New Proposed Rules for Alabama Medical Marijuana Program Released
In just one day, both the Alabama Medical Cannabis Commission (AMCC) met to discuss some of the nitty-gritty of the state’s gestating medical marijuana market, and the Alabama Board of Medical Examiners (ALBME) released a draft of their proposed cannabis rules. It’s yet another sign that we are coming closer and closer to the day when you will be able to get an Alabama Marijuana Card.
November 18, 2021 a Busy Day for Medical Marijuana in Alabama
During its November 18th meeting, the AMCC heard testimony from one of its members, Dr. Sam Blackmore, about his suggestions for the yet-to-open market. In his presentation, Blackmore covered a lot of ground, but he focused especially on ways to maximize the efficacy of medical marijuana for Alabama patients and on keeping costs down.
That same day, the ABME released a draft of its rules governing how and when doctors may prescribe medical marijuana.
Efficacy is All About Dosing, Getting the Right Combinations of THC and CBD
Dr. Blackmore was speaking to the AMCC in his capacity as the head of the subcommittee on dispensaries. His presentation represented the suggestions of the subcommittee, not guaranteed steps the AMCC will be taking in implementing the state’s medical marijuana law.
Much of Dr. Blackmore’s presentation was about making medical marijuana as effective as safely possible for patients, and to that end the doctor focused on dosing and finding the right strains and combinations of medical marijuana.
Dr. Blackmore suggested that the maximum daily dose of medical marijuana be capped at 75 mg of THC a day, but said the AMCC should recognize the need for flexibility in specific cases.
“Neurologists treat to effect,” Blakemore said, explaining that a one-size-fits-all dose might not work for all patients under a neurologist’s care. He suggested one way the AMCC might handle this concern. “Practicing neurologists would submit in writing why they are exceeding the maximum dose.”
Dr. Blackmore said that 2.5 mg of THC is the “threshold dose” for medical marijuana. In other words, most people need to take 2.5 mg of THC before experiencing any significant benefit. He said that 5 mg is “usually efficacious and tolerated,” whereas 10 mg produces strong effects except for those with high tolerance. He said doses of 20 to 30 mg and above could risk negative side effects.
In the final analysis, Blackmore said, the right dose is the “lowest that produces a therapeutic benefit without associated adverse events.”
Blakemore suggested that patients be able to buy 60 days worth of medicine at one time, and be allowed to possess up to 70 days worth at any given time.
Beyond the Amount of Medicine, the Right Combination is Also Important
Dr. Blackmore also emphasized the importance of finding medical marijuana strains with the right chemical profiles, and discussed the difference between strains with differing ratios of THC to CBD.
Blackmore also said that the other ingredients in medical marijuana combine with the THC and CBD to produce the entourage effect. The entourage effect refers to evidence that suggests that taking CBD and THC along with other natural ingredients in marijuana may reduce unwanted effects of THC some people experience, like anxiety, hunger, and sedation, and it may also offer neuroprotective and anti-inflammatory effects.
Dr. Blackmore expressed his belief that this effect is caused by a change in patients’ perceptions about how their medicine is working, not any actual change in the efficacy of the medicine itself.
“The ‘entourage effects’ enhance the product’s feel for the patient,” Blakemore said. “Because of that the patient says ‘I have a better effect with that product.’”
Regardless of whether or not the improved results attributed to the entourage effect can be chalked up to improved efficacy or the perception of improved efficacy, Blackmore acknowledged that the combination of a variety of marijuana-derived ingredients makes a difference in patients’ experiences, and needed to be taken into consideration as the AMCC moves forward.
Member Urges AMCC to Consider Costs when Issuing Rules
Dr. Blackmore also discussed some of the options for cannabis products that the AMCC could adopt under the state’s medical marijuana law, noting that some options, such sublingual sprays, may be more effective, but also more costly, than some other options.
“It’s important not to focus on high-end products, to ensure there are affordable options,” Blakemore said. “Price transparency is important. We need to do anything we can to ensure patient affordability, so they’re not just getting certified by a physician and then going back to the black market.”
ALBME Releases Proposed Rules for Doctors, Patients
The same day that Dr. Blackmore made his presentation to the AMCC, the Alabama Board of Medical Examiners (ALBME) released a draft of the doctor/patient rules they’ve been developing. The public is invited to comment on the rules, which are available here, by emailing the ALBME at email@example.com. Comments will be accepted until January 4, 2022, and at some point after that the ALBME will make its final decisions.
ALBME Rules for Alabama Marijuana Doctors
Physicians interested in prescribing medical marijuana for their patients would have to be licensed Alabama doctors who have been at least three years, or one year if they are certified by a specialty board.
Interested doctors would then have to complete a 4-hour training course about medical marijuana, and register with the AMCC, DEA, and the Alabama Department of Public Health. Doctors would have to complete two hours of refresher courses and re-register with all relevant agencies annually in order to renew their medical marijuana licenses.
Proposed Rules for Marijuana Patients in Alabama
The ALBME also issued their proposed rules for qualifying patients to use medical marijuana.
Certifying doctors would have to meet new marijuana patients in person, and then provide ongoing care to the patient. In addition to their initial examination being in person, both doctor and patient must be physically in Alabama during subsequent examinations. Physicians would also have to attempt to treat patients with conventional medical therapies unsatisfactorily before trying medical marijuana.
The qualifying conditions were already determined in the original legislation that passed in May, 2021. They include the following:
Cancer-related weight loss, chronic pain, nausea or vomiting, or cachexia
Chronic or intractable pain that has not been effectively treated with opioids or for which opioid therapy is inadvisable
Sickle Cell Anemia
Persistent nausea that has not been alleviated by more common treatments and that is not caused by pregnancy or marijuana use
A terminal illness
Some News is Good News
While these proposed rules may not please everyone, there is no way to see these developments as anything but good news for the future of medical marijuana in Alabama.
It is far easier to modify an existing medical marijuana program than it is to implement one, and while Alabama’s law is likely to displease many, any law at all means progress toward real relief for everyone in the Yellowhammer State.
Don’t be Left Out! Prepare for Medical Marijuana Today!
Progress is great and all, but you’ve waited long enough for relief. Why wait any longer than you have to?
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