Tag: medical marijuana

How the Hippocratic Oath Drove This Doctor to Speak Up About Medical Cannabis

Dr. Michael Verbora spent six years in medical school, but in that time, only 30 minutes were devoted to learning about cannabis.

“We were taught that (cannabis) was a drug that had high potential for abuse,” says Dr. Verbora of medical school. “That’s really about it.”

Now the lead physician at a clinic that prescribes medicinal cannabis to Canadian patients, Verbora is baffled at his alma mater’s limited curriculum.

“We were taught that it was a drug that had high potential for abuse and that it could cause anxiety and addiction problems,” he tells Leafly. “That’s really about it. In psychiatry you learn about cannabis use disorder and how it can affect people’s mental health negatively.”

After finishing his training at the University of Toronto in 2013, Verbora learned about the Canabo Medical Corp., a chain of clinics that prescribe cannabis to patients referred by a family doctor. At the time, he was clueless that physicians could be the gatekeepers to this type of medicine. He signed up to be a resident at the Toronto Cannabinoid Medical Clinic, where he spent time shadowing another doctor, and soon realized there when it came to cannabis education, a lot was left out of his schooling.

Embracing What Was Not Taught

The first case Verbora heard involved a six-year-old boy who’d previously been prescribed about 10 different pharmaceuticals for chronic seizures. None of them worked. The child’s parents praised the effects of CBD oil, reporting that the compound, which Verbora knew nothing about, helped their son go from 100 seizures a month down to one.

The more time he spent in the clinic, the more stories he heard about the positive outcomes cannabis had on patients’ ailments.

“His parents told me he was walking, talking and doing things for the first time in his life,” says Verbora. “I was completely blown away, especially since no one had told me anything about cannabis.”

The more time he spent in the clinic, the more stories he heard about the positive outcomes cannabis had on patients’ ailments. Verbora decided to learn as much as he could from mentors at the clinic, online tutorials and textbooks. Soon, he was promoted to staff, which gave him the ability to start prescribing. He’s now the medical director of Canabo Medical Corp and physician lead at the Toronto Cannabinoid Medical Clinic.

After working in the space for a few years, Verbora felt it was crucial to share his knowledge and experiences with other doctors.

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“It’s important for the medical field to embrace this as a medicine and objectively present the data that we have and understand why the observational, anecdotal stories we get from patients is what is it, which is, that is has such positive benefits,” he says.

His intentions, however, haven’t always been met with enthusiasm.

Stigma in the Academic Community

When Verbora approached universities, there didn’t appear to be any interest in the information he had to share.

“It feels like they’re not interested in looking at this from a medical perspective at this point in time,” he says. “I was told essentially I wasn’t allowed to teach residents or students in this field of medicine. They said they’d be discussing it in certain areas but they didn’t have a desire or want to bring further cannabis education to the curriculum.”

University representatives told Verbora that he was welcome to teach from his experience with family medicine, but they didn’t want to approve him to teach through the cannabis clinic. He found this puzzling, given the demand for information, especially as Canada moves towards legalization. About 30 students have come to the clinic in the past two years to shadow doctors and learn more about the uses of medicinal cannabis.

“Most of the students who come through (the cannabis clinic) are pretty amazed and curious as to why they’re not being taught this in a formal fashion.”

“Most of the students who come through are pretty amazed by what they see and most are curious as to why they’re not being taught this in a formal fashion and why it has to be what we call a ‘hidden curriculum,’” Verbora says. “At the front lines, you have doctors who are embracing this and new students who are interested in learning how to prescribe this for the right patients, and yet, it doesn’t seem like the academic community seems ready to provide the education to the students or faculty.”

Traditionally, medical students have to take the Hippocratic oath when they begin their studies, which vows to do no harm. Verbora feels the oath allows if not compels him to discuss the potential of cannabis, especially CBD oil, which the World Health Organization recently declared as posing no risk.

“It’s supposed to be ‘Do no harm’, but when people come and criticize cannabis they talk about the lack of evidence,” he says. “As a physician, my oath isn’t to ‘do best evidence,’ it’s to do no harm first. And that’s why I prescribe cannabis. I find, at least with CBD, the side effects are minimal and there’s zero potential for abuse or harm so far.”

Stigma in the Medical Community

The resistance to cannabis’ potential extends past medical school. Verbora says he regularly feels shunned by his peers. He’s had conference presentations derailed by doctors who attack his character, or the information he’s presenting.

“It’s challenging and frustrating to face my own physician peers who won’t listen to me or look at the data.”

“It’s challenging and frustrating to face my own physician peers who won’t listen to me or look at the data,” Verbora says. “I wanted to share my patients’ stories and information I’d been reading, but (my presentations) would be hijacked by doctors who would share their views, which were essentially a confirmation bias.”

Every year Canadian doctors are required to accumulate 50 credits by attending informational presentations at conferences. Verbora’s presentations have been denied academic credit by organizations in the medical community.

At a conference called Academic Pain Day, the College of Canadian Family Physicians (CCPF) told him that his information was biased, even though Verbora felt it presented a well-balanced meta-analysis from a large, reputable organization.

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“They wanted me to change my slides to only focus on the harms, not the benefits, which in my opinion is not balanced,” he says. “They told me unless I change my slides, the people who were there wouldn’t receive credit.”

The CCPF did not respond to a request for comment.

Verbora is committed to presenting the best evidence available, while sharing his patients’ stories and encouraging more research in the field. He also acknowledges that there are different layers of evidence.

“Cannabis is very observational and anecdotal, but people have been using it for thousands of years, and we can’t just discredit all of these observations and anecdotes,” he says. “It is evidence—not the best evidence, but we also have to be cognizant on why we don’t have that. It’s hard to say there’s no evidence or research, because it’s impossible to do and there’s no incentive to do it.”

Predicting Growing Pains

Verbora suspects that once cannabis is legalized, there will be growing pains in how it’s received. He refers to American states that have legalized cannabis and specifically, the edible market, which has lead to problems amongst naïve or novice users, unclear on how much to take.

“I anticipate the media will be there to pick up on all this,” he says. “They’ll sensationalize anecdotes, whether good or bad, like they do anyways.”

He also anticipates positive change—patients will turn to cannabis instead of some more harmful substances, like tobacco or alcohol, which are the two legal drugs that kill the most people in North America. In some US states where recreational cannabis is legal, there’s been a decline in opioid deaths by as much as 25%.

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“It’ll be interesting to see how data pans out in the long run,” Verbora says. “There will be some negatives, but I think the positives overall will outweigh them. I think we’ll have to get to five or 10 years to look back to recognize the positives.”

Verbora also anticipates legalization will foster progress in the medical community. He suspects there will be more research and eventually drug identification numbers for cannabis products, which will facilitate insurance coverage and the “pharmaceuticalization” of cannabis products, with researchers isolating cannabis ingredients and producing medicines out of them.

“You’re going to need physicians who have an interest and expertise in the next few years,” says Verbora.

In the past decade, Verbora has heard growing talk of “patient-centered” care, where patients engage in the decision-making process with their doctors and share their goals and targets for treatment. This approach could be key when it comes to prescribing cannabis.

“The patient in front of you isn’t the patient in the research study that the pharmaceutical company funded,” he says. “It’s always a different patient, so you have to look at that one patient and find what works for them. That’s the future of medicine, and cannabis is pushing us towards that and we need to embrace it and understand it.”

Meet the Lawyer Suing Jeff Sessions to End Cannabis Prohibition

Last week, in a lawsuit that could put an end to federal cannabis prohibition, a federal judge in New York acknowledged the healing potential of medical marijuana. “It’s saved a life,” he said, referring to a Colorado girl with epilepsy. “She has no more epileptic seizures.”

The judge then turned to lawyers for the federal government, who have argued that cannabis is a dangerous drug with no accepted medical benefit. “If there is an accepted medical use,” he told them, “your argument doesn’t hold.”

The five plaintiffs have clearly obtained, and are able to maintain, a better quality of life because of cannabis.

David C. Holland, lead plaintiffs’ attorney

The case of Washington v. Sessions has generated great interest. Five plaintiffs, including former NFL player Marvin Washington; 12-year-old Colorado medical refugee Alexis Bortell; youngster Jagger Cotte; US military veteran Jose Belen; and the Cannabis Cultural Association, a nonprofit that helps people of color benefit from cannabis in states where it’s legal, have challenged the constitutionality of the classification of marijuana under the federal Controlled Substances Act. The case, filed in 2017, finally received its first hearing in federal court last week, when US District Court Judge Alvin Hellerstein heard the federal government argue for the case’s dismissal.

Leafly sat down with David C. Holland, the lead attorney representing plaintiffs in the suit, following the Feb. 14 hearing. Holland is a litigator in New York City and the executive and legal director of Empire State NORML. He’s former counsel to High Times Magazine and a member of the New York Cannabis Bar Association.

Holland walked us through what’s at stake in the lawsuit and the significance of the government’s recent effort to dismiss it.

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Leafly: Why have the plaintiffs sued US Attorney General Jeff Sessions?

Holland: The five plaintiffs have sued Sessions and the DEA to declare the classification of cannabis under the Controlled Substances Act unconstitutional on claims it violates their rights, including that to travel, to be engaged in business’ interests, and to be free from racial discrimination and in enforcement of the law against communities of color. The federal government denies those claims and has moved to dismiss the action.

What are the main components of the Controlled Substances Act? Take us through its procedural history.

In 1970, the federal Controlled Substances Act established five classifications, from Schedule I to V, ranging from prohibited to prescription, which classify and categorize drugs and how they may be researched, used, and administered. Marijuana was placed in Schedule I, the most restrictive category, based upon three criteria: high risk of abuse, no medical efficacy or use, and no ability to use or research it in a safe manner. Cannabis has never been rescheduled since 1970.

He was clearly wrestling with the reality that 30 states have already found cannabis to be a useful medical treatment, which directly contradicts one of the criteria of the CSA.

That Schedule I classification of cannabis can be changed by one of three ways: through an act of Congress, an act of the US attorney general, or an act of the FDA. Within the CSA is an administrative remedy where anyone can petition the FDA to have cannabis rescheduled where it would no longer be prohibited in that most restricted classification.

If anyone can petition the FDA, why haven’t more patients done so?

The petitioning process can take years, if not a decade to get an FDA determination on a rescheduling request. The FDA has repeatedly denied those petitions, as recently as 2013 (Americans for Safe Access v. FDA), and 2016 (Krumm Petition), finding that cannabis still should sit as a Schedule I substance based on those three criteria.

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Tell us a bit more about the plaintiffs.

Three of the plaintiffs in the Washington case—Alexis Bortell, Jagger Cotte, and Jose Belen—suffer life-threatening or severely debilitating diseases. They are seeking to bypass the FDA’s administrative petitioning process in order to get more immediate relief, because they may not live long enough to otherwise await and hear the determination.

The CSA petitioning process does not have any realistically viable means for them to expedite review of a petition to bring relief to their life-altering and life-threatening circumstances. Therefore, for them, the petitioning process is futile. They seek relief from the federal court for the CSA’s violation of their constitutional rights, with regard to this medicine as well as redress of other violations and due process.

The government has moved to dismiss the plaintiffs’ claims on a multitude of theories rather than put in an answer to the claims and let them be heard and determined by the judge or jury.

On Feb. 14, Judge Hellerstein entertained written opposition to the motion to dismiss and heard oral argument from the parties. At the conclusion of oral argument, the judge reserved his decision and retired to his chambers to deliberate and draft an opinion about all the legal issues he was wrestling with in regard to motion.

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Why did Judge Hellerstein seem so conflicted when speaking in court?

He was clearly wrestling with several legal issues pertaining to the Controlled Substances Act, and the reality that 30 states have already found cannabis to be a useful medical treatment, which directly contradicts one of the criteria of the CSA.

The first issue is referred to in legal terms as “exhaustion of remedies.” That is, the judge may be considering whether he must defer to the prior decisions of the FDA regarding the scheduling of cannabis. The government based its dismissal motion in part on a claim that the five plaintiffs had failed to exhaust their administrative remedies under the CSA. In other words, because no petition had first been filed with the FDA to reschedule cannabis, [the government argued that the court] does not have the jurisdiction to entertain the claims of the plaintiffs. Thus, their reasoning goes, the case should be dismissed.

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Judge Hellerstein, however, did not seem particularly swayed by that argument. Several federal criminal cases have found that there is no requirement to file a petition to exhaust that administrative petition remedy when there are claims that constitutional rights are being violated by the enforcement of cannabis as a Schedule I drug under the CSA. That rule was upheld in late 2017 by the federal court in upstate New York, in a case known as US v. Green, which caused Judge Hellerstein to pause during the course of oral argument.

Do you think that was Hellerstein’s primary concern?   

Not really. The issues that seemed to trouble Judge Hellerstein the most about the CSA petition process was whether he, as a judge, was without jurisdiction to hear, or must defer to, the administrative agency role of the FDA and prior findings in 2013 and 2016. In those findings, the FDA determined that cannabis was properly classified as a Schedule I substance.

If he did have such jurisdiction, could he then stand in the shoes of the FDA and make his own determination about the propriety of that schedule?

He further was concerned about any restrictions on the court’s analysis of the language of the statute, and the proper evidence to be evaluated, to determine whether the three criteria of Schedule I status continues to be met by cannabis. Some of the factors he noted included the fact that 30 states have legalized marijuana for medical purposes; the federal government has filed a patent on certain cannabinoids from the cannabis plant; and the five plaintiffs have clearly obtained, and are able to maintain, a better quality of life because of [medical cannabis].

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The language of the CSA regarding the three scheduling criteria seems straightforward.

It is straightforward as “conjunctive,” in that cannabis seemingly must satisfy each and every one of the three factors to qualify as a Schedule I substance. The failure to satisfy any one of those factors renders the designation void. In other words, if the plaintiffs prove that cannabis fails to meet any one of the three criteria, [then the question becomes: Is the court] required to declare the Schedule I classification null and void?

What seemed to concern Judge Hellerstein was that generally, when a federal court reviews an agency’s determinations, like those of the FDA, and that agency has repeatedly determined that cannabis satisfies the Schedule I criteria, the court must generally evaluate and disjunctively weigh all the factors in the aggregate to determine if they are satisfied with the intent of the criteria and classification.

This was a concern to the court in the Green case I mentioned earlier. It also troubled the Eastern District of California court in the US v. Picard case. In Picard, the court allowed a five-day hearing of evidence on the science behind the Schedule I classification, and then ultimately concluded that any determination to reschedule cannabis is best left to Congress.

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Do you think Hellerstein will defer to Congress?

This quandary of whether to defer to Congress invokes the “political question” doctrine, which says courts should generally not make decisions that are political in nature and best left to the legislative process. It is difficult to tell where Judge Hellerstein will ultimately fall on this political question issue. But he surely will wrestle with the fact that 30 states have already legalized cannabis despite its Schedule I status. That means that as a matter of politics, the actions of Congress should already have responded to the legislative actions already taken by an overwhelming majority of the states.

One argument advanced by your lawsuit is that the Controlled Substances Act and federal law enforcement should not govern cannabis in the 30 legalized states.

That is correct. The plaintiffs argue that although Congress may regulate interstate commerce—a.k.a. the commerce clause—between the states, the state-based activity of medical marijuana in those 30 states does not impact upon interstate commerce. Judge Hellerstein seemed to dismiss the argument out of hand, citing federal case law which finds that even a negligible or de minimis impact on commerce is enough to give the federal government jurisdiction over the issue.

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There was also the argument about racism and equal protection under the law. While the history of cannabis prohibition, ignited by former federal drug czar Harry Aslinger, wasn’t addressed in court, President Nixon and his administration’s racist motivations for instituting the Controlled Substances Act were definitely called into question. Hellerstein seemed dismissive of the Nixon argument. How is Nixon’s racism still a contributing factor to the Controlled Substances Act? 

It is unclear how Judge Hellerstein will rule on this “as applied” claim of the Cannabis Cultural Association (CCA). The CCA brought a claim on behalf of their members of color, who were disproportionately targeted for prosecution for marijuana offenses under the CSA. People of color unequally suffered collateral consequences stemming from those convictions as a result.

Judge Hellerstein seemed unpersuaded by statements of President Richard Nixon and his advisor, John Ehrlichman, which made clear that the criminalizing of marijuana under the CSA was done as a means to suppress minorities and social dissent against the Vietnam War. Judge Hellerstein suggested that any racist tendencies of the Nixon administration were not attributable to Congress under the separation of powers doctrine—where the powers of one branch of government are not affected by the actions of another. While there are compelling arguments to the contrary, which were not heard during the hearing, the plaintiffs hope that the issue is revisited in Judge Hellerstein’s opinion. Since so much of that claim seems to be a question of fact that will require lots of discovery and information to be tendered by the government, however, it’s unlikely to be the primary focus of the judge’s anticipated decision.

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It seems that there are various possible outcomes. Do you think Hellerstein will dismiss the case? He hinted that he was going to kick the case to the Second Circuit Court.

There are three possible resolutions to the federal government’s motion to dismiss. Firstly, there is the potential dismissal of the claims. Secondly, Judge Hellerstein could deny the motion, and all claims will proceed to trial. Or, lastly, some mixture of the two.

Based on the comments and concerns [expressed by the] court, there is a possibility that the court will follow the precedent of the district courts in Picard and Green and find this to be a political question. However, if Judge Hellerstein finds that there are some claims that may be dismissed but [that] others are tenable, then there is a strong possibility that the court will berate both the FDA and Congress for failing to reschedule or deschedule cannabis, especially in light of the fact that 30 states have found that there is medical validity to marijuana. After all, as he openly stated, the plaintiffs are the best evidence of the effectiveness of cannabis as a medical cure.

For now, we will just have to wait and see. A ruling is expected as soon as this coming week.

Canadian Health Insurer Announces Groundbreaking Medical Cannabis Plan

One of Canada’s biggest health insurance companies will soon offer coverage for medicinal cannabis. Sun Life Assurance Co. of Canada today announced an extended-health care plan that insures medicinal marijuana, with the option available to members starting March 1.

Sun Life supplies group health and dental benefits to 22,000 businesses in Canada—or one in six Canadians.

The Toronto-based firm supplies group health and dental benefits to 22,000 businesses in Canada—or one in six Canadians. In its press release, Sun Life said coverage will range from $1,500 to $6000 a year, and will apply to cannabis dispensed “according the government regulations.”  Plan members and their dependents must meet clinical criteria or have undergone a prior approval process.

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Medical evidence supports the use of cannabis for some serious and severe medical conditions,” said Dave Jones, senior vice-president of group benefits, to  The Globe and Mail. “As this has become something our clients have been asking us about more and more, we have moved from the stage of evaluate and review, to now offering it as a benefit for medicinal purposes.”

Due to cannabis’ lack of a drug identification number, Sun Life will cover medical cannabis under Medical Services and Equipment.

A longstanding obstacle for medical marijuana has been its lack of a drug identification number (DIN), without which it is ineligible under most employee health care plans. As a result, Sun Life will cover medical cannabis not through drug benefits but under the Medical Services and Equipment section of the extended plan, making medicinal cannabis subject to the same deductibles and reimbursements as other expenses in this category.

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Jonathan Zaid, executive director of Canadians for Fair Access to Medical Marijuana (CFAMM), said the news is a positive step forward for the broader cost coverage of medical cannabis. However, since the plan is an optional add-on and not underwritten in normal drug benefits, it still rests on individual plan sponsors—the employers—to buy the coverage.

“We hope (employers) will see the positive benefits in medical cannabis coverage for their employees and include this type of coverage on their plan.”

Jonathan Zaid, founder of CFAMM

“We hope plan sponsors will see the positive benefits in medical cannabis coverage for their members and employees, including potential cost savings and substation of more harmful drugs, and include this type of coverage on their plan,” said Zaid.

It’s also going to provide valuable counterevidence to the United States’ designation of cannabis as a Schedule I narcotic—how can the feds continue to claim cannabis has “no known medical benefits” when it’s covered by Canadian health insurance?

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As for the specific conditions and symptoms covered under the Sun Life plan, they mostly relate to pain, nausea and appetite, and include:

*Severe or refractory pain related to cancer and nausea associated with cancer treatments

*Neuropathic pain and spasticity related to multiple sclerosis

*Pain related to rheumatoid arthritis that doesn’t respond to standard therapy

*Anorexia and neuropathic pain related to HIV/AIDS

*Palliative care

Sun Life says it will continue reviewing advances in clinical evidence related to conditions that currently don’t apply for coverage.

Arizona Proposal Would Jail Cannabis Doctors Who Break Rules

PHOENIX (AP) — An Arizona House panel on Thursday approved a proposal making doctors who sidestep rules for medical marijuana recommendations guilty of a felony.

Physicians who violate any medical marijuana rule or law could get up to a year in prison.

The proposal backed by Yavapai County Attorney Sheila Polk was approved by the House Health Committee on a 6-3 party-line vote with Democrats opposed. It now goes to the full House after a routine constitutional review.

Physicians who violate any medical marijuana rule or law could get up to a year in prison. Currently medical boards can discipline violators, including revoking their license.

Polk said that hasn’t kept doctors from failing to follow rules requiring them to have a physician-patient relationship with each patient and to review their medical history and a year’s worth of records.

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Once a doctor recommends that a patient use medical marijuana, they can apply for a state-issued card allowing them to purchase and possess pot.

The statute “has no teeth,” Polk told the committee. “There are no consequences for not adhering to the statute. And of course the physicians under this statute are the gatekeepers as to who is getting these cards.”

Republicans hailed the proposal, with Rep. Jay Lawrence of Scottsdale repeatedly praising Polk for championing the legislation. But Democrats lashed out at the notion that Arizona would be slapping heavy penalties on doctors who can already face penalties from their licensing boards.

“To me this bill seems to be a solution seeking a problem, because if we already have sanctions on doctors who break the law I’m not sure why we’re adding more regulation onto the medical marijuana industry,” said Democratic Rep. Pamela Powers Hannley of Tucson. “This is a plant that never killed anybody, so I’m not seeing the harm.”

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A lobbyist for the medical marijuana dispensary industry, Kevin DeMenna, testified that adding felony penalties is unneeded because the medical boards have the ability to discipline doctors who stray from the rules. He also noted that the nation as a whole is moving toward marijuana legalization.

“We’re trying to criminalize something that is moving in exactly the opposite direction,” DeMenna said, “We are decriminalizing this. It is now effectively legal on three of our four corners — Canada, California and Mexico.”

Polk and many other top prosecutors in Arizona vehemently oppose marijuana legalization. She led an effort to defeat legalization of recreational marijuana in 2016.

She cited statistics from 2013 that showed just 25 physicians were responsible for 70 percent of the marijuana recommendations in 2013. She also said the most recent state medical marijuana report showed 85 percent of the medical marijuana cards issued were for chronic pain and most went to young people.

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“What I see from my perspective as county attorney is a culture of young folks who get their green card and then they’re going out and they’re smoking pot, and they’re not sick,” Polk said. “For me it’s a problem for the state because this becomes kids who are not going anywhere.”

— The legislation is House Bill 2067 .

North Dakota Chooses System for Medical Marijuana Program

BISMARCK, N.D. (AP) — North Dakota’s Health Department has selected a Florida-based company to implement a system to monitor North Dakota’s developing medical marijuana program.

BioTrackTHC has similar contracts in six other states including Delaware, which has a medical marijuana program similar to what North Dakota plans. The Fort Lauderdale company was chosen from among six proposals.

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The management system will track medical marijuana from seed to sale, as well as help register dispensaries and patient card holders.

Medical Marijuana Division Director Jason Wahl says BioTrackTHC submitted a five-year, $600,000 proposal. He says final dollar terms will be decided through negotiations that could wrap up by the end of the month.

State voters approved medical marijuana in November 2016. The drug is expected to be available to patients late this year.

Pennsylvania Begins Legal Medical Cannabis Sales

The first legal medical marijuana sales under a 2-year-old state law began Thursday at a dispensary in western Pennsylvania, with the first purchase by a woman who lobbied for passage of the law.

A line of about a dozen people greeted employees as they opened the doors of the Cresco Yeltrah dispensary in Butler. Five other dispensaries are expected to start sales in the coming days.

Dispensaries are expected to open to customers Friday in Pittsburgh, Bethlehem and Enola, and on Saturday in Sellersville and Devon.

Diana Briggs of Export, Pennsylvania, said the $178 purchase she made should easily be enough to treat her 17-year-old son Ryan for a month.

She credits medical marijuana for reducing Ryan’s seizures from more than 400 to fewer than 50 a day.

“A very long and winding, four-year journey brought me here today,” Briggs said after buying a tincture and some capsules. “I have been crying all day.”

Cresco Yeltrah chief executive Charlie Bachtell said the first day of public operation was “so far, so good.”

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“You forget, sort of, what that initial patient, that initial purchase, how long they’ve been waiting for it,” Bachtell said.

He said products ranged in price from $30 to $95. As a grower-producer, his company’s dispensary gets the product it sells from its own 46,000-square-foot growing facility about 60 miles away in Jefferson County.

Dispensaries are expected to open to customers Friday in Pittsburgh, Bethlehem and Enola, and on Saturday in Sellersville and Devon.

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Medical insurance does not cover the cost of medical marijuana, neither doctor visits nor the medicine itself.

Chris Goldstein, a cannabis consumer advocate with the National Organization for the Reform of Marijuana Laws, said the restrictive nature of Pennsylvania’s law may make it challenging for dispensaries to turn a profit.

“The rest of the country is fully legalizing, New Jersey is vastly expanding. Pennsylvania is rolling out one of the most limited medical cannabis programs in the country,” Goldstein said.

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Democratic Gov. Tom Wolf, who pushed for the law and has overseen its implementation , called the start of sales a historic day.

Wolf said Thursday that nearly 3,000 patients have obtained medical marijuana cards, more than 17,000 have registered to participate, and some 700 doctors have been qualified or are getting qualified to treat patients.

A 2016 state law restricts the drug to pills, oils, vapor or liquid marijuana, but not in smokable form or what are considered edibles.

Pennsylvania allows medical marijuana for those with one of 17 qualifying conditions, including AIDS, autism, cancer, epilepsy, post-traumatic stress disorder, chronic pain and Crohn’s disease.

Meet the 24-Year-Old Fighting for Canadian Cannabis Patients’ Rights

Jonathan Zaid never imagined that his chronic illness would set him on a path to leadership, helping Canadian patients gain access to affordable medicinal cannabis. But since becoming the founder and executive director of Canadians for Fair Access to Medical Marijuana (CFAMM), in 2014, Zaid can’t imagine doing anything else.

Zaid’s journey to cannabis leadership began in his teens, when he began experiencing constant intense headaches.

Zaid’s journey to cannabis leadership began in his teens. At 14, Zaid began experiencing constant intense headaches and insomnia, which made focusing in school impossible. After being diagnosed with New Daily Persistent Headache, he visited a slew of doctors in an effort to find some relief.

“For five years, I tried more than 40 medications, different types of therapies, went to the leading neurology clinic in North America,” he says. “I found nothing helped.”

Through online research, Zaid learned of others with his ailment who had positive breakthroughs from using cannabis. When he tried it, he found immediate relief from pain, and his insomnia subsided. But Zaid would spend another year trying to find a doctor who would support and authorize his use of the drug.

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When he was finally able to legally take medicinal cannabis for his conditions, Zaid had other hoops to jump through. The federal government was changing their cannabis statute from the Marihuana Medical Access Regulations (MMAR) to the Marijuana for Medical Purposes Regulations (MMPR). Zaid was on the right path to helping his condition, but that path was riddled with bureaucratic loopholes.

“I saw that affordability was crucial for patients, including myself, yet there were no organizations willing to speak about it at the time.”

Jonathan Zaid

“I finally found a physician but struggled with consistent access as well as lack of insurance coverage,” he says.

Zaid looked for non-profits that advocated for medicinal cannabis patients. The only organizations he could find focused on home-growing rights and not on issues like insurance coverage.

“I saw that affordability was crucial for patients, including myself, yet there were no organizations willing to speak about it at the time and represent patients on such a vital issue,” he says.

In 2014, the same year Zaid gained access to medical cannabis, he took his university’s student health plan to task, after they refused to cover his new treatment. The University of Waterloo’s committee that reviewed which drugs were covered under the student health plan argued that since there was no drug identification number (DIN) for medical cannabis, it couldn’t qualify.

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It didn’t take long for Zaid to poke a hole in that argument.

“They previously covered a medication I used from the US, which didn’t have a drug identification number,” he says. “By that, I’d proved that a medication without a DIN could be covered and used that as the basis for why they could cover cannabis.”

Zaid worked with the committee to show how much money could be saved in lieu of other insured medicines he wouldn’t be using anymore, along with the positive impacts cannabis had on his condition, and in turn, his studies.

“In the end, they agreed with it, approved my case and that allowed other students the precedent to go through that process and prove a medical need for cannabis and provide the documentation and get coverage,” he says.

“I (launched CFAMM) out of the lack of support for cannabis patients that were looking to use this as a medicine and not necessarily go down the litigious route.”

Jonathan Zaid

From there, CFAMM was launched.

“I did it out of the lack of support in the space for cannabis patients that were looking to use this as a medicine and not necessarily go down the litigious route as well,” Zaid says. “I really tried to build it into an evidence-based organization.”

It’s now considered to be one of the most credible non-profits to represent medical cannabis patients, working collaboratively with government, the medical community, and the cannabis industry to ensure that patients are represented professionally.

Zaid, who is now 24, is the face of the organization, though he works with 30 volunteers across the country. The role has forced him to step away from his studies full time, since it requires a lot of travel.

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Since launching CFAMM, he has come to learn that for every victory, there are many more battles to be fought.

In November 2017, the federal proposed an excised tax to both recreational and medicinal cannabis, going against everything CFAMM was working towards.

In response to the government’s proposed levy on cannabis, CFAMM launched a campaign called Don’t Tax Medicine.

Part of CFAMM’s mandate is to advocate against sales tax, both GST and HST, since no other prescriptions are subject to a levy. They do this in conjunction with the Arthritis society, the AIDS society and a several other non-profits.

In response to the government’s proposed levy on cannabis, CFAMM launched a campaign called Don’t Tax Medicine, which calls for the elimination of both sales tax and the new proposed DIN tax. Zaid says that so far over 16,000 Canadians have sent letters to their MPs, and the campaign has garnered support from a dozen non-profits as well as a group of leading physicians.

“We’re really happy to see the momentum the campaign is building but at the same time, the government only has one decision to fairly treat medical marijuana and that’s to eliminate tax on it,” he says. “We haven’t received any decisions at this point but we’ll continue to advocate strongly until we hear positive change from the government.”

While positive change might come slow from the federal level, Zaid says Canadians’ attitudes are changing, as the country moves towards legalization.

Along with the fight to gain insured medicine for patients, CFAMM is also focused on calling the government to fund research on medical marijuana.

“I haven’t been doing this that long, so I have seen in that short time a tremendous shift in stigma away from medical cannabis,” he says. “There’s still opposition. But the amount of acceptance that medical cannabis has amongst the general population and decision makers and MPs, you can see the advocacy work done across the country has driven a lot of change.”

Along with the fight to gain insured medicine for patients, CFAMM is also focused on calling the government to fund research on medical marijuana.

“So far they’ve committed millions to enforcement and other monitoring program around legalization and that’s positive but we really need to see investment in medical marijuana research so we can fully understand how it works,” he says.

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In January, the federal government announced it would spend $1.4 million on cannabis-related research, showing progress in the work CFAMM does.

Zaid says the most rewarding part of what he does comes from hearing stories of the positive impact his work has on the lives of Canadians.

“We often hear how patients feel alone and stigmatized, so hearing that we’re making a difference in their lives is a great motivation and always will drive the work that we do,” he says.

‘Trading a Constitutional Right for Pain Relief’: The Week in Cannabis Quotes

Covering everything from entrepreneurial Girl Scouts to enlightened gun lovers,  here are the week’s most notable cannabis quotables.

“Trading a constitutional right for pain relief is a choice no one should have to make.”

—David Keene, former NRA president, in a Washington Times op-ed arguing against depriving MMJ patients of gun ownership

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“We really want girls to be cookie entrepreneurs, to find new and creative ways to reach customers.”

—Girl Scouts spokeswoman AnneMarie Harper, supporting the San Diego Girl Scout who sold 312 boxes of cookies in six hours outside a cannabis dispensary, in the New York Times

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“(It’s) a necessary first step of righting the wrongs of the past.”

—Seattle Mayor Jenny Durkan, on erasing hundreds of criminal convictions for misdemeanor cannabis possession

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“We have a drug-testing policy: You have to test pot. If you don’t like it, you don’t have to try it again.”

Tony Magee, founder and CEO of Lagunitas Brewing Company, speaking at the National Cannabis Industry Association’s Seed to Sale Show 

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“We do want to find a solution to make sure that businesses that have large access to cash have a way to get them into a depository institution for it to be safe.”

—Treasury Secretary Steve Mnuchin, testifying before the House Financial Services Committee regarding cannabis and banking 

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Cash-Strapped Greece Sees Growth in Medical Cannabis

ATHENS, Greece (AP) — Greece’s government says it’s fast-tracking plans to legalize growth of medical cannabis, arguing that growing interest from investors could help efforts to pull the country out of years of crisis.

Legislation to legalize cannabis production was submitted to parliament Wednesday and is due to be voted on later this month.

Greece allowed the use of medical cannabis products last year, but currently relies solely on imports until the legal framework for domestic growers was prepared. Government officials, presenting details of the bill, said they hoped domestic production and processing could attract investments worth 1.5 billion euros (1.85 billion) over three years.

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According to the draft legislation, growers must be age 21 or over, have no drug-related convictions, and have more at least 1 acre of land available.

Utah Advances Plan to Allow Cannabis for Terminally Ill, Growing For Research

SALT LAKE CITY (AP) — A Utah lawmaker’s proposals that would allow terminally ill people to use certain forms of marijuana and farmers to grow it for research purposes passed their first hurdle in a committee despite criticism that the piecemeal approach doesn’t go far enough.

Rep. Brad Daw, a Republican from Orem, said during a hearing Wednesday that the measures help dying people try another alternative that may help and provides a way for researchers to get marijuana locally.

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Senate Stunner: Orrin Hatch Passionately Defends Medical Marijuana

Medical marijuana advocate Christine Stenquist says the state needs comprehensive medical marijuana legalization so everyone with chronic pain, and not just those with terminally ill conditions, can get relief.

She and other advocates are gathering signatures to get an initiative on the November ballot so they can ask voters to pass broad marijuana legalization.