Tiffany Carwile wants to give her 7-year-old son marijuana. Diagnosed at 2, Jaxsyn has severe autism. He’s nonverbal, sometimes hurts himself in violent outbursts, and is a picky eater who’s prone to gastrointestinal issues.
Carwile and her family live in the northwest corner of Ohio, about 50 miles west of Toledo. If they lived another 20 miles north in Michigan—or in any of nearly two dozen states that now allow pediatric use of medical cannabis to treat autism—she could try a drug that studies have shown to help some autistic children become more social, better eaters, less edgy and frustrated, and even more communicative.
“I wish I could eradicate that word marijuana, because it carries such a stigma,” says 30-year-old Carwile, who has petitioned the State Medical Board of Ohio three years running to add autism to its list of conditions allowed in the Ohio Medical Marijuana Control Program. “We’re not giving kids marijuana. We’re not getting kids high. What we’re giving them is medication.”
Ohio’s medical marijuana law was approved on September 8, 2016, by the Republican-led state legislature. Sales began roughly two years ago. Proponents say the law is just hitting its stride, while critics, including Carwile, call it limited, biased, expensive, and a long way from helping everyone who could benefit from the medical uses of cannabis.
Around the country, more and more states are snuffing out the stigma and prohibition of marijuana. Today, adult recreational use is legal in 18 states—including neighboring Michigan and nearby Illinois—as well as in Washington, D.C., and two U.S. territories. All but three states (Idaho, Nebraska, and Kansas) have some sort of medical cannabis program—although some, like Kentucky, allow only cannabidiol (CBD) or low tetrahydrocannabinol (THC) products. In June, Michigan surpassed $1 billion in total sales in its recreational program after less than two years.
Other shifts are occurring as well. Procter & Gamble removed marijuana from the company’s post-job-offer drug screen in 2019. Amazon, the second largest U.S. employer, did the same in June for all positions not regulated by the U.S. Department of Transportation. Last year, the University of Cincinnati began offering a five-course Cannabis Studies certificate, described as a “multidisciplinary foundation for understanding the cannabis plant and the cannabis industry, enabling [students] to more readily gain employment in one of its many subfields.”
In a growing number of cities, including Cincinnati, marijuana possession has been decriminalized. Since 2019, anyone possessing 100 grams (3.52 ounces) or less of marijuana within the city limits is issued a warning, with no criminal charge or fine. Those with past possession charges under 100 grams can apply to get their record expunged.
The federal government is considering changes related to cannabis, too. Three pieces of legislation are currently on the table: the Marijuana Opportunity Reinvestment and Expungement Act, which would de-schedule marijuana from the Controlled Substances Act and enact various criminal and social justice reforms; the Secure and Fair Enforcement Banking Act, which would provide a safe harbor for banking institutions providing services to cannabis clients; and the Clarifying Law Around Insurance of Marijuana Act, which would guarantee that businesses in legal states get access to things such as workers’ compensation and title insurance.
“We have this really weird system where something is illegal federally and legal in a majority of states,” says Kristopher Chandler, an associate attorney in the Benesch law firm’s Columbus office. He’s represented several clients in the cannabis industry, including helping Cresco Labs, one of the country’s largest vertically integrated multistate cannabis operations, obtain its licenses in Ohio.
Marijuana’s listing as a Schedule I drug by the U.S. Drug Enforcement Administration creates a lot of challenges for the industry, Chandler says. Schedule I, by definition, is a “drug with no currently accepted medical use and a high potential for abuse.” Because of this classification, things like banking and medical research have been stymied. Financial institutions and research funders opt not to risk working with a drug that’s still considered illegal by the feds. “The rationale for why it’s federally illegal,” says Chandler, “is slipping away more and more.”
Bridget Williams, M.D., registers nothing but shock on the man’s face after suggesting he consider medical marijuana. She had watched him hobble into her family clinic in Cleveland a couple of times, accompanying his wife to her appointments. Williams could tell he was suffering, leaning heavily on a cane.
“I just asked him, What’s up with you?” she recalls. His hip really hurt. A doctor had prescribed him Percocet, a combination of acetaminophen and oxycodone, but had recently discontinued his prescription. On a pain scale of 1–10, he said he was living with a constant 8 to 10.
“I asked, Would you consider cannabis?” Williams says. “He said, Oh my god, what would people think? Oh my god, no! I asked him how many Percocet was he taking a day? Eight to 10, he said. That’s a huge amount! I said, What do people think of that? Why was that OK? And why do you care what other people think if you feel better, if you’re able to do things?”
About 15 years ago, a patient asked Williams about medical cannabis, something she hadn’t given much thought to. “I’m a Reagan kid, so I was all about Just say no!” she says. “But I was shocked by the amount of information and the possibilities. I had no idea people were using it for so many medicinal uses.”
Ohio now allows people with certain medical conditions, upon the recommendation of an Ohio-licensed physician certified by the State Medical Board, to purchase and use medical marijuana. The state currently lists 25 qualified conditions, which include cancer, Alzheimer’s disease, epilepsy, and inflammatory bowel disease. Pediatric use is allowed for all of these conditions, Williams says.
Once the legislation became law, Williams considered working at a card clinic. “Some people call them card mills, because all you have to do is prove—or maybe prove—you have a legal diagnosis and they give you a card,” she says. “They’re 10- to 15-minute visits.”
Williams sees herself as a holistic doctor who wants to get to the root of an individual’s health problems. She asks things like, What changed in your life that brought about the weight gain that brought about your hypertension? What changed in your life that brought about the diabetes or the high cholesterol?
She opted to open Green Harvest Health, where every patient gets a personal consultation and treatment plan. Williams makes a recommendation (doctors can’t prescribe marijuana because of its illegal federal status) for a medical marijuana card, if the patient qualifies. Her clinics help them navigate available cannabis products and offer free follow-up appointments for a year. There are now two Green Harvest Health clinics in Columbus and one in Cleveland, while Williams operates her family practice one day a week.
She says she’s seen improvement in all sorts of people with all sorts of conditions. One of her most memorable cases is a woman in her 30s with a severe case of fibromyalgia, a disorder characterized by widespread musculoskeletal pain often accompanied by fatigue, sleep, memory, and mood issues. The woman came in for her follow-up appointment and teared up almost immediately. Oh no, Williams thought, the cannabis hadn’t worked. “No, she said, this is the first time in 15 years I’ve been pain free,” Williams says.
The biggest misconception from patients about medical marijuana, she says, is that people use it just to get high. “What I hear is they’re terrified of opioid addiction and medicines that ruin their liver or their kidneys or their stomach,” Williams says. “They don’t want medications that will make them zonk out or not interact with the world. We can create combinations with CBD and THC that will not give you a high feeling at all.”
It’s a Tuesday morning, and there’s a steady flow of customers coming and going from the Verilife Medical Cannabis Dispensary across the street from Aldi on Ridge Avenue in Columbia Township. It’s one of 54 dispensaries operating in Ohio as of July. The location serves 400 to 500 patients a day, says Jamie Gallaspie, Ohio district manager for parent company PharmaCann, who has driven down from Wapakoneta to give me a tour.
“A lot of patients come in looking like a deer in the headlights with lots of questions,” says Gallaspie, who has a doctor of pharmacy degree from Ohio Northern University. Prior to her position with PharmaCann, she managed pharmacies for Mercy Health, Kmart, and Rite Aid.
Unlike Williams’s patients, Gallaspie says most people who come in haven’t really talked much with the doctor who recommended their card. Verilife is happy to assist and holds consultations in private meeting rooms to talk about the differences between edibles, beverages, capsules, creams, patches, and sublingual tinctures. Staff members explain that Ohio law doesn’t allow people to ignite or “smoke” marijuana in a pipe or rolled in paper. The only legal way to inhale Ohio’s medical marijuana is to vaporize it.
Employees show customers how to vape at specific temperatures to get the marijuana to release its medicinal properties and achieve the effects they desire. Flower—marijuana plant matter—is the most popular product, Gallaspie says. Patients are advised to “start low and go slow.” The largest populations they serve by medical condition are pain, post-traumatic stress disorder, and cancer, she says.
One of the biggest complaints with Ohio’s system has been the distance many people travel to a dispensary, but the Board of Pharmacy approved licensing of 73 more dispensaries in April, Gallaspie says.
Every state program works in its own silo because it’s illegal to transport marijuana over state lines. In Ohio, every part of the industry and control program, from growing to processing to testing, happens in-state.
“I’m just so excited to be from a state that’s growing its program by adding new medical conditions and opening more dispensaries,” says Bonnie Rabin, founder of the Cincinnati Medical Marijuana Meetup group, which gathers monthly at MadTree Brewing in Oakley and has grown from only a handful of members in 2019 to more than 300 today. After a career in social work, community organizing, and education, Rabin opened Cincinnati-based Medical Marijuana Patient Care to educate patients, caregivers, and doctors on the intricacies of Ohio’s law and system.
Tripling the number of dispensaries and adding new cultivation and processing facilities should help lower the cost of medical marijuana, another big gripe, Rabin says. The state charges an annual $50 registration fee per patient and a $25 fee per caregiver, with a 50 percent discount for veterans and those with indigent status. A doctor’s appointment for a card recommendation should cost between $150 and $250, though rates fluctuate, Rabin says. Then there’s the cost of the cannabis products themselves, which aren’t covered by insurance. In July, one-tenth of an ounce of medical marijuana retailed for $31.56.
“An example is sleep medication,” says Rabin. “You pay $4 a month for medication with health insurance. To move to a cannabis remedy, which you might be interested in trying, would be $150.”
Legalizing marijuana—for whatever use—requires a reckoning with our past, says Cincinnati Vice Mayor Christopher Smitherman. “There are people who literally went to jail for marijuana and did like five, six, seven, 10 years for it,” he says. “Not cocaine. Not crack. Marijuana. We’ve come a long way from where we were incarcerating people for marijuana and ruining their lives.”
In 2018, marijuana-related arrests accounted for more than 43 percent of all U.S. drug arrests, according to a study by the American Civil Liberties Union. The same study also found that, on average, a Black person is 3.64 times more likely to be arrested for marijuana possession than a white person, even though Black and white people use marijuana at similar rates.
Smitherman works as a licensed financial planner, and he began to see marijuana companies become publicly traded and knew some investors were making a lot of money. At the same time, he says, “I’m watching predominantly African American men be locked up for small amounts of marijuana or given a citation creating a criminal record that then stops them from getting a job.”
The councilman, who officially serves as an Independent and recently announced his bid for the Hamilton County Commission in 2022, worked with now-suspended Councilman Jeff Pastor on the 2019 legislation that decriminalized possession of 100 grams or less of marijuana within city limits. The measure passed 5–3 with one abstention. Between October 2019 and April 2021, the Cincinnati Police Department issued 1,254 marijuana warnings to adults.
If someone is caught with marijuana outside of the city, in Hamilton County or another part of the state, local authorities follow local laws or fall back on state law, which is a criminal misdemeanor charge and $150 fine for 100 grams or less. Cross the river into Kentucky, and possession of less than 8 ounces (226 grams) can result in a misdemeanor possession charge, a $250 fine, and up to 45 days in jail.
Smitherman’s wife Pamela, the mother of his five children, died from cancer in 2019. He asked her if she wanted to try medical cannabis during her treatments. She didn’t. “But if I had wanted to get it for her, I would have liked to have access to it and not have this stigma when I’m out buying marijuana,” he says.
Back up in northwest Ohio, Carwile vows to continue fighting to get autism listed in Ohio’s control program. Meanwhile, there’s talk of a much wider overhaul to Ohio’s marijuana law at the Statehouse in Columbus.
Sen. Steve Huffman, Republican of Tipp City, co-wrote Ohio’s current law. An emergency room physician, he told The Columbus Dispatch in April that he and fellow Republican Sen. Kirk Schuring, of Canton, were working on a new bill to make sweeping changes, including oversight of dispensaries and how new medical conditions get approved. “We made it too cumbersome,” Huffman told the newspaper.
The push for covering pediatric autism is an example, the lawmakers have said, of the current law’s downfalls. Any Ohioan has the ability to petition the state medical board to add a condition, as Carwile has done, but all three times the board sided with Nationwide Children’s Hospital and its Center for Autism Spectrum Disorder in Columbus, which opposed the petition. Given what they’ve seen and heard from their constituents, some legislators are now working to go over the heads of the State Medical Board to add autism as a covered condition. One of those legislators is Rep. Bill Seitz, a Green Township Republican representing portions of western Hamilton County.
“I have been at the forefront of efforts to increase treatments for autism, which affects an alarmingly high number of children these days,” Seitz said at the hearing for House Bill 60, which he co-sponsored. “I worked with Governor Kasich and the General Assembly to ensure that autism treatment was included as an essential health benefit under Medicaid expansion. . . . How is [marijuana] any more injurious than addicting the patients to Ritalin or other expensive drugs that are now used for this purpose? Passing this bill does not require any patient or parent to ingest medical marijuana. It just gives them a choice, in consultation with their doctor, to try.”
In testimony, Nationwide Children’s Hospital leaders countered that it “would be not only negligent but also unethical to approve medical cannabis as an indication of autism spectrum disorder and anxiety prior to the completion [of] several well-designed, randomized, double-blind placebo-controlled trials currently underway.”
“In our view, there is little rigorous evidence that marijuana or its derivatives is of benefit for patients with autism and anxiety, but there is a substantial association between cannabis use and the onset or worsening of several psychiatric conditions,” wrote the Center for Autism Spectrum Disorder’s medical director and Nationwide’s director of quality improvement in neurology and division chief of developmental and behavioral pediatrics.
Carwile, who also testified, pointed out that Nationwide was the only opposition to attend any of the bill’s four hearings. Supporters included parents, doctors, and autism organizations. Since the March 23 hearing where she and Seitz gave their testimonies, 11 more states have created a legal pathway to give medical marijuana to children with autism.
Will she move out of the state if this effort fails? “There are 44,000 kids with autism in Ohio, and that’s just the statistics, not the undocumented ones and those misdiagnosed or undiagnosed,” Carwile says. “I look at my son and I see suffering, but I see hope, too. He’s a survivor. His story is a testament as to why we need to listen to all science available and why I won’t stop fighting.”