With Oklahoma's passage of State Question 788 legalizing medicinal marijuana, there remains strong debate and conflicting information surrounding cannabis and its potential benefits and risks.

(Editor's note: This is the first article in a series of informative articles on marijuana.)

MIAMI – State Question 788 passed with 57 percent of Oklahoma voters legalizing the licensed cultivation, use and possession of marijuana for medicinal use. Now questions center on uses, what forms will be allowed, and how marijuana will be dispensed as implementation of legalization in the state proceeds.

The Oklahoma law outlines no qualifying conditions, allowing physicians to authorize marijuana use for a broad range of ailments.

In all other states with medical marijuana legalization, marijuana is regulated by a list of medical conditions. A patient is presented with a list of checkboxes and a signature line, then checks his/her “condition” box and signs. The physician then just agrees with the patient and the medical marijuana is prescribed. The physician is not ethically or legally bound by their decision.

Under Oklahoma’s SQ788, a physician must recommend medical marijuana and is legally and ethically bound by their decision.

Oklahomans For Health, a grassroots organization that helped write the law and lead the push and petition drive calling for a vote to legalize medical marijuana, says the Oklahoma law passed is far more restrictive than in any other medical use state.

Oklahomans For Health and other supporters of SQ788 claim research supports marijuana is medically useful to the “endocannabinoid system,” a master regulatory system in the human body, which helps with the regulation of the immune system, in turn, helping with inflammation and pain.

Local community members have mixed feelings about the legalization of medical marijuana, some are against all uses or feel SQ788 was a way to push further for recreational use, others are for “legitimate” medical uses only, and others see it as a win for the state’s medical users.

“As an officer for the past 30 years, I have seen the problems with marijuana. Until my first wife was diagnosed with cancer I made a lot of arrests of people who sold and used marijuana. I along with other great officers fought the battle against any type of drug misuse including the ones that doctors overprescribed,” Butch Crockett of Miami said. “With that said, I was then introduced to cancer. I watched as the person I loved more than life suffer even with the amounts of powerful prescribed drugs. I had a wonderful friend that made eatable marijuana. I was able to have just a little more time with the woman I loved and not watch her in pain.”

“Medical Marijuana and CBD has helped for many years with a herniated disc in my lower back, I have not had any pain since I added CBD to my daily routine,” Vernon Moss said. “I use to have severe migraines and it has taken care of that as well. Before I started on CBD I was having cardiovascular issues and was told that I would probably have to have a stint put in. CBD has improved that from 75 percent blockage to 60 percent. I just recently had problems with my prostate, meds were not helping and I raised my CBD intake and have improved greatly.”

Medical benefits and risks

Claims and testimonies of the medical benefits of marijuana by proponents cite a long list of uses for diseases from Lyme disease to cancer aid and even use as a potential cancer cure.

Marijuana contains more than 80 active chemicals, according to the Federal Drug Administration (FDA).

To date, studies have proven contradictory or are insufficient for marijuana’s medical usage to meet FDA standards. FDA protocol calls for studies and clinical trials involving hundreds and thousands of human patients to determine effectiveness, side effects, benefits and risk.

The FDA has recently approved the first marijuana-derived drug, Epidiolex, to treat two rare forms of epilepsy. The drug contains cannabidiol and not THC, delta9-tetrahydrocannabinol, the property that causes a high.

A 2015 study of patients with severe epilepsy saw a decrease of 54 percent in seizures while taking cannabidiol. The New York University study involved 213 people from toddlers to adults.

The National Cancer Institute, established as the federal government's primary agency to address research and training needs for the cause, diagnosis, and treatment of cancer, purports cannabis and cannabinoids may have benefits in treating cancer symptoms and the side effects of cancer therapies such as pain, nausea, vomiting, anxiety, and loss of appetite.

Preclinical studies of cannabinoids on mice and rats have shown cannabinoids may inhibit tumor growth by causing cell death, blocking cell growth, and blocking the development of blood vessels needed for tumor growth, according to the National Cancer Institute.

The FDA has not approved marijuana as a safe and effective drug for any other indication except the specific uses of cannabidiol for epilepsy seizures.

“The FDA is aware that there is considerable interest in the use of marijuana to attempt to treat a number of medical conditions, including, for example, glaucoma, AIDS wasting syndrome, neuropathic pain, cancer, multiple sclerosis, chemotherapy-induced nausea, and certain seizure disorders,” the FDA states on their official website.

The National Institute on Drug Abuse (NIDA) differentiates the usefulness of the marijuana plant and cannabinoids and states continued research may lead to more FDA approved medications.

“So far, researchers haven't conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it's meant to treat,” according to NIDA.

Proponents hope legalization forces education of physicians and other medical professionals of the possible medical uses of marijuana.

Claims have also been made that medical marijuana can be used to improve mood, to reduce anxiety, slow the progression of Alzheimer’s, reduce painful symptoms of multiple sclerosis, and other conditions such as Crohn’s disease and Lupus.

However, recreational marijuana use can cause trouble with thinking, memory, and problem solving, slows reaction times and impairs body coordination in some users. Marijuana raises heart rate by 20 percent to 100 percent for up to three hours increasing the risk of heart attack during that time period, according to NIDA.

There are also claims recreational use can increase suicidal thoughts, contains chemicals that can damage lungs, and is unsafe during pregnancy and can cause developmental problems for unborn babies. Marijuana may lower sperm counts, cause irregular menstrual cycles and adversely affect PTSD sufferer.

It is also estimated that 20 to 50 percent of users who consume marijuana daily become addicted at some point.

People on all sides of the medical marijuana issue agree more medical research must be conducted to substantiate the successfulness, effects and any potential benefits of medical uses patients using cannabis are claiming.

“I began using CBD oil in January. A few drops in the morning and before bed daily," Twyla Yandell of Miami said. “My past problems from radiation and chemo had caused situations with my normal body functioning resulting in embarrassment to leave our home. Not only has that been reversed, but I actually lost weight and my arthritis in my knees is less. I’m sleeping at night after being nocturnal most of my life. We never say this is a guaranteed cure-all but it’s natural and your body discharges what you don’t need.”

Legalization and Opioids

There are also arguments on whether or not legalization of marijuana will decrease the use of opioid medications. Medical marijuana proponents say the plant is safer and less addictive than pharmaceuticals.

A study published in the January 2018 American Journal of Psychiatry found patients' cannabis uses increased their risk of prescription opioid abuse.

Yet, another study published in JAMA found a significant reduction in opioids prescribed to Medicare Part D patients in states with permit dispensaries and cultivation-only state medical cannabis laws.

“Some studies have suggested that medical marijuana legalization might be associated with decreased prescription opioid use and overdose deaths, but researchers don't have enough evidence yet to confirm this finding,” according to NIDA.

The JAMA of Psychiatry cited three national studies supported data that adults are more likely to use illegal marijuana in states where medical marijuana is legal, but drew no conclusion whether changes in the laws caused the increase.

“Opioids has its place in the field of pain management and they are also very addictive. It's been 10 years since the loss of my wife. I remarried six years ago. Last January my current wife was diagnosed with stage 3c ovarian cancer and I am watching this play out all over again. So it does not matter if marijuana is legal or not when it comes to watching a loved one suffer. If all that is of an opinion that marijuana is an evil drug then come with me to the cancer center and look at the faces that are taking treatment. Make no mistake, this is and will be abused... I have seen first hand the good, bad, and ugly with this drug,” Crockett said. “I still fight the fight against the recreational use of any drug and will continue until the day that I am done.”

“Two members of my family are having their much-needed pain meds halved. Not in a way they can adjust just cold turkey on top of their excruciating pain. What will they do when the government takes the next dose away? Seeing them suffer is horrible and if any plant can help take away that pain I’ll make edible anything for them. Those who abuse already are without this passing or not. Those who are suffering need help,” another community member said who did not wish to be identified.

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Marijuana legalization in the U.S.
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Smokeable versus edibles

Experts and users claim ingested versus inhaled marijuana offer two different highs and effects.

Edible forms of marijuana include a variety of products including muffins, candies, butter, tea, pizza, and yes, brownies and cookies, a virtually endless list of cannabis-infused foods.

THC is absorbed differently and marijuana edibles are typically much stronger than smoked or vaporized forms.

The THC in ingestible forms travels through the stomach and is metabolized by the liver which converts it to an active metabolite that is particularly effective in crossing the blood-brain barrier resulting in a more intense high. The effects or high can take 30 minutes to two hours to kick in but lasts from 6 to 10 hours and varies between types of edibles.

Edibles can be more difficult to dose and determine potency, and because of the delay in onset of effects consumers can underestimate the dose.

Edibles are considered a healthier alternative to smoking and cause less risk for some long-term health concerns

When inhaled through smoking or vaping THC undergoes a different metabolic process traveling directly to the brain, causing the effects, the high, to come on faster and diminish quickly. About 50 to 60 percent of the THC reaches the brain and last 5 to 15 minutes and trailing off in one to two hours when inhaled by smoking.