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 (N- arachidonoylethanolamine, also called AEA) and the other one is called 2-AG (2- arachindonoyleglycerol).

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

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, time- consuming, 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: ami.ruffing@ieso.co Website: http://www.ieso.co