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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 use, manufacture, distribution, and possession of marijuana with a tetrahydrocannabinol (THC) concentration greater than 0.3% is prohibited in Tennessee (Section 39-17-417 of the Tennessee Code Annotated).

Tennessee permits the possession and use of cannabidiol for the treatment of intractable seizures in specific circumstances (Sections 39-17-402(16)(E) to (F) of the Tennessee Code Annotated). Specifically, cannabis oil containing cannabidiol is exempt from the definition of “marijuana” when it has a THC concentration of less than 0.6% and is manufactured or possessed by a four-year public or private institution of higher education as part of a clinical research study certified by the drug enforcement administration in the state (Section 39-17-402(16)(E) of the Tennessee Code Annotated). Cannabidiol is also exempt from the definition of “marijuana” if:

  • it has a THC concentration of less than 0.9%;
  • is labelled by the manufacturer as containing cannabidiol with a THC concentration of less than 0.9%;
  • is possessed by an individual with proof of a legal order or recommendation from the state; and
  • the individual or the individual’s immediate family member has been diagnosed by a Tennessee-licensed medical doctor with intractable seizures or epilepsy (Section 39-17-402(16)(F) of the Tennessee Code Annotated).

Outside the provision permitting institutions of higher education to use cannabidiol in clinical studies, Tennessee has no provision regarding the legal sale of cannabidiol. Thus, receiving cannabidiol through a clinical study is the only legal way to obtain cannabidiol in Tennessee. Hemp is also exempt from the definition of “marijuana,” as are products derived from hemp, including cannabidiol with a THC concentration of less than 0.3% (Sections 39-17-402(16)(C) and 43-26-102(4)(B) of the Tennessee Code Annotated).

The Agriculture Improvement Act 2018 legalized “hemp”—defined as any part of the cannabis sativa L. plant with a THC concentration of less than 0.3%—by removing it from the Controlled Substance Act’s definition of “marijuana.” Therefore, marijuana products with a THC concentration of less than 0.3% can legally be used without prescription. However, to the extent that Tennessee allows marijuana with a THC concentration greater than 0.3% to be used or distributed, it remains illegal under federal law. It remains to be seen whether Tennessee will modify its definitions to comport with the definition of “hemp” in the Agriculture Improvement Act. 

Physician licensing

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

There is no medical marijuana program in Tennessee. The state does not explicitly address the licensing requirements of physicians seeking to prescribe marijuana products. To fall within the exception to the definition of “marijuana,” cannabidiol must be distributed through a state-approved clinical study at a four-year institution of higher education. Therefore, physicians must be licensed in Tennessee and associated with a state-approved clinical research study at a four-year institution of higher education to prescribe cannabidiol (Section 39-17-402(16)(E) of the Tennessee Code Annotated).

Pharmacy licensing

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

There is no medical marijuana program in Tennessee. The possession, use, and distribution of marijuana with a THC concentration greater than 0.3% is prohibited under Tennessee law (Section 39-17-417 of the Tennessee Code Annotated). The limited exception for medicinal cannabidiol does not contemplate a role for pharmacies. Only state-approved four-year institutions of higher education are permitted to manufacture and distribute cannabidiol with a THC concentration of less than 0.6% as part of clinical studies (Section 39-17-402(16)(E) of the Tennessee Code Annotated). Therefore, pharmacies cannot legally dispense marijuana products under Tennessee law.

Health insurance

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

The possession, use, and distribution of marijuana with a THC concentration greater than 0.3% is prohibited under Tennessee law (Section 39-17-417 of the Tennessee Code Annotated). However, the state permits the use of cannabidiol for the treatment of intractable seizures when prescribed by a licensed physician as part of a state-approved clinical study at institutions of higher education (Section 39-17-402(16)(E) of the Tennessee Code Annotated). Tennessee law does not address the role of health insurers in regard to cannabidiol. Therefore, insurers are likely not required to cover the cost of cannabidiol.

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?

Tennessee law permits state-approved public and private four-year institutions of higher education to conduct clinical trials on the use of cannabidiol with a THC concentration of less than 0.6% for the treatment of intractable seizures and epilepsy (Section 39-17-402(16)(E) of the Tennessee Code Annotated). These institutions of higher education are the only entities authorised to study and develop cannabidiol products in Tennessee.

The Agriculture Improvement Act 2018 removed only “hemp”—which it defines as any portion of the Cannabis sativa L. plant with a THC concentration of 0.3% or less—from the Controlled Substances Act’s definition of “marijuana.” Therefore, to the extent Tennessee allows marijuana with a THC concentration greater than 0.3% to be used or distributed, it remains illegal under federal law. It remains to be seen whether Tennessee will modify its definitions to comport with the definition of “hemp” in the Agriculture Improvement Act.