SIOUX CITY | A new law that will allow seizure sufferers in Iowa to use a marijuana extract to help control their disease has a local doctor worried about the possible risks to children.
Iowans who can legally possess up to 32 ounces of cannabidiol oil starting July 1 will have to buy the product from out-of-state dispensaries and dealers, and there's no way to know what kinds of impurities it may contain, said Mercy Medical Center emergency room physician Thomas Benzoni.
"More and more we're seeing toxic agents seep into drugs,” Benzoni said.
Some cannabidiol contains potentially deadly oil-based insecticides used to treat cannabis plants.
"When something is extracted from cannabis or any plant with oil, then anything that is oil-soluble will be in the oil portion,” he said. “Many substances that are very toxic are oil-soluble.”
Given the way Iowa’s law is configured, allowing patients to possess the medication but requiring them to obtain it out of state, Benzoni said he believes cannabis will “do plenty of harm to children” and adults alike.
The federal Drug Enforcement Administration classifies marijuana and its components as a Schedule I substance, meaning it is illegal and not regulated by the Food and Drug Administration.
NOWHERE TO GO?
Gov. Terry Branstad signed the Medical Cannabidiol Act into law May 30 at the urging of parents who believe the oil can reduce the frequency of seizures and in some cases eliminate them.
The law allows adults and children who suffer from uncontrollable epilepsy to have the drug in Iowa, where other forms of marijuana are illegal.
The law requires patients with "intractable epilepsy" to get a written recommendation from a neurologist who has treated them for at least six months. Neurologists submit the recommendation to the Iowa Department of Public Health, which then permits the Iowa Department of Transportation to issue a cannabidiol registration card to patients who are at least 18 years old or, in the case of a minor patient, a primary caregiver.
Neurologists have the sole authority to recommend the use and the amount of cannabidiol oil, which can be taken by mouth or rubbed into the skin. The oil is free of THC, the mind-altering ingredient in the cannabis plant.
Once the new law goes into effect, Iowa will be one of 23 states that have decriminalized the drug for medical use.
Some states, including Minnesota, have empowered state regulators to oversee the growing of medical cannabis and its distribution. The law signed by Minnesota Gov. Mark Dayton in May requires the state’s commissioner of health to register two in-state marijuana manufacturers by December.
Iowa residents won’t be able to buy medical marijuana in Minnesota. The state’s law restricts access to Minnesota residents diagnosed with qualifying conditions and registered with the Department of Health.
Iowans can travel to Colorado to buy marijuana and marijuana products from a licensed retail shop but can't legally take it out of the state. According to the Colorado Department of Public Health & Environment, there is no difference between marijuana sold for retail and medical use.
Anyone caught traveling with marijuana through Nebraska, which is between Colorado and Iowa but where the substance is illegal, faces possible arrest.
“Nebraska law has not changed, and marijuana in any form remains illegal,” said Deb Collins, spokeswoman for the Nebraska State Patrol.
Only the states of Arizona, Delaware, Maine, Michigan, Nevada, New Hampshire and Rhode Island offer reciprocity for patients with out-of-state medical marijuana identification cards.
Tyler Brock, Siouxland District Health Department deputy director, said local public health offices won't be involved in issuing registration cards for Iowans.
"That's probably why we haven't had much conversation with this at a local level," he said.
CALLS FOR MORE TESTING
Steve Fox, 61, of Sioux City, has lived with epilepsy most of his life. A native of Homer, Neb., he has been on multiple medications to help control seizures. He had the first of many brain surgeries at the age of 8 months.
Fox established the Siouxland Epilepsy Support Group in 2004. Four years later, the local organization merged with the Epilepsy Foundation of America’s North/Central Illinois, Iowa and Nebraska chapter. He hopes to re-energize a local support group.
Fox agreed the prospect of legalized cannabidiol oil treatment may give parents a glimmer of hope for their children’s health.
“I think it’s a new solution,” he said.
However, he said more testing needs to be done to make sure it’s safe and effective. He said he doubted local physicians would be quick to suggest the oil as a treatment option.
A statement from the Epilepsy Foundation’s regional chapter supports the rights of patients and families living with seizures and epilepsy to access medical marijuana but contends, "There is still a lot we don't know about the medical use of marijuana for epilepsy."
"The Epilepsy Foundation calls for an end to Drug Enforcement Administration restrictions that limit clinical trials and research into medical marijuana for epilepsy," the statement by foundation president and CEO Philip Gattone and board chairman Warren Lammert said.
"The Epilepsy Foundation believes that an end to seizures should not be determined by one's ZIP code."
Justin Johnston, 37, of Sioux City, developed epilepsy at age 15. His treatment has included myriad medications to which his brain eventually becomes accustomed. Although he wasn’t too familiar with Iowa's new cannabidiol law, he said any new treatment option would be beneficial.
“I think it would be a great idea if it would make a younger person much better,” he said.
Linda Kalin, executive director of the Sioux City-based Iowa Poison Control Center, said the federal Schedule I designation hinders medical researchers from performing controlled studies on cannabidiol oil.
"This is compassionate use. It seems reasonable," she said of the law. "We do need more studies. We as a country need objective data from randomized trials."
In the meantime, Benzoni cautioned that no one really knows what's in a vial of marijuana extract made or sold by a dispensary or a lone dealer.
He said he would like to see more studies being done on cannabidiol oil to learn what it contains and whether it offers any medical benefits.
"If people have a scientific inquiry about it, go ahead and study it, but be willing to accept the conclusion before the scientific study is done," he said. "People demand a certain answer before they do the study. If they don't agree with the results of the study, then they say, 'The study's wrong.'"
Journal staff writer Molly Montag contributed to this report.