Qualifying Conditions for Medical Marijuana

December 07, 2017|4:57 p.m.| ASTHO Staff

Currently, 31 states and territories, as well as Washington, D.C., authorize the use of medical marijuana and establish the qualifying or debilitating conditions a person must have before being allowed to use it. These conditions, as well as their overall number, vary among jurisdictions. For example, according to the Prescription Drug Abuse Policy System’s dataset, 26 jurisdictions allow medical marijuana for multiple sclerosis, while only three allow its use for Tourette syndrome. At the same time, Illinois allows a total of 23 different conditions and symptoms, whereas Nevada only allows 11.

While all legislatures can add or remove the conditions for medical marijuana, many have delegated the authority to approve new qualifying or debilitating conditions to state and territorial health agencies. A few states authorize a different entity (e.g., a consumer protection agency, independent commission, or physician board) to approve additional conditions, while others have not delegated the authority to anyone. Finally, while not a delegation of authority, some jurisdictions permit physicians to certify a patient’s use of medical marijuana for conditions beyond those outlined by law. A few examples of recent additions to qualifying or debilitating conditions include bills enacted in New York (S 5629) and Vermont (S 16) to add post-traumatic stress disorder, as well as the Minnesota Health Commissioner’s decision to add autism spectrum disorders and obstructive sleep apnea.

Pain is another condition or symptom that nearly all medical marijuana programs allow as a qualifying condition. With the prescription of opioids to treat and alleviate pain being a major driver of today’s national opioid epidemic, medical marijuana is sometimes looked upon as a safer, effective alternative to opioids. For example, a 2016 cross-sectional study indicated a reduction in opioid use in a jurisdiction with medical marijuana, while a 2014 analysis of the presence of medical marijuana laws and death certificate data (often not the best measurement of opioid overdoses) pointed to a slower increase in opioid deaths in jurisdictions with medical marijuana. Care and caution, however, should be exercised before recommending medical marijuana as a solution to the opioid epidemic, as there are still many questions about marijuana’s effects on the brain, heart, and lungs, its potential to cause cancer, as well as its impact on mental health.

First, while the January 2017 National Academy of Sciences report on the health of effects of marijuana found substantial evidence of the effectiveness of marijuana for adults with chronic pain, it must be noted that the studies that were reviewed by the report showed correlations rather than causations between marijuana and effectiveness for pain. A better understanding of the effectiveness of marijuana on pain is still to come. Second, in many states, response to the opioid overdose epidemic has been concurrent with adoption of medical marijuana. Other public health efforts to reduce opioid overdoses (e.g., prescription limits, provider education, expanded access to naloxone, etc.) may not be accounted for when looking at marijuana’s impact on the epidemic. Finally, there is recent evidence that marijuana use can contribute to the opioid crisis. A longitudinal study in the American Journal of Psychiatry looked at the association between marijuana use and opioid use at two time periods of the National Epidemiologic Survey on Alcohol and Related Conditions. Although several limitations to the study were noted (e.g. the information was self-reported, there was an inability to distinguish recreational from medical marijuana use, the data was collected over a decade ago, etc.), researchers concluded that marijuana use appears to increase rather than decrease the risk of developing opioid use disorder.

There are still many unknowns when it comes to the comparative risks and benefits between medical marijuana and opioids. More research, such as a recently announced Canadian-based study to compare the efficacy and safety of marijuana vs. opioids, as well as the patient data that state medical marijuana programs can collect about whether medical marijuana lowers opioid dosage, will be useful in further understanding the impact of medical marijuana on pain and the opioid epidemic. With the oversight of medical marijuana’s qualifying conditions falling on many of the state and territorial health agencies and marijuana’s impact on pain and opioid overdoses still unknown, ASTHO will strive to keep our members informed on these issues.