Pictured: Ryan Bartell. Photo credit: John Bartell.
While 36 states, the District of Columbia, and four U.S. territories allow medical cannabis use, the loose assemblage of state laws has resulted in a system riddled with inconsistencies.
And despite growing recognition of cannabis’ medicinal benefits, the plant remains illegal as a Schedule 1 drug under federal law.
Misaligned state and federal policies, in turn, manifest those inconsistencies among healthcare facilities and hospitals, where end-of-life treatment can be painful, isolating and politically contentious.
As a consequence, terminally-ill patients still suffer from a lack of access to medical cannabis products as a frontline treatment option or therapeutic recourse.
But that is gradually changing. Below is an exploration of ongoing litigation efforts in the U.S. to ensure safe and expanded access to medical cannabis for the patients that need it most.
When doctors diagnosed Ryan Bartell with stage 4 pancreatic cancer and gave him just weeks to live, his father, Jim Bartell, embarked on a medical mission to help his son stay alert and comfortable in his last days.
At first Ryan, a former athlete and member of the U.S. Coast Guard, was prescribed morphine. Then came large doses of fentanyl. The medication induced a semi-comatose state in his son, Jim told Emerald.
“During one of his rare waking moments, he grabbed my hand and asked me to get him off the fentanyl,” Jim said. “He didn’t want to spend his last few weeks sleeping.”
In his bleakest moment, Jim made a promise to help. After he consulted with a chemist in the medical cannabis industry, Jim asked Ryan’s doctors to replace his fentanyl with medical cannabis — an idea which Ryan welcomed. But the hospital did not.
The issue was funding, the doctors explained. They attributed it to the federal prohibition of cannabis.
Undeterred by the classification of cannabis as a Schedule 1 substance, Jim found a hospital in Washington willing to provide Ryan alternative care for his terminal illness.
“They said bring in the medicine; we’ll refrigerate it with his name on it; show us how to administer it; and we’ll take it from there,” said Jim. “A complete reversal of the first hospital.”
At that point, Ryan could not swallow. So instead of edibles, doctors administered medical cannabis with an under-the-tongue spray.
After his first dose of medical cannabis in the hospital, Ryan and his family noticed an immediate impact on his energy and alertness.
“He was awake, pain-free and texting his friends,” Jim said. “He was like that for two and a half weeks before he died.”
Ryan Bartell was 41. But his fight is not over.
Senate Bill 311: Ryan’s Law
Now, Jim is advocating for Senate Bill (SB) 311 in California, also known as Ryan’s Law. If approved, Ryan’s Law will require healthcare facilities and hospitals to allow terminally-ill patients use of some types of medical cannabis.
Close to 87% of Americans support medical cannabis as an option for treatment in cases where the patient has received a terminal diagnosis. That is according to a survey from MorseLife Health System Hospice and Palliative Care.
Additionally, more than five million patients in legal states consume medical cannabis, according to data from the Medical Marijuana Project.
With this immense public support, Jim said he feels emboldened in his efforts.
“This is my therapy,” Jim said. “To me, that millions of people will benefit from this gives some meaning to why he died, because there’s no other reason that I can come to grips with it.”
To alleviate concerns about federal funding, SB 311 includes certain caveats. Those considerations allow healthcare facilities and hospitals to determine how medical cannabis is stored and used.
Under Ryan’s Law, a licensed physician would prescribe medical cannabis, which the patient would then procure. In other words, the doctor does not act as a supplier. Instead, the doctor just ensures that the hospital does not interfere with patient use.
Moreover, the bill would prohibit certain forms of consumption such as smoking and vaping. Additionally, there is also a “safe harbor clause,” which allows hospitals to opt-out should the federal government intervene.
Democrat Sen. Ben Hueso of San Dieg authored the current and previous iteration of the bill. After both state houses approved it, Gov. Gavin Newsom “begrudgingly” vetoed it in 2019. Gov. Newsom cited similar worries as doctors at Ryan’s first hospital, according to Jim.
The bipartisan legislation recently passed the Senate, and now awaits Gov. Newsom’s renewed appraisal.
No Patient Left Behind
Jim continues to advocate for states such as Oregon to pass legislation like SB 311.
“This is about the quality of life and dignity of people who are going to die in the hospital,” he said.
As such, public health officials and politicians consider flexible policy options for healthcare facilities.
In Minnesota, officials collaborated on a program that extends state law protections to clinicians caring for medical cannabis patients.
“Federal law, Minnesota law, (Centers for Medicare & Medicaid Services) regulations and accrediting organizations’ requirements do not clearly align with one another,” the Minnesota Hospital Association stated on its website.
But so long as the discrepancy in access to quality care remains, some terminally-ill patients are left adrift for options.
In Missouri, for example, Nolan Sousley, a patient with stage four pancreatic cancer, was harassed by Bolivar police. Officers rifled through his belongings in the hospital room following a call regarding alleged cannabis use on the premises. According to the Kansas City Star, police did not find cannabis in Sousley’s room; nor did they arrest or cite the terminally-ill patient — who recorded the entire incident, and maintained in the video that he consumed medical cannabis off-site in pill form.
Situations like these concern Dr. Larry Bedard, a former physician and long-time medical authority on cannabis legislation who testified at hearings for Ryan’s Law. The issue is not just with the politicians and police, but often the physicians themselves, Bedard said.
“Ninety percent of physicians know nothing about cannabis,” Bedard, who currently serves on the American Medical Association’s Cannabis Task Force, said. “I think that’s the biggest problem we have now.”
All parties must be purposefully addressed so terminally-ill patients see peace, Bedard said.
Americans for Safe Access
Enter Americans for Safe Access (ASA), the “largest national member-based organization of patients, medical professionals, scientists and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research,” according to its website.
Conducted every year since 2015, ASA’s State of the States report reviews and scores the functionality of healthcare programs serving medical cannabis patients.
“This year’s report will focus on the huge policy gaps that exist in state medical models for patients — from patient rights and civil protections through access and product safety (testing/labeling, and affordability) — that states seem fine with leaving in place as they move on to authorize adult-use programs,” Dustin McDonald, interim policy director, wrote in an email.
For now, federal scheduling of cannabis remains a roadblock to progress, McDonald said. But as public perception steadily aligns with emerging medical research and pleas for dignity, those barriers may break down.