Medical vs. Recreational Marijuana: Laws, Misconceptions and the Future

Definition of Recreational Marijuana vs. Medical Marijuana

Many people have trouble defining the differences between medical and recreational cannabis. Do they differ structurally or just legally? “A lot of people conflate recreational with medicinal use,” Dr. David Bearman, a California-based physician and medical marijuana expert, told DrugRehab.com. “But there are clear differences.” He says several factors distinguish these two categories of cannabis. A key difference: intent. For example, people who use marijuana recreationally often smoke it to achieve a high rather than to ease a chronic condition. THC is the mind-altering chemical in marijuana primarily responsible for producing euphoria. THC-based medications, such as Marinol, often are used to increase appetite and reduce nausea. This chemical may also decrease pain, inflammation and muscle control problems. However, not all chemicals in marijuana produce euphoric effects. Bearman said many medical cannabis patients use the drug solely for its therapeutic properties. These individuals aim to minimize marijuana side effects, including the high.

This is where cannabidiol, or CBD, comes into the mix.

CBD is nonpsychoactive, meaning it does not have mind-altering side effects. It also partially blocks the euphoric effects of marijuana caused by THC. CBD is potentially useful in controlling epileptic seizures and reducing pain and inflammation. The cannabinoid may also be effective in treating mental illness or addiction, according to the National Institute on Drug Abuse. Recreational cannabis generally contains high levels of THC and lower levels of CBD. Medicinal marijuana often is rich in CBD with little or no THC. Therefore, medical marijuana users will likely feel the therapeutic effects of the cannabis without achieving a high. “With medical, you’re looking for, in most cases, a relatively short effect of the material that you’re consuming,” explained Bearman. “It’s all about what is in the cannabis you are consuming and the goal you have in mind.”

The Effectiveness of Medical Marijuana

Medical marijuana describes using the cannabis plant or its extracts to treat a disease or symptom. Marijuana comprises more than 100 active cannabinoids, a group of active chemicals that influence the central nervous system. Cannabinoids regulate pleasure, memory, concentration, body movement and awareness of time. A 2014 study published in the New England Journal of Medicine outlined clinical conditions with symptoms that may be relieved using medicinal marijuana. These conditions include glaucoma, AIDS-associated anorexia and wasting syndrome, multiple sclerosis and epilepsy. “We have a lot of people with different illnesses and conditions that say they benefit from cannabis use,” said Bearman. But like prescription drugs, medical marijuana may not be effective for everyone. “People with migraines [who use medical cannabis] say they never get a migraine, while others say it doesn’t help at all,” he said.

Research on Medicinal Marijuana

Cannabinoids can be useful in medicine. The two primary chemicals of medical interest in marijuana are THC and CBD. Researchers have carried out numerous studies designed to explore the effectiveness of these cannabinoids in medical treatment. A 2007 study published in the journal Anesthesiology examined the effects of smoked cannabis on pain management. Researchers found that a medium dose of marijuana, measured as 4 percent THC by weight, reduced pain in participants 45 minutes after using the drug. However, a high dose of marijuana, 8 percent THC by weight, increased pain in these individuals 45 minutes after they smoked it. Researchers saw no significant effect with a low dose of 2 percent THC. In January 2017, the National Academy of Sciences, Engineering, and Medicine released one of the most comprehensive reviews of the health effects of marijuana and cannabis-derived products. The report concluded that marijuana has medical value in treating chronic pain in adults, but it also associated cannabis use with more frequent bouts of chronic bronchitis. Researchers also reviewed evidence suggesting cannabis use likely increases the risk of developing schizophrenia and other psychoses, social anxiety disorders and depression. These findings contrast a popular notion today among Americans: Marijuana use is a harmless activity.

Public Opinions on Marijuana Risks

Many Americans believe cannabis is less dangerous than other mind-altering substances. For example, a 2014 Pew Research Center survey found that 69 percent of Americans view alcohol as more harmful to a person’s health than cannabis. Although marijuana has been used for medical purposes, the drug can be physically and psychologically damaging. As with alcohol, heavy marijuana use can lead to addiction, a chronic brain disease that causes compulsive activity. A 2015 study published in JAMA Psychiatry suggested that nearly 30 percent of cannabis users in the United States had a marijuana use disorder in 2012 and 2013. People with this addiction may exhibit irritability, mood swings, restlessness and physical discomfort. Some reports indicate regular marijuana use during adolescence can affect memory, learning and impulse control. However, other studies show no significant structural differences between the brains of marijuana users and nonusers. “Side effects of medical marijuana are primarily related to THC,” Dr. Michelle Sexton, a licensed naturopathic doctor in California, told DrugRehab.com. “So side effects can include dizziness, low blood pressure and heightened sensory perception.”

Dr. Michelle Sexton, a licensed naturopathic doctor in California, says cannabis use can alter a person’s perception of time.

A report by Harvard University says medical marijuana may help treat nerve pain and chemotherapy-related nausea. But few studies support its effectiveness in treating psychiatric conditions, such as post-traumatic stress disorder. Researchers know much more about the psychological risks of cannabis use. Some studies have suggested medicinal marijuana use can cause anxiety, psychosis, pneumonia and other respiratory problems, according to the Harvard report. Despite the potential consequences associated with cannabis use, the number of legal medical marijuana patients in the United States continues to grow. As of March 1, 2016, more than 758,000 people in California legally sought medical marijuana, according to the online data resource Statista. Michigan had more than 182,000 medical marijuana patients. Washington and Colorado also had more than 100,000 medical marijuana users. Cannabis is the most popular illicit drug in the United States. In 2016, Gallup, a research-based consulting company, reported that 13 percent of U.S. adults currently used recreational or medical marijuana. Forty-three percent of adults said they had tried the drug at least once. The number of medical and recreational marijuana users is bound to swell in the coming months and years — thanks in part to Election Day 2016.

Rules and Regulations

Leading up to Election Day, many spoke in favor of legalizing medical or recreational marijuana. Tom Angell, chairman of the pro-marijuana group Marijuana Majority, told USA Today in August 2016 that science supports the medicinal value of marijuana. Others said legalization could negatively impact society. Kevin Sabet, co-founder of the anti-marijuana legalization organization Smart Approaches to Marijuana, traveled the country prior to Election Day warning people that cannabis legalization would lead to the creation of THC-laced candy intended to get children high. The pro-marijuana argument rang louder on election night. Nine states had a marijuana-related measure on the ballot. Voters approved the medicinal use of marijuana in three states: Arkansas, Florida and North Dakota. Montana rolled back restrictions on an existing medical cannabis law. Meanwhile, voters in California, Massachusetts and Nevada approved the recreational use of cannabis. Arizona voters rejected a measure that would have legalized recreational marijuana, though the state allows medicinal use.

Today, 29 states and the District of Columbia approve the medicinal or recreational use of marijuana.

Source: Business Insider

However, marijuana remains a Schedule I drug, making its use illegal under federal law. The U.S. Drug Enforcement Administration classifies this group of substances as having no currently accepted medical use and a high potential for abuse. Schedule I drugs also include heroin, ecstasy and LSD. State marijuana laws differ from one another. Residents of California likely will not be able to purchase marijuana until 2018, as the state needs time to iron out its recreational laws after the passage of Proposition 64. But California adults aged 21 and older have more legal flexibility with marijuana possession than they had prior to November 2016. They can legally use, possess and share cannabis. They can walk the streets with up to an ounce of dried marijuana or eight grams of concentrate without fear of arrest. Some past drug offenders will even have a chance to have their records expunged. Residents cannot smoke or ingest marijuana in public, though California law eventually will allow for licensed on-site consumption. Hotels or bed-and-breakfast establishments could choose to allow consumption on their property. Californians aged 21 and older also can grow cannabis at home. A household in California is limited to growing six plants at a time. The product must be grown and consumed in that state only. Also, cannabis cannot be taken across state lines. Nevada allows for the recreational use of marijuana, and residents can grow cannabis if they meet certain requirements. The state requires those who wish to grow cannabis legally to live more than 25 miles from a dispensary. However, the law does not prevent adults from gifting legal amounts of marijuana to someone aged 21 or older. Nevada residents can drive while possessing marijuana. But it remains against state law to drive while under the influence of the drug. Not even passengers can smoke marijuana while the vehicle is in operation. Like California, Nevada has banned the public consumption of recreational or medical marijuana. This includes locations where cigarette smoking is permitted, such as bars, hookah lounges and casinos. The only place to legally use marijuana is in a private residence. This may soon change. A bill request from Sen. Tick Segerblom, D-Las Vegas, would give local governments the power to allow cannabis use in areas they see fit. This could include public locations. Many marijuana-friendly areas do not allow public use of the drug. However, Denver voters approved Proposition 300, which allows bars and restaurants to give patrons the option to use marijuana. It is the first city in the United States to permit marijuana use in these businesses.

Denver is the first city in the United States to allow marijuana use in bars and restaurants.

Florida recently became a medical marijuana state. Seventy-one percent of Florida voters approved Amendment 2, a measure legalizing the medicinal use of cannabis for individuals with specific debilitating diseases or other conditions as determined by a licensed state physician. About 200 licensed doctors in Florida have completed a training course with the Florida Medical Association and are approved to recommend marijuana to qualified state residents. These doctors can be found in every major city in Florida, such as Miami, Jacksonville, Orlando, Tampa and Tallahassee. Despite having access to licensed physicians, most Florida residents cannot receive medical cannabis just yet. The Florida Department of Health has six months from election night to establish program regulations, including a possession limit. It has an additional nine months to implement those rules. Regulations could set restrictions on where marijuana dispensaries can set up shop, Morgan told Johnny’s House. He maintains that these businesses likely will not be seen near educational institutions or places of worship — contrasting a popular legalization misconception held by many. “That’s what our opponents said during the election. They’re going to set up next to a church. They’re going to set up next to a school. They’re going to have carts outside with marijuana lollipops and try to give them to kids,” explained Morgan. “What’s going to happen is these local governments are going to say, ‘No, you can’t put it next to the church. You can’t put it next to the school.’ They have rules that prevent that from happening.” However, cannabis dispensaries exist near these very locations in Colorado. A 2016 report by The Denver Post found more than two dozen Denver schools located near a store selling medical or recreational marijuana. Out of 215 marijuana shops in Denver, The Post identified 25 located within 1,000 feet of at least one school. Gina Carbone, a co-founder of Smart Colorado, a group that advocates protecting children from marijuana, suggested marijuana shops could encourage children to engage in drug use. She told The Denver Post that the city should reconsider allowing these shops to set up near schools. “We are making this attractive to kids and young people,” she said. A recent study found that marijuana laws affect education. A 2016 report published in Drug and Alcohol Dependence examined the possible impact of exposure to medical marijuana laws on rates of high school and college completion. Researchers found that young people aged 14 to 18 who were exposed to medical marijuana laws were less likely to earn a high school diploma or GED, enroll in higher education and earn a college degree. Sabet said some components of marijuana, such as THC and CBD, can be properly used for medications. But he says the movement to legalize medicinal and recreational marijuana is more about producing kid-friendly items, such as marijuana candies, than treating serious medical problems.

Source: National Center for Biotechnology Information

“None of us want people to suffer from cancer, but most people who use medical marijuana do so for back pain,” Sabet told DrugRehab.com. “Miniscule amounts of those who use [medical marijuana] have cancer pain.” He also noted that marijuana use can result in death, referring to the number of drivers high on cannabis involved in fatal vehicular accidents. In Colorado, 94 people died in vehicular crashes involving a driver who tested positive for marijuana in 2014. This was the first year marijuana was available in retail stores. A 2016 report by the AAA Foundation for Traffic Safety showed the number of deadly car accidents involving marijuana doubled in Washington after the drug was legalized in 2012. One in six Washington drivers involved in fatal crashes in 2014 had recently used marijuana, the study found.

Limited Access Laws

Some states have legalized limited access medical marijuana programs. In many cases, these programs limit legal cannabis use to products low in THC and rich in CBD, which reduces the drug’s euphoric effects. Through a contract with the National Institute on Drug Abuse, the University of Mississippi is the only institution in the country permitted to grow marijuana for federally approved research. But the DEA announced in August 2016 that it is accepting applications from growers interested in supplying the drug for federally sanctioned research and drug development.

States with Limited Access Marijuana Product Laws:

Alabama, Florida, Georgia, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming

In Kentucky, the Clara Madeline Gilliam Act exempts CBD from the legal definition of marijuana. This allows public universities or schools of medicine in the state to administer CBD products for clinical trials or for expanded access programs approved by the FDA. Wisconsin has also lifted restrictions on CBD. Act 267, enacted in 2014, allows physicians and pharmacies with an investigational-drug permit from the FDA to dispense CBD products. Those qualified to access CBD may pick up products that contain the ingredient from an out-of-state dispensary. As of March 2016, 17 states had implemented limited access medical marijuana laws. Of these states, 16 specify conditions approved for use, 10 include patient registries and five allow dispensaries to distribute marijuana.

Obtaining Medical or Recreational Marijuana

The process of obtaining medical marijuana differs from state to state. In California, it requires the approval of a physician. People with a medical condition as defined by Proposition 215 generally qualify for medical marijuana. These conditions include AIDS, anorexia, cancer, chronic pain, glaucoma, migraine, seizures and severe nausea. The California Department of Public Health oversees the Medical Marijuana Identification Card Program, established to create state-authorized medical marijuana ID cards and a registry database for verification of qualified medical marijuana users and their primary caregivers. Participation in this program is voluntary. California law gives physicians the authority to determine whether a person can benefit from medical marijuana. Sexton says the language in the law allows doctors to recommend it for nearly any condition, no matter the severity.

Many marijuana dispensaries sell various types of cannabis strains that target different symptoms.

In theory, physicians could recommend medical marijuana to someone with a minor headache. “Most doctors do not recommend [medical marijuana] to their patients” said Sexton. “They don’t recommend it because it is not federally legal and therefore not approved by the FDA” Because of its Schedule I classification, no doctor can prescribe cannabis. However, physicians can write an approval for recommendation for patients. They can take this written documentation to a nearby dispensary and pick up their medication. Many marijuana dispensaries across the United States occupy brick-and-mortar shops filled with various types of cannabis strains designed to treat different symptoms. These medications come in a form that can be inhaled or consumed. Cannabis dispensaries often are rigorously secure. Only those with written documentation can enter a given location. Individuals cannot walk into a medical dispensary without a patient ID card. “They usually have one or two large people there for security purposes,” explained Bearman. “As the industry becomes more and more regulated, security personnel are being mandated by state governments.”

CNBC: A look inside a marijuana dispensary in Colorado.

In Colorado, people must show a medical marijuana ID card before entering a dispensary. Coloradoans can purchase up to an ounce, about 28 grams, of marijuana at a time with this identification. People who reside out of state can buy up to a quarter ounce. The process of purchasing recreational marijuana is a bit more lax. For example, Washington residents aged 21 and older don’t need an ID card to purchase recreational cannabis. But purchases must be made at state-licensed stores. Recreational marijuana is taxed at a higher rate than medical marijuana in Colorado. The state approved through a voter initiative, Proposition AA, two taxes on recreational marijuana: A 15 percent excise tax and a 10 percent state sales tax. Many cities and counties implement their own tax, as well. Medical marijuana can be purchased for much less. According to the Colorado Department of Revenue, medical cannabis has a 2.9 percent sales tax, in addition to local sales taxes. Licensed medical users in Colorado have an incentive to renew their medical licenses: Those who decide to renew can do so at a lower rate than before. As of Feb. 1, 2014, the cost of renewal decreased from $35 to $15.

The Future of Cannabis in America

National support for the legalization of marijuana — medical and recreational — has grown over the years. In 1969, Gallup first asked Americans: “Do you think the use of marijuana should be made legal or not?” Twelve percent of respondents supported its legalization. Gallup posed the same question in 1995. This time, 25 percent of respondents approved the legalization of marijuana. By 2005, that figure had risen to 36 percent, and it had reached 50 percent by 2011. Sixty percent of Americans supported marijuana’s legalization in 2016, according to Gallup. With the continued legalization and growing acceptance of medical marijuana, many believe the drug could be legalized in all 50 states at some point in the future. “The majority of states have medical marijuana laws now,” Morgan said on Johnny’s House. “And you see a domino effect across the nation. … I think our culture, our society, I think we’re ready for it.” Sabet hopes the expansion of legalized marijuana comes to an end. He believes a public outcry against cannabis use could effectively prevent mass-legalization efforts. People need to know the truth behind the plant, he says.

Source: Gallup

“I hope we can realize that we don’t need another tobacco industry,” said Sabet. “We have to strike the right balance. We don’t want to keep people in jail or criminal records. We do want to see a balanced policy that talks about the science and makes it harder to get pot candy.” However, he conceded that the mass commercialization of marijuana has influenced public perception and legalization. The marijuana industry is a booming business. In 2015, Americans spent more than $5 billion on legal medical and recreational marijuana. The continued legalization of medical cannabis has affected recreational legalization. A common trend has developed over the years: Many states that approve medical marijuana eventually legalize recreational cannabis.

Several states have passed laws approving the recreational and medicinal use of cannabis.

“I do think there is a trend,” said Sexton. “Once medical legalization is passed and society gets accustomed to it, they become more open-minded.” Continued cannabis legalization likely means lower marijuana-related incarceration rates, which has been a hot-button topic in recent years.

“I hope we can realize that we don’t need another tobacco industry. We have to strike the right balance. We don’t want to keep people in jail or criminal records. We do want to see a balanced policy that talks about the science and makes it harder to get pot candy.”

In 2015, law enforcement made more than 574,000 arrests for marijuana possession, according to a report by the American Civil Liberties Union and the Human Rights Watch. This number exceeded the total arrests made that year for all violent crimes, including murder and rape. However, the advent of drug courts has allowed drug offenders to avoid incarceration. Drug courts provide these individuals the opportunity to seek court-ordered rehab in lieu of jail time. If a drug court decides the offender has a marijuana dependence, the judge can recommend he or she enter a treatment program that uses evidence-based techniques to help the individual overcome drug problems. The National Association of Drug Court Professionals believes cannabis use can result in addiction. The organization’s stance on the legalization of marijuana can be found on its website: “Drug Courts serve seriously addicted individuals with long criminal records who have alienated nearly everyone they love. In every case, they tell us it began with marijuana. Convinced that marijuana was safe, they learned it is, in fact, addictive, causing serious cardiovascular and respiratory disease, triggering mental illness and addiction to more serious drugs, and estranging friends, family and co-workers.” As of June 31, 2015, more than 3,000 drug courts operate nationwide, according to the National Drug Court Resource Center. At a rally on Oct. 15, 2016, then-presidential candidate Donald Trump announced his intentions to expand incentives for states and local governments to use drug courts and mandated treatment. Doing so would be a cost-effective, appropriate and humane response to addiction, he said. The Trump administration could impact the future of marijuana legalization in America. Trump has softened his stance on marijuana legalization in recent years. At the Conservative Political Action Conference in 2015, the former real estate magnate announced his opposition to recreational use, but he said he approves of medical use. He told Fox News in 2016 that medical marijuana can effectively treat people with various medical ailments. Research suggests medicinal benefits of the drug may exist. But studies also show significant physical and psychological consequences of marijuana use. Continued research — as well as marketing strategies, politics and public opinion — will determine the future of cannabis in the United States.

Medical Disclaimer: DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.