Analysis: Medical cannabis is a win, despite issues in bill

In late 2020, a Senate bill (S.150) was introduced that would give South Carolinians the right to use medical cannabis to treat certain debilitating conditions, called as the “Compassionate Care Act”. Now, after days of debate, and many years of sitting on the issue, the bill finally passed the Senate. Below is a breakdown of the long-overdue proposal, including some its less desirable components.

Who would be eligible for medical cannabis?

Individuals suffering from the following conditions would be eligible for medical cannabis treatment: 

  • Cancer;
  • Multiple sclerosis;
  • A neurological disease or disorder, including epilepsy;
  • Glaucoma;
  • Post-traumatic stress disorder;
  • Crohn’s disease;
  • Sickle cell anemia;
  • Ulcerative colitis;
  • Cachexia or wasting syndrome;
  • Autism;
  • Severe or persistent nausea in certain cases;
  • Medical conditions causing causing severe and persistent muscle spasms;
  • A chronic medical condition causing severe and persistent pain;
  • Any chronic or debilitating disease for which an opioid is being prescribed according to a physician; and
  • Any terminal illness with a life expectancy of less than one year. 

The bill also creates a Medical Cannabis Advisory Board to consider adding or reviewing medical conditions that qualify for cannabis treatment. The board would be comprised of various medical professionals, a medical cannabis cardholder, and the parent of a cardholder.

In its current form, the bill represents one of the more restrictive medical cannabis policies in the country, and would prohibit eligible patients from smoking cannabis as a form of treatment. Permitted usage of cannabis would include ingestion of oils, tinctures, capsules and edibles.

The enabling legislation would terminate after 2028 unless extended by lawmakers, a confusing decision since fully implementing the program could take years.

The cardholder process

Before a medical card can be issued, which is required to use medical cannabis, a physician must certify that the person has one of the medical conditions listed above, and that the “benefits of using medical cannabis products outweigh any risks”. More specifically, a physician must conduct a lengthy assessment of a patient’s: 

  • History of illness;
  • Social history;
  • Medical and surgical history;
  • Alcohol and substance use history;
  • Family history (with an emphasis on addiction, mental illness or psychotic disorders); and
  • Other requirements under the bill

A physician must also consider other measures that could ease a patient’s suffering that don’t involve cannabis, specifically “chiropractic interventions”, and ensure the patient is familiar with a lengthy set of alleged cannabis-associated risks.

After this information is sent to the Department of Health and Environmental Control (DHEC), including the patient’s card application, the department would issue a medical cannabis card within 25 days. A person is ineligible for a card if they are a member of law enforcement or their job involves carrying a weapon, operating heavy machinery, or operating a train, bus, or any form of public transportation.

The benefits of medical cannabis

While S.150 is rather restrictive, the proposal still offers citizens a promising option for treating a long list of debilitating conditions. A study by Harvard Health determined that cannabis is particularly helpful for treating chronic pain and is effective at reducing tremors in individuals with Parkinson’s disease. It also found positive results when used by individuals suffering from PTSD, glaucoma and even Crohn’s disease (all covered by the bill).  

The data also shows cannabis is a safer alternative than certain prescription medications like opioids and other sedatives. According to the Centers for Disease Control (CDC), overdosing on cannabis is unlikely. Other reporting suggests that you cannot overdose on cannabis at all. And while there are obviously negative effects associated with overconsumption, they generally amount to a temporary, uncomfortable high sensation. 

Meanwhile, overdoses caused by opioids are reaching critical levels. According to the CDC, almost 1,400 people died in South Carolina during 2020 from an opioid overdose, a 59% increase from the previous year. State government is so concerned about the issue that they’ve developed an official opioid emergency response plan. Given that opioids carry a much higher risk, yet many of the same conditions can be treated with cannabis, why shouldn’t patients be given the choice? 

South Carolina already passed “right to try” legislation in 2016, a policy which gives terminally ill patients access to experimental treatment and medicine regardless of FDA approval. Legalizing medical cannabis isn’t all that different (if anything cannabis would be more proven than many experimental drugs.) The bottom line is that these decisions should be left to a person and their doctor where possible.

Neighboring states on the issue 

According to the National Conference of State Legislatures, Georgia and North Carolina only permit use of cannabidiol (CBD) products and those with low levels of THC. For context, THC is the psychoactive ingredient in cannabis that produces a high sensation, while CBD has more mild effects and is commonly used for anxiety and depression.

Meanwhile, other southern states like Florida and Alabama have already legalized medical cannabis, the former in 2016 and the latter in 2021. In total, 37 states across the country have adopted some kind of medical cannabis program. This proposal is a great opportunity for South Carolina to join the rest of the country in expanding access to a promising form of medical treatment.

Gun rights and medical cannabis

Despite the benefits of medical cannabis, cardholders across the country face a major issue: federal law still classifies marijuana as a Schedule I controlled substance. As such, cardholders are prohibited from owning or purchasing a firearm according to the Gun Control Act. This forces otherwise lawful gun owners who want to use medical cannabis to either forfeit the Second Amendment rights or omit their card status when filing federal gun purchase paperwork.

It’s not exactly clear how this policy is enforced on the ground in other states. In one Florida attorney’s opinion, a driver owning both a gun and medical cannabis card may not have issues if they were pulled over by state or local police, given that both items are legal under that state’s jurisdiction. If stopped by a federal agent, however, that person could face years in prison and thousands of dollars in fines. 

Unfortunately, this issue can’t be resolved by the bill. Federal law would need to be updated to include an exemption for gun owners using medical cannabis, or more preferably, marijuana would be removed the Schedule I list entirely (other drugs on this list include heroin, ecstasy and LSD).

How much would the program cost? 

Given the many requirements under the bill, medical cannabis in South Carolina won’t be cheap. According to the bill’s Fiscal Impact Summary, the program is expected to cost about $16 million in its first year. That includes roughly $5 million for DHEC, partially to cover the cost of hiring 34 new department employees. Another $11 million would go to the State Law Enforcement Division (SLED) to pay for new vehicles and equipment, and two new police units.

Future net costs are less clear. The summary predicts that the fines and fees established by the program should cover DHEC’s recurring costs starting in FY24, though not SLED’s. That may be an optimistic prediction, however, given the burdensome cardholder process established by the bill, which may discourage eligible patients from joining and funding the program. 

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