Elsevier

Epilepsy & Behavior

Volume 112, November 2020, 107452
Epilepsy & Behavior

Review
Current legal status of medical marijuana and cannabidiol in the United States

https://doi.org/10.1016/j.yebeh.2020.107452Get rights and content

Highlights

  • Keeping the marijuana user in up-to-date information about the legal aspects of cannabis products

  • Knowing legal terminology associated with marijuana use (medical marijuana, legalization, and decriminalization)

  • Understand the difference between hemp- and marijuana-derived cannabidiol

Abstract

In the United States, access to marijuana and its related products has been outlawed since passing the Controlled Substance Act (CSA) in 1970. Under this act, marijuana is classified as Schedule I substance and is considered to have a high potential for dependency and abuse as well as unaccepted medical use. From that time, multiple states have taken measures to legalize and decriminalize the use of marijuana. In June 2018, Epidiolex® (cannabidiol, CBD) was the first cannabis-derived drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of severe forms of epilepsy, Lennox–Gastaut syndrome, or Dravet syndrome. In December 2018, Farm Bill was significant progress in cannabis-related law by which hemp was removed from the definition of marijuana in the CSA. This paper provides an up-to-date overview of the legal status of cannabis-related aspects, including medical marijuana, home cultivation, patient registration, and hemp-derived CBD from the medical perspective in the United States.

Introduction

Medicinal marijuana is a plant-based drug obtained from the Cannabis sativa plant [1]. Marijuana consists of more than 421 components and 60 pharmacologically active cannabinoids. The two most common cannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) [[2], [3], [4]]. In the U.S., marijuana use is regulated by federal and state law. The Marihuana Tax Act 1937 was a turning point in the regulation of cannabis use which paved the way for ongoing laws that controlled cannabis-derived products in the U.S. Under this act, the medical use of marijuana was still legal, and the federal government imposed taxes for any person or entity that sells, acquires, dispenses, or possesses marijuana [5]. In 1970, The Federal Controlled Substances Act (CSA) was established, making marijuana and all its cannabinoid forms Schedule I substances belonging to the same class as heroin. Schedule I substances are considered to have a high potential for dependency and abuse as well as unaccepted medical use. This means that the cultivation, distribution, and possession of marijuana are federal offenses [6]. The only U.S. Food and Drug Administration (FDA)-approved cannabis-extracted drug for treatment of rare epilepsy disorders, Lennox–Gastaut syndrome [7] or Dravet syndrome [8], and seizures associated with tuberous sclerosis complex [9] is Epidiolex® (CBD) [10]. Other FDA-approved products related to cannabis are Marinol® and Syndros® which contain dronabinol (synthetic THC) and Cesamet® which contains nabilone (a synthetic substance similar to THC). Dronabinol and nabilone can be prescribed by a licensed physician to be used in the treatment of nausea and vomiting induced by cancer chemotherapy. Dronabinol can also be used to treat loss of appetite and weight loss in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) [11,12]. According to state laws, cannabis-based drugs can be used for different medical disorders including pain, anxiety, epilepsy, glaucoma, loss of appetite and weight loss associated with HIV/AIDS, inflammatory bowel disease, irritable bowel syndrome, movement disorders due to Tourette syndrome, multiple sclerosis, nausea and vomiting related to cancer chemotherapy, posttraumatic stress disorder (PTSD), and sleep problems [12]. Compounds found in the marijuana plant are pharmacologically active, and they can cause adverse effects on the user's health [13]. The aim of this paper was to provide a general overview about the legal status of cannabis-related aspects, including medical marijuana, home cultivation, patient registration, and hemp-derived CBD from the medical perspective in the United States.

Section snippets

Defining decriminalization and medical marijuana legalization

Over several decades, policies that control marijuana use have variations or overlaps among state law. An understanding of the meaning of marijuana-related policies will establish a clear picture for the user to be aware of the legal and social impacts. Decriminalization means that state law is removing any criminal penalties (misdemeanor or felony) that require jail time for using a small amount of marijuana products [[14], [15], [16]]. Some states retained marijuana possession as a criminal

Legislation status of medical marijuana in the U.S.

The term “medical marijuana law” first appeared in California in 1996 when state law legalized marijuana use for medical purposes. As of February 2020, 33 states, Washington, D.C., and U.S. territories (Puerto Rico, Guam, and U.S. Virgin Islands) had passed legislation legalizing or decriminalizing medical marijuana. These states include Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan,

Home cultivation and possession

Variations between states inhome cultivation and possession are governed by state law, diagnosis, physician opinion, and distance of the nearest dispensary from the patient's residence. The majority of states with legalized medical marijuana allow home cultivation and possession of marijuana plants under specific amounts and time periods. Qualified patients or caregivers are allowed to cultivate cannabis in 17 states including Alaska, California, Colorado, Hawaii, Illinois, Maine,

Patient registration

Patient registration can be mandatory or voluntary in some states. The states that require patient registration in order to be protected are as follows: Alaska, Arizona, Arkansas, Connecticut, Florida, Minnesota, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Pennsylvania, Vermont, and West Virginia, as well as Washington, D.C. Patient medical marijuana identification (ID) cards are voluntary in Maine, California, and Washington, but they provide strong legal protection

Hemp plant and cannabidiol (CBD)

Marijuana and hemp are two common types of cannabis plant. Both have varying concentrations of THC and CBD. The marijuana plant contains a different level of THC compound, which is responsible for the high or euphoric effect, while hemp plants contain low levels of THC (less than 0.3% of THC on a dry weight basis). Cannabidiol, which does not cause a high, can be derived from either marijuana or hemp [22]. In December 2018, the Agriculture Improvement Act of 2018 (2018 Farm Bill) legalized

Conclusion

Federal and state law are both responsible bodies for the regulation of controlled substances in the U.S. Legalization of marijuana has a long history of controversy and still has somehow mysterious rules in the U.S. Over the last few years, significant legal changes have occurred in 33 states which allow marijuana to be used medically for qualified patients under specific regulations. However, the marijuana plant is still classified as Schedule I substance based on the federal CSA. The passing

Funding

None.

Declaration of competing interest

None.

Acknowledgments

I would like to express my special thanks to Professor Robert C. Speth for his valuable comments on this review.

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