The number of Americans who live in states that permit recreational cannabis use quadrupled on Election Day, as voters in California, Maine, Massachusetts, and Nevada approved ballot initiatives allowing adults over 21 to buy, transport, and possess cannabis up to a certain quantity for nonmedical use. A total of eight states and the District of Columbia now allow nonmedical cannabis. Arizona voters rejected a similar measure.
Alaska, Colorado, Oregon, Washington, and the District of Columbia previously legalized recreational cannabis through ballot initiatives, the only method that has been successful for cannabis advocates—no state has passed legislation allowing recreational use. Legalized recreational cannabis states permit only licensed or registered entities to sell cannabis, but adults may share with other adults. Cannabis is taxed and regulated.
In addition, according to the National Conference of State Legislatures, the majority of states—28 plus the District of Columbia—now have comprehensive medical cannabis laws, with 2016 election victories in Arkansas, Florida, and North Dakota.
Some legal issues remain unclear. “Under states’ medical cannabis laws, producers are only allowed to sell to dispensaries registered in their own state, and dispensaries are only allowed to sell to patients, caregivers, and in some cases other dispensaries. Therefore, there’s no interstate transportation of wholesale marijuana—and even if State A allowed growers to ship to an adjacent State B, it’d also have to be legal for State B’s dispensaries to buy from out-of-state growers under State B’s law,” Karen O’Keefe, director of state policies at the Marijuana Policy Project, told Pharmacy Today. “So far that’s not the case anywhere, largely due to federal policy.”
Because cannabis is classified as a Schedule I substance under the Controlled Substances Act—considered to have a high potential for dependency and no accepted medical use—distribution remains a federal offense. The U.S. Department of Justice, however, issued a 2009 memo encouraging federal prosecutors not to prosecute individuals who distribute cannabis if they are adhering to state law. That memo was updated in 2013.
Pharmacists have medical cannabis dispensing roles for patients with qualifying conditions in Connecticut, Minnesota, New York, and Pennsylvania. Recently enacted Ohio legislation charges the State of Ohio Board of Pharmacy, as well as the Ohio Medical Board and Department of Commerce, with regulating the state’s medical cannabis program. Maryland’s regulatory commission also has a spot for a pharmacist.
Gina Moore, PharmD, MBA, assistant dean for clinical and professional affairs at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, said pharmacists should stay on top of the evidence for or against cannabis.
“[Pharmacists] should remember to ask if patients are using marijuana when taking a medication history and be respectful of patient choices,” Moore told Today. “The body of evidence for medical cannabis is limited, although it is important for us to treat this as any other drug or supplement to understand [its] physiologic issues, potential drug interactions, and potential adverse effects.”