Medical cannabis

Medical use

Which medical conditions qualify for treatment with cannabis products? What other rules and restrictions govern medical use of cannabis (eg, dosage limits)?

The Drug Crimes Amendments Act 1987 (Sections 13A-12-210 et seq. of the Code of Alabama 1975) prohibits the use, production, distribution, and possession of cannabis with a tetrahydrocannabinol (THC) concentration greater than 0.3% in Alabama. However, Alabama law allows for an affirmative defense from prosecution for the possession of cannabidiol for persons with “debilitating medical conditions,” defined as “a chronic or debilitating disease or medical condition including one that produces seizures” (Id. at Section 13A-12-214.3(2)(b)). Notably, this affirmative defense applies only to distributions of cannabidiol in Alabama by the University of Alabama at Birmingham.

In addition, the Agriculture Improvement Act 2018 legalized “hemp”—defined as any part of the cannabis sativa L. plant with a THC concentration of 0.3% or less—by removing it from the Controlled Substance Act’s definition of “marijuana.” Thus, cannabis products with a THC concentration of 0.3% or less can legally be used without a prescription.

Further, the sale of the U.S. Food and Drug Administration-approved prescription drug Epidiolex, which contains cannabidiol, is legal under Alabama law and is regulated like other prescription drugs. Epidiolex is legal in Alabama because it is derived from hemp, and hemp and its derivatives fall outside the scope of the definition of “marijuana” under Alabama law (Section 20-2-2(14) of the Code of Alabama 1975). 

Physician licensing

What licensing requirements apply for physicians seeking to prescribe cannabis products to patients?

The Drug Crimes Amendments Act 1987 (Sections 13A-12-210 et seq. of the Code of Alabama 1975) prohibits the use, production, distribution, and possession of cannabis with a THC concentration greater than 0.3% in Alabama. However, Alabama law allows for an affirmative defense from prosecution for the possession of cannabidiol for persons with “debilitating medical conditions,” defined as “a chronic or debilitating disease or medical condition including one that produces seizures” (Id. at Section 13A-12-214.3(2)(b)). The University of Alabama at Birmingham can distribute limited amounts of medical-use cannabidiol. 

Further, the sale of the U.S. Food and Drug Administration-approved prescription drug Epidiolex, which contains cannabidiol, is legal under Alabama law and is regulated like other prescription drugs. Epidiolex is legal in Alabama because it is derived from hemp, and hemp and its derivatives fall outside the scope of the definition of “marijuana” under Alabama law (Section 20-2-2(14) of the Code of Alabama 1975). 

Pharmacy licensing

What licensing requirements apply for pharmacies seeking to dispense cannabis products?

The Drug Crimes Amendments Act 1987 (Sections 13A-12-210 et seq. of the Code of Alabama 1975) prohibits the use, production, distribution, and possession of cannabis with a THC concentration greater than 0.3% in Alabama. However, Alabama law allows for an affirmative defense from prosecution for the possession of cannabidiol for persons with “debilitating medical conditions,” defined as “a chronic or debilitating disease or medical condition including one that produces seizures” (Id. at Section 13A-12-214.3(2)(b)). Only the University of Alabama at Birmingham may distribute cannabidiol.

Therefore, pharmacies cannot legally dispense cannabis products under Alabama law other than Epidiolex, a cannabidiol product which is regulated like any other prescription drug in Alabama. Epidiolex is legal in Alabama because it is derived from hemp, and hemp and its derivatives fall outside the scope of the definition of “marijuana” under Alabama law (Section 20-2-2(14) of the Code of Alabama 1975). 

Health insurance

How are cannabis products covered by health insurers (both public and private)? Are there any rules or restrictions in this regard?

The Drug Crimes Amendments Act 1987 (Sections 13A-12-210 et seq. of the Code of Alabama 1975) prohibits the use, production, distribution, and possession of cannabis with a THC concentration greater than 0.3% in Alabama. However, Alabama law allows for an affirmative defense from prosecution for the possession of cannabidiol for persons with “debilitating medical conditions,” defined as “a chronic or debilitating disease or medical condition including one that produces seizures” (Id. at Section 13A-12-214.3(2)(b)). Health insurers may choose not to reimburse prescriptions of cannabidiol (Id. at Section 13A-12-214.3(5)).

Product development

What opportunities are available for cannabis businesses to cooperate with healthcare providers, pharmaceutical companies and research institutes in the development of new medical cannabis products? Are there any notable regulatory considerations in this regard?

Carly’s Law and Leni’s law have allowed for cannabidiol research at the University of Alabama at Birmingham. Currently, all Cannabidiol oil used for this research is from a single vendor (Bob Shepard, “UAB launches study of cannabidiol oil for severe seizures,” University of Alabama at Birmingham, March 3, 2015). Further, the sale of the U.S. Food and Drug Administration-approved prescription drug Epidiolex, which contains cannabidiol, is legal under Alabama law and is regulated like other prescription drugs. Epidiolex is legal in Alabama because it is derived from hemp, and hemp and its derivatives fall outside the scope of the definition of “marijuana” under Alabama law (Section 20-2-2(14) of the Code of Alabama 1975). Therefore, it stands to reason that if the U.S. Food and Drug Administration approves other hemp-derived cannabidiol products, such products will be treated similarly under Alabama law.

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