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At least three in 10 Ohioans could use medical marijuana

3.5 million Ohioans - about ten times as many as the state has estimated will use the medical marijuana program.

If you live in Ohio, chances are good that you or someone you know is eligible for a medical marijuana card.

Enquirer research suggests at least three out of 10 Ohioans endure one of the 21 medical conditions that under state law can be treated with medical marijuana.

That could be 3.5 million Ohioans - about ten times as many as the state has estimated will use the program.

Ohio's medical-marijuana program, two years in the making, officially comes online Sept. 6, although delays in getting the crop into the ground, grown and processed means that the drug likely will not be available until later this fall.

The Ohio Board of Pharmacy, which will issue the medical-marijuana cards, anticipates that between 200,000 and 300,000 Ohioans will apply, said board spokesman Cameron McNamee. A patient can get a state permit on the recommendation of a doctor that the state has certified. The permit allows the bearer to buy marijuana at state-regulated dispensaries. The annual fee for the card is $50, with a half-price discount for veterans and people on Social Security Disability Insurance.

ALSO | Ohio's first medical marijuana grower can start planting in Ravenna

In other medical-marijuana states, patient enrollment averages at most 3 percent of the population, McNamee said, and Ohio likely will hold true to that number. If so, Ohio could have close to 350,000 cardholders.

That number would make Ohio the second-biggest medical-marijuana state in the country, according to the nonprofit Marijuana Policy Project. This year, California is No. 1 with 1.2 million patients, followed by Michigan with 218,000 patients and Arizona with nearly 153,000.

How the Enquirer estimated 3.5 million

The Enquirer set out to determine how many Ohioans could be eligible for medical marijuana under the 21 qualifying conditions from the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention and private nonprofits that raise money for medical research. For many diseases, the numbers of patients are estimates, since the government does not track patient counts for every ailment.

The conclusion: About 3.5 million Ohioans deal with at least one of the qualifying conditions. Ohio's population is 11.66 million.

State Sen. Kenny Yuko, a Cleveland Democrat, worked on the legislative task force that created the medical marijuana program in 2016. He said the panel studied what other states were doing and consulted with Ohio doctors. The goal was to make Ohio's list of qualifying conditions as broad as possible.

"I would have had 5,000 diseases if I could," said Yuko, a cancer survivor. "I didn't want to exclude anybody."

Humans have used marijuana as medicine for at least 5,000 years for all kinds of disease. The United States banned marijuana in 1937 and in 1970 listed the drug as having no therapeutic value. Prohibition has meant almost no funding, from government or private sources, for U.S. clinical examination of marijuana's medical use.

Most research has come from other nations - and that growing body of study, as well as anecdotal evidence from thousands of Americans, has fueled the two-decade movement to return marijuana to respectability as a tool for easing pain or restoring health. Today, 28 states have a medical-marijuana program.

Ohioans are curious about medical marijuana. A poll by The Enquirer/Suffolk University released in June found a third of respondents were at least somewhat likely to try it.

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The 21 qualifying conditions

(some grouped together because of similarity)

AIDS, HIV-positive status

Listed as separate conditions in the Ohio law.

Number of patients: About 23,000 people, with about 1,000 new cases diagnosed annually, according to the Ohio Department of Health.

Evidence: There is no clinically tested medication approved by the U.S. Food and Drug Administration. One study found that when AIDS/HIV patients used marijuana to control side effects, they were better able to stick to medication routines.

Do other states cover this condition? Yes, all states.

Amyotrophic lateral sclerosis

Also known as Lou Gehrig’s disease.

Number of patients: About 1,000, according to Marlin Seymour, executive director of the ALS Association, Central and Southern Ohio.

Evidence: No clinically tested, FDA-approved medication. But many medical-marijuana states include ALS on their lists because of its potential to delay symptoms. A 2017 Italian study in mice found promise.

Covered in other states: Yes, 16.

Alzheimer’s disease

Disorder of the brain structure.

Number of patients: About 210,000 people in Ohio.

Evidence: No clinically tested, FDA-approved medication. A 2014 study shows small quantities of the psychoactive ingredient of marijuana could protect brain proteins against the disease.

Covered in other states: Nine.

Cancer

Ohio's cancer rate is higher than the national average.

Number of patients: The Ohio Department of Health says about 320,000 Ohioans had cancer between 2011 and 2015. About 65,000 new cases are diagnosed every year.

Evidence: No clinically tested, FDA-approved medication. Few organizations are researching a direct effect of marijuana on cancer. In general, marijuana is used for side effects of treatment such as loss of appetite. The National Cancer Institute says cancer patients feel better with cannabis – they sleep better and are in less pain.

Covered in other states: All states with medical marijuana programs cover cancer.

Chronic traumatic encephalopathy

Brain disorder caused by repeated head trauma, commonly found in military veterans and professional athletes such as football players and boxers.

Number of patients: Not known. CTE is generally diagnosed at autopsy.

Evidence: No clinically tested, FDA-approved medication. No one has studied the effects of marijuana on CTE. Researchers at Johns Hopkins University have been recruiting football players to study marijuana use.

Covered in other states: Ohio is the only state to qualify CTE.

Inflammatory bowel disease, Crohn’s disease, ulcerative colitis

These disorders of the digestive system are listed separately in Ohio's law.

Number of patients: At least 58,000 Ohioans have at least one of these disorders, said Jennifer Steele, executive director of the Crohn’s and Colitis Foundation of Southwest Ohio.

Evidence: No clinically tested, FDA-approved medication. A 2016 study said more research is needed because it’s not clear whether marijuana relieves the disorder or makes symptoms more tolerable.

Covered in other states: Sort of. Ohio is the only state to list these conditions separately. Seventeen states list Crohn’s disease only.

Epilepsy or another brain-seizure disorder

Epilepsy is an umbrella term for disorders that trigger brain seizures.

Number of patients: About 126,000 in Ohio, about 17,000 under 18, according to the U.S. Centers for Disease Control.

Evidence: There is more evidence for marijuana’s effects on epilepsy than for most disorders. Last month, the FDA approved the first drug made from the marijuana plant to treat epilepsy, a drug tested at UC Health with 13 residents of Greater Cincinnati.

Covered in other states: Yes, although many use the general term “seizure disorders.”

Fibromyalgia

A mysterious chronic-pain syndrome of the muscles and fascia.

Number of patients: About 20,000 adults, according to the CDC.

Evidence: No clinically tested, FDA-approved medication. A 2018 Israeli study found that medical marijuana so improved the pain of fibromyalgia that some patients stopped taking any other medications.

Covered in other states: Ohio is the only state to list this disorder.

Glaucoma

Vision disorder than untreated can lead to blindness.

Number of patients: About 105,000 over 40.

Evidence: No clinically tested, FDA-approved medication. But in 1971, researchers found marijuana use reduced pressure inside the eye, but no one knows how this action happens. A 2015 Yale University study cautioned that medical marijuana worked best only on certain kinds of glaucoma.

Covered in other states: All states except Delaware, New York and Vermont.

Hepatitis C

A disorder of the liver.

Number of patients: About 2,800 in Ohio, although the numbers are taking a worrisome trend upward due to the opioid crisis.

Evidence: No clinically tested, FDA-approved medication. A 2014 Canadian study of regular marijuana users with the disease showed the drug did not hasten the progression.

Covered in other states: Twelve other states.

Multiple sclerosis

A potentially crippling disease of the brain, spinal cord and central nervous system.

Number of patients: At least 21,000 members in two Ohio chapters of the National MS Society.

Evidence: No clinically tested, FDA-approved medication. But people with MS have embraced medical marijuana. The American Academy of Neurology says marijuana appears to reduce muscle spasticity but cautions that more study is needed. A 2012 California study found patients had better pain reduction and control with daily medical marijuana use.

Covered in other states: Seventeen states include MS as a qualifying condition, although some use the more general term “muscle spasticity.”

Pain that is either chronic and severe or intractable

In states with medical marijuana programs, chronic pain is the most common reason people give for obtaining a medical-marijuana card.

Number of patients: This is a difficult number to fix because chronic pain is its own ailment as well as a complication of many other conditions. The Ohio Department of Mental Health Addiction Services says at least 295,000 Ohioans are on more than a 30-day supply of opioid pain medication. A 2012 chronic-pain study found 17.6 percent of Americans suffer “chronic pain.” Applying this percentage to Ohio’s 9 million adults, the estimate would be 1.63 million.

Evidence: No clinically tested, FDA-approved medication. But a growing body of study finds that marijuana treats pain by binding to brain receptors called endocannabinoids.

Covered in other states: All 28 medical-marijuana states cover chronic pain, although many use different terms to define it.

Parkinson’s disease

A progressive nervous system disorder that affects movement.

Number of patients: Dan Davis at the Parkinson’s Foundation of Ohio said no hard numbers are available but based on a population estimate, about 30,000 to 50,000 Ohioans have this disorder.

Evidence: No clinically tested, FDA-approved medication. A 2017 study found that cannabis can help symptoms for people with this nerve-degenerating disease.

Covered in other states: Eight states list Parkinson’s disease as a qualifying condition.

Post-traumatic stress disorder

Mental-health ailment that develops after experiencing or witnessing a stressful event such as combat, car accident or sexual assault.

Number of patients: 750,000 in Ohio in any given year, based on a population estimate that about 8 percent of Americans suffer with PTSD at any one time.

Evidence: No clinically tested, FDA-approved medication. A 2015 Yale University review of research said mouse studies indicate marijuana can have a positive effect on the brain's endocannabinoid system. But a 2017 New York University review concluded that the risks of marijuana “outweigh unknown benefits for PTSD.”

Covered in other states: Nine other states cover PTSD.

Sickle cell disease

A genetic disorder of the red blood cells, which carry oxygen through the body.

Number of patients: The Ohio Department of Health says 43 people a year are born with sickle cell disease. The agency does not count how many Ohioans are living with the disorder.

Evidence: No clinically tested, FDA-approved medication. A 2016 Minnesota study on mice indicated some ingredients of marijuana act on the nerve pathways to control pain.

Covered in other states: No other states list sickle cell disease as a qualifying condition.

Spinal cord disease or injury

Often caused by accidents or falls but also by genetic disorders.

Number of patients: About 10,000 in Ohio, a population-based estimate from the National Spinal Cord Database at the University of Alabama-Birmingham. Another 600 cases are diagnosed every year.

Evidence: No clinically tested, FDA-approved medication. In 2006, researchers at the University of Washington found marijuana provided the best relief for spinal cord injuries. A 2016 study at VA hospitals in Northern California found vaporized marijuana relieved pain, and relief was enhanced when the sense of “feeling high” was factored into results.

Covered in other states: Only Ohio qualifies this disorder for medical marijuana.

Tourette syndrome

A neurological disorder of repetitive motions and vocalizations called tics.

Number of patients: No one knows. A CDC estimate puts the number at about 7,200 Ohio children.

Evidence: No clinically tested, FDA-approved medication. A study as early as 1993 suggests marijuana could help control facial and head tics. In 2017, a Canadian study had astonishing results: 18 of 19 patients were at least “much improved,” and tics were reduced by 60 percent.

Covered in other states: Only Ohio qualifies this disorder for medical marijuana.

Traumatic brain injury

Defined as an injury so severe it causes a loss of consciousness.

Number of patients: As many as 1.8 million Ohioans, says Stephanie Ramsey, president of the board of trustees of the Brain Injury Association of Ohio. The most causes are falls and motor vehicle accidents.

Evidence: No clinically tested, FDA-approved medication. A 2017 Virginia Commonwealth University study found that marijuana’s action on the endocannabinoid system is a promising frontier for TBI.

Covered in other states: Only Ohio qualifies this disorder for medical marijuana.

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