The Problematic Patchwork of State Medical Marijuana Laws – New Research

By Abraham Gutman

The legal status of medical marijuana in the United States is unique. On one hand, the Controlled Substance Act of 1970 classifies marijuana as a Schedule I drug with no acceptable medical use and high potential for abuse. On the other hand, as of February 1, 2017, 27 states and the District of Columbia have passed laws authorizing the use of medical marijuana. This discrepancy between federal and state regulation has led to a wide variation in the ways that medical marijuana is regulated on the state level.

In a study published today in Addiction, our team of researchers from the Temple University Center for Public Health Law Research and the RAND Drug Policy Research Center finds that state laws mimic some aspects of federal prescription drug and controlled substances laws, and regulatory strategies used for alcohol, tobacco and traditional medicines.

In the past, studies on medical marijuana laws have focused on the spillover effect of medical marijuana to recreational use and not on whether the laws are regulating marijuana effectively as a medicine. Using policy surveillance methods to analyze the state of medical marijuana laws and their variations across states, this study lays the groundwork for future research evaluating the implementation, impacts, and efficacy of these laws.

The study focuses on three domains of medical marijuana regulation that were in effect as of February 1, 2017: patient protections and requirements, product safety, and dispensary regulation.

Here’s some of what we found:

Of the 28 jurisdictions that authorize the use of medical marijuana (27 states and the District of Columbia), all jurisdictions have laws protecting patient privacy, while only 14 protect patients from discrimination.

Medical marijuana is authorized for use of specific qualifying diseases and symptoms in all jurisdictions except for that the District of Columbia, which allows physicians to recommend medical marijuana for any illness or symptom. All jurisdictions except Florida and Ohio place limitations on the location of medical marijuana use, like public spaces or in plain view, in schools, in the presence of a minor, or in correctional facilities.

Only 18 jurisdictions require product safety testing prior to any sale of medical marijuana products. Almost all jurisdictions have labeling and packaging regulations, although they vary widely. For example, labels are required to include the amount of usable marijuana in 20 jurisdictions, but only require instructions for use in five.

All jurisdictions that authorize the use of medical marijuana also regulate dispensaries, except for Alaska, Florida, and Montana. While 21 jurisdictions include some ban on the location of dispensaries, 18 have a limit to the total number of dispensaries in the jurisdictions, and only 12 set stock amount limitations. Most jurisdictions have explicit site structural requirements, such as hand washing stations and secured locked spaces, and 21 jurisdictions have explicit waste protocols.

The piecemeal regulation on medical marijuana leads to some concerns. Medical marijuana is a Schedule I drug, so it has not undergone the Food and Drug Administration approval process like any other drug. Patients are not protected from discrimination under the American with Disabilities Act, which does not prohibit discrimination based on use of illegal use of drugs (defined federally), and depending upon whether marijuana was provided under prescription, patient privacy might not be covered by federal patient privacy rules.

Policy uniformity assures that patients all across the country use the same product, with the same potency, that has undergone the same product safety testing, and was packaged in the same way to communicate that what they’re using is indeed a trustworthy and safe product.

The federal scheduling of marijuana as a drug has resulted in a peculiar situation — products used as medicine without well-tested efficacy, standardized dosing, safety standards, or clear clinical guidelines. To learn from these experiments, rigorous research and evaluation of the law is a necessary next step. The data presented in this paper can facilitate that research.