About a year ago I commenced a journey through Nevada’s legalized marijuana world, as a cancer patient wanting to avoid the use of opioids. That experience proved to me full federal legalization is needed to make this resource work well for medical marijuana users.
Since January 2017 adults in Nevada can purchase marijuana at dispensaries both for medical and recreational purposes. So, what is the problem?
Marijuana is classified as a Schedule I drug under the federal Controlled Substances Act of 1970 and is illegal for use for any purpose federally. As a Schedule I substance, it has been determined to have a high potential for abuse and not to have any accepted medical use. This is plainly erroneous.
Whereas marijuana is listed as a Schedule I drug, many opioids are classified as Schedule II, or lower. Marijuana is often used to replace opioids, so a comparison of the safety of marijuana with opioids is appropriate.
An article in the Journal of Nursing, April 2017, comparing the safety of cannabis and opioids, quoted the medical director of a neuropsychiatric hospital at UCLA: “Although marijuana can cause health problems if used in excess, there are no known cases of somebody dying from a marijuana overdose. The same cannot be said for opioids.” He noted the CDC reported that in 2015, more than 15,000 Americans died from overdoses involving prescription opioids.
A recent Australian study of 3,961 patients in a registry of medical marijuana users demonstrated the safety and effectiveness of prescribed oral marijuana over a two-year period. Use, under doctors’ supervision, showed medical marijuana was well tolerated under a variety of diagnoses, even when combined with other medications, while producing significant improvement across all measured clinical outcomes.
Federal agencies do not challenge marijuana sales or use in states where marijuana is legal under state law, under a memorandum of the Department of Justice and amendments to the yearly federal fiscal budget. On these threads hang the legality of marijuana use in the United States.
My experience started when medical imaging showed a metastatic malignant growth in my spine. I started oral chemotherapy. The oncologist warned of possible unpleasant side effects. Opioids are often used for side effects of chemo, and I knew from prior experience my body does not do well on them.
Friends suggested trying marijuana. My oncologist told me to look into something called CBD. She disclaimed any knowledge of dosing or functional information.
I decided to get a Nevada Medical Marijuana Registry card. Benefits included exemption from the 10% retail excise tax Nevada charges for cannabis purchases. I later learned having the card does not protect you from DUI charges or from being fired from employment because of testing positive for marijuana, according to a couple of 2022 Nevada Supreme Court decisions.
Each case arose after workplace accidents when the employees were required to test for drugs, tested positive for marijuana, and were fired. Both had used marijuana in compliance with Nevada law. One had a medical marijuana card. Neither used on the job. In holding neither employee had a private right of action for discharge under state law, the Court held their use violated the federal prohibition and was not lawful.
Common urine drug tests target THC metabolites that may be present in the body for weeks or even months after use, according to an article in the Journal of Medical Toxicology of March 2017, and a positive result does not document impairment, or even recent use. Even when complying with Nevada law, marijuana users risk penalties for use.
Application for the medical marijuana card required a physician sign a certification. My oncologist told me their practice decided not to get involved with signing these, and my treating physician said the Renown Medical Center group did not allow affiliated physicians to sign the applications. When I found a local physician who would sign, he told me he could not help with information on the details of medical marijuana and denied knowing anything about its use.
Thus, I learned that the medical professionals who were treating me would not help me with information on using marijuana because it is classified as a Schedule I drug. I also learned that they are not trained to advise patients on cannabis use.
Using medical marijuana is not just a matter of buying “weed” and smoking it. A new user needs a lot of information: what cannabis type helps what condition? How much is a dose? What is the best delivery method—under the tongue, capsules, vaporizing, smoking, salve, edibles, chewing? Where can you get safe cannabis? Will cannabis interact with other medications I am taking? Dispensary staff members are supposed to be able to advise customers to some extent, but they are not medical professionals.
I read everything I could. Hemp and marijuana are not two different species of plant. They are two different names for cannabis, a flowering plant, that produces a large variety of cannabinoids or chemicals. Science does not differentiate between “hemp” and “marijuana,” but the law does. Legally the difference is in THC (tetrahydrocannabinol) content, which varies from plant to plant. THC is what gives the “high” associated with some cannabis. Little to no THC, no high.
“Hemp” is cannabis that contains 0.3 percent or less THC by dry weight, according to U.S. law. This number was used in the legal definition of hemp in the Agricultural Act of 2018, making hemp products with that low THC content legal to possess and use in the United States. THC is frequently used with hemp-derived drugs to enhance their effectiveness, which may cause hemp-derived drugs to become federally illegal.
I started with a bottle of “full spectrum” cannabis oil derived from hemp. I tried it—putting a half dose under my tongue once a day—before I started chemo. I learned to start with a low dose and gradually increase it until I achieve the relief needed. Publications advise, “Go low and slow.”
The chemo drug I am taking has as some of its major side effects nausea, diarrhea, vomiting, fatigue and depression. At first I felt a minor digestive upset a couple of times, but that passed; I felt fatigued initially, but that passed also. I feel hopeful, which I suspect has to do with the use of the hemp oil, as it is known to help mood and anxiety. The cannabis does not totally block pain but it does moderate it, so that I can continue with cancer treatment comfortably.
My cannabis products cost about $200 per month. My insurer told me the company would reimburse only for medication that had been approved by the Federal Drug Administration and was prescribed by a medical provider for “on label” use.
Except for a handful of drugs, the Federal Drug Administration has not approved the use of cannabis, and insurance companies and federal programs like Medicare and Medicaid will not reimburse for them. They do reimburse for the cost of prescribed opioids. The out-of-pocket cost stops some patients.
Medical cannabis use is being severely hampered by marijuana classification as a Schedule I drug.