Oklahoma: Medical industry pushes for THC limits on medical marijuana

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Although a large majority of public comments about State Question 788 urged the Oklahoma State Department of Health not to impose cannabinoid percentage limits for medical marijuana products, records show multiple medical industry officials support the proposed strict regulations.

However, a doctor who specializes in the scientific study of cannabis says limitations on product potency will diminish the spirit of the ballot measure approved last month that rightly gives wide latitude to medical professionals.

The state Health Department, through the newly established Oklahoma Medical Marijuana Authority, received roughly 1,000 public comments through July 3 about emergency draft rules that will, if approved during a Tuesday board meeting, help govern the implementation of State Question 788.

Copies of the comments were made public on Thursday, which revealed hospital systems such as Hillcrest — whose CEO, Kevin Gross, is on the Oklahoma Board of Corrections — and St. John offered their views on the Health Department’s propositions.

Among the most controversial portions of the 61-page draft rules are provisions indicating concentrate and flower medical marijuana products shall contain no more than 12 percent and 20 percent tetrahydrocannabinol, or THC. Many of the public comments questioned the rationale for those limits, saying scientific studies have shown higher amounts are more effective for medical treatment.

But Hillcrest HealthCare System and St. John Health System, in identical letters submitted on Tuesday, said medical marijuana products should not have more than a 12 percent THC level and that regulations should only allow for “products that provide predictable dosing to prevent poisonings, impaired driving and drug dependency.” The Marijuana Policy Project, a national policy reform organization, argued against a THC limit, noting it was not part of the state question.

Chance Gilbert, president and co-founder of the Oklahoma Cannabis Trade Association, told the Tulsa World on Thursday that activists have already shared their concerns with the Health Department.

“We told them that limiting the THC content in the medication is not going to help patients, so there’s no real reason to be putting limitations,” he said. “That will only help the black market thrive.”

Similarly, Sunil Aggarwal, a doctor from Washington state who studies the use of cannabis for symptom management for various illnesses, said Friday that the proposed percentage limits will likely make it harder for patients to receive proper treatment and for doctors to do their jobs. Aggarwal, originally from Muskogee, advised activists in Oklahoma during early stages of bringing State Question 788 to voters.

“We have opioids that are more concentrated and less concentrated,” he said of the issue. “Nobody would ever argue against that. The Department of Health should be looking at (medical marijuana) that way.

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“We created (SQ 788) in a way to maximize the doctor-patient relationship and not have political regulations. Limiting it like that will limit the chance of doctors being able to address the disease modification that patients are interested in. Patients should have the right to try things.”

Aggarwal said dispensaries in Washington routinely carry products that have upwards of 70 percent THC for treatment of pain symptoms, along with mid-range items such as extracts, edibles and some flower products, and items with low THC but high cannabidiol, or CBD, content. A patient’s health history and needs will help determine which ratio is most suitable, he said, which is why doctors should have the freedom to choose from a wide array of prescriptions.

The letters from Hillcrest and St. John also ask that medical marijuana should not be sold in smokable forms, saying such a method is hazardous and potentially cancer-causing. The Oklahoma Hospital Association, in its own letter, made the same request.

“The Oklahoma State Department of Health in charge of the regulation of medical marijuana has many employees dedicated to smoking cessation, and it would be a step backward to have the agency issue regulations contrary to its statutory mission,” Oklahoma Hospital Association President Craig Jones said in a letter to the Health Department.

“Other states such as Arkansas, New York and Pennsylvania disallow smoking in favor of safer and more reliable methods of dosing for patients like oral medications, creams and oils.”

Aggarwal expressed skepticism at the hospital systems’ proposal, saying the variety afforded by plant products — of which there are numerous strains and THC ratios — is essential for patients.

“Cannabis is phytomedicine. They might not be used to thinking of plants as medicine, but most of the world has been using plants as medicine,” he said. “It’s important to have different ranges (of THC) that the plants offer. Strength (of prescriptions) is in variety.”

A separate letter to the Health Department from the American Lung Association requested the Medical Marijuana Authority prohibit smoking in all public places and workplaces. That rule also has already been proposed, and Gilbert has said rules regarding tobacco use in public will also apply to marijuana consumption.

INTEGRIS Health Care Systems interim CEO and President Chris Hammes discussed in his letter concerns with homegrown medical marijuana — which is permissible under the state question — and advocated for separate licensing, fees, record-keeping and inspections.

New Health Solutions Oklahoma, a trade group for the medical marijuana industry, has also encouraged those changes be made and has called for a special legislative session to enact regulations, a move that has drawn backlash from grass-roots activists.

New Health Solutions Oklahoma executive director Bud Scott said Friday that letters provided to the Health Department are proof there are “plenty of interests still out there that want to tear this program apart.”

Scott said the Health Department, as it stands, doesn’t have the legal authority to impose limits on the amount of cannabinoids in medical marijuana products.

“It’s not based on any kind of any industry standard or national standard, which is what you should go by when you’re looking at any kind of rule development for any industry,” he said of the proposed thresholds.

He said the idea of SQ 788 is to leave medical decisions between a physician and their patient.

“If you try to keep THC levels down, especially in plants, all that’s doing is encouraging a black market, especially a recreational market,” Scott said. “Our industry should be allowed to develop its products according to safety standards.”

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