and, as Williams puts it, “willing to go out in the business world and do things other people are scared or reticent to do.” They own a fast-growing chain of optical stores, and many of their patients suffer from glaucoma. So when they read that marijuana can reduce pressure in the eye for hours at a time—not to mention easing cancer pain and chemotherapy nausea, both of which Wolenhaupt has endured—they knew what their next enterprise would be.
“How many new industries do we see in our lifetimes?” Williams asks. “One if we’re lucky. I’m 32; I’ve seen the Internet. But this? It’s a totally untapped industry, a totally new line of revenue that never existed in the U.S.”
They’ve even got a logo. “We are not just going to open up your typical head shop or bodega,” Williams says. “We are looking at a community-friendly, highly brandable image.”
Sort of like Starbucks? I ask.
He clears his throat. “We were heavily inspired by commercial coffee chains. We don’t want people showing up at our store eager for a high. The future is not Cheech & Chong. The future is pharmaceutical.”
The Illinois law is one of the toughest yet, says Bob Morgan, statewide project coordinator for Illinois’ Compassionate Use of Medical Cannabis Pilot Program. “We limit the number of dispensaries [60], the number of cultivation centers [21], the number of eligible medical conditions [35 at press time].” Illinois doesn’t even include chronic pain, let alone “writer’s cramp,” as California does. But California’s nonchalant; it was the first to legalize, back in 1996. Illinois was 20th, followed by Maryland and Minnesota. Bills are pending in 15 more states, including Missouri.
The Obama administration, like the Bush Administration before it, has promised not to interfere. Yet the U.S. Drug Enforcement Agency has continued to raid legal dispensaries, and the U.S. Food & Drug Administration still classes marijuana as a Schedule I drug, “with no currently accepted medical use and a high potential for abuse.”
It’s a weird time.
The FDA warns of possible contamination and wildly varying potency, unforeseen interactions with other drugs, and the absence of solid, long-term clinical trials. But the reason there are so few long-term clinical trials is that 44 years ago, marijuana was labeled a Schedule I drug. Not because we knew it to be useless and risky, but because we didn’t know anything else. As then Assistant Secretary of Health Dr. Roger Egeberg put it in 1970, “There is still a considerable void in our knowledge of the plant and effects of the active drug contained in it.”
I call the DEA to ask why marijuana can’t be rescheduled so more research can be done. They tell me they’d need either an act of Congress or a new review by the FDA. I call the FDA. They tell me that only the DEA can reschedule a controlled substance. Granted, the DEA needs an FDA evaluation to do so. But the FDA can’t recommend rescheduling until there’s more research.
In short, neither agency’s tripping over itself to change marijuana’s legal status. The House of Representatives felt it necessary to pass legislation this May to stop the DEA from raiding legal dispensaries. Just one week earlier, the DEA had released a report calling all claims of medical benefit anecdotal. Yet the FDA has approved a drug, Marinol, that contains synthetic tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana.
The problem is that a marijuana plant contains hundreds of other chemical compounds, and the FDA wants controlled, long-term clinical trials of their effects. That’s hard to get when marijuana’s being doled out to researchers leaf by leaf from a single source, the feds’ farm at the University of Mississippi.
The DEA did make one giant concession earlier this year: It increased the amount of marijuana that the farm makes available to researchers from 21 kilograms (about 462 pounds) to 650 kilograms. Researchers are lining up, willing to brave the mandatory registration and reporting paperwork because there’s now strong incentive to do these studies.
Medical marijuana is our new growth industry, with financial reporters publishing lists of “10 Marijuana Stocks to Watch” and firms registering names like Green Rush Consulting and the Cannabis Career Training Institute.
It’s all about compassionate health care—and money. Just as Dupont’s invention of nylon dealt a death blow to Missouri’s hemp industry, new pharmaceuticals helped turn marijuana (listed in the United States Pharmacopeia from 1850 until 1942 and used for everything from labor pain to nausea, convulsions, and rheumatism) into a crime. Now there’s economic incentive to reverse both decisions. Hemp’s a hot crop; even conservative Missouri lawmakers want to legalize farming it again. And Arcview Market Research, a marijuana investment firm, expects the legal marijuana industry to reach $10.2 billion within the next five years.
Quite an inducement for an economy in need of a high.
Marijuana has been used medicinally since 2700 B.C. But for a remedy that’s been around five millennia, we know damn little about it. A hemp plant, cannabis sativa, it contains THC and hundreds of other compounds. We’ve identified 66 or so as unique to the plant and labeled them “cannabinoids.” If we ever figure out the properties and mechanisms of each one, we’ll be able to target particular strains or extracts for particular ailments.
But we’re nowhere close.
Meanwhile, many physicians are wary of prescribing anything this inconsistent. The feds’ Potency Monitoring Program found that THC—the psychoactive ingredient—in marijuana available on the street jumped from 3.4 percent in 1993 to 12.3 percent in 2012, on average, with some samples as strong as 36 percent THC.
“THC tracking is a big challenge,” concedes Morgan, the Illinois program coordinator. “The goal is to have a process where a patient purchasing the product can know what they are purchasing.” Illinois will require each batch to be lab-tested, but because testing is tricky—different plants and even different parts of a plant have different chemical compositions—the label will only specify a range of THC. With a possible spread of 15 points.
A patient’s prescription refill could contain anywhere from, say, 3 percent to 18 percent of a psychoactive ingredient? I may not tell my mother that.
“The idea over time is to become more sophisticated, so a patient knows what he or she is buying,” Morgan says hurriedly. “We think the market is probably going to narrow that range a lot more.” The idea is that those more interested in reducing inflammation or spasticity than in relieving severe pain or suppressing nausea will choose strains with very low THC ranges, prompting greater supply of those strains.
The FDA-approved Marinol is a tidy little pill, as consistent and clean as a sterile lab can make it. But it doesn’t decrease anxiety and insomnia the way marijuana can, and users have complained that it’s too psychoactive. It seems the natural plant’s cannabinoids—chief among them cannabidiol (CBD)—reduce not only inflammation but anxiety, moderating the sometimes agitating high of THC.
The FDA has also approved Cesamet, which has a similar chemical structure to THC, and is currently evaluating an oral spray called Sativex—used in Europe for multiple sclerosis—as a treatment for cancer pain. An extract from the natural plant, it’s been refined to contain only THC and CBD, in proportions that do not create a high.
But the grass-roots movement—patients, those who love them, and their legislators—wants access to the whole plant.
Clinical studies have shown that marijuana can protect nerve cells; increase appetite and reduce nausea during chemo; stop the wasting effects of AIDS; relieve cancer pain; increase the effectiveness of narcotic pain killers; reduce eye pressure in glaucoma; reduce the frequency of epileptic seizures; help control blood sugar; reduce the pain and inflammation of rheumatoid arthritis; decrease the stiffness and spasticity of multiple sclerosis; ease Crohn’s disease and post-traumatic stress disorder.
Side effects vary with the individual, the condition, and the context. Marijuana can flare up a psychotic episode in patients with schizophrenia, and high doses can cause a temporary psychotic episode in anyone. It can lower blood pressure, which is great for preventing strokes; it can temporarily increase your heart rate by 20 to 100 percent, which could be dangerous if your heart’s already ticky. A joint’s got more carcinogens than a cigarette, but at least one study found no association with lung cancer, perhaps because of the anti-inflammatory cannabinoids. Marijuana can make you dizzy and sleepy, decrease reaction time, slow motor skills, and impair memory—so it can blunt chronic pain or anxiety, but you’re risking a temporary loss of IQ points and a lessening of productivity.
Overall, “studies suggest that marijuana is safer than alcohol, which has much more serious side effects,” says Dr. Thomas Burris, chair of pharmacological and physiological science at Saint Louis University School of Medicine. “Acute withdrawal from alcohol can kill you. So the logic is not there.” He pauses. “Of course, the U.S. government has tried to outlaw alcohol…”
What about drug interactions with marijuana? “Really, there’s not much,” Burris says. Concerns that marijuana lowers productivity and destroys work ethic? “It would not surprise me that a central nervous system depressant, used habitually, would sap motivation.” Marijuana as a gateway to harder drugs? “Alcohol is, too. You are modulating the reward system in the brain, and different people are wired differently. Some will seek reward more than others. So if their reward-seeking behavior is primed, they may go further.”
A quarter-century ago, another researcher at Saint Louis University, Dr. Allyn Howett, startled the scientific community with her discovery that the human brain comes equipped with natural cannabinoid receptors. No one knew, until she and her collaborators published their work in 1988, that chemicals similar to THC already flow through our brain. What we now call the “endocannabinoid system” is involved with appetite, pleasure, mood, anxiety, sleep, memory, thinking, concentration, sensory and time perception, pain sensation, immune function, and coordinated movement.
According to the National Institutes of Health, marijuana can overload this natural system, altering perception and mood, impairing coordination, and disrupting learning and memory.
But from a patient’s perspective, marijuana can also support and enhance the brain’s natural system.
The arguments spin in circles: Is marijuana addictive? In about 9 percent of cases, says the National Institute on Drug and Alcohol Abuse. For tobacco, “the number is closer to 30 percent,” says Dr. Sanjay Gupta, CNN’s chief medical correspondent. “There is clear evidence that in some people marijuana use can lead to withdrawal symptoms, including insomnia, anxiety and nausea. Even considering this, it is hard to make a case that it has a high potential for abuse… I have seen the withdrawal from alcohol, and it can be life threatening.”
Gupta has done a 180 on the issue of medical marijuana. “We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that,” he wrote on CNN.com.
Then he added that he’d never let his own children smoke pot—or drink alcohol—until they reached their mid-20s, when their brains were fully developed and not as susceptible to harm. The strongest consensus about marijuana is that heavy use can damage young minds. The NIH cites a recent study of users who began smoking in adolescence: Researchers found “substantially reduced connectivity among brain areas responsible for learning and memory.” A study in the Proceedings of the National Academy of Sciences showed that people who began smoking heavily in their teens lost an average of 8 IQ points between ages 13 and 38. Those who began smoking as adults, however, did not show significant IQ declines. And a later study in the same journal suggested that the loss could have been caused by the effects of poverty.
When I mention medical marijuana to my mom, she says, “You made me stop smoking!”
“You don’t have to smoke it. I’ve been reading—there are all sorts of options. You can vaporize it. Or put a few drops of a tincture under your tongue. Or buy medibles.”
“Medibles?”
“Like Alice B. Toklas brownies. They use a cannabis-infused butter, or an oil, to make all sorts of foods. They even make lollipops from resin extract.”
“Lollipops.”
I hear the tone: She’s humoring me. So I play the trump card, the one that changes the hearts and minds of conservative lawmakers. I tell her about children who had hundreds of seizures a day until they used CBD oil. It comes from Charlotte’s Web, a strain of marijuana that’s high in cannabidiol (CBD) but extraordinarily low (no more than 0.3 percent) in THC. And it is now legal in Missouri.
Missouri Sen. Jason Holsman (D-Kansas City) has a tougher bill pending, one that would legalize medical marijuana for adults. “Y’know, we have made it a crime for a citizen to plant a seed, water it, let the sun bring it out of the ground, harvest it, and let it provide natural relief for pain and suffering,” he remarks. “This morning a drug commercial came on for some drug that had to do with bipolar disorder, and it listed off six or seven really horrible side effects and concluded that it could lead to stroke or death. That drug is legal! But a plant will put you in jail.”
“The biggest problem law enforcement’s going to see, it’s going to be traffic safety,” predicts Chief Joe Edwards of the Columbia, Ill., police department. His square jaw is set, his voice as grim as Joe Friday’s on Dragnet. “Cannabis slows your reaction time and motor coordination and affects your judgment. One cannabis cigarette with a moderate amount of THC will impair a person’s ability to drive for 24 hours.”
The Illinois Association of Chiefs of Police expects to see (and worry about pulling over) about 270,000 medical marijuana patients. Morgan’s assured them that the state doesn’t want anyone driving impaired. “The field sobriety test is the standard,” he says.
Edwards says it doesn’t work with marijuana.
“Effectiveness is a different question,” Morgan concedes.
“They blow zeros on a breathalyzer,” Edwards says, “and the officer’s left with, ‘Hey, look, something still doesn’t look right.’ But that alone is not enough for him to ask for a blood test.”
Which wouldn’t be conclusive anyway, Morgan says, because while the marijuana might stay in the system a very long time (THC dissolves in body fat, then seeps into the blood and brain over time—often weeks), that doesn’t necessarily mean the person was impaired while driving. “It’s a challenge. Local law enforcement will be working with the Illinois state police to develop best practices.”
The only halfway solution Edwards can imagine is putting every officer in his small department through six months of training in drug recognition. And he can’t afford the cost. He’s also worried about increased drug dealing. By his calculations, doling out up to 2.5 ounces of cannabis every 14 days gives a patient five or six joints a day, and the average smoked will be three or four. “People will be selling what’s left, or trying to get it,” he predicts. “And with ‘caregivers’ allowed to buy and deliver the marijuana to the patients, potential for abuse is extremely high.”
Morgan says, “We are doing everything we can to prevent diversion. We will have a product-tracking system from the moment a small plant sprouts through processing to the sale at the dispensary. We will know who’s purchasing it and where it’s going.” Up to a point. Illinois can’t bar-code brownies once they’re taken out of the original packaging and resold to a friend. But Morgan says they’ll keep a close eye on trends, purchasing patterns, and criminal activity.
Edwards is bracing for robberies around the dispensary sites: Medical marijuana’s been cash-only until recently, with banks and credit cards leery of an industry that’s still illegal under federal law. VISA and MasterCard are starting to relax, and the U.S. Justice Department has issued guidance intended to open up banking access. But Williams says the large banks still aren’t coming round; only smaller, community banks are showing any interest.
As part of its application, HW Holdings has to show the state blueprints of Erba’s proposed dispensary and its security measures. “‘Bulletproof glass is actually in the administrative rules,” Williams says. “This needs to be bank-level security.” Cultivation centers will have a live security camera video feed to the Illinois Department of Agriculture, and the state police will have access.
That’s not enough to put Edwards’ mind at rest. He’s a true-blue, straight-arrow sort of guy, and it drives him crazy that “Illinois is now passing laws to violate federal laws.” Constitutional lawyers call it “the laboratory of the states.”
The problem is, nobody agrees on the experiments’ results.
Some criminal justice experts say that the more freely you legalize and sell marijuana, the faster you’ll lower the price, eliminate drug crimes, and weaken the cartels. Others say that by making marijuana readily available, you’ll increase theft, lure people to other drugs, and strengthen the cartels.
Williams is betting on the former scenario. “The U.S., now that they have a taxable commodity, is going to start closing opportunities to bootleg this stuff across the border,” he predicts. “This is going to be the end to prohibition all over again. And if recreational use becomes legal across the board in a few years, the prices will drop, because manufacturing can no longer be controlled. With deregulation, this now becomes national agriculture.”
He grins. “There’s a reason they call it weed. It’s not difficult to grow. It’s grass!”
My mom calls, her voice tight with pain, just as I’m finishing my research.
Sounding like I’m opening an envelope at the Academy Awards, I read aloud from a British Royal National Hospital for Rheumatic Disease study: “Lessening of pain and inflammation and significant improvements in movement and in quality of sleep. And researchers at Tokyo’s National Institute for Neuroscience said marijuana could even suppress joint destruction and slow the disease’s progression.”
“Oh, honey, thank you,” she says. “But I’m already taking medicine, and it might have a funny reaction. Or I might drive the car up a telephone pole.”
I’m not worried about her ability to drive. At least, no more than I’ve worried about her alertness when the pain’s left her panicky and tearful or she’s trying to gulp a useless aspirin at a stoplight. But what if she gets a crazy-strong batch and gets paranoid and agitated? She’ll never trust me again.
I sift through the research, trying to summarize the pros and cons for her, and realize there’s no real conclusion. Maybe I’m a little too eager to relieve her pain. Maybe it’s too soon.
On the other hand, it’s been 5,000 years.
Clinical studies have shown marijuana can…
- reduce inflammation
- protect nerve cells
- slow reaction time and impair judgment
- be addictive in about 9 percent of cases
- stop the wasting effects of AIDS
- temporarily increase heart rate
- relieve pain
- reduce eye pressure in glaucoma
- increase the efficacy of narcotic painkillers
- reduce the frequency of epileptic seizures
- help control blood sugar
- decrease the stiff-ness and spasticity of multiple sclerosis
- induce a psychotic episode
- help with post-trau-matic stress disorder
- increase appetite and reduce nausea during chemotherapy
- cause young users who use heavily to lose IQ points
- zap motivation
