Legislators are debating Iowa’s marijuana laws on the foundation of one basic question: Can a state expand access to medical marijuana while limiting recreational use? Medical marijuana has been an active topic of debate by the Iowa Legislature for the better part of a decade. Democrats and Republicans have fought back and forth over whether a medical marijuana program expands access to marijuana for needy patients or encourages recreational use.
Is medical marijuana misunderstood?
But there’s another question that should be addressed before asking what expanding a medical marijuana program would accomplish: Does marijuana have medical use?
To explore the answer to this question, it’s useful to understand the basics of pharmacology. Pharmacology works upon the basis that drugs create effects in the body by binding to specific receptors. Every drug has its own receptor, and drugs are often grouped into classes based upon the receptors to which they bind. The drugs that bind to opioid receptors in the body range from loperamide (the active ingredient in Imodium) to codeine, hydrocodone and heroin. The U.S. Drug Enforcement Administration (DEA) classifies these different opiates and synthetic opioids accordingly, from Schedule V (very low likelihood for addiction and abuse) to Schedule I (highest likelihood for addiction and abuse) for heroin.
Unfortunately, the DEA does not have the same sort of nuanced approach when it comes to cannabis. Currently the DEA and federal law considers all forms of marijuana to be Schedule I controlled substances.
Just as the body has opioid receptors, the body also has cannabinoid receptors. These receptors are located in the brain, lungs and central nervous system. When the cannabinoid (chemical compounds found in marijuana) Tetrahydrocannabinol (THC) binds with these receptors, the body experiences euphoria, pain is relieved, appetite may be restored and nausea is quelled. THC also posses known psychoactive properties, otherwise described as the marijuana “high.” It is this additional effect of the high—and its ability to impair the user—that gives some lawmakers pause.
There is a form of synthetic THC available in the U.S., sold under the brand name Marinol and used to treat weight loss in AIDS patients and nausa for those undergoing chemotherapy, but the market for this drug is small and its efficacy has been questioned.
Another cannabis-derived drug, cannabidiol (CBD), a cousin of THC, has been widely researched for its potential medical use. CBD binds to different cannabinoid receptors and doesn’t induce the high of THC, yet may be effective in the treatment of epilepsy, anxiety, and conditions.
The medical marijuana debate in Iowa
CBD oil has been the focus of the recent medical marijuana debate in Iowa. In 2010, members of the Iowa Board of Pharmacy unanimously voted to recommend that the Iowa legislature change marijuana’s status from Schedule I to a less severe classification in the Iowa Controlled Substance Act, but legislators declined to approve the board’s recommendation. Since that time cannabidiol has been at the center of our state’s debate on medical marijuana. In 2014, Governor Branstad signed the Medical Cannabidiol Act into law, making CBD oil accessible, with a neurologist’s approval, to Iowa residents if they have intractable epilepsy. However, the requirement to buy CBD oil outside the state of Iowa has hindered accessibility for those who need it.
What is the Future for Medical Marijuana?
In 2015, the Iowa Board of Pharmacy unanimously voted to recommend that the legislature reclassify CBD oil from Schedule I to Schedule II, which would acknowledge that at least one marijuana derivative does indeed have medical use. The board declined to include this in their legislative initiative for 2016. In February 2016, the Iowa House introduced a bipartisan bill (HF 2384) that would set up a distribution system for CBD oil in Iowa and expand the conditions for which medical marijuana can be used. Currently there has been no movement on the pharmacy board’s recommendation on behalf of the DEA, and the house bill has since been stalled.
Ben Urick received a Doctorate in Pharmacy from Drake University in 2011. In addition to part time community pharmacy practice, he is a Presidential Fellow and PhD Candidate in the Division of Health Services Research at the University of Iowa College of Pharmacy. His academic interests lie at the intersection of pharmacy practice, healthcare and health policy. This article was originally published in Little Village issue 197.