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Legality

The Over the last few decades, attitudes, perceptions, and laws have become more supportive of marijuana use. Arizona laws permit the use of medical and recreational marijuana; however, the federal statutes deem it illegal.(1) California legalized medical marijuana in 1996, and Colorado legalized recreational marijuana in 2012.(2)


The Grand Canyon State joins 34 other states which have legalized medical marijuana and 17 other states where recreational marijuana is legal.2 The Arizona Medical Marijuana Act (AMMA), passed in 2010 and legalized the use of medical marijuana without requiring testing from the U.S. Food and Drug Administration (FDA). The act became effective in 2011 and Arizona’s first dispensary opened in 2012.(3​)

The Arizona Department of Health Services (ADHS) is the designated state agency that oversees licensing and issuing authority of the
Arizona Medical Marijuana Program (AMMP).(4) About a decade later in 2020, Arizona passed the Smart and Safe Act, which legalized use of recreational marijuana.(5) It is worth noting this legislation passed despite opposition from medical societies, due to the paucity of research into prolonged marijuana use.(6)

Attitudes and Behaviors

According to a Medscape Medical News Poll in 2018, 67% of physicians nationwide support medical marijuana and 53% support recreational use only. A Pew Research poll in 2021 showed that 91% of Americans are in favor of either medical and recreational marijuana use, or for medical marijuana use only.

Demographics

ADHS reported in February 2022 there were over 244,000 qualifying patients with active medical marijuana cards. The most qualifying patients reside in Maricopa (66.2%), Pima (13.8%), and Pinal (6%) counties. The most frequent qualifying health condition for this demographic is chronic pain, accounting for 94.23% of active patient card holders. Other qualifying health conditions are cancer (2.10%), PTSD (1.97%), nausea (1.58%), and muscle spasms (1.51%). The rest of the qualifying health conditions had under 1% of active patient card holders.

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Dispensary Limitations

Arizona differs from other state medical marijuana programs by limiting the number of dispensary licenses available.(4) For instance, dispensaries can be limited by geographic location where a new medical marijuana dispensary certification may not be granted if it is
within 25 miles of another registered certified dispensary. Also, ADHS may not issue more than one dispensary license for every ten registered pharmacies in the state. New recreational dispensaries must compete to acquire a license if not already affiliated with a
licensed medical marijuana dispensary. Dispensary licenses for rural or underserved communities are permitted through a separate application process.(4) An additional 26 licenses were granted for recreational dispensaries in April 2022 due to the social equity ownership program introduced in the Smart and Safe Act.(5)

Revenue

Medical marijuana is subject to the state transaction privilege tax of 5.6%.4 Recreational marijuana sales must include another 16% Marijuana Excise Tax (MET) on top of the state and local sales tax. The Smart and Safe Fund holds this MET and is where the licensing and registration fees for recreational marijuana are also held. This fund contributes monies towards different departments and organizations including the state and local agencies that regulate marijuana, community colleges, and public health programs.(5)
Arizona Department of Revenue has reported around $239 million in tax revenue for the total combined medical and recreational marijuana since January 2021.

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Definitions

Marijuana is scientifically known as Cannabis sativa and is not FDA approved. Marijuana is defined by the components of the plant from
the genus cannabis including the leaves, stems, flowers, and seeds. This definition does not include the other parts of the plant like the stalks, fiber from the stalks, oil or cake made from the seeds of the plant, or any other compound of the plant which is incapable of germination.(2) Hemp includes some Cannabis varieties that have low cannabinoid levels compared to marijuana. They are used for fibers and seeds instead of their CBD or THC properties.

Cannabinoids are chemical substances that bind to cannabinoid receptors in the body. Marijuana has two primary cannabinoids, cannabidiol and tetrahydrocannabinol.

Cannabidiol (CBD) is processed Cannabis plant extract, oil, or resin that contains a high percentage of cannabidiol, but a low percentage of tetrahydrocannabinol (THC).


Tetrahydrocannabinol is the primary psychoactive chemical in Cannabis, delta-9-tetrahydrocannabinol (THC), which is a partial agonist at cannabinoid receptors in the body.


Marijuana Strains. The ratio in CBD and THC plays a role in the strains used for medical and recreational purposes. ADHS reported in February 2022 that 94.23% of active card holders for medical marijuana are qualified because of chronic pain. Since THC is responsible for the euphoric effects of marijuana, those who are using medical marijuana may opt for strains that have lower THC and higher CBD content.

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Current Findings for Medical Marijuana Benefits

The In spite of overwhelming support for medical marijuana, there is still underwhelming consensus in research to prove its benefits. Efforts to establish credibility as a treatment for various medical conditions have not yet produced convincing enough results for instrumental agencies such as the FDA and Centers for Disease Control and Prevention (CDC).(7) A recent review of the health effects of
medical marijuana sponsored by authorities such as ADHS, CDC, and the FDA, found barriers in medical marijuana research include funding and access to medical grade marijuana. These barriers often produce low quality results which impact the already limited data. They also found a gap in this research for evidence on short and long term health effects of marijuana use. Concerning aspects of the research reviewed is the studies did not use medical dispensary products and mostly used CBD or THC instead of the marijuana plant itself. Another recent review highlights more deficits in medical marijuana research such as unknown biphasic effects, the influence of THC and CBD on addiction, and the lack of clinical testing for therapeutic treatments on humans.(8)

FDA Approval

The FDA has approved Cannabis derived and Cannabis related treatments and drugs. Epidiolex is an FDA approved drug primarily
for the treatment of seizures and contains CBD. Marinol and Syndros are approved treatments which contain a synthetic derivative of THC, dronabinol, to address anorexia associated with weight loss in AIDS patients. Lastly, Cesamet is an FDA approved drug that has a synthetic derivative of THC, primarily used to treat or prevent nausea and vomiting because of cancer medications.(9)

Arizona Medical Marijuana Program

The AMMP functions to facilitate AMMA within its specified rules and regulations. Arizona physicians can participate in varying degrees.
 

First, they may certify adult qualifying patients to become part of the medical marijuana registry. Physicians would review the patient’s medical history and assess conditions which qualify for the AMMP. In providing certification to a patient for a debilitating qualifying condition, the physician assumes responsibility for providing management, routine care, and maintaining a medical record for
the patient.(3)


In a more involved role, Arizona physicians may also be associated with a dispensary as a medical director, a position required by law of each medical dispensary. The medical director must be either on site or available by phone, and he or she must identify another physician designated to cover if the medical director is not available. The duties are to establish and provide training to the designated
dispensary agents annually, put together educational resources for qualified patients and caregivers, and consult with qualified patients to assist them in tracking their symptoms, medical marijuana usage, and any side effects.(3)


There are some limitations. Any physician serving as a medical director for a dispensary may not provide a written certification for medical marijuana for qualifying patients.(3) Additionally, Arizona physicians who submit Physician Certification Forms for qualifying patients will not be able to have the convenience of an in-house dispensary like some practices have in-house pharmacies.

References

1. Arizona Department of Health Services. 2016. Arizona Medical Marijuana Act End of Year Report. http://www.azdhs.gov/

2. Federation of State Medical Boards. 2022. Model Guidelines for the Recommendation of Marijuana in Patient Care. Available at: <https://www.fsmb.org/siteassets/advocacy/policies/model-guidelines-for-the-recommendation-of-marijuana-in-patient-care.pdf>.

3. Arizona Department of Health Services. Medical Marijuana Rules. 2013. https://www.azdhs.gov/documents/licensing/medical-marijuana/resources/az-medical-marijuana-2013.pdf

4. Arizona Medical Marijuana Act. Arizona Revised Statutes § 36- 28.1 (2010).

5. Smart and Safe Act. Arizona Revised Statutes § 36-2856 (2020)

6. Arizona Medical Association is in Full Opposition of Prop 207. 2022. Arizona Medical Association. Available at: <https://www.azmed.org/news/526601/Arizona-Medical-Association-is-in-Full-Opposition-of-Prop-207.htm>.

7. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). (2021) U.S. Food and Drug Administration. Retrieved from https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd

8. National Academies of Sciences, Engineering, Medicine, Division, H. M., Practice, B. on P. H. P. H., & Agenda, C. on the H. E. of M. A. E. R. R. (2017). The Health Effects of Cannabis and Cannabinoids. National Academies Press. https://doi.org/10.17226/24625

9. Nelson, & Kaminsky, D. B. (2021). New momentum in exploring marijuana's medical benefits: Marijuana has been lauded and lambasted for its potential effects on the body. In part 1 of a 2-part series, we investigate the accumulating evidence for the effectiveness of cannabis in treating some medical conditions. Cancer Cytopathology, 129(8), 575–576. https://doi.org/10.1002/cncy.22492