Episode 28 Part II: Legal Implications, Financial Constraints, and Personal Experience
This is Part II of a three-part series exploring into the efficacy of medical marijuana for individuals living with fibromyalgia. The focus of this episode is on exploring legal implications, financial benefits and constraints as well as another glimpse into my experience using medical marijuana and the different delivery methods as part of my fibromyalgia management plan.
RECAP from Part I: Benefits
Medical Cannabis is considered a safe alternative for pain management for fibromyalgia (Strand). According to researchers at the Mayo Clinic, the effectiveness of cannabis on fibromyalgia pain affirmed positive outcomes for using medical marijuana to curb symptoms. This is upheld by other studies including this one detailing the effects on fibromyalgia symptoms and reiterates that symptoms of fibromyalgia are curbed with cannabis use citing the medicinal properties of THC and CBD as the main components for relief. In part one, I shared my personal hesitation in using this controversial plant as medicine. I explained that my profession and marijuana's legality prevented me from doing so because, early on in my career, I could have lost my job if I was tested and the drug was found in my system. This is no longer the case in the state of Minnesota.
Legal Implications
So what are the legal implications? Well, it does depend on which state you live in, and it depends on where you work. If a worker is a federal employee, no matter where they live, they are required to remain "drug-free". This means, FBI and Congresspersons all the way down to the U.S. Forest Service and the like. In other words, if I live in a state, like Minnesota, where marijuana is legal for recreational use and I am a federal employee, my employer can take corrective action against me, including loss of employment.
I am a Teacher: Can I Lose My Job?
Maybe, but not in Minnesota. However, nothing is without its twists and turns. I am a teacher; I am certified by my doctor with 3 qualifying medical conditions that fall under Minnesota's protections for using cannabis as medicine; I have a prescription for medical marijuana and I use it beneficially at home. Can my employer drug test me? Yes they can. In a report by CBS news, Cummings explains who can be drug tested and who cannot, "Except for certain jobs explicitly stated in the bill—like police officers, firefighters, educators, or someone with a commercial driver's license — an employer cannot require a cannabis drug screening for a job candidate as a condition of employment". This does not mean I will be fired, after all, I am using cannabis for medicinal purposes, however, I may need to explain a positive cannabis drug screening test and show that I am certified to use it in this capacity.
Don't Go to Work HIGH!
It would be unusual for an employer in Minnesota to screen for cannabis after a person has already been employed but just like alcohol, under new house file 100, "If you do go to work high, your employer has every right to fire you under this bill," said Stephenson, the House bill's author. This is true in most states that allow medical and recreational marijuana. Just as an employee should not go to work drunk, an employee should not go to work high. I don't think this requires any more explanation.
Medical Marijuana Certification and Qualification
Getting certified in the state of Minnesota is really a matter of finding a Minnesota-licensed physician, physician assistant, or advanced practice registered nurse that can certify your medical condition. Medical conditions that qualify are: Alzheimer's disease, Amyotrophic lateral sclerosis (ALS), Autism spectrum disorder (must meet DSM-5), Cancer (If your illness or its treatment produces one or more of the following: severe or chronic pain; nausea or severe vomiting; or cachexia or severe wasting), Chronic motor or vocal tic disorder, Chronic pain, Glaucoma, HIV/AIDS, Inflammatory bowel disease, including Crohn’s disease, Intractable pain, Irritable bowel syndrome, Obsessive-compulsive disorder, Obstructive sleep apnea, Post-traumatic stress disorder (PTSD), Seizures, including those characteristic of epilepsy, Severe and persistent muscle spasms, including those characteristic of multiple sclerosis (MS), Sickle cell disease, Terminal illness, with a probable life expectancy of less than one year*, Tourette syndrome. These are all conditions, disorder, and diseases in which medical cannabis has been shown to make a difference and improve quality of life.
The Financial Benefit
There are a lot of numbers here so if addition, multiplication, and percents make your head explode, you can skip this section. Just know that if you are looking to cannabis for symptom relief, there is a significant monetary benefit to getting certified for medical marijuana use and buying from a medical dispensary.
In the state of Minnesota, there used to be a $200 cost associated with medical certification for cannabis. Since the new law allowing recreational use took effect in June of 2023, that cost has gone away. But, because Minnesota is now a dual medical and recreational use state, there are differences to the benefits I receive by being medically certified and prescribed cannabis. The main benefit and most important to me is financial. I do not have to pay taxes on the cannabis I buy from my licensed medical cannabis dispensary. The difference is, in the state of Minnesota, recreational cannabis comes with not only sales tax at 6.8+%, but on top of that, there is a 10% gross tax. Along with that, in the city in which I live, before the 10% gross tax is added, my local government adds a 1.5% "sales and use" tax. This comes to 8.3% tax on any sale in my city plus 10% cannabis tax on top of the gross. That means if I buy $50 of recreational cannabis, I will add 8.3% (6.8%+1.5%), or $4.15, to equal $54.15; add the gross tax of 10% and that is another $5.43. My $50 of recreational cannabis is now $60. Considering, on average, $50 gets about 1/8th of an ounce of dry flower, or maybe twenty 5mg gummies, including tax, that's a lot of money for a recreational buzz. Thankfully, I don't have to pay that tax.
My Personal Journey with Medical Cannabis
I have been certified for medical cannabis since late 2023. It was a shift for me to decide to use cannabis because I was so against it for most of my career. Previous to 2014, even medical use could have gotten me fired. But considering I have tried industry medicines, namely pregabalin (Lyrica) with terrible results, antidepressants, again with terrible results, and a multitude of non-opioid pain relievers with little to no success, I decided that since medical cannabis is legal in my state, that it was an option that would either work, or not work.
Delivery Methods
As for method of delivery, as someone who used to smoke tobacco, I've chosen to skip smoking or vaping cannabis products to protect my lungs. Instead, I've explored only oral methods of consumption, like tinctures, sublingual drops, lozenges, gummies, and other edibles. I have had better results with some methods, and not so desirable results from others.
Gummies
My least favorite method of use is edibles, particularly gummies. When I have used gummies, I have had mixed results. First, because ingested THC is processed and metabolized through the liver, it can take 1-2 hours to provide any benefit or experience, and second, gummies seem to be inconsistent in their potency. Sometimes it has felt like one gummy in the pouch got ALL the THC and another gummy got little to none. Sure, the package says 75mg total, but as it happened, that 75mg was not spread evenly throughout the batch. A couple of times I have experienced the psychoactive effects so intensely that going to bed was the only option. Other times, I have taken a gummy or two only to wait, and wait, and wait as my pain lingered and was not in the least resolved. The best time for me to use a gummy is at night to hopefully promote restful sleep. But again, it isn't consistent.
Edible Inconsistencies at Home and Across the Industry
Edibles that I make myself are better than gummies, but again, it can be inconsistent. Where does the inconsistency come from? Basically, it comes from the irregularity in distribution of THC throughout the product. Sometimes the psychoactive properties from the plant material settles to the bottom of a batch of infused oil or butter and as it gets mixed into the batch or brownies, or cookies, or candy, the amount of THC is concentrated more or less depending on which part of the edible you bite into. This is not only a problem in my own kitchen, it seems to be an industry problem as reported by the Denver Post in 2014. In one report, products tested in state-sponsored labs were wildly inconsistent. Some products labeled with 100mg THC, actually had 140+mg, whereas other products labeled with the same 100mg, had less than 1mg of THC. Again, it can be wildly inconsistent.
Preferred Method of Delivery
If you don't already know, having control over my body is a priority to me. Fibromyalgia tries to take this away. However, medical cannabis gives me back a piece of my life that went missing when fibromyalgia showed up. It has restored my ability to sleep peacefully, offered temporary respite from anxiety, and has aided in effectively alleviating my pain. After 2 months of trial and error, I have discovered 3 delivery methods that I prefer for real time use and almost immediate relief: sublingual spray, lozenges, and external salves.
I use the sublingual spray method, as needed, for almost immediate pain relief and for sleep. My prescription says, "1-4 sprays under the tongue up to 5 times a day" for relief of pain and anxiety. Um... NO! The most I use is one spray 1 time per day as needed for daytime pain relief after I get home from work, and two sprays at bedtime for pain-free sleep. That's it. But, let it be known, coming to this dosage did not come without failed experimentation. I sometimes make the mistake thinking that more is better. In the case of cannabis, this is a no no. Three sprays put me to bed for well beyond the 8 hours required for good health and four sprays practically put me under the bed. This is not enough to overdose (it's HARD to overdose on cannabis) nor to put my vital organs at risk. The biggest risk would be if I didn't have common sense and had planned to drive myself somewhere or operate heavy machinery, neither of which I have any desire to do when I get home from a stressful day of teaching. I just need one spray for pain which gives me relief within 1-2 minutes of dosing. I use two sprays before bed which provides restful pain-free and anxiety-free sleep.
I am new to lozenges this month, but so far my experience tells me that it is a cross between a spray and an edible. It is more immediate than a gummy because it releases the cannabinoids (the active ingredients in cannabis) into the bloodstream directly through the tissues in the mouth. But, unlike a spray where the cannabinoids are suspended in ethyl alcohol and sprayed under the tongue for quick absorption and almost immediate relief, a lozenge slowly dissolves in the mouth and provide relief within 15-30 minutes. The benefit of using a lozenge over a spray is that I can take the lozenge out of my mouth if I start to feel relief before it is completely dissolved. I can manage the dosing for more or less relief by simply spitting it out (and saving it for later - I'm not about wasting!).
Cannabis salve is an anti-itch, anti-inflammatory, analgesic topical medicine. A cannabis salve interacts with the endocannabinoid system to provide an antinociceptive effect. "Antinociceptive" refers to the ability to block or reduce pain perception. Our skin harbors numerous CB1 and CB2 cannabinoid receptors. Cannabis salve rubbed into the skin interacts with these receptors and has the potential to relieve pain from the skin on in. I discovered that this works for me because I have frozen coconut oil cannabis cubes on hand to melt into hot herbal tea and I used one to rub into my shoulder as an experiment for pain and IT WORKED! I have repeated this "experiment" several times and it continues to have positive results. So, at this point, I am in the process of making my own cannabis salve because, on the market for 2-4 ounces, it can be $50-100 retail.
RECAP:
Finally, in Part II of my exploration into the efficacy of medical marijuana for fibromyalgia, I explored legal implications, financial benefits, and my personal experiences. Legal considerations vary by state and employment status; as a teacher in Minnesota, I'm protected under state laws for medical cannabis use but I acknowledge the possibility of employer drug testing. Financially, medical certification offers tax benefits compared to recreational cannabis purchases. My journey with medical cannabis showed me the importance of finding effective delivery methods. As I continue navigating my journey with medical marijuana, I've come to realize the importance of finding what works best for me amidst the legal complexities and financial considerations. Through trial and error, I've discovered delivery methods that provide relief, offering a glimmer of hope in managing my fibromyalgia symptoms. Moving forward into Part III, I'm eager to dig deeper into my experiences and continue sharing them, with the aim to shed light on the ever-changing landscape for fellow fibromyalgia warriors as they navigate the challenges of this condition.
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Karen Palmen, EdD is a veteran educator in Saint Paul, Mn. She teaches Dance and English at Saint Paul Central High School. She has an active TikTok page that features humorous, political, mental health, and educational content (kickin it with karen). And a a dormant YOUTUBE channel with the same name, featuring fermented foods and other cooking oddities.
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