Virginia’s “Secret” Medical Marijuana Program

The doctor who should be governor. State Sen. Siobhan Dunnavant is a Republican from Henrico County. She is also a practicing physician. In this year’s General Assembly session she put forth SB1557 which expanded last year’s so-called “Let Doctor’s Decide” legislation (HB1251).

What’s new? The 2018 legislation (HB1251) authorized licensed medical providers to prescribe CBD and THC-A oil “to alleviate the symptoms of any diagnosed condition or disease determined by the practitioner to benefit from such use.” CBD, or cannabidiol, is a naturally occurring compound found in the resinous flower of marijuana plants. It is used to treat a variety of maladies. It is non-intoxicating. THCA, or tetrahydrocannabinolic acid, is the non-psychoactive acid form of THC found in marijuana plants when raw. It is also non-intoxicating unless it is heated. Once heated, THCA releases THC which is intoxicating.  The 2018 legislation restricted THCA oil to contain no more than 5 mg of THC (the psychoactive component of marijuana).

How high is high? The restrictions in the 2018 legislation were pretty clearly intended to provide a means for health care providers to prescribe cannabis-based treatments without opening a “side door” to psychoactive use. The legislation allowed the prescription of THCA only in oil form and limited the concentration of THC to 5 mg per dose. This begs the question of how many milligrams of THC are required to achieve noticeable psychoactive results. This is a complex question that requires an understanding of the user’s weight, regularity of use and, perhaps most importantly, means of ingestion. Drinking unheated THCA isn’t psychoactive at all while dipping regular cigarettes into THCA oil and smoking the cigarettes would be intoxicating if there were a sufficient concentration of THC in the THCA oil. Let’s put that all aside for now and move onto the 2019 legislation.

A broader view. Dunnavant’s legislation increased the allowable potency per dose of medical cannabis and expanded the way the cannabis could be delivered. The legislation, as passed, increases the maximum strength to 10mg THC per dose and allows prescription via any ingestion means other than smokable marijuana. Capsules, sprays, lozenges and lollipops are all allowable under the newly passed legislation. Does the new legislation meet the presumed goal of allowing medical use of cannabis while preventing psychoactive use of prescribed marijuana products? THCA does not produce psychoactive effects … unless it’s heated to very high temperatures (such as smoking leaf marijuana).  While nobody should doubt the ingenuity of a stoner wanting to get high, the ability to smoke a lollypop is doubtful. But what about the 10mg per dose oil (or tinctures for that matter)?

Let’s go to the dispensary. Ten states and the District of Columbia have legalized the adult use of small amounts of cannabis. Nine of those states have active marijuana retail operations. The legal cannabis products in those states are sold through licensed dispensaries. Those dispensaries have websites. One such dispensary is Native Roots of Aspen, CO. They sell a product called Tinctures by Sweet Mary Jane.  The tincture comes in an eye-dropper style bottle with each bottle containing 90 mg of THC. Presumably, the common method of using these tinctures is to put a few drops in your mouth or your iced tea and wait for the buzz. Presumably, the tinctures that will be prescribed in Virginia will contain unactivated THC (i.e. THCA). Ingesting these tinctures won’t get you high. But what if you burn the tincture by dipping a cigarette into the tincture and then smoking the cigarette? Probably not a viable way to get high. Burning anything containing THC destroys about 80% of the THC. It goes “up in smoke.”  Using a very broad rule of thumb you need to ingest 10 mg of THC to get high. Therefore, you’d need to consume 50mg of THC in a burning tincture to ingest 10mg of THC to get high. Those tincture bottles from Sweet Mary Jane contain 90mg of THC per bottle. You’d have to dunk enough cigarettes in the tincture to absorb more than half the bottle in order to get high. It seems that Virginia’s General Assembly has expanded our medical marijuana program in a way that minimizes the potential for misuse.

Oh so secret. Early versions of the 2019 house bill referred to the bill as part of a “medical marijuana program.” That terminology was stricken from the bill while leaving the rest of the bill intact. State regulators involved in the program also shun the “medical marijuana” terminology preferring “low-THC” instead. Why? Presumably, our legislators want to discourage Virginians from rushing to medical providers in order to obtain cannabis for its psychoactive properties. As described earlier in this post, that probably wouldn’t work anyway. They may also want to disguise this effort for fear of Virginia being seen as the 34th state to legalize medical marijuana. Historically, legalizing medical marijuana is a step on the path to legalizing recreational marijuana. Grow operations get established, dispensaries are started, etc. Patrons of both the 2018 and 2019 legislation are Republicans. They may not have been able to get Republican support if they called these two years of work what they really are – legalizing medical marijuana in Virginia.

Author’s note. Marijuana is illegal at the federal level and, outside of very narrow boundaries, illegal in Virginia too. Nobody should read anything I write as suggesting or encouraging the breaking of any laws. I also have no experience with medical marijuana, cannabis tinctures or dipping cigarettes into cannabis tinctures. My understanding of all this is based on what I read and may contain inadvertent factual inaccuracies. Anybody who believes they have found such factual inaccuracies is invited to suggest corrections in the comments section.

— Don Rippert

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6 responses to “Virginia’s “Secret” Medical Marijuana Program

  1. All very confusing. You can go into countless local retailers and purchase CBD oil produced from hemp, in various concentrations. No THC, not considered marijuana or “medical marijuana” at all. The medical benefit claims (all totally without any FDA-blessed science at this point) seem to be exactly the same as the benefits touted for either low-dose (non intoxicating) THC products and also for “high” test. It may turn out that CBD by itself, from hemp and thus THC-free, does just as much good as high test. So why not stick with that?

    The medical argument of course is another line of debate than the libertarian/”what’s the harm in my getting high” argument. But many, many people are hard up for a decent response to chronic arthritis, etc. CBD oil from hemp is legal and available.

    • It is confusing. Basics – CBD might as well be cod liver oil. Might be good for you, might not. No intoxicating effect. Caveat emptor on the health benefits but the risks are low. THC-A (unactivated) – supposedly provides additional benefits to CBD as well as catalyzing the benefits of CBD. No intoxicating effect unless heated (but generally not too hard to heat). If not heated – probably also low risk, especially at low doses. Heated THC-A produces THC. Also supposed to have medical benefits in addition to CBD and THC-A (for example, people say they are less anxious when they are high). Higher risk.

      One interesting example. When a child suffers a seizure one common practice is to use a valium as treatment. Cannabis proponents claim that oral ingestion of CBD would also work. Apparently, the FDA agrees that it would help.

      The treatment for a seizure is the administration of a potentially addictive drug. What is worse – CBD / THC or valium?

      There’s something to the medicinal use of marijuana but it’s early days on clinical trials.

  2. Ha. Ms. Stolle (related to the Stolle family) needs to keep their nose clean before worrying about illegal/legal substances like MJ.
    First, she got caught and was let off for using her patients as people to send campaign letters to. Articles online will give more info.
    Second I caught a druggie doc practicing who shouldn’t have been. She was on the list of people I sent the complaint to. Hush hush hush. They tried to sneak around it but a week later his license was pulled. No thanks to Dr. Stolle and her brother Dr. Stolle. That was the State Board that did it.

  3. Given it was hush, hush, hush you have no idea what she did with the complaint, VN. She’s not going to tell you. I’m with DJ, she’s on the watch list for statewide office. Lord knows the party needs new choices. I’ve had policy disagreements with members of that clan, and worked a campaign against Ken 20 years ago, but in my experience the Stolle’s are what we call in Virginia “Good People.” They think. Getting to be rare.

    • Hmmm. They did a trial of that CBD drug for seizures on 516 patients and found “The most common side effects that occurred in Epidiolex-treated patients in the clinical trials were: sleepiness, sedation and lethargy; elevated liver enzymes; decreased appetite; diarrhea; rash; fatigue, malaise and weakness; insomnia, sleep disorder and poor-quality sleep; and infections.” Ouch. Of course these folks have severe symptoms they are trying to reduce. It seems the dosage is 100 mg. You call it a potentially addictive drug but I thought the point of CBD is there is no high…?

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