Medical Marijuana; How Legal is Legal?

Even though many states are working toward legalization of marijuana, it is still illegal at

a federal level. This conflict between stated and federal laws leads to an uncertain path for

health care plans and workplace accommodations. As of 2018, thirty states plus the District of

Columbia had passed some form of legislation legalizing marijuana. Although marijuana is legal

at the state level, it is still considered a Schedule I drug by the federal government. Schedule I

classification means that the drug has a high potential for abuse and no acceptable medical use.

For those with legal medical marijuana cards, the health care system has not come up

with any formal policies regarding coverage for medical marijuana. Health plans are not

required to provide coverage in any state where marijuana is legal. A national health plan

would have to provide patchy benefits depending on the applicable laws in the participants

state of residency. Regardless of state legality, the majority of health plans do not cover

medical marijuana because of the Schedule I classification. In 2016 a survey by the

International Foundation of Employee Benefit Plans found that only 3.1% of multiemployer

health plans and 2.1% of heath plans for public sector employees, provided any type of medical

marijuana benefits.

Not only are health care plans unsure of how to handle medical marijuana, neither are

employers. Is it possible for employers to enforce zero-tolerance drug use policies when

employees are receiving prescriptions for medical marijuana from their doctors, or are they

required to provide reasonable accommodations under the Americans with Disabilities Act

(ADA). Under federal law, individuals who engage in the use of illegal drugs, including

marijuana, are excluded from the definition of qualified individual with a disability. (Bardes)
Because of this rule, employers are not required to provide ADA accommodations to individuals

for medical marijuana use.

State laws can provide disability protection and can require accommodations that are

not required by federal statutes. Some states that have legalized marijuana use did not take

the steps necessary to protect medical marijuana users from discrimination in the workplace.

As an example, Oregon which has legalized marijuana for medical and recreational use, did not

extend its disability law to protect employees using marijuana that would be legal under the

state’s own laws. More recently, some states have begun to require employers to attempt to

make reasonable accommodations for the medical needs of an employee who holds a valid

medical marijuana card. This rule applies as long as the accommodations don’t pose a threat of

harm or danger to persons or property, or impose an undue hardship on the employer, or

prohibit the employee from fulfilling any and all of his or her job responsibilities. (Bardes) In

2017 the Rhode Island Superior Court also issued a decision that prohibits discrimination

against medical marijuana card holders and extends protection for cardholders who used

medical marijuana.

Veterans that receive health care through the Department of Veterans Affairs health

system are also struggling to obtain and use medical marijuana. Veterans experience chronic

pain at much higher rates than the general population and the rates of Post -Traumatic Stress

Disorder (PTSD) are soaring. Many are turning to medical marijuana for treatment of these

chronic conditions instead of prescription opioids. Unfortunately, under VA policy, VA doctors

can’t prescribe or recommend medical marijuana to patients, even where medical marijuana is

legal, because of the Schedule I classification.

 The Department of Veterans Affairs has noted the lack of research into the potential

benefits of medical marijuana but has not been able to conduct their own research due to

federal red tape. One option for vets is to see a doctor outside of the VA system, which would

leave them paying the bill out of pocket and that could be costly. Using marijuana can throw

veterans VA-prescribed medication into jeopardy. Veterans who are prescribed opioid pain

killers are routinely screened for drugs to check for harmful drug interactions. If they test

positive for marijuana, the opioid prescription could be pulled.

Veterans groups are pushing for reform. They argue that marijuana may help treat

chronic pain and mental health disorders which are both behind the opioid epidemic and the

suicide rate among veterans. Research has found that VA patients die of accidental overdoses

from opioids and cocaine, at nearly twice the rate of the general population. (Hanson) Opioids

are being overused and over prescribed. Medical marijuana could be a better alternative for

pain management while helping to reduce the use of opioids. A recent poll of veterans and

their caregivers found that 92% of veterans support medical marijuana research and 81%

support legalizing medical marijuana. The poll also showed that 1 in 5 veterans are currently

using marijuana for a medical condition.

The VA has not undertaken any research projects, on the use of medical marijuana for

treatment of PTSD and chronic pain in veterans, due to a lack of involvement in other federal

agencies. They cite restrictions in federal laws as reasoning in their refusal to participate in past

FDA approved private-sector research on medical marijuana use for PTSD in veterans. A recent

bill titled the VA Medicinal Cannabis Research Act of 2019 currently has more than 60 sponsors

and is the latest reform effort that would require the VA to conduct research on the effect of
medical marijuana on veterans diagnosed with PTSD and chronic pain. A second bill introduced

in April, the Veterans Cannabis use for Safe Healing Act, would protect veterans from being

denied benefits based on participation in medical marijuana programs and would provide

assistance to veterans trying to enroll in state marijuana programs. Even if doctors are allowed

to prescribe marijuana, it would only be an option for veterans living in states with medical

marijuana programs. This would result in uneven treatment programs in the national health

system. Without legalization at a federal level, it is unlikely that the VA will change its policies.

Marijuana contains more than 60 pharmacologically active cannabinoids which act on

cannabinoid receptors located throughout the body, but mainly in the spinal cord and brain.

Cannabinoids in marijuana activate 2 types of G protein coupled receptors, CB1 and CB2,

directly inhibiting the release of multiple neurotransmitters including acetylcholine, dopamine,

and glutamate indirectly affect opioid and serotonin receptors. CB1 receptors are primarily

concentrated on spinal cord and peripheral nerves while CB2 receptors are found on cells in the

immune system. This may explain why cannabinoids have an effect on pain and inflammation.

The psychological responses are euphoria, psychosis, impaired memory and cognition, reduced

locomotor function, increases appetite, pain relieving and sleep promoting effects. Primary

cannabinoids contained in marijuana are THC (tetrahydrocannabinol) and CBD (cannabidiol).

The therapeutic effects of marijuana depend on the concentration and ratio of THC in a given

formula.

In 20 15 there were only 2 FDA approved cannabinoids in the United States. Both are

available in pill form and are approved for nausea and vomiting associated with chemotherapy

and appetite stimulation used to treat wasting from HIV/AIDS and eating disorders. Medical
marijuana is purchased from dispensaries or grown by patients but is not available from

pharmacies because it is still illegal on a federal level. The United States Pharmacopoeia and

the FDA have been trying to work through the complexities of regulating medical marijuana.

Medical marijuana is widely used to treat many diseases and their symptoms. It is

currently being used to treat neuropathic pain, fibromyalgia, rheumatoid arthritis, chronic pain,

nausea from chemotherapy, Multiple Sclerosis, Parkinson’s disease, Huntington’s disease,

Tourette’s, Epilepsy and seizures, anorexia, dementia, PTSD, glaucoma, and HIV/AIDS.

Currently 28 states, the District of Columbia, Guam, and Puerto Rico are allowing

comprehensive public medical marijuana and cannabis programs.

Regulation of cannabis therapy and medical marijuana is complex, from possession and

cultivation to distribution and legal hurdles. Doctors can’t legally prescribe medical marijuana

due to its classification as a Schedule I drug and it isn’t reimbursable through government

medical assistance programs or private health insurers. There are also unforeseen factors like

adequate numbers of patients for research trials, prohibition of driving during clinical trials, and

limited availability of clinical research to support or refute therapeutic claims.

Despite all of the controversy, legalization governing use of medical marijuana continues

to rapidly evolve. Hospitals and care facilities need to consider the implications, logistical

concerns, and feasibility of permitting patient access to treatment. It is unclear how regulations

for treatment will progress because the agenda changes with each new government

administration.
Works Cited
Bardes, Diana M. "From on High: A Discussion of Federal Law and State Court Decisions on Medical
Marijuana and the Workplace." Benefits Magazine 55.8 (2018): 14. web.
<http://eds.b.ebscohost.com.libprox1.slcc.edu:2048/eds/pdfviewer/pdfviewer?vid=3&sid=18c9
2d93-5f87-4719-9791-03ee6dc2c492%40pdc-v-sessmgr02>.

Brideman, Mary Barna. "Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care
Setting." Pharmacy and Theraputics 42.3 (2017): 180-188. web.
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/>.

Hanson, Claire. "Veterans Face Hurdles to Marijuana Access." U.S. News - The Civic Report (2019): C22-
C25. web.
<http://eds.a.ebscohost.com.libprox1.slcc.edu:2048/eds/detail/detail?vid=0&sid=390cfeeb-
d992-4b14-80a5-5950385da2ea%40sdc-v-
sessmgr03&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=136764934&db=f6h>.

Hill, Kevin P. "Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric
Problems." JAMA Network 10.1001 (2015): 2474-2483. web.
<https://jamanetwork.com/searchresults?q=medical%20marijuana%20for%20treatment%20of
%20chronic%20pain&allJournals=1&SearchSourceType=1&exPrm_qqq={!payloadDisMaxQParse
r%20pf=Tags%20qf=Tags^0.0000001%20payloadFields=Tags%20bf=}%22medical%20marijuana
%20for%20t>.