Oklahomans responded with an outcry when the state Department of Health proposed limiting THC in medical marijuana.
State Question 788, which passed in late June, legalized the sale and possession of marijuana plants and products without a limit on tetrahydrocannabinol, the chemical that produces euphoria in marijuana users. Regulations passed by the state Board of Health on July 10 created a cap at 12 percent THC in finished products and 20 percent in mature plants.
The board may have to change that regulation, however, after a letter from Attorney General Mike Hunter on Wednesday suggested board members may have overstepped their authority to regulate medical marijuana.
More than 500 of the 1,034 public comments the Health Department released on the proposed rules earlier this month objected to the THC limits. Some commenters said it would be impossible to control the level of THC in plants. Others, like Noel Treadwell, said that doing so would make medical marijuana largely worthless.
“Restrictions on THC content deprived many medical conditions to be untreated by medical cannabis,” Treadwell said. “I am currently on pain medication that has negative side effects and I voted for all the medical benefits cannabis has to offer, not just what the state decides to restrict it to.”
Fewer than a dozen comments in a database from the Health Department supported limiting THC, though it's possible that some comments in files that didn't come through also favored limits. Several people, like Shelley Brown, said a limit would make medical marijuana safer.
“Regulations should only allow products that provide predictable dosing to prevent poisonings, impaired driving, and drug dependency,” she said.
Unfortunately, there's very little solid research to settle the debate. Some studies have found that recreational marijuana users who use strains of the drug with more THC have a higher risk of cognitive impairment, and that high-potency marijuana could increase the risk of psychosis in some users.
Using a form of marijuana with a higher level of THC increases a patient's risk of addiction, said Dr. Jason Beaman, chair of psychiatry and behavioral health services at the Oklahoma State University Center for Health Sciences. Beaman, who said he opposed State Question 788 because it lacked sufficient controls, advised medical groups looking to influence the development of medical marijuana regulations.
While voters approved the state question without limits on THC, public opinion can be a poor guide for medical decision-making, Beaman said. For example, many people want antibiotics when they have a virus, even though the drugs would be a waste and possibly contribute to the growth of drug-resistant superbugs, he said.
“If you left it to the voters to decide if you get antibiotics whenever you have a cough, most of them would probably be OK with that,” he said.
Carey Clark, president of the American Cannabis Nurses Association, said everyone reacts to the chemicals in cannabis slightly differently, so it takes some experimentation to find the right strain and dosage. Generally, she advises patients to start at a low dose, and if that doesn't work, to increase their use slowly, to try to minimize side effects, she said.
“Doctors and nurses don't necessarily write down, ‘You need to take this strain with this percentage THC,'” she said.
Pain patients can benefit from using strains with more THC, because it reduces the distress associated with pain, Clark said. Patients who don't get the results they're seeking from legal products for sale in Oklahoma may turn to the black market, or take larger doses to try to get more THC, she said.
“The problem with keeping those THC percentages low is that some people need a higher percentage to manage their symptoms,” she said. “There's really no great data to support that lower THC content is going to be safer.”