Download The Current State of Medical Cannabis in Illinois

The Current State of
Medical Cannabis in
Illinois
Ami Ruffing, PhD.
Ieso, LLC
and
Southern Illinois University Carbondale
Disclaimers

I am the chief science officer for
Ieso, LLC, a licensed medical
cannabis cultivation facility near
Carbondale.

The purpose of the presentation is
not to discuss the pros and cons of
medical cannabis, just to bring you
up-to-date concerning the program
status.
Cannabinoid System

Nearly all vertebrates – fish, amphibians,
reptiles, mammals, humans – have a
metabolic cannabinoid system.

It includes naturally occurring cannabinoid
compounds which act as chemical
messengers, and receptors for those
compounds inside cells.

Cannabinoid compounds enter cells and
dock in a place called a receptor.

The compounds act to upregulate
(agonists) or downregulate (antagonists)
certain cellular mechanisms by interacting
with other chemicals.
Cannabinoid System

There are two main kinds of cannabinoid
receptors in humans: CB1 receptors, and
CB2 receptors.

CB1 receptors occur most frequently in the
central nervous system, while CB2
receptors are found in immune system
cells and other peripheral cells.

There are two major cannabinoids called
endocannabinoids, and they are produced
in your body.

One is called anadamide (Narachidonoylethanolamine, also called
AEA) and the other one is called 2-AG (2arachindonoyleglycerol).
Cannabinoid System

Andadamide plays a role in regulation of
feeding behavior, and plays a role in neural
generation of feelings of pleasure and in
motivation.

The role that 2-AG plays is still under
study, and not yet well characterized. It
may be involved in cardiovascular function,
pain management, immune system
functions, and may inhibit cancer cell
proliferation.
Cannabinoid System




People make and use more 2-AG than
they do anandamide.
These cannabinoid chemical
messengers interact with the dopamine
system and the serotonin system
These systems can act together to
improve mood and regulate hunger.
Upregulation of CB-2 receptors
reduces inflammation.
Cannabinoid System




There is some growing body of evidence
that some people have low amounts of
anandamide and 2-AG in their bodies.
This can be compared to diabetes, in
which some people have low amounts of
insulin in their bodies, or can’t use the
insulin they have effectively.
We give them insulin as treatment, or other
compounds to improve their use of insulin.
Similarly, we can supply people with
cannabinoids to raise their levels.
Cannabinoid System

Cannabinoids that occur in your body
naturally are called endocannabinoids.

Cannabinoids that can be administered to
patients come from plants, and are called
phytocannabinoids.

There are at least 113 different known
cannabinoids.

Two of the most studied cannabinoids are
THC (tetrahydrocannabinol) and CBD
(cannabidiol).
Cannabinoid System

All the different cannabinoids seem to
interact with each other, and with cell
receptors, in complicated ways.

This is called the entourage effect.

We don’t clearly understand all the
interactions, because it is difficult to
conduct research on cannabinoids.

However, it is clear that people get more
benefit from whole-plant compounds, as
opposed to single drug compounds.
Background of Medical
Cannabis in the United States

The first written record of cannabis used
as medicine was in 1500 BC in China.

It was available and used in the U.S. until
the early 1900s.

Between 1915 and 1927, ten U.S. states
passed laws restricting the use of
cannabis, and in 1937 the Federal
government passed the first national
restrictions.
Background of Medical
Cannabis in the United States

In 1956, cannabis was included in
the federal Narcotics Control Act,
resulting in stricter penalties for
cannabis possession.
Background of Medical
Cannabis in the United States

In 1970, cannabis was classified in
the federal Controlled Substances
Act as a schedule I drug, with “no
accepted medical use,” rendering
cannabinoid research in the U.S.
nearly impossible and preventing
physicians from prescribing its use.
Background of Medical
Cannabis in the United States



New Mexico passed the first state law
recognizing the medical value of cannabis
in 1978.
A synthetic form of THC, called Marinol,
was approved for use by cancer patients in
1985, and for HIV/AIDS patients in 1992. It
is not as effective as whole-plant medicine.
The federal Anti-Drug Act of 1986 greatly
increased the penalties for possession and
use of cannabis.
Background of Medical
Cannabis in the United States

California was the first state to
legalize medical cannabis, in 1996,
followed by Alaska, Oregon and
Washington in 1998.
Background of Medical
Cannabis in the United States

Illinois became the 20th state to
approve a medical cannabis
program in 2013.

By January 2017, 28 states had
established medical cannabis
programs.

Also by January 2017, eight states
and the District of Columbia had
approved recreational, or “adult
use,” cannabis programs.
What’s going on with medical
cannabis in Illinois?



The Compassionate Use of Medical
Cannabis Pilot Program Act was signed
into law on August 1, 2013 and became
effective on January 1, 2014.
It was originally a four-year pilot program,
extended now to expire June 30, 2020.
The act regulates the production and sales
of medical cannabis in Illinois, through the
Illinois Departments of Agriculture, Public
Health, and Professional Regulation.
Parts of the Act

The act controls the establishment of
cultivation facilities and dispensaries
in Illinois.

It also establishes the requirements
for patients to enter the program.

It establishes oversight of the
program through a director who
coordinates the three State
departments concerned in regulation
of the program.
Cultivation Facilities

The act permits a licensed cultivation
facility in each of the State Police districts
in the state, a total of 21 permits. 19
permits have been issued, and 18 are
growing as of April 2017.
Cultivation Centers

Cultivation centers grow, harvest,
manufacture, package, and distribute
medical cannabis.

A variety of forms of medicine are
available: dried flowers, concentrates,
edibles.
Dispensaries

The Act allows for up to 60
dispensing organizations to receive
permits; at present, there are 52
dispensaries licensed.

Dispensaries receive medicine from
the cultivation centers and sell it to
patients.

Dispensaries are not allowed to
repackage or alter medicine from the
cultivation centers.
Patients

Patients must apply to the Illinois
Department of Public Health for a
patient identification card.

Patients must provide proof of
residency, identity and age; a
photograph; a physician’s
certification of qualifying condition;
fingerprints; and a fee of $250 for
three years.

Patients must select a dispensary to
use.
Latest Statistics:
Sales
Month, 2017
February
March
April
Total sales
$4.7
million
$4.9
million
$6.3
million
Grams of flowers
sold
229,000
249,000
291,500
Sales of flowers
$2.7
million
$2.8
million
$3.5
million
Sales of
concentrates and
edibles
$2.0
million
$2.1
million
$2.8
million
Latest Statistics:
Patients
Month, 2017
March
April
No. Patients
Served
10,714
12,224
No. Patients
Registered
16,990
18,300
Qualifying Medical Conditions

Cancer

Glaucoma

Human immunodeficiency virus /
acquired immune deficiency
syndrome

Amyotrophic lateral sclerosis (Lou
Gehrig’s disease)

Crohn’s disease
Qualifying Medical Conditions

Agitation of Alzheimer’s disease

Cachexia / wasting syndrome

Muscular dystrophy

Sever fibromyalgia

Spinal cord disease

Hepatitis C

Parkinson’s disease

Post-traumatic stress disorder

Seizure disorders
Qualifying Medical Conditions

Debilitating medical conditions
(including Tourette’s syndrome and
lupus)

Patients can apply for a special card
for terminal illnesses

Does NOT include chronic pain, or
osteoarthritis.
Vulnerable Group Warning

A study by Northwestern University in 2013
showed that teenagers who use cannabis
daily for three years showed abnormal
changes in brain structure.

These changes affect working memory,
which can in turn affect academic
performance and everyday functioning.

It is particularly important to prevent
adolescents from chronic abuse of
cannabis, since the negative outcomes
can be lifelong.
Difficulties for the Illinois
Program

The Act has been extended to expire June
30, 2020.

The application process to obtain a
patient’s card is expensive, timeconsuming, and difficult. However, this has
improved with the initiation of the program
to issue 3-year ID cards, rather than 1-year
cards. The large backup of patients who
have applied for ID cards but not yet
received them has been reduced from
30,000 patients last year, to about 3,000
patients now.
Difficulties for the Illinois
Program

While some conditions have been added
to the list of allowed conditions – PTSD
and seizure disorders – the list still does
not include chronic pain.

Because of the DEA status of cannabis,
many physicians are unwilling to issue a
statement to a patient saying that he/she is
eligible for the medical cannabis program.

This has been exacerbated by the current
position of U.S. Attorney General Jeff
Sessions.
Possibility of a Recreational
Cannabis Program in Illinois

In March 2017, the Paul Simon
Public Policy Institute at SIU
conducted a telephone survey of
1,000 people, asking opinions about
decriminalization and legalization for
recreational use.
Possibility of a Recreational
Cannabis Program in Illinois
Possibility of a Recreational
Cannabis Program in Illinois

Support is strong in Illinois for
approval of a recreational cannabis
program, if it is regulated and taxed
like alcohol.

Overall, 74% of people polled
approved of the proposed program,
and 45% of those strongly supported
it.
Questions and Discussion



Dr. Ami Ruffing
e-mail: [email protected]
Website: http://www.ieso.co