You may remember that earlier this year, I wrote a post updating the status of medical marijuana nationwide and in Louisiana, talking at length about how health insurance companies like Blue Cross and Blue Shield of Louisiana view marijuana products. Since that article was published, several important things have changed in Louisiana concerning medical marijuana.

Louisiana’s Marijuana Laws and Regs
In its most recent session, our state legislature increased the number of conditions medical marijuana can now be “recommended” for. Here’s the current list:  

Approved Conditions by Louisiana
Original (2015-16) List New (2018) List
  • Cancer
  • Cachexia (wasting)
  • Seizure Disorder
  • Muscular Dystrophy
  • Crohn’s Disease
  • Multiple Sclerosis
  • Cerebral Palsy
  • Spinal Cord injuries
  • Glaucoma (both lists)
  • Severe muscle spasms
  • "Intractable" pain
  • Post Traumatic Stress Disorder (PTSD)
  • Parkinson’s Disease
  • Certain parts of the Autism Spectrum

It’s worth remembering that it is still a federal offense for a doctor to actually prescribe any marijuana-derived product; they can only issue a letter of recommendation (after approval by the Louisiana State Board of Medical Examiners) for a patient to take to a state-approved pharmacy (there will be 10 or fewer statewide) acting as a medical marijuana “dispensary.” And, it’s still illegal to sell or use marijuana in a “smokeable” form. These dispensaries will offer marijuana as cannabinoid oil, topical creams or edibles.

The Louisiana State Pharmacy Board assigned up to 10 licenses to distribute medical marijuana, and it definitely won’t be available at your local CVS, Walmart or Walgreens. An approved marijuana dispensary is typically a local, independent pharmacy or a brand-new startup financed by out-of-state interests. They are scattered throughout the state, in accordance with the medical districts assigned by the U.S. Center for Medicare and Medicaid Services, plus one extra license.

Louisiana’s medical marijuana program also requires physicians who want to “recommend” the product to become specially licensed to do so. As of mid-June 2018, only 15 physicians had applied. Each of these physicians is allowed to manage a maximum of 100 patients, and the patients must come back to the physician every 90 days for a check-up and new recommendation.

Medical experts predict the addition of “intractable pain” to the list of conditions will mean hundreds of thousands of Louisianians will have a qualifying condition for a medical marijuana recommendation. In a recent news article, one doctor indicated he might be interested in recommending marijuana, if there were a way to determine patients were not also on opioids.

Is It All For Naught?
On June 26, 2018, something very interesting happened and I think it could have dire implications for the medical marijuana industry. The federal Food and Drug Administration approved to sell in the U.S. an actual drug that contains the “medicinal” part of marijuana (not the part that gets you high)

This drug, Epidiolex, went through all the usual pharmaceutical testing and processes and was approved to treat several of the conditions listed above, especially the rarer forms of epilepsy that medical marijuana supporters have used as a justification for many years. This drug is also reportedly effective for anxiety disorders in some cases.

Because Epidiolex contains cannabis compounds, it is still considered a Schedule 1 drug and will be illegal to prescribe until the federal Drug Enforcement Administration (DEA) sets conditions, but it’s on the DEA fast-track. The rush is because this drug has tons of science behind it, purification processes and formal procedures that will have the potential to make this a known quality, safe drug, unlike some of the marijuana being distributed at dispensaries around the nation.

NPR Healthshots reported in March 2018 that statewide sampling of marijuana dispensaries in California turned up marijuana products contaminated with bacteria, mold and pesticides. CBS News reported in January 2017 on strong scientific evidence linking regular marijuana use to schizophrenia and other causes of psychosis, with the risk increasing with frequent use.

It’s clear consumers of these products would benefit from a well-regulated, well-defined drug with purity standards and full notifications of potential side effects.

What About Medical Marijuana?
As cannabidiol (the active ingredient in marijuana) is better understood and processed, safer drugs that take advantage of its medicinal properties will certainly make their way onto the market.

It seems very likely to me that more drugs like Epidiolex will emerge. These drugs are ones a doctor can prescribe and a regular pharmacy can fill, minimizing the need for “medical” marijuana in the long run.

The Straight Talk is that one of the things that has driven the adoption of “medical” marijuana over the past decade is the perception that it has strong medicinal properties and that the federal government (FDA and DEA) simply weren’t providing the answers patients needed.

Now that a drug company has pushed a marijuana-based drug through the standard processes and protocols at the FDA, and the DEA seems about to let it be sold through any pharmacy with a typical prescription, some of the reasons medical marijuana dispensaries have spread into 29 states appear to be going away.

Stay tuned! More to come…