Making sense of the changing laws and regulations surrounding the use of medical marijuana in dogs and cats.
The legalization of medical cannabis for both pets and people is a hot topic. Opinions range from 100% nationwide decriminalization to a more cautious approach advocating for further research. So how do you know what to ask your veterinarian about medical cannabis for your dog or cat? What exactly can the doctor discuss, recommend or prescribe? How will the current political turmoil in DC affect the future of medical cannabis? The answers to these questions aren’t easy to find or understand, and they change frequently. That being said, let’s look at what we do know.
Medical properties aren’t widely recognized
Beyond defining and typing cannabis (see sidebar on page xx), one big hurdle is whether C. sativa has any medical value. In the United States, at least on a federal level, no part of the cannabis plant is deemed to have any medical value. The majority of states beg to differ and medical cannabis dispensaries abound. Nonetheless, the lack of medical efficacy acknowledged at the federal level puts professionals in an awkward position when it comes to discussing cannabis with their human patients. Extending this problem to the veterinary world, the law is even less clear and often varies state to state. The California state veterinary medical board currently prohibits veterinarians from discussing medical cannabis, while Oregon’s board authorizes such discussions provided they are properly noted in medical records.
Where we stand on cannabis – for now
Here is where we currently stand in the United States regarding cannabis chemotypes:
- Marijuana is officially regarded as a Schedule I drug having no medical value.
- Hemp is an industrial crop from which many companies obtain CBD (the non-psychotropic and purportedly medically beneficial compound in cannabis).
However, these general definitions are rapidly changing, which leaves consumers and professionals reeling.
- The 1970 enactment of the Controlled Substances Act (CSA) added synthetic THC to the Schedule I list and adopted the following definition of marijuana from the Marihuana Tax Act of 1937. “The term ‘marihuana’ means all parts of the plant Cannabis sativa L., whether growing or not; the seeds thereof; the resin extracted from any part of such plant; and every compound, manufacture, salt, derivative, mixture, or preparation of such plant, its seeds or resin. Such term does not include the mature stalks of such plant, fiber produced from such stalks, oil or cake made from the seeds of such plant, any other compound, manufacture, salt, derivative, mixture, or preparation of such mature stalks (except the resin extracted therefrom), fiber, oil, or cake, or the sterilized seed of such plant which is incapable of germination.”As a Schedule 1 controlled substance, deriving CBD from marijuana violates the federal CSA. However, the Act does not include the plant’s “mature stalks” in its definition. These stalks are used to create hemp products (which contain little to no THC and have no intoxicating effects). Hemp is not scheduled under the CSA, so it doesn’t come under the enforcement authority of the Drug Enforcement Administration (DEA). Similarly, CBD is not scheduled under the CSA, has a different molecular structure, and is recognized with its own unique DEA Control Number (CBD is #7372, marijuana is #7360).
- On February 7, 2014, the 2013 Hemp Farm Bill was enacted into law. Section 7606 of the bill defines industrial hemp as “the plant Cannabis sativa L. and any part of such plant, whether growing or not, with a delta-9 tetrahydrocannabinol concentration of not more than 0.3% on a dry weight basis.”Hemp refers to cannabis varieties primarily grown as an agricultural crop (such as seeds and fiber, and by-products such as oil) and is characterized by plants low in THC. The U.S. Congressional Research Service’s 2016 report to legislators states: “A level of about 1% THC is considered the threshold for cannabis to have a psychotropic effect or an intoxicating potential. Current laws regulating hemp cultivation in the European Union and Canada use 0.3% THC as the dividing line between industrial and potentially drug-producing cannabis.”
- December 2016 saw a different take on cannabis-related compounds. A new rule published by the DEA arguably makes hemp (which contains CBD as well as THC) a Schedule I drug under the CSA because of the broad definition of “marijuana extract”. However, an agency cannot substantially change a statute implemented by Congress, nor can it list a new drug without following listing procedures in the CSA. Arguably, this new rule attempts to do just that by redefining “marijuana” and creating a new code number. The DEA indicated this new rule was not intended to change substantive law regarding the control of a substance. While this statement is not binding, it does indicate the DEA does not currently intend to take enforcement actions against entities otherwise in compliance with the CSA before adoption of the new rule. Nonetheless, there are already efforts being made by various industries to contest the new rule and clarify the state of the law.
- On January 23, 2017, the Congressional Research Service published a report on hemp to help clarify its definition. Generally, “‘cannabis’ refers to the plant species Cannabis sativa and all of its industrial, medicinal, and recreational varieties. The terms ‘industrial hemp’ and ‘hemp’ are used interchangeably, and the term ‘marijuana’ refers to the plant used as a medicinal or recreational drug unless otherwise specified.”
Making sense of it all – you and your veterinarian
When it comes to medical cannabis, the Internet offers a plethora of anecdotal reports regarding its use. These reports range from THC toxicity to CBD “miracle cures”, and everything in between. Recommendations for cannabis administration to ailing dogs or cats abound, and include “blowing (cannabis) smoke in their ears” (do not attempt this as dogs and cats do not like to get high) or instructions like “just give one drop per day and increase as needed”. This advice is also dangerous because the cannabis industry is not as tightly-regulated as one would think, and a drop of one product can contain drastically different CBD or THC concentrations than a drop from a different batch of the same brand. Hemp-based products are also available for pets and each company provides differing guidelines for administration. Realizing the enormity of the task at hand, many people rightly turn to their veterinarians for guidance, only to end up feeling stonewalled.
Here’s why. Veterinarians are between a rock and a hard place when it comes to cannabis. Because the cannabis revolution is a ground-based movement, medical professionals are no more or less educated than many laypeople, and are at a loss when it comes to helping their clients. When they do attempt to garner more information, they often encounter contradictory results. Additionally, many veterinarians have DEA licenses which are may be put in jeopardy by marijuana recommendations; and state medical boards often do not have clear recommendations for such situations. In short, when it comes to cannabis, your vet may not know the best way to help you, despite his/her desire to do so.
Education, education, education
The best way to combat confusion is to educate yourself. Learn the facts of what the research community does and doesn’t know about medical cannabis.
- You can start the process by understanding that all mammals have an endocannabinoid system (ECS). The cannabis plant is the only one known to man with an entire receptor system devoted just to the ECS. It appears to be active in all tissues, and dogs and cats respond similarly to humans when it comes to both medical benefits and negative effects. Despite a significant volume of anecdotal evidence, double-blinded studies are lacking and realistic expectations should be maintained when considering any such therapy.
- Utilize certificate of analyses (COA) to help understand exactly what you are giving your pet. While not required by any regulatory agency, COAs provide third party laboratory results for a given product, helping to standardize the industry. Ask a dispensary or specific company if they have viewable COAs for their products. Many will provide them on request and even indicate the exact batch in question. Such companies are generally open and happy to help move the industry forward. Reading a COA can be tricky, but in general, you are checking to make sure the potency of CBD and THC (% or mg/g) are as advertised.
- Pet parents should come prepared to educate their veterinarians on this topic, and it’s helpful to provide the legal aspects as you understand them, along with resources for further research. While no veterinarian can prescribe Schedule I drugs, conversations and recommendations made between a medical professional and client are considered a form of protected speech. In October 2003, the United States Supreme Court let stand a ruling by the Ninth Circuit Court of Appeals permitting physicians to recommend marijuana to human patients whom they believe might benefit from its use. From litigation in that case, “The government agreed with plaintiffs that revocation of a [physician’s] license was not authorized where a doctor merely discussed the pros and cons of marijuana use.” (Conant v. Walkers, 2002). First Amendment principles at the heart of the Conant decision also apply to veterinarians (veterinary law often follows human law in cases like this) in the US who wish to:
- Discuss fully and candidly the risks and benefits of cannabis use with patients.
- Do one of the following: “recommend” (or “approve”, “endorse”, “suggest” or “advise”) legal cannabis products in accordance with their medical judgment, as with any other pet supplement, for a patient’s use.
- Record in their patients’ charts discussions about, and recommendations of, cannabis products.
- Educate themselves about the full value of the cannabis plant, its applications, and different routes of administration.
Defining and typing cannabis
One of the most confusing aspects of cannabis legalities involves the various definitions used for the plant. The genus Cannabis encompasses a staggering array of plants whose continental Asian origins prompt some sources to place all species under C. sativa. Others prefer three different variations: C. indica, C. ruderalis and C. sativa. For this article, we will primarily address C. sativa since it encompasses marijuana and hemp varieties.
Genetic testing of Cannabis spp. is ongoing though it is not yet standard practice to identify types of cannabis based on DNA analyses. This means scientific and political communities are left to reference cannabis strains by phenotype (what the plant looks like) and chemotype (how the plant looks chemically). Phenotyping is difficult even for cannabis experts, let alone a lawmaker, so it isn’t traditionally used.
That leaves chemotyping as our primary means of identifying and regulating cannabis species. Currently, the focus is on THC percentages and where such values may have originated. One would think chemical analysis eases this confusion, but a closer look proves otherwise. Broadly, we can categorize cannabis into marijuana and hemp, with marijuana having THC levels above psychotropic levels (>1% THC) and hemp containing THC levels <0.3%. This latter value is consistent with the EU and Canadian definitions of hemp. China, which has been a major hemp producer for decades, has no central governmental definition for the crop, but its Yunnan provincial Drug Enforcement Administration classifies industrial hemp as “the plant Cannabis sativa L. and any part of such plant, whether growing or not, with THC concentration of no more than 0.3% on a dry weight basis.”
Where do we go from here?
We all know the American federal government is in turmoil right now, but what does that mean for medical cannabis in veterinary medicine? In short, no one knows. It is likely, however, that further clarifications of THC and CBD, hemp and marijuana, and the medical aspects of cannabis are on the books. It is also likely such clarification will be challenged a few times, although it is unlikely the genie will be put back in the bottle.
It’s clear to me that cannabis is here to stay, and while the waters may be rough right now, the legalities will eventually get smoothed out and our dogs and cats will benefit from this useful plant.