November 8, 2020

Legalization and Decriminalization: Marijuana and More

During the Presidential election, several states featured measures on the ballot regarding the legalization of marijuana, as well as the decriminalization of other Schedule I drugs.

Several of these measures passed, indicating that the nation’s views on certain drugs continues to evolve. We have seen this change in social acceptance trickle down into healthcare, including workers’ comp.

Voters in four states passed measures to legalize recreational marijuana, bringing the total number of states with legalized recreational marijuana to 15. Meanwhile, two states legalized medical marijuana, bringing the total states with legalized medical marijuana to 41.

Arizona Proposition 207 passed, legalizing limited marijuana possession, use, and cultivation by adults aged 21 or older. Criminal penalties for possession are set to be amended, while also allowing for the expungement of marijuana offenses. Smoking marijuana in public is banned and a 16% excise tax on marijuana sales will be in effect.

Mississippi Initiative Measure 65 passed, legalizing medical marijuana for qualified patients with debilitating conditions, as certified by Mississippi licensed physicians. The list names 22 qualifying conditions, including cancer, epilepsy, seizures, multiple sclerosis, and ALS. According to the ballot, over 228,000 Mississippi residents signed petitions to put this initiative on the ballot.

Montana passed Initiative No. 190, legalizing the possession and use of limited amounts of recreational marijuana for adults over the age of 21. The initiative requires the Department of Revenue to license the regulation, cultivation, transportation, and sale of marijuana and marijuana-infused products. A 20% tax on non-medical marijuana will be put in place, and individuals serving marijuana-related sentences can apply for resentencing or expungement.

New Jersey Public Question No. 1 passed, amending the state Constitution to legalize recreational marijuana for adults aged 21 and older. The State commission created to oversee the State’s medical cannabis program would also oversee the new, personal use cannabis market. Cannabis products would be subject to the State sales tax, and if authorized by the Legislature, a municipality may pass a local ordinance to charge a local tax on cannabis products.

South Dakota Constitutional Amendment A passed as well, legalizing the possession, use, transport, and distribution of recreational marijuana and marijuana paraphernalia by people aged 21 and older. Individuals may possess or distribute one ounce or less of marijuana. Marijuana plants and marijuana produced from those plants may be possessed under certain conditions.

Furthermore, the State Department of Revenue will control licenses for commercial cultivators, manufacturers, testing facilities, and more. A 15% sales tax on marijuana sales will be imposed.

It is no secret that support for medical marijuana is at an all-time high, and as the drug occasionally finds its way into workers’ comp for the treatment of chronic pain, seizures, and other conditions, the clinical impacts of continuing legalization are important to track. Another consideration: as recreational marijuana use continues to grow common with legalization, injured workers in certain states may be utilizing marijuana outside of their work-related injury, which could impact drug therapy and claims management.

But marijuana isn’t alone in this conversation. Oregon passed Measure 110, which, among other initiatives created to tackle rampant drug addiction in the area, removes drug penalties for a sweeping number of scenarios, reducing them to Class A misdemeanors instead of felonies. The ballot reduces the following possession scenarios to Class A misdemeanors:

  • Peyote, if in connection with good faith practice of a religious belief, or in a manner not dangerous to the health of the user or others in proximity of the user
  • LSD if possession is limited to less than forty units
  • Psilocybin if possession is under 12 grams
  • Methadone if possession is limited to under 40 units
  • Oxycodone if possession is limited to under 40 units
  • Heroin if possession is limited to under a gram
  • MDMA if possession is limited to under one gram or less than five units
  • Cocaine is possession is limited to under two grams
  • Methamphetamine if possession is limited to under two grams

This measure was intended to help direct individuals with substance abuse disorders to treatment, reserving more serious criminal penalties to those who sell narcotics. While these actions are certainly sweeping, there is more to be said about psilocybin and MDMA.

Oregon also passed Measure 109, giving certain patients legal access to psilocybin, the active ingredient in “magic” mushrooms for mental health treatment in supervised settings, with a complex framework of how this is to be managed.

In related news, Washington D.C. passed Initiative Measure 81 to decriminalize psychedelic plants, which covered substances such as psilocybin, mescaline, peyote, and more.

These measures are particularly noteworthy, as clinical research surrounding psilocybin has shown promise for the treatment of major depressive disorder and post-traumatic stress disorder (PTSD). Phase 3 clinical trials are currently under way for certain psychiatric disorders, and the John Hopkins University launched the Center for Psychedelic and Consciousness Research in September of 2019.

In the next several years, psilocybin, or some derivative of psilocybin, could potentially see an FDA approval, meaning healthcare, and workers’ comp, would have to learn more about the drug.

And a similar thing could be said for MDMA (methylenedioxymethamphetamine), also known as the street drug “ecstasy” or “molly.” Clinical research supports the potential use of MDMA-assisted therapy for the treatment of PTSD, so much so that in 2017, the FDA granted Breakthrough Therapy designation to MDAM-assisted psychotherapy for PTSD, agreeing to special protocol assessment for Phase 3 clinical trials. At the moment, approximately 20 clinical trials are underway involving MDMA.

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