Whilst there is considerable variation in the law from state to state, currently in the United States the use of cannabis for medical purposes is essentially legal in 29 states, as well as in Puerto Rico, Guam and the District of Columbia.
In a further 17 states, access is allowed to cannabis products containing cannabidiol (CBD) but where the amount of Tetrahydrocannabinol (THC) in those products is limited. THC is the main psychoactive component of cannabis whereas CBD is non-psychoactive and possesses a broad range of actual and potential medical applications.
The law in Illinois
Since 2013 in the State of Illinois, a medical practitioner can prescribe cannabis to a registered patient to treat any medical condition that appears on a prescribed list of “debilitating medical conditions”. The contents of that list, or rather its many noticeable absentees, has proved controversial. For example, whilst Rheumatoid Arthritis is on the list, Osteoarthritis is not.
In terms of chronic pain, both CRPS I and II appear on the list, as does “severe Fibromyalgia”, but more general chronic pain does not.
The recent ruling
Now a Circuit Court judge in Illinois, Judge Raymond Mitchell, has ordered the State to add “intractable pain” to the list of debilitating medical conditions. This more general definition could significantly increase access to medical cannabis. However, a spokesman for the State’s Department of Public Health has said that they will appeal the ruling.
The person who took the issue to court, Ann Mednick, suffers from Osteoarthritis. She says that she has taken opioid drugs for the extreme pain she suffers as a result of the condition but would far prefer a treatment with fewer side effects that would better allow her to function.
This is not Ms Mednick’s first attempt at getting intractable pain added to the list and Illinois’s now-defunct Medical Cannabis Advisory Board had previously agreed unanimously with her. However, in January 2016, the Director of the Department of Public Health turned down the recommendation, citing a “lack of high-quality data” from clinical trials to establish that the benefits outweighed the risks.
Noting that the Director was “clearly erroneous,” Judge Mitchell has accepted that intractable pain is a unique medical condition within the definitions provided by the International Statistical Classification of Diseases and Related Health Problems (ICD). He also found “that individuals with intractable pain would benefit from the medical use of cannabis” adding that studies had found that adverse effects generally were not serious and were well-tolerated.
A possible alternative for some?
In states that allow medical cannabis, chronic pain conditions account for the majority of prescriptions.
In the ongoing war on opioids, which is gathering momentum in the US, the UK and elsewhere, access to medical cannabis may prove invaluable to some people suffering chronic pain whose access to opioid-based medication is denied suddenly or restricted.
Interestingly, in Illinois the potential for using cannabis as a viable alternative to opioid-based medication has prompted a proposed change in state law, with a Bill submitted that would allow medical cannabis to be prescribed for any medical condition in place of prescribed opioids.
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