A Community Forum
Exploring the Potential Health, Economic and Legal
Impacts of Medical Marijuana on Ohio
June 4, 2015
“Medical Marijuana: Truth and Consequences”
In April 2012, The Free Medical Clinic of Greater Cleveland (The Free Clinic) began a series of annual
forums designed to highlight the inseparable connection between the health of the Northeast Ohio
workforce and our long-term regional economic competitiveness. The first two forums, supported by a
wide range of business and community partners, brought together individuals from a variety of
disciplines seeking strategies, promising practices, and research regarding the evolving area of
workforce wellness.
A brief video synopsis of the inaugural forum can be found at:
http://thefreeclinic.org/economic-development-whats-health-got-to-do-with-it.html.
This year, we turn our attention from the growing field of workforce wellness to Medical Marijuana - an
issue that could have broad impact on our region’s workforce, health care delivery options, safety
considerations, research and commercial prospects, taxing options, among other issues. We plan to
review lessons learned from other jurisdictions that have implemented some form of medical marijuana
and to help Ohio prepare for such an eventuality, should well-publicized efforts to pass a voter initiative
on the subject prove successful. The Free Clinic has not taken a formal position on this issue, and the
forum is not intended to advocate for or against passage of any proposed initiative. Rather, it is
designed to provide a rational, fact-based dialogue regarding the relevant issues that such a dramatic
legal and policy shift in Ohio would entail.
The Challenge: A Rapidly Changing Landscape
Since the passage of the Controlled Substances Act in 1970, marijuana has been classified as a Schedule
1 controlled substance “as having a high potential for abuse, no currently accepted medical use in
treatment in the United States, and a lack of accepted safety for use of the drug or other substance under
medical supervision.” Consistent with this categorization, the Drug Enforcement Administration (DEA)
has stated in its Position on Marijuana:
“The campaign to legitimize what is called ‘medical’ marijuana is based on two propositions:
first, that science views marijuana as medicine; and second, that the DEA targets sick and dying
people using the drug. Neither proposition is true. Specifically, smoked marijuana has not
withstood the rigors of science – it is not medicine, and it is not safe. Moreover, the DEA targets
criminals engaged in the cultivation and trafficking of marijuana, not the sick and dying. This is
true even in the 15 states [in 2011] that have approved the use of ‘medical’ marijuana.” (The
DEA Position on Marijuana, January 2011)
Similarly, the FDA has stated the following regarding the safety of marijuana for medical use:
“The FDA has not approved any product containing or derived from botanical marijuana for any
indication. This means that the FDA has not found any such product to be safe or effective for
the treatment of any disease or condition. Study of marijuana in clinical trial settings is needed
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to assess the safety and effectiveness of marijuana for medical use.” (FDA and Marijuana:
Questions & Answers, http://www.fda.gov/NewsEvents/, accessed 1/26/15)
The FDA states that it “believes that scientifically valid research conducted under an IND
[investigational new drug] application is the best way to determine what patients could benefit from the
use of drugs derived from marijuana.” However, researchers indicate that the drug’s continued
classification under Schedule 1 makes getting research funding to explore the beneficial uses of
marijuana extremely difficult.
Despite the federal government's position regarding medical marijuana, to date, 23 states and the District
of Columbia have passed laws allowing for the use of the drug to treat a variety of medical conditions.
In addition to the jurisdictions that have enacted broad medical marijuana programs, eight states have
enacted Limited Access Marijuana Product Laws to treat several conditions. A listing of those
jurisdictions, including the conditions for which medical marijuana is authorized, can be accessed at The
Network for Public Health Law, https://www.networkforphl.org/_asset/sbth8b/State-MedicalMarijuana-Law-Table.pdf.
In response to this changing landscape at the state level, federal enforcement agencies have taken
several key steps to attempt to reconcile the inconsistency between federal and state treatment of those
engaged in the manufacture, distribution, or dispensing of marijuana that has been made legal under
state law. The Department of Justice has issued three Guidances regarding marijuana enforcement. The
most recent Guidance, issued on August 29, 2013, acknowledges the passage of a number of state ballot
initiatives that legalize possession of small amounts of marijuana and provide for the regulation of
marijuana production, processing, and sale. Justice indicated it will focus its enforcement priorities on
certain key areas, leaving state and local authorities to regulate marijuana use consistent with state laws.
Those priority enforcement areas include:
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Preventing the distribution of marijuana to minors;
Preventing revenue from the sale of marijuana from going to criminal enterprises, gangs, and
cartels;
Preventing the diversion of marijuana from states where it is legal under state law in some
form to other states;
Preventing state-authorized marijuana activity from being used as a cover or pretext for the
trafficking of other illegal drugs or other illegal activity;
Preventing violence and the use of firearms in the cultivation and distribution of marijuana;
Preventing drugged driving and the exacerbation of other adverse public health consequences
associated with marijuana use;
Preventing the growing of marijuana on public lands and the attendant public safety and
environmental dangers posed by marijuana production on public lands; and
Preventing marijuana possession or use on federal property.
In addition, the Financial Crimes Enforcement Network, a division of the Department of the Treasury,
issued a Guidance on February 14, 2014 in order to clarify “how financial institutions can provide
services to marijuana-related businesses consistent with their Bank Secrecy Act obligations, and aligns
the information provided by financial institutions in BSA reports with federal and state law enforcement
priorities.” Because these Guidances can be revoked at any time without notice, and do not negate the
existence of the underlying federal criminal statutes, they provide limited protection for businesses and
entrepreneurs interested in engaging in a business that has been sanctioned at the state level.
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In addition, according to a 2010 CNBC report, HR managers at employers in the then 14 states where
medical marijuana had been authorized have struggled to reconcile their treatment of applicants and
workers with legitimate marijuana prescriptions with their Drug-Free Workplace Act requirements,
safety requirements mandated by the Department of Transportation for transportation workers,
obligation to maintain a safe working environment pursuant to Occupational Safety and Health
Administration regulations, among others, with their obligation to avoid discrimination under the
Americans With Disabilities Act and other state-level protections that may arise from the enactment of a
medical marijuana program. “The Drug-Free Workplace vs. Medical Marijuana” (CNBC.com 4/20/10,
http://www.cnbc.com/id/36179669#, accessed, 1/26/15).
These legal ambiguities aside, there are many practical concerns and considerations that any responsible
community should address when anticipating the possible enactment of a broad medical marijuana
program.
The Event: An Educational Forum to Separate Fact from Fiction
The issues surrounding medical marijuana have assumed greater importance in Ohio in recent months
based upon certain polling and advocacy activities. A poll conducted in May 2009 by the Institute for
Policy Research at the University of Cincinnati (http://www.ipr.uc.edu/) found that 73% of Ohio adults
favored allowing medical marijuana. A similar national survey conducted around the same time by the
Pew Research Center for the People & the Press (http://people-press.org/) came up with similar results.
More recently, a February 2014 Quinnipiac University poll of Ohio voters found that 87% support the
use of medical marijuana, while only 11% oppose.
Spurred, in part, by this dramatic shift in public sentiment regarding marijuana use, at least two
organizations, the Ohio Rights Group and ResponsibleOhio, have each indicated plans to gather enough
valid signatures (305,591) to place the issue before Ohio voters in November 2015 and/or November
2016.
The Free Clinic plans to host a public forum designed to accomplish several goals, including:
1. A discussion of the current state of the science regarding the health benefits and risks associated
with medical marijuana;
2. A review of lessons learned from other states in which medical marijuana programs have been
implemented;
3. An identification of employment, safety, youth involvement, treatment and other potential issues
flowing from a medical marijuana program in Ohio;
4. An exploration of the potential financial impact of a regulated medical marijuana program; and
5. The implications of the potential inconsistency between state and federal drug enforcement laws.
We anticipate the invited speakers to provide hard metrics from other states, where available, but also to
help us identify and weigh the competing values that makes this decision so complicated. For example,
a recent Associated Press article demonstrates the difficulty in determining marijuana's impact on traffic
accidents. “In Washington, there was a jump of nearly 25 percent in drivers testing positive for
marijuana in 2013 -- the first full year after legalization -- but no corresponding increase in car accidents
or fatalities.” “Data unclear on whether legalized marijuana causing more traffic deaths.” (A.P., 9/2/14).
Recent suspensions by the National Football League of players found to have smoked marijuana, which
is generally considered not to be performance enhancing, have sparked discussions about whether the
league should reform its position on marijuana use. Players have claimed that, given the pain they must
endure in the normal course of their work, many would prefer to use marijuana for relief as compared to
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more toxic and addictive substances that their physicians may prescribe. A recent study published in
JAMA Internal Medicine appears to give some credence to the players’ position. According to the
study's results, “States with medical cannabis laws had a 24.8% lower mean annual opioid overdose
mortality rate… compared with states without medical cannabis laws. Examination of the association
between medical cannabis laws and opioid analgesic overdose mortality in each year after
implementation of the laws showed that such laws were associated with a lower rate of overdose
mortality that generally strengthened over time.” The authors urge further investigation to determine
how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.
Moreover, many institutions and professional associations have come to varying conclusions regarding
their position on medical marijuana. Of those that have opposed such expanded access, the rationale is
often the relative paucity of scientific research to support anecdotal reports of medical benefit. However,
two highly reputable organizations have recently come out in favor of reclassifying marijuana to allow
more peer-reviewed research to take place. On January 26, 2015, the Wall Street Journal reported that
the American Academy of Pediatrics (AAP) has recommended that marijuana be downgraded to the list
of Schedule 2 drugs (including such widely prescribed narcotics as oxycodone, fentanyl, morphine and
codeine), which are considered to have a “high potential for abuse which may lead to severe
psychological or physical dependence.” According to the article, the AAP also proposes that marijuana
should be made available on a “compassionate use basis for children with debilitating or life threatening
illnesses.” Similarly, in 2014, the Epilepsy Foundation called on the DEA to reschedule marijuana in
order “to improve and bolster research, reflecting a growing belief that medical uses can combat the
affliction.”
Conclusion
Whatever one's opinion about medical marijuana, the fact remains that it may become a reality in Ohio,
as it is in nearly half of the states in the country. If the opponents of expanded marijuana access are
successful, any preparation policymakers undertake may prove premature or wholly unnecessary. If,
however, proponents are successful in convincing voters to pass an initiative allowing for access to
medical marijuana, we would be wise to give thorough and rational consideration to steps that may
minimize the potential harm and maximize the potential benefits of such development.
As Plain Dealer columnist Mark Naymik wrote in his January 21, 2015 piece, “Trust Our Pot and Other
Themes of ResponsibleOhio…,” following the disclosure of additional details regarding the group’s
proposed Ohio constitutional amendment to legalize and tax marijuana, “It's time to pay attention to
the campaign to legalize marijuana. It will likely light up the November ballot.”
For additional Information, contact:
Danny R. Williams, JD, MNO
Executive Director
The Free Medical Clinic of Greater Cleveland
12201 Euclid Ave., Cleveland, OH 44106
dwilliams@thefreeclinic.org
(216) 707-3400
2/17/15
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