Bob Kressig

Bob Kressig

A guest opinion essay by Flora Schmidt shared that the Iowa Behavioral Health Association supported Gov. Kim Reynolds’ decision to veto the medical cannabis changes proposed by the Legislature this year (HF732). I wanted to make sure some factual information was shared to counter the IBHA statements.

There is indeed a need for medical CBD in Iowa, but there is also a need for medical THC. Both are permitted under the Iowa cannabis program, and the qualifying conditions in Iowa necessitate both are available to patients. It is time we stop relying on the crutch of a misnamed program and acknowledge Iowa currently has a (very limited) medical cannabis program.

Untreatable pain is a certifiable condition in the program. As noted by the National Academies of Sciences, Engineering and Medicine, there is substantial evidence to support that cannabinoids are effective for the treatment of chronic pain in adults.

Note the current 3% formulation cap limits the individual products, but it does not limit the level of THC someone may consume.

On the contrary, HF 732 put a responsible limit on the amount someone may purchase (and presumably consume) that takes into account the needs of patients in the program.

Note that cannabis lifetime risk for dependence is 9%, according to studies (Lopez-Quintero et al 2011, Anthony et al 2006). This is compared to 67% for nicotine users, 22.7% for alcohol users, and 20.9% for cocaine users. Every day, more than 130 people in the United States die after overdosing on opioids.

Comments by Schmidt claim 20 mg was well into the psychoactive range. Requests have been made for this information but it has not been received. I suspect it does not exist. I was told by the Cannabis Advisory Board, in its letter to the General Assembly, that 50 mg was well into the psychoactive range.

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What citations of peer-reviewed literature will show, in fact, is there is not a consistent dose considered psychoactive, especially in medical subsets of patients.

The 277 mg limit/day (25 grams/90 days) has a basis in literature, as well as in other state medical programs purchase caps. 25g/90 days will still make Iowa the most restrictive purchase cap for a medical program.

Patient data from Minnesota and Iowa support patients are taking up to (and occasionally above) 277mg of THC/day for their conditions. This is perhaps the most important note of why moving to a 4.5-gram cap would be so problematic — patients will be forced to taper their doses without their consent, and the medicine will no longer help them.

In a medical cannabis program like Iowa’s, with patients’ average ages from 56 to 57 years old, what has been shown, like in other medical programs, is that patients establish a dose and then stay there. The idea all patients will purchase 25 grams of THC every single 90-day period is in direct contradiction to the facts and is simply stated without evidence to prey on the fear some have.

Forcing patients to a 4.5-gram limit demonstrates this group, which has not asked MedPharm Iowa to understand dosing protocols or purchase habits, does not know how patients are administering their medicine. Worse, it will force patients to taper their dose without their consent. It would force patients who have an alternative to opioids today to no longer receive relief through this program, essentially kicking any patient who needs more than 4.5 grams off the program.

If Gov. Reynolds would have worked with legislators prior to vetoing the bill she may have understood some of these concerns. But that didn’t occur.

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Rep. Bob Kressig, D-Cedar Falls, has been working to expand the medical cannabis legislation for years.


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