By Jane Ehrhardt
Medical marijuana could become a part of Alabama physicians’ options for alleviating pain and making numerous conditions more endurable as soon as next year. “This topic can be difficult to keep up with but needs to be put back on physicians’ radar due to patient demand,” says Harrison Irons, MD, a pain management physician with Alabama Pain Physicians.
Last September, the Alabama Medical Marijuana Commission (AMCC) began accepting medical cannabis business applications for cultivators, processors, secure transporters, state testing laboratories, dispensaries, and integrated facilities. By the close of the submission period, 80 applications had been received to fill the 35 spots in the limited license categories.
“It’s all going to be done in-state, like farm-to-table marijuana,” Irons says. “I’m very happy with Alabama doing this in a methodical and scaled-down fashion.” For instance, the state is issuing only nine dispensary licenses with 25 total sites allowed.
Oklahoma, on the other hand, has over 2,400 dispensary sites. They took a fast and furious route to unrolling medical cannabis and created a fiasco. The Oklahoma Bureau of Narcotics and Dangerous Drugs now estimates about 2,000 medical marijuana license holders obtained permits fraudulently or are masking illegal sales. “The number of dispensaries is fighting to be in the ranks of the number of cows in Oklahoma,” Irons jokes. The state also issued enough medical marijuana cards for one in 13 adult residents to possess one, according to Oklahoma Watch.
Alabama has announced that once the business licenses have been awarded, physicians can begin the certification process to be able to recommend medical cannabis to qualified patients, according to the AMCC website (amcc.alabama.gov). Certification involves obtaining an annual Alabama Medical Cannabis Certification Permit from the Alabama Board of Medical Examiners.
Requirements include numerous, expected conditions for drug prescriptions along with having been in practice for at least a year and be registered with the Alabama Medical Cannabis Patient Registry System maintained by the AMCC. Physicians must also attend a four-hour course and pass the subsequent exam. The initial application fee runs $300. “It’s similar to being able to prescribe opioids,” Irons says. “It’s continuing education relating to medical cannabis—who qualifies, how to dose—for category 1 credits. Hopefully we will soon see more data involving the mixture of the two medications.”
Based on the conditions currently listed as approved for treatment with medical cannabis, the array of specialties that may want to certify spans from oncology, pain, neurology, psychiatry, obstetrics, hematology, and orthopedics to any physician dealing with chronic pain and terminal illness.
“I imagined the scope of conditions that Alabama would allow for use would be end of life care, nausea, vomiting, and maybe certain chronic painful conditions,” Irons says, thinking the list would align more with FDA-approved conditions for Marinol, the synthetic version of a chemical found in marijuana. “It’s great that they were open to more conditions. It means there must be a lot of good data and science behind these or they would not have listed them.”
Beyond the expected cancer-related and pain issues on the list, the 14 approved conditions include multiple mental afflictions, such as depression, PTSD, autism, and Tourett’s, along with some general symptoms, such as spasticity and seizures.
Irons is disappointed, however, that Alabama is not allowing the use of opioids with medical cannabis. “The verbiage for chronic pain sounds like it has to be medical marijuana or opioids, but not both,” he says. “A lot of people are stable on marijuana, but need a pain medication for bad days.
“Alabama has only slightly limited the routes of administration of the drug to help alleviate the typical recreational avenues, such as smoking and edibles. You can’t buy buds at a dispensary or vape it. And although children can qualify for medical marijuana use, other rules on how you administer and manufacture it appear to minimize its appeal to children.” The list does offer a wide array of options beyond pills, including gels, suppositories, liquids for inhalers, and transdermal patches.
The current and complete regulations outlining all the aspects of usage, dosage, certifying, and administration of the drug are downloadable on the Laws and Rules page of the AMCC website.
In May 2021, when Alabama became the 37th state to legalize the medical use of cannabis products, Irons says his office was inundated with calls from patients asking if they qualified and how to get their medical marijuana card. “These facilities are going to be up and dispensing before we know it,” he says, knowing the calls will flood in again. “For doctors who fall into this range, this could be another good tool to add to our patient treatment plan.”
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