MEDICAL CANNABIS and NEEDLES

THC (delta-9-tetrahydrocannabinol)

The main psychoactive part of marijuana that gives the 'high'

CBD (cannabidiol)

Thought to have a safer profile than THC; non-psychoactive compound from Cannabis sativa

Difference between THC and CBD

THC is psychoactive (produces 'high'); CBD is not psychoactive and has a safer profile

Current federal classification of marijuana (as of 2026)

Schedule I drug under the Controlled Substances Act (1970)

Marinol® (dronabinol)

Synthetic THC; approved for AIDS-related anorexia and chemotherapy-induced nausea/vomiting

Epidiolex® (cannabidiol)

Approved for

1. seizures associated with Dravet syndrome,

2. Lennox-Gastaut syndrome (patients ≥2 years), and

3. tuberous sclerosis complex (patients ≥1 year);

originally Schedule V, now not scheduled

2018 Farm Bill (Agriculture Improvement Act of 2018)

Legalized hemp cultivation broadly, not just pilot programs; allows sale, transport, and possession of hemp-derived products across state lines

THC limit in hemp under 2018 Farm Bill

Hemp cannot contain more than 0.3 percent THC

Pros of medical cannabis use (some say)

Beneficial for

1. nausea from chemotherapy

2. anorexia from HIV/AIDS

3. seizures/muscle relaxation for spasticity

4. glaucoma

Cons of medical cannabis use (some say)

1. Frequent use can affect short-term memory and cognitive ability,

2. impair motor skills (dangerous driving)

3. lead to schizophrenia

4. cause lung damage

5. “Gateway”

Carly's Law (Alabama, April 2014)

bill allowing UAB to conduct research on CBD oil for the treatment of seizures

Leni's Law (Alabama, May 2016)

Allows people to bring CBD oil into Alabama and legalizes possession of CBD oil with up to 3% THC

May 2021 (The Compassion Act)

Date medical cannabis was signed into law by Governor Ivey

Alabama Medical Cannabis Commission (AMCC)

14-member commission appointed by Governor Ivey in September 2021; Dr. Blakemore is the only pharmacist on it; addresses implementation and regulation of medical cannabis in Alabama

Particulars of medical cannabis treatment in Alabama

1. Available for ~15 conditions including cancer, Parkinson's, chronic pain

2. forbids smoking or baking into food

3. patient needs physician and registration card up to 65/year

4. patients under 19 must have a certified caregiver

No

Does Alabama medical cannabis law recognize patients from other states?

CBD drug interaction mechanism

CBD is a substrate for hepatic isoenzymes CYP3A4 and 2C19

Liver

Organ most likely affected by CBD drug interactions

Alabama needle exchange program

No, Alabama does not have a state-sanctioned needle exchange program

First state to have legislation in support of supervised injection sites

Rhode Island (2021)

Supervised injection sites in Europe – two countries with highest numbers

Germany and the Netherlands

Supervised injection sites – one of the latest countries to open one

Scotland

First supervised injection sites in the U.S. – how many and where

Two sites opened in New York City in 2021 (the first officially sanctioned SIFs in the U.S.