Alabama was able to codify the most stringent “medical” marijuana regulations in the world when the U.S. Supreme Court dismissed FDA v. Alliance for Hippocratic Medicine on technical grounds in June 2024.
The Alabama Board of Medical Examiners have set a new standard for physicians, medical boards, and public safety advocates worldwide. With compassionate and scientific analysis, the Board adopted rules that regulate Alabama physicians who are seeking cannabis certification. These rules are designed to ensure meaningful protections for pregnant women, developing babies, vulnerable patient populations, and the public at large.
Remarkably this effort to secure the safety of so many people never made the news — until today.
Like most success stories, their genesis is rooted in failures barely buoyed by small victories. The near hopeless appearance of a pile of ashes still bears the embers of change. All they need is a little oxygen to rise from those ashes and produce something beautiful.
Christine Carr, a newly retired Certified Registered Nurse Anesthetist, devoted the last three years to the worthy effort of protecting the public from Alabama’s problematic “medical” marijuana bill. She described the regulatory process that began with one conversation in November 2023 and culminated in June 2024. When direct legislative efforts were blocked during the 2022 and 2023 legislative sessions, a discouraged Ms. Carr still found support among many legislators, medical experts, and organizations such as Eagle Forum of Alabama. They supplied just enough oxygen for a heap of legislative ash.
When passage of the Drug Free Babies bill failed passage a second time, Alabama State Representative Susan Dubose accompanied CRNA Carr to speak with key leaders within the Alabama Medical Cannabis Commission. Acknowledging the need to protect developing babies, mothers and the vulnerable, Rep. Dubose and Christina Carr reached out to the Alabama Board of Medical Examiners. Rep. Dubose introduced Christine to key officials at the ALBME to whom she presented scientific data and medical precedence that supported the need for better safety measures for Alabama physicians and their patients.
Christine was so encouraged to work with medical professionals who immediately recognized and put sound science and public policy above politics and finances. After two months of review, the ALBME adopted its new rules in January 2024. That was a good beginning, but the challenge was not complete. Next came the required time for public comment, further board review and legislative counsel.
“I was unsure what to expect during the public comment period after watching key legislative members block the Drug Free Babies bill in 2022 and 2023. I was greatly relieved when many physicians, nurses and advocates sent positive comments. I was grateful that not a single lobbyist or pro-pot legislator responded with a challenge! It was like baby Moses in the basket. The regulatory changes floated along unscathed.”
In Spring 2024, Alabama was fighting a war over gambling. Like the ferocious crocodiles in the Nile River, Alabama pot advocates were chomping at the AMCC via lawsuits and well-funded lobbyists. But they did not notice the small reed basket containing our proposed Drug Free Babies lifesaving regulations floating by.
While Christine Carr and many others continue to advocate for a complete repeal of “medical” marijuana legislation, Alabama is celebrating the protection of babies and patients with the following requirements:
- All patients of child-bearing capacity must have a negative pregnancy test in order to receive a marijuana card recommendation. They must also maintain a negative pregnancy test every 30 days in order to maintain card activity. No home tests are allowed.
- All medical cannabis applicants must have a negative drug screen.
- All medical cannabis patients must see their certified cannabis physician every 90 days for case review, dosage changes, and continuation/discontinuation of card activity.
- No telemedicine is allowed.
- All caregivers must be present at every visit as well as sign documentation that they have read, heard, and understood the risks outlined by the ALBME.
The entire set of rules can be found here: Chapter 540-X-25 Physician Recommendation of the Use of Medical Cannabis.
The protections for pregnant women and their babies are particularly remarkable. “This was not a political process, fortunately. Physicians and advocates from diverse backgrounds agreed on science and medical precedence over any particular political viewpoint. And that’s how good medicine is done,” said Ms. Carr.
Several sources helped aid the ALBME in their deliberations: Physician experts with International Academy on the Science and Impact of Cannabis, emerging research on the embryological and epigenetic consequences of pre- and intranatal cannabis exposure, and the FDA’s iPledge program that regulates Accutane (a popular yet teratogenic acne medicine). If women must have negative pregnancy tests to receive acne medicine, it makes sense to apply similar standards for cannabis.
“Cannabis use during pregnancy and lactation has been shown to cause serious behavioral changes in the offspring which persist into adolescence. It is not advisable to use during pregnancy or lactation due to the potential harm to the developing brain, which is consistent with American College of Obstetrics and Gynecology and American Academy of Pediatrics,” emphasizes Dr. Kenneth Finn of Colorado. A double board-certified Anesthesia and Pain Management specialist, Dr. Finn is on the Board of Directors for IASIC, past President of the American Pain Society, and editor of the medical textbook Cannabis in Medicine: An Evidenced Based Approach.
While the debate over marijuana as medicine still captures popular attention, be encouraged that sound science and good policy continue to prevail. Let Alabama’s success inspire other states to regulate this drug that is dangerous to babies.
