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“The Simpsons” have been highlighted in the media for being able to “predict the future.” With the episode of “Weekend at Burnsie’s,” could they have predicted the future changes arising with the reclassification of medical marijuana? Only time will tell, but here are some hypothetical changes that COULD arise with the news of marijuana potentially being reclassified. Again, nothing here is absolute. We are simply asking the question of what the implications might be.
In pharmacy, drug classifications are vital for regulating medication dispensing and ensuring patient safety. You may have recently heard about the discussions from the DEA and Senate to reschedule marijuana or cannabis from Schedule I to Schedule III under the Controlled Substance Act (CSA). This change may pose significant changes to pharmacy operations. How will this impact pharmacies, pharmacists, and pharmacy technicians?
The Cannabis Specialty Pharmacist course is a six-hour specialty certificate aimed at helping pharmacists understand the pharmacology and clinical care concerns of current prescription cannabinoids including dosage, drug interactions, and side effects.
Understanding Controlled Substance Classifications:
As you may or may not know, controlled substances are held under five categories based on medical use and abuse potential. Below are the current schedules and some example medications for each class.
- Schedule I: no accepted medical use and high abuse potential. Drugs such as cannabis, LSD, heroin, and ecstasy fall under this category.
- Schedule II: dangerous and high addiction but used medically mainly for analgesia. Drugs such as cocaine, methamphetamine, methadone, and hydromorphone fall under this category.
- Schedule III: used medically for analgesia and hormone replacement therapy with a moderate to low abuse potential. Drugs such as ketamine, anabolic steroids, and testosterone fall under this category.
- Schedule IV: used medically for pain, anxiety, and other reasons with low risk for abuse and dependence. Drugs such as alprazolam, carisoprodol, and tramadol fall under this category.
- Schedule V: used medically as an antidiarrheal, antitussive, and analgesic with a lower abuse potential than schedule IV. Drugs such as pregabalin, difenoxin/atropine, and diphenoxylate/atropine fall under this category.
Implications of Reclassification for Pharmacies:
If cannabis is rescheduled to a schedule III, there will likely be some changes pharmacies must make to accommodate this change, both positive and negative.
Increase in Revenue:
Will pharmacies experience an increase in revenue as they can dispense medical marijuana? This medication, of course, will only be available behind the counter with a valid prescription. This could open new doors for pharmacies to have an increase in profit.
Training and Education:
Training programs are already available for pharmacists, but additional training and education may be necessary in the future for proper drug handling and patient counseling. This will be necessary to show that pharmacy professionals are prepared to dispense medical marijuana.
Amended Federal Laws:
Changes in federal drug testing laws may also be amended due to this legislation. But it could be assumed that pharmacy employees still should not be under the influence at any time near their shifts. Moreover, health insurance reimbursements could be amended for regulatory purposes. It will be important for pharmacies to stay informed and up to date on any regulatory changes to ensure they comply with the Federal system and DEA.
Another challenge that could be posed is the difference between federal and state laws. Currently, several states have legalized marijuana for medical and recreational use, such as California and Virginia, despite it being a schedule I drug. The reclassification to schedule III may cause grey areas between state and federal laws. This could affect state-legal businesses and could pose a risk of being affected by federal law. Would this mean that a change in state laws would also be necessary?
Potential Challenges:
One question that must be asked is, what about drug diversion? As we have seen with the opioid crisis, drug diversion and counterfeit prescriptions could become more common for medical marijuana if this law is amended. The implementation of a Prescription Drug Monitoring Program (PDMP) may help mitigate this issue.
Role of Pharmacy Technicians
Pharmacy technicians may find themselves with more duties if marijuana were moved to a schedule III medication. They may be required to complete additional training and certifications, similar to administering vaccines. Regardless, pharmacy technicians will play a vital role in ensuring the safe and responsible dispensing of marijuana, as they are an integral part to daily pharmacy operations. Pharmacy technicians are often responsible for not just filling medications, but also managing an accurate inventory and maintaining proper storage of medications. There may be more responsibility with medical marijuana being stocked in pharmacies such as tracking expiration dates and stock levels, while watching out for diversion!
Navigating the Future
Looking ahead, several non-pharmacy developments may be important to consider:
Dosage forms:
What will be the available dosage forms of medical marijuana held in pharmacies? With the many dosage forms of marijuana such as oral, inhaled (smokable), topical, and sublingual. These various routes of administration all have different doses, onsets of action, durations, and storage requirements. Moreover, maintaining uniform dosages and strengths of marijuana has continued to be a challenge. Standardizing the cultivation, manufacturing, and consistency of medical marijuana will be imperative but there is still a lot of work to be done in this area. All of these clinical pearls would be important to be educated on for both pharmacists and pharmacy technicians.
Cannabis Breathalyzers:
DUIs due to marijuana have become a rising issue. Discussions are ongoing about the implementation of marijuana breathalyzers to prevent DUIs. This will be significant for public safety as marijuana use becomes more prevalent.
Recreational Use: What Will Happen?
The rescheduling of marijuana would mainly affect its medical use, but the laws regarding recreational use may be affected too. Federal rescheduling will not automatically legalize recreational use, as it would still be subject to individual state laws. States with legal recreational use would likely continue their current regulations but would this cause these states to reevaluate? Laws surrounding recreational use may become stricter and people who use marijuana recreationally may face new restrictions on purchasing, possessing, and taking the drug.
What About Criminal Records?
Could rescheduling marijuana lead to federal charges being dropped for those convicted of marijuana-related crimes? Senate Majority Leader, Chuck Schumer, has reintroduced the Cannabis Administration and Opportunity Act which could expunge the criminal records of many Americans with low-level marijuana offences. This particularly affects minority populations who have disproportionately been affected by the War on Drugs.
This act could provide some much-needed relief to those whose lives have been disrupted by minor marijuana charges. Expunging these records and releasing people who have federal charges could improve chances of employment, housing, and overall quality of life for thousands of individuals. This also may shift the public perception regarding medical marijuana use becoming more widespread, though surveys have shown that the majority of Americans are already in favor of it. This may be an opportunity to bridge modern perceptions from citizens and legislation.
Economic Impacts
Dispensaries:
Rescheduling cannabis could significantly impact the economy, especially for dispensaries that currently operate as a cash-only business due to current Federal regulations. This change could allow these businesses to open bank accounts and obtain credit cards, increasing revenue and allowing for businesses to be expanded.
Regulatory Changes:
This also affects pharmacy, as the new regulatory laws could impact the finances of pharmacy. This includes DEA registrations, new guidelines, and insurance reimbursements.
What would happen if marijuana were no longer a controlled substance?
Another hypothetical going around is: what if marijuana is no longer a controlled substance at all? This would cause big changes for the pharmacy, economic, and regulatory systems.
Regulatory Changes:
Could de-classifying marijuana align federal and state laws who have already legalized marijuana for medical or recreational use? How would this reduce or increase legal conflicts? There would be a significant reduction in marijuana related arrests and incarcerations, but what would this look like?
Economic Impact:
The legal marijuana market would likely expand. Could this be a new opportunity to create jobs and increase tax revenues? Marijuana business would have easier access to financial services leading to stability and growth, but could barriers and stigma continue to limit these businesses from thriving?
Social Impact:
Speaking of stigma, removing marijuana from the controlled substances list could reduce stigma, making it more socially acceptable. There could be an increase in education on responsible use and regulations on product quality and safety. Could this cause push back from citizens who do not agree?
Medical Impact:
Would healthcare professionals be more likely to prescribe medical marijuana if it is federally recognized for having therapeutic benefit? Insurance coverage for these prescriptions may become available, for which it would be important for pharmacy professionals to be aware of. This could also increase access and affordability for patients.
International Impact:
How would the United States navigate international drug control treaties? Would this cause a global shift in global drug policy?
Conclusion:
As the current regulation of marijuana may undergo modifications, pharmacies will be at the forefront of this change. Pharmacy professionals will have to adapt to new responsibilities, including patient education, drug-drug interactions, and appropriate documentation. These changes could also benefit businesses and consumers, making it very important to stay informed about the latest updates as pharmacy professionals.
For pharmacists looking to expand their knowledge, please consider the free CE available through PharmCon for medical marijuana by Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, “Cannabis Specialty Pharmacist”. This certification can help pharmacists be well-equipped to navigate the evolving environment of marijuana in pharmacy practice.
