Cresco Labs’ high-security facility for packaging and distribution, operates cultivation centers in Kankakee, Joliet, and Lincoln. Submitted photo

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With subtle signs in its frosted windows, Evanston’s only medical marijuana dispensary is easy to miss while strolling the Maple and Church shopping district. Entry into the austere PharmaCannis facility, located in the public parking garage at 1804 Maple Ave., requires a state-issued medical cannabis card and a security check.

But once inside, card-holding patients can seek relief for their ailments from a selection of cannabis products with quirky names like Zombie Zone, Bear Dance, Chicago Blue Dream, Katsu Bubba Kush, and Strawberry Shaman. Welcome to the world of medicinal pot.

Recreational marijuana is illegal in Illinois, but it has been partially decriminalized: Possessing 10 grams or less amounts to a civil violation with fines up to $200 and no jail time.

Governor Pat Quinn legalized medical marijuana on Jan. 1, 2014, when he signed the Compassionate Use of Medical Cannabis Pilot Program Act. (“Cannabis” is both Greek and Latin for what Americans call marijuana, with three subspecies: Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Hemp, a variety of C. Sativa, is used to make rope, textiles, paper, plastics, insulation, and biofuel, although its legality varies throughout the United States and the world.)

Medical cannabis is the smokeable marijuana plant, and as cannabis-infused foods, oils, ointments, vaping oils, waxes, and other products are used to treat or alleviate a medical condition or the symptoms of a medical condition. Dispensaries like PharmaCannis are just one component in the network of farms (called “cultivation centers”), laboratories, researchers, legislators, product specialists, pharmacists, bakeries, physicians, and patients that operates within Illinois’ Compassionate Use Act, which legalized cannabis as an “alternative treatment for serious diseases causing chronic pain and debilitating conditions.”

Pot for Pain and More
“Pain is the main symptom we see, from a number of different conditions,” explains Dan Scheidt, General Manager of the Evanston PharmaCannis dispensary, which has attracted patients with Crohn’s disease, cancer, multiple sclerosis and many other health issues since it opened in December 2015.

The main goal, Mr. Scheidt explains, is to help alleviate symptoms rather than to try to treat the conditions that cause them. “If they’re not sleeping at night, I want to help them go to sleep, and if they have stomach pain I want to fix that.” He has managed two dispensaries in Colorado and two in Illinois since 2009. “I really want to work on the symptoms and improve their overall quality of life,” he says.

Pain is one of the top reasons for medical cannabis use, according to a 2016 survey conducted by HelloMD, a San Francisco-based medical cannabis community, along with anxiety, stress, insomnia, depression, migraines, arthritis, inflammation, and muscle spasms.

HelloMD survey respondents also reported using medical cannabis for post-traumatic stress disease (PTSD), bi-polar disorder, and attention deficit/hyperactivity disorder.

Middle-aged and elderly respondents were more inclined to use cannabis for pain management, while younger ones rely on it for stress and anxiety, mental disorders, and nausea or appetite problems.

An Ancient Remedy
Cannabis as medicine has been documented in Asia, Africa, the Middle East, and India dating back almost 5,000 years.

Marijuana was prescribed medicinally in the United States starting around 1850 to treat many conditions including tetanus, rabies, alcoholism, leprosy, incontinence, rheumatism, headaches, tonsillitis, and menstrual symptoms.

The American Medical Association (AMA) has long supported it as a potentially useful drug. Thought to cause addiction, violent behavior, and “reefer madness,” marijuana’s reputation declined and by 1970 the Bureau of Narcotics and Dangerous Drugs (now the Drug Enforcement Agency, or DEA) assigned it Schedule 1 status –  defined as having a high potential for abuse, no currently accepted medical use, and lacking accepted safety under medical supervision. Heroin, LSD, mescaline, and methaqualone are also Schedule 1 drugs.

Since 1996, when California first legalized medical cannabis, its reputation has improved. To date, 29 states and Washington, D.C. have legalized medical cannabis, opening up treatment options beyond lab-developed pharmaceuticals.

The AMA still supports research into marijuana’s medical applications, and has even called for decriminalizing and rescheduling cannabis, which would help make it more available for research.

Bagging the Coveted Card
A joke goes that all it takes to get a medical cannabis card in California is a driver’s license. Illinois requires a bit more validation than that, including a fingerprint-based background check and no drug convictions.

A patient’s physician must certify that the patient has one of several dozen “debilitating conditions” before applying for a Patient Registry Card, which costs between $50 and $250. (See tinyurl.com/medical-pot-conditions for the full list.) Terminally ill patients with a life expectancy of six months or less can apply for
a card at no charge.

Since the program’s inception, the Illinois Department of Public Health has approved more than 19,500 applications for Patient Registry Cards, which includes about 160 people under age 18. (Minors commonly use medical cannabis for seizure disorders, and in Illinois they can use only non-smokeable products.)

Card-holders must register with one of the state’s 52 dispensaries, and can buy their medical cannabis at that facility only. They are allowed up to 2.5 ounces of medical cannabis during a 14-day period – considered an “adequate supply” as defined by the Compassionate Use Act.

Not Just Wacky Tobacky
It is easy to assume that smoking a little weed helps people cope with their maladies simply by helping them relax and forget about it. But science has found that the skunky herb offers more than just a temporary vacation from reality.

Marijuana contains dozens of compounds called “cannabinoids,” the most prominent of which are tetrahydrocannabinol (THC) and cannabidiol (CBD). In 1964, Raphael Mechoulam, Ph.D., an organic chemist at the Hebrew University of Jerusalem in Israel, identified and synthesized THC, the psychoactive chemical in pot that causes people to feel high.

In the following decades, Dr. Mechoulam (who says he has tried pot only once) and other researchers found THC effective for treating nausea and vomiting from chemotherapy, and for stimulating appetite and weight gain in HIV/AIDS patients. CBD is notable for its medicinal benefits – especially minimizing epileptic seizures and multiple sclerosis symptoms – but without getting people stoned.

Dr. Mechoulam and his colleagues determined that the human body naturally manufactures its own cannabinoids (called “endocannabinoids”), one of which they named anandamide, from ananda, the Sanskrit word for “bliss.”

They later discovered an extensive system of cell receptors (sort of like locks on cells) that bind with human endocannabinoids and marijuana cannabinoids (the keys that fit into the locks). So, when THC from marijuana binds with this endocannabinoid system (ECS), the bound cell receptors transmit signals that can, for example, reduce pain, inflammation, nausea, and seizures.

The ECS reaches throughout the whole human body, including the brain, central nervous system, organs, intestines, and musculoskeletal system, which is how cannabinoids can potentially help alleviate so many different symptoms and conditions.

Scientific Proof Accumulating Slowly
While many thousands of patients benefit from medical cannabis products, there are still not enough scientific studies proving whether cannabis works medically. According to the National Institute on Drug Abuse, researchers have not conducted enough large-scale clinical trials showing that marijuana’s benefits outweigh its risks in patients. And because pot is still federally illegal, researchers can face difficulty securing funding and product to use in marijuana studies, so research progresses slowly.

“There are hardly any clinical trials that prove it is working,” explains Pal Pacher, Ph.D., a Senior Investigator with the Laboratory of Cardiovascular Physiology and Tissue Injury at the National Institutes of Health in Maryland. “There was a big analysis of all these clinical trials in which marijuana and products were used, and most of them are negative.”

Dr. Pacher, a cannabis researcher, points out that controlled clinical trials in the United States have shown cannabinoids effective for stimulating appetite and weight gain in AIDS and cancer patients experiencing weight loss from anorexia, as well as chemotherapy-induced nausea and vomiting (CINV) when other antiemetic treatments have failed.

The FDA has approved two marijuana-based drugs to treat these issues: Marinol (whose main ingredient is synthetic THC called dronabinol) and Cesamet (containing nabilone, a synthetic cannabinoid similar to THC) for CINV. Marinol also treats AIDS-associated anorexia. Most other cannabis-derived drugs are exploratory or available only outside the U.S.

After several petitions to loosen marijuana’s classification under the Controlled Substances Act, the DEA reiterated their position last August that it should remain a Schedule I drug, which continues to make cannabis research challenging.

Farms That Encourage Weeds
Illinois’ medical cannabis dispensaries can stock their shelves with a variety of products from 22 Illinois cultivation centers, which invest heavily in their state presence. (Cannabis cannot be imported or exported across state lines, so all players must be located within Illinois.)

Cultivation centers pay a $200,000 licensing fee and $100,000 annual renewal fee, while dispensaries pay $30,000 for a license and $25,000 annually to renew. In addition to growing cannabis, cultivation centers also harvest, process, and package the products they sell to dispensaries.  

“A regular farm is going to grow and produce a crop, then sell to someone else for packaging and distribution,” explains Jason Nelson, Regional Cultivation Manager for Cresco Labs, which operates cultivation centers in Kankakee, Joliet, and Lincoln “For us, all parts of that manufacturing chain are under one roof.” Mr. Nelson says they also have a health department-regulated kitchen that infuses chocolates, gummies, and other treats with Cresco’s cannabis extracts, to be sold as “edibles.”

The Illinois Department of Agriculture makes weekly cultivation center inspections – monitoring inventory, checking for chemical and pesticide applications, and making sure each center is staying within state regulations, which Mr. Nelson says are strict. A third-party lab must test every finished product before sale as well, examining random samples for THC and CBD potency, pesticide residue, visible contaminants such as hair and bugs, and microorganisms such as yeast and mold. Products that pass inspection must be put into tamper-proof child-resistant packaging before leaving Cresco’s high-security facility.

“Illinois launched its program with this high level of scrutiny, and is still the most strict from a patient safety standpoint,” Mr. Nelson says. “We’ve always had confidence that our product is clean and healthy.”

Making Marijuana Profitable for Illinois
Since November 2015, retail sales in Illinois dispensaries have totalled $60.4 million. Patients pay a 1% sales tax on medical cannabis products, which goes to local governments. Cultivation centers collect a 7% excise tax on all medical cannabis products they sell.

That revenue goes to the state agencies responsible for administering and enforcing the Compassionate Use Act, including the Department of Agriculture, the Illinois Department of Public Health, and the State Police. Since fiscal year 2015, more than $22 million in medical cannabis revenue – about a quarter of which comes from taxes, and the rest from fees – has gone back into the program.

By comparison, Colorado’s medical and recreational marijuana tax revenue guarantees at least $40 million annually for repairing and improving school buildings; anything above that goes to a K-12 public school fund. The millions collected each year represent a fraction of the state’s multi-billion-dollar education budget.

Washington State, where both medicinal and recreational pot are legal, allocates 60% of its marijuana revenues to public health programs including Medicaid, substance-abuse prevention efforts, and community health centers.

Illinois State Senator Heather Steans (D-7th district) says she believes prohibition of marijuana, like alcohol prohibition, does not work, so she and State Representative Kelly Cassidy (D-14th district) are proposing a bill to legalize recreational marijuana. Sen. Steans says legalizing pot completely will ensure a safer product and potentially generate between $350 million and $700 million in revenue for the state.

“We have an estimated 750,000 people in Illinois who use marijuana and only 17,000 have medical marijuana cards, so 98% are getting it on the black market,” Sen. Steans explains. If buyers can instead buy from a licensed tax-paying business, the marijuana will likely be safer and the revenue will go into state coffers. Legalization also removes the violence and criminal elements associated with illegal drugs.

The proposed bill – which would not go to vote until 2018 – allocates 30% of marijuana sales revenue to education and 20% to the Department of Public Health for substance abuse programs.

Slow Going, but Growing
Back at the Evanston PharmaCannis dispensary, patients can choose from more than 100 medical cannabis products, manufactured by a number of state cultivation centers. A menu lists the percentage or milligrams of THC and CBD in each. (See the list here: tinyurl.com/medical-pot-menu.)

Physicians sometimes recommend cannabinoid content, but more often the patient and dispensary staff determine which product might work best and at what dose.

“We are sitting down with the patient, hearing what their preferences are, and trying to make a recommendation,” Mr. Scheidt explains. “We talk, they go home, try some things, and we talk again. We try to tweak it to see exactly what works.”  

Mr. Scheidt  says he thinks Illinois’ medical cannabis program is going well; although it is growing more slowly than some anticipated, he says they are seeing increases in patient numbers every month.

“This is the kind of growth that I expected,” he enthuses. “A lot of other states took 10 years to get to where we are – we’re going really well for how young we are in Illinois.”