ALTHOUGH the Virginia General Assembly killed several bills this session that would have legalized or decriminalized marijuana, lawmakers cautiously approved measures to expand the medical use of cannabidiol (CBD) or tetrahydrocannabinolic (THC–A), both non-psychoactive ingredients derived from the cannabis plant.
State legislators were not quite ready to endorse a “medical marijuana program,” but they did loosen restrictions on access to CBD or THC–A for people suffering from a variety of ailments in addition to the childhood epilepsy for which CBD had already been approved.
One bill (SB1557) patroned by Sen. Siobhan Dunnavant, R-Henrico, a practicing ob-gyn, directs the state Board of Pharmacy to “promulgate regulations establishing dosage limitations” for adults and allows licensed physician assistants and nurse practitioners to issue a “written certification” for medical marijuana use.
Dunnavant pointed out in a Jan. 25 oped in the Richmond Times–Dispatch that her bill was needed because medical marijuana is “available only to a narrow patient population and is restricted to pediatric dosing strength.” She said her bill will allow the five state-licensed marijuana producers to sell a variety of “low-THC” (the active ingredient in marijuana) products with “dosing that will be sufficient to provide relief to patients.”
Another bill (HB1720) patroned by Del. Chris Hurst, D–Blacksburg, allows any public elementary or secondary school student “who possesses a valid and unexpired written certification” to use CBD “on school property, on a school bus, or at a school sponsored activity,” and stipulates that local school boards cannot expel students who use CBD or punish school personnel who administer it. Only three other states allow this.
The General Assembly’s willingness to relax state regulations on the use of medical marijuana for suffering patients is admirable, but so is its reluctance to take the leap into decriminalization or outright legalization of marijuana for recreational use, as 10 states have already done.
Just last year, the federal Food and Drug Administration approved Epidiolex, a medication containing CBD, to treat seizures associated with two rare forms of childhood epilepsy. It’s still the only drug derived from the cannabis plant to receive FDA approval. And as FDA Administrator Scott Gottlieb, a physician, noted, the epilepsy drug’s approval was based “on adequate and well-controlled clinical studies.”
Gottlieb pointed out that the FDA has still not conducted clinical studies to determine the safety and efficacy of using CBD to treat other conditions, which is why it is still classified as a Schedule I controlled substance.
A 2017 review of the available scientific literature by the National Institutes of Health confirmed CBD’s “favorable safety profile” and acknowledged that it has a “number of beneficial pharmacological effects.” However, researchers cautioned that there are still “knowledge gaps,” and said that “more studies on long-term safety aspects and CBD’s possible interactions with other substances,” including human hormones and the immune system, were needed.
People who are given written certification for CBD use should be informed that its long-term effects are still not known. But they should still be able to give this remedy a try, especially if their symptoms are not being relieved by other medications, without running afoul of state law.
However, it must also be noted that Thalidomide and OxyContin were once considered wonder drugs, too, until their awful side effects—severe birth defects and addiction—became too widespread to ignore.
The General Assembly’s cautious, baby-step approach to expanding access to medical cannabis for some patients, while refusing to join the current stampede to legalize or decriminalize marijuana, especially for recreational purposes, is just the right approach. Better to be safe than sorry later on.